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Rugby players from Aviva Premiership Rugby and Greene King IPA Championship are to take part in a major study led by the University of Birmingham as part of its work to develop a ground-breaking pitch-side test to diagnose concussion and brain injury.
The study, being carried out in collaboration with the Rugby Football Union (RFU), Premiership Rugby and the Rugby Players’ Association, will run throughout the 2017/18 rugby season and is the biggest of its kind to take place in the history of UK sport. It is a key element in the University of Birmingham’s research programme to create a test that can be performed rapidly pitch-side and will determine whether a player has been concussed. The study is part of the University of Birmingham’s REpetitive COncussion in Sport (RECOS) project.
The test also has the potential to assist in return to play decisions and could be used across sports, from grassroots to professional level. It is hoped it could also be used more widely by frontline medics in the NHS and military to improve diagnosis and treatment within the first critical hour after brain trauma.
The team at the University’s College of Medical and Dental Sciences, led by neurosurgeon Professor Tony Belli, has spent the last nine years carrying out research which has led to the development of a test that measures biomarkers present in the saliva and urine of players. The test, if validated, could be done on a hand-held device, which is currently under development.
Professor Belli said: “Early and accurate diagnosis of concussion is one of the biggest challenges we face clinically and is particularly a major concern in the sporting world.
“The University of Birmingham recently made a significant breakthrough after identifying molecules, which can be found in saliva and act as biomarkers to indicate whether the brain has suffered injury.
“In this exciting next study with the RFU, Premiership Rugby and the Rugby Players’ Association, we will collect players’ saliva and urine pre and post-injury, which we will then test in the laboratory in order to assess the reliability of these biomarkers.
“If these biomarkers are found reliable, we can continue our work with industrial partners with the hope to have a device available within the next two years that will instantaneously diagnose concussion on the pitch-side with the same accuracy as in the laboratory – a major step forward for both sport and medicine.”
Dr Simon Kemp, RFU Chief Medical Officer, explained: “This is an important addition to the breadth of research we are undertaking into concussion and player welfare more broadly. There is currently no reliable or proven biomarker or objective test for the diagnosis of concussion and this lack of objectivity is the biggest challenge facing medical professionals in dealing with this type of injury.
“While very much an exploratory piece of research, this is a project that has the potential to make a very significant impact on the diagnosis and management of players following concussion.”
Premiership Rugby Head of Elite Performance and Player Development Corin Palmer said: “Premiership Rugby is committed to putting our clubs and players at the front and centre of what we do, and player welfare is our number one priority. This research has the potential to impact positively on the way in which we assess and manage concussion and as such we are keen to give it our full support.
“All Premiership Rugby clubs and players are already taking part in the preparatory stages of the research ahead of the new season, and we look forward to seeing the results of Professor Belli’s work.”
The Rugby Players’ Association’s Rugby Director Richard Bryan said: “The RPA Players’ Board has given its full support to this vital research study which we hope will be a significant development for the future of concussion diagnosis.
“This forms part of the RPA’s ongoing commitment to work collaboratively with the RFU and Premiership Rugby to ensure that the game continues to make advances in concussion education, research and management for the wellbeing of all players.”
Players participating in the study will provide saliva and urine samples to act as a base-line benchmark. During a match, players with confirmed or suspected concussion will provide saliva samples immediately following injury. Players will also provide follow-up saliva samples, as well as urine samples, as they go through the return to play protocol. These will be compared to the baseline benchmarks, plus those from players from the same game who did not suffer head injury, and those who had other injuries. If there are no Head Injury Assessments (HIAs) or confirmed concussions in a match, then no samples will be collected.
The study will be carried out during all Aviva Premiership and Greene King IPA Championship club competitions where the HIA is in operation and will run alongside the existing HIA off field screen that will be for a fixed period of ten minutes. This study replaces the King-Devick research project that was conducted last season. The King-Devick results are currently being analysed and the aim is to publish the findings following scientific peer review.
Researchers Hope New Biomarkers Will Lead to Potentially Life-Saving Sports Pitch-Side Test for Brain Injury
Researchers at the University of Birmingham have identified inflammatory biomarkers which indicate whether the brain has suffered injury.
The team, led by Professor Antonio Belli, at the University’s College of Medical and Dental Sciences, now hopes to use these new biomarkers to develop a test which can be used on the side of a sports pitch or by paramedics to detect brain injury at the scene of an incident.
Dr Lisa Hill, of the Institute of Inflammation and Ageing at the University of Birmingham, said: “Traumatic brain injury (TBI) is the leading cause of death and disability among young adults and, according to the World Health Organization, by 2020 TBI will become the world’s leading cause of neurological disability across all age groups.
“Early and correct diagnosis of traumatic brain injury is one of the most challenging aspects facing clinicians.
“Being able to detect compounds in the blood which help to determine how severe a brain injury is would be of great benefit to patients and aid in their treatment.
“Currently, no reliable biomarkers exist to help diagnose the severity of TBI to identify patients who are at risk of developing secondary injuries that impair function, damage other brain structures and promote further cell death.
“Thus, the discovery of reliable biomarkers for the management of TBI would improve clinical interventions.”
Inflammatory markers are particularly suited for biomarker discovery as TBI leads to very early alterations in inflammatory proteins.
In this novel study published today in Scientific Reports, blood samples were taken from 30 injured patients within the first hour of injury prior to the patient arriving at hospital.
Subsequent blood samples were taken at intervals of four hours, 12 hours and 72 hours after injury. These blood samples were then screened for inflammatory biomarkers which correlated with the severity of the injury using protein detection methods.
In the laboratory, the team used a panel of 92 inflammation-associated human proteins when analysing the blood samples, which were screened simultaneously.
The serum biomarkers were analysed from patients with mild TBI with extracranial injury, severe TBI with extracranial injury and extracranial injury only and all groups were compared to a control group of healthy volunteer patients.
The results identified three inflammatory biomarkers, known as CST5, AXIN1 and TRAIL, as novel early biomarkers of TBI.
CST5 identified patients with severe TBI from all other cohorts and, importantly, was able to do so within the first hour of injury.
AXIN1 and TRAIL were able to discriminate between TBI and uninjured patient controls in under an hour.
Dr Valentina Di Pietro, also of the Institute of Inflammation and Ageing at the University of Birmingham, said: “Early and objective pre-hospital detection of TBI would support clinical decision making and the correct triage of major trauma.
“Moreover, the correct diagnosis of TBI, which is one of hardest diagnosis to make in medicine, would allow clinicians to implement strategies to reduce secondary brain injury at early stage, for example, by optimising blood and oxygen delivery to the brain and avoiding manoeuvres that could potentially increase intracranial pressure.
“In addition, this has potential implications for drug development, as novel compounds could be given immediately after injury and potentially commenced at the roadside, if there was sufficient confidence in the diagnosis of TBI.
“We conclude that CST5, AXIN1 and TRAIL are worthy of further study in the context of a pre-hospital or pitch-side test to detect brain injury.”
A newly released hockey helmet has earned four out of five stars from the Virginia Tech Helmet Ratings, scoring higher than any other helmet since the first hockey ratings were released two years ago.
The new helmet, the Bauer RE-AKT 200, is the first to earn more than three stars. The star rating system, developed by researchers in the Virginia Tech Helmet Lab, rates a helmet’s ability to reduce the risk of concussion in the event of a head impact. All sports helmets, including those for hockey, must meet an impact-protection standard that evaluates the ability of helmets to minimize catastrophic head injury on a pass-fail basis.
“We supplement the standard by providing additional data so consumers can see the relative differences between helmets,” said Steve Rowson, an assistant professor of biomedical engineering and mechanics in the College of Engineering and director of the Helmet Lab. “We make that data available and release our testing methodology, which then becomes an additional design tool for the manufacturers.”
Using a headform instrumented with sensors, the Helmet Lab team simulates a range of impacts that a player might experience during a game, and measures how much the helmet reduces the head’s linear and rotational acceleration.
Rowson and Stefan Duma, the Harry Wyatt Professor of Engineering and interim director of the Institute for Critical Technology and Applied Science, began evaluating football helmets in 2011, designing the test methods based on millions of impacts they recorded from Virginia Tech football players.
The Helmet Lab team started testing hockey helmets a few years later, and has since rated more than 40 models.
Hockey players hit their heads on the ice, the glass around the rink, or each other; these surfaces can be rigid and players are typically traveling at high speeds, so impacts may be more severe than in other contact sports.
And hockey helmets tend to be light and thin, which limits their ability to reduce the force of a hit. In order to effectively absorb energy during an impact, thinner foam must be stiff. Thicker, softer foam that has more time to compress can cushion a broader range of impacts. The new Bauer helmet has slightly thicker padding than other models.
“I think this is the first example of the hockey helmet manufacturers using this test methodology and ratings protocol to influence the design,” Rowson said. “What we wanted to do was set a framework for improvement in protective design.”
The team’s methods have already contributed to improvements in football helmet design. When the first batch of ratings was released, only one helmet earned five stars. Today, 16 do, and virtually all new helmets get high marks.
“With the helmet ratings, we provide unbiased data and a transparent process that manufacturers can use to inform their design process and consumers can use to guide their choices,” Duma said. “We’ve been glad to have the opportunity to work with helmet companies to drive innovation, because we all have the same goal: to keep athletes as safe as possible.”
The team is also developing five-star ratings for bicycle and lacrosse helmets and soccer headgear.
Rowson says that helmets are just one piece of the equation in eliminating concussions. Behavioral changes in sports — for example, banning body-checking in youth hockey — can make an even more significant difference in reducing the number of injuries.
“You want to eliminate as many head impacts as you can, and then have the very best head protection in the event that you do hit your head,” he said.
The team’s current ratings are available online, and updated on a rolling basis.