Written evidence submitted by the UK Acquired Brain Injury Forum

 

 

Sport-related Mild Traumatic Brain Injury

 

 

Dr Michael J. Grey1,2

 

1 UK Acquired Brain Injury Forum

2 Concussion Action Programme, University of East Anglia

 

Executive Summary

Concussion is a mild traumatic brain injury occurring at all levels of sport.  Post-concussion syndrome and the damage caused by subconcussive injury is a growing concern.  The Government’s current position that “National Governing Bodies (NGBs) are responsible for the regulation of their sport and for ensuring that appropriate measures are in place to protect participants from harmmust change because the NGBs have not met this responsibility.

UKABIF’s recommendations for change were presented in 2018 and remain unchanged.

Concussion is a public health issue. The government should take a leadership role in the management of concussion research, public health campaigns for concussion awareness and education, and should implement better pathways for concussion management in the NHS.

 

UKABIF Background

The UK Acquired Brain Injury Forum (UKABIF) aims to promote better understanding of all aspects of Acquired Brain Injury; to educate, inform and provide networking opportunities for professionals, service providers, planners and policy makers and to campaign for better services in the UK. UKABIF is a membership organisation and charity, established in 1998 by a coalition of organisations working in the field of Acquired Brain Injury.

 

Sport-related mild traumatic injury is a growing concern

Concussion is a mild traumatic brain injury (mTBI) occurring at all levels of sport. The commonly quoted figure of 1.4 million people reporting annually to UK A&E departments with head injury is mostly (80-95%) comprised of mTBI.  This figure almost certainly underestimates the number of brain injuries occurring in the country as most mTBIs are not considered serious enough to necessitate a visit to A&E. Many people do not fully appreciate that concussion is a brain injury because it is on the lower end of the TBI spectrum, and the potential seriousness of mTBI is not fully understood within the sporting community, by the public, and by many clinical professionals.

 

Whilst the vast majority of mTBIs resolve without medical intervention within a couple weeks, between 10-25% of these people develop persistent concussion symptoms – a condition known as post-concussion syndrome (PCS).  There is a dearth of data on PCS in the UK.  Anecdotal reports from clinical professionals suggest that people with PCS far too often fall through the cracks in our health care system and do not receive proper advice and/or treatment for months. This occurs because mTBI is poorly understood by too many clinical professionals, and the NHS does not have a specific pathway for the condition.  In some cases, this means children are delayed in school or adults are prevented from working. Because it is a hidden epidemic, we do not know the full extent of its socioeconomic cost. Better UK data would help us understand this cost.

 

Particular to contact sport, we now understand that repetitive subconcussive injury – such as heading a ball – is also a concern.  A subconcussive injury follows the same mechanism as concussive injury whilst not resulting in overt concussion symptoms.  The intensity of impact that causes damage is still unknown.  Subconcussive impacts have been linked to cognitive decline and changes in both brain biochemistry and structure. Numerous studies are now suggesting significant neurodegeneration including motor neurone disease and dementia can result from subconcussive injury.

 

Time for Change Report

In September 2018, the APPG for Brain Injury submitted the Time for Change Report [link]. A similar APPG report for Wales will be submitted soon, and the recommendations are mostly unchanged. The 2018 APPG report recommended the following:

 

The Government’s response to these recommendations has been mixed and the bulk of the responsibility has been left with individual sporting NGBs indeed, the government response to the APPG report specifically stated responsibility is with the individual sporting authorities.  The response stated:

 

National Governing Bodies (NGBs) are responsible for the regulation of their sport and for ensuring that appropriate measures are in place to protect participants from harm, including serious injuries. With that in mind, DCMS looks to individual sports to take responsibility for the safety of their participants”.

 

Since this report was produced, we note the following:

UKABIF Recommendations

The government response to the APPG recommendations puts the responsibility on the sporting NGBs.  We believe the oral testimony given to the DCMS committee demonstrates very clearly that the NGBs have not met their responsibility and have a conflict of interest where player welfare is at odds with the business of the game. NGBs have no obligation to conduct research for the public good or to conduct awareness campaigns for the public.  Sport-related brain injury is a public health issue – we urge the government to take a significant leadership role in the following areas:

 

Research

 

Campaigning/Awareness

 

Consistent Diagnosis and Care