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Researchers investigate sideline concussion testing

25 October 2019

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Concussion Fitwzmwmcwzmdbd 2018

As the world’s rugby titans clash on the field, a team of scientists and clinicians in New Zealand are closing in on developing the first ever rapid, reliable, on-the-spot test for sports related concussion. The test could potentially transform diagnosis of a range of head injuries.

There is currently no objective diagnostic test for sports related concussions (SRC).

Diagnosing an SRC involves assessing a range of factors including clinical symptoms, physical signs, cognitive impairment, neurobehavioral features, and sleep/wake disturbance (only 10-20 percent of patients lose consciousness).These factors can take time to emerge and rely heavily on the symptoms a patient reports, combined with a doctor’s best clinical judgement.

Lead Institute of Environmental Science and Research (ESR) scientist Dr Rachel Fleming says being able to diagnose an SRC with a reliable, quick and reproducible test will help recovery, rehabilitation and reduce the long-term effects of concussion:

Dr Fleming’s research is seeking to develop a test to measure RNA (ribose nucleic acid) markers present within an individual’s body fluids to confirm a SRC diagnosis.  RNA is a component within cells that determines the function of each cell, and after an injury such as a SRC, the RNA from injured cells (brain), may be able to be detected in other body fluids. 

In the longer-term, if RNA markers are identified which robustly detect a SRC, then the development of hand-held devices for RNA marker detection will be investigated.

ESR along with Mātai, the University of Auckland, Auckland Bioengineering Institute, Auckland District Health Board, Axis Sports, Auckland University of Technology, and other groups have come together through the Traumatic Brain Injury (TBI) research platform developed at University of Auckland’s Centre for Brain Research, to find an easy and definitive test for concussion.

Researchers in collaboration with clinicians at the Axis Sports Concussion Clinic (Auckland), will collect samples from athletes diagnosed with concussion and non-concussed athletes (control participants).

Dr Fleming says, “Using relatively easy body fluids to collect, such as blood and saliva, we will identify RNA markers that can be used to diagnose concussion”. 

She says the test could be a diagnostic tool that would have applications beyond sports injuries.  “At scene testing for family violence and vehicle accidents are just two other important examples of rapid diagnosis making significant improvements for victims.”

Dr Stephen Kara, a Sports Medicine Registrar at the Axis Sports Concussion Clinic says, “Diagnosis of sports-related concussion needs a gold standard test. Clinical history forms a significant part of diagnosis. In our clinic early assessment and management is governed by making an accurate diagnosis and we would welcome tests that could enhance this process”.

Professor Helen Danesh-Meyer, an ophthalmologist researcher at the University of Auckland involved with this research says, “This is an exciting collaboration as it brings together several dimensions of injury from concussion. We are looking at structural changes through state-of-the-art neuroimaging, biomarkers in the eye which reflect concussion damage and blood and saliva markers. This is a unique collaboration as clinicians and scientists join forces with the aim of identifying a rapid, non-invasive test to diagnose and monitor patients with concussion.”

Dr Samantha Holdsworth, medical physicist at the University of Auckland and Research Director of Mātai, says, “MRI is a promising technology for detecting changes in the brain resulting from impacts to the head, which may help to validate the effectiveness of Dr Fleming’s RNA tests”.

The ultimate goal of the study is to come up with a test which robustly detects a SRC shortly after the injury or event has occurred. It may also be possible to diagnose a SRC, identify the part of the brain that has been injured and help monitor ongoing rehabilitation. As Dr Kara says, “The role of advanced imaging in the management and prognosis for those who had sustained a sports-related concussion is an exciting area. Being able to visualise functional changes in neuronal pathways and correlating that with the patients clinical presentation would be a huge advancement in our understanding of this injury and in the way we manage this injury, leading to even more personalised therapies than we have now.”

The study will begin gathering saliva samples from participants in December.

Concussion is a brain injury that can occur in any sport, particularly where there is body contact. It is caused by the impact of force (a blow) to part of the body, not necessarily the head directly. Evidence shows repeated SRC can lead to a decline in health and quality of life up to 10 years following the injury.

In New Zealand, one in five injuries (7,350 per year) are sustained through a sport related activity. Almost half (46 percent, 3,381 per year) are classified as ‘mild with a high risk of complications’. However, ACC only receive claims for 6,250 SRC injuries, suggesting that 1,100 currently go untreated.