Your Brain Health is thrilled to welcome the renowned Professor Mike Loosemore MBE to its expanding network, forging a partnership that puts cutting-edge concussion care right in the heart of London. With decades of expertise in concussion management, musculoskeletal injuries, and exercise as medicine, Prof. Loosemore’s collaboration marks a pivotal moment in our mission to deliver world-class care around the globe.

This partnership is a double win for anyone passionate about their brain and body health. Here’s what’s happening:

The ISEH Concussion Clinic Joins the Your Brain Health Network

Located on Tottenham Court Road, the Concussion Clinic at the Institute of Sport and Exercise Health (ISEH), led by Prof. Loosemore, has officially joined the growing Your Brain Health network. This international network already includes Prof. Jon Patricios’s clinic in Johannesburg, South Africa. Both Loosemore and Patricios were co-authors of the most recent Concussion in Sport Group Consensus Statement and played instrumental roles in the development of the groundbreaking SCOAT6 (Sports Concussion Office Assessment Tool 6). Their shared expertise ensures that patients have access to care informed by the latest global standards.

The ISEH Concussion Clinic is one of the leading centres in the country for concussion diagnosis and management, offering pioneering technology and treatments that set it apart. What makes this clinic exceptional is its unique ability to treat children as well as adults with concussions—a vital service. From young athletes to professionals recovering from injuries, the clinic combines advanced diagnostic tools with personalized care plans to ensure optimal recovery.

Prof. Loosemore’s expertise in the pathophysiology of brain injuries, backed by decades of research, means patients receive care rooted in science and tailored to their individual needs. Whether it’s the result of a sports injury, an accident, or a fall, this clinic is redefining what’s possible when it comes to managing concussions.

Don’t Miss the Concussion Workshop on 22nd March

In addition to running one of the country’s most innovative concussion clinics, Prof. Loosemore is passionate about sharing his expertise. That’s why he’s teaming up with physiotherapist Nicola Hunt to deliver a Concussion Workshop at ISEH on 22nd March.

This workshop promises to be an eye-opening event for healthcare professionals, sports coaches, and anyone looking to understand the science behind concussion recovery. Expect practical tools, insights from cutting-edge research, and real-world strategies for optimising recovery and long-term brain health.

Prof. Loosemore is not just a leader in concussion care—he’s also a passionate advocate for exercise as medicine, believing in its power to prevent and treat chronic diseases. Combined with Nicola Hunt’s hands-on expertise in rehabilitation, this workshop is set to be an unmissable opportunity to learn from the best.

Reserve your spot!

Meet Professor Mike Loosemore MBE

If you’re wondering what makes Prof. Loosemore such a trailblazer in his field, here’s the lowdown:

Areas of Expertise: Diagnosis and treatment of concussion, musculoskeletal injuries, and sports injuries; exercise as a tool for disease prevention and management.

NHS Base: University College London Hospitals.

Private Practice: ISEH and The Portland Hospital.

Prof. Loosemore’s groundbreaking work has earned him an MBE for services to Sports Medicine, alongside numerous awards like the Sir Robert Atkins Award and the David Hemery Award. With a PhD in the Pathophysiology of Boxing Injuries, he’s at the forefront of concussion research and has dedicated his career to improving care for athletes, children, and anyone dealing with injury.

Beyond the clinic, Prof. Loosemore’s influence extends globally. He’s traveled with national squads to the Olympics, Commonwealth Games, and World Championships, using his expertise to help athletes perform—and recover—at their best.

The Future of Brain Health in London

The collaboration between Your Brain Health and Prof. Mike Loosemore marks a new era of accessible, expert-led brain health care in London. Whether it’s through the world-class care provided at the ISEH Concussion Clinic or the upcoming workshop designed to empower others with knowledge, this partnership is set to change lives.

So, if you or someone you know is navigating the challenges of a concussion, don’t wait—explore the possibilities at the ISEH Concussion Clinic today. And for those eager to dive deeper, make sure to reserve your spot at the Concussion Workshop on 22nd March.

Your brain health deserves the very best—and now, it’s right here in London.

By Sam Peters, founder Concussed Media

Your Brain Health today launches a global campaign calling on all sports clubs, schools and other sporting organisations to appoint a Concussion Officer responsible for overseeing head injury protocols.

The initiative, which already has the backing of sports stars, coaches, medics, charities, concussion campaigners and grassroots organisations, including Datchworth RFC, calls on governing bodies to embrace an open conversation about concussion and facilitate the push for increased safeguards.

Become a Concussion Officer Today

Similar in principle to a club Fire Warden or Safeguarding Officer, which have been widely adopted by sports clubs and associations in recent years, a concussion officer would be nominated by each organisation and take responsibility for ensuring protocols and best practice are followed.

Speaking about the initiative, Your Brain Health (YBH) Chief Operating Officer and current Welsh Fire Lead Physiotherapist David Bartlett, said:

‘Sport is an incredible force for good—it builds physical fitness, mental resilience, and lifelong friendships. But to keep sport safe and accessible for everyone, we need to take concussions seriously. Appointing a Concussion Officer ensures that when head injuries happen, they’re managed properly, and allows participants to recover fully and return to enjoying the sports they love.’

Originally promoted by the Australian Institute of Sport, the Concussion Officer campaign is also fully supported by influential medical figures in the UK, including Mike Loosemore, Professor of Sport and Exercise medicine at the Institute of Sport, Exercise and Health (ISEH).

Professor Loosemore said: ‘I fully support this initiative being run by Your Brain Health. The concept of having a Concussion Officer in place is just simple common sense and I hope to see many clubs and schools embrace it over the coming months’

The campaign, which is being launched by Your Brain Health to coincide with the Six Nations Rugby tournament in Europe and the start of the Australian Football League (AFL) season in Australia, is aimed at all sports.

‘The Australian Institute of Sport has recommended in their 2024 Brain Health statement that every club and school should have a Concussion Officer. We already have safeguarding officers for child protection and fire wardens for emergencies. A concussion officer should be seen in the same way: a key role dedicated to ensuring safety and best practice in concussion management.

‘Early intervention is critical when managing concussions. Properly recognising and responding to a concussion can significantly reduce the risk of long-term complications, including persisting symptoms that in some instances can include mental health concerns. Having a Concussion Officer in place ensures that individuals get the right care from the start, improving recovery and protecting their future well-being.’

While the sports field would seem the most likely place for a child to sustain a concussion, or mild traumatic brain injury as it is also referred, school playgrounds see an estimated 27,000 diagnosed cases in Australia alone each year.

‘Schools have a duty of care to ensure these injuries are managed appropriately. Without clear protocols, concussions can be missed, leading to long-term health consequences. A Concussion Officer ensures that no child falls through the cracks and that brain health is treated with the seriousness it deserves.’

YBH, with the backing of Concussed Media and other concussion awareness groups, believe the campaign will help clubs and sports organisations achieve:

  • Better protection for clubs / schools
  • Better health outcomes
  • Better performance
  • Peace of mind of players / parents
  • Increase participation
  • Improve reputation of organisation

Datchworth Rugby Football Club, who play in Herts/Middlesex League One, this week became the first UK rugby club to embrace the campaign.

Sports Club Chairman Andrew ‘Woody’ Wood, believes the onset of professional rugby, which sees some aspiring amateurs players training five or six times a week while others can only manage one or two training sessions between work commitments, has created a serious disconnect at grassroots level.

He would also welcome the introduction of weight banded categories, similar to those used by the New Zealand Rugby Football Union, to avoid potentially dangerous mismatches between youngsters at different developmental stages.

He said: ‘I’ve taken my eldest son and youngest son through all the age groups as a coach, and sometimes you get it where it’s effectively a man against somebody who hasn’t even been through puberty. And there’s a massive size difference there.’

The RFU was criticised for attempting to reduce the tackle height in the amateur game in 2023, but former Datchworth First XV captain Stu Young believes the reluctance of referees to penalise head high tackles, which have always been illegal under the game’s laws, is the biggest stumbling block to progress.

‘Massive hits to the head are either just given as a penalty or 10 minutes in the sin bin and then they come back on,’ Young said. ‘It’s not really achieving what I assume the RFU want to do which is to lower the height of tackles and therefore lower the amount of head knocks.

‘If the referees were a bit more on it (prepared to give red cards) that might have more of an impact than just saying ‘we’re going to lower the contact area from shoulder height to sternum’.’

Another Datchworth stalwart, Warren Sullivan, who coaches the junior section and is current Chairman, is concerned the mounting threat of legal action has caused some parents to become overcautious. He wants a renewed focus on coaching the tackle, where most concussions occur.

‘People have got scared,’ Sullivan said. ‘they’re more or less throwing the baby out of the bathwater.  A lot of parents don’t want their kids to play rugby anymore but I think a lot of it’s unfounded.

‘We need to improve tackle technique across the game. It doesn’t help seeing the professionals tackling so upright.’

Six Nations Concussion – let’s cut straight to the chase!

Yes, having one concussion can increase the risk of getting another. But why does this happen? And more importantly, what can we do about it?

At Your Brain Health, we believe answering this question is pivotal to improving the future of concussion management. Understanding why the risk increases gives athletes, clinicians, and researchers the tools they need to develop smarter, safer strategies for prevention and recovery. The ultimate goal? Safeguarding the long-term health of the brain, especially for those who put it on the line every time they play.

The evidence tells us some of the story—but not all of it. So, let’s unpack what we know and what might be contributing to this increased risk.

Keep an eye on this year’s Six Nations concussion cases – how big is the collision and are they sustained by players with a history? You can find all the men’s, women’s and U20s fixtures HERE

Risk Factors: The Inside and Outside Story

When it comes to concussion, there are external factors—like the rules of the game, training schedules, or protective gear—and internal factors, which are more about what’s happening inside the brain and body.

Both matter, but internal factors seem to be the bigger piece of the puzzle when it comes to why one concussion can make future ones more likely.

Let’s take a look at the breakdown of some of the key internal factors that might contribute to the Six Nations concussions this season.

Internal Risk Factors

1. Motor Control and Coordination: The Body’s Foundation

Ever feel like your body just isn’t moving the way it should? After a concussion, changes in coordination, reaction time, and spatial awareness can throw athletes off their game. This can lead to awkward movements or reduced neck and head stability, making another hit more likely.

The good news? Targeted rehab focusing on neck strength, stability, and dynamic movement can help restore confidence and reduce risk. Think of it as rewiring the body’s GPS.

2. Cognitive Function: Fast Brains Make Smart Plays

Split-second decisions are the bread and butter of most sports. But concussions can slow processing speed, mess with attention, and cloud memory. The result? Poor decisions on the field, unexpected collisions, and even higher odds of another injury.

Solution? Incorporate sport-specific cognitive training into recovery plans. Faster thinking equals smarter, safer gameplay.

3. Vision: More Than Meets the Eye

Your brain and eyes work as a team. After a concussion, that teamwork can falter, impacting things like depth perception, eye movement control, and spatial awareness. This leaves athletes vulnerable to missing critical visual cues during play.

The emerging field of vision training holds promise for retraining the brain’s eye control systems. It’s early days, but the potential is exciting.

4. Vestibular System: Balance and Beyond

Concussions don’t just make you dizzy—they can also mess with how your brain processes movement, balance, and spatial orientation. Even small disruptions in these areas can make athletes more prone to falls or poorly executed plays.

Vestibular rehab is a key part of recovery, addressing those subtle balance issues that might otherwise fly under the radar.

5. The Threshold Effect: When Resilience Takes a Hit

Ever notice that some athletes, after multiple concussions, seem to get injured more easily—and from less severe impacts? This is what’s known as the “threshold effect,” where the brain’s ability to recover diminishes with each injury.

Several factors play into this:

Metabolic Imbalance: The brain struggles to regulate energy after repeated hits.

Cumulative Damage: Neurons take a beating, making cognitive and neurological issues worse.

Neuroinflammation: Chronic inflammation makes the brain more vulnerable.

Blood-Brain Barrier Breakdown: This critical protective layer weakens, leaving the brain exposed.

Synaptic Dysfunction: Communication between neurons slows, impacting overall brain performance.

The solution lies in understanding these risks early and tailoring recovery programs to build resilience instead of rushing back to play.

6. The Autonomic Nervous System: A Hidden Player

This system controls vital functions like heart rate, blood pressure, and breathing. Concussions can throw it out of whack, which might explain why some athletes struggle with performance or symptoms only during high-pressure gameplay. That’s why mimicking real-game conditions during return-to-play protocols is so crucial.

7. Rest: Finding the Sweet Spot

Believe it or not, too much rest can backfire. While rest is essential in the early days of recovery, prolonged inactivity can lead to deconditioning, loss of confidence, and even higher injury risk.

A balanced recovery plan gradually reintroduces physical and cognitive activity, rebuilding resilience in a way that’s specific to the athlete’s sport.

What’s Next?

Every concussion tells a story—and every recovery is a chance to learn. The more we understand the factors behind increased concussion risk, the better we can protect athletes. At Your Brain Health, we’re committed to being part of the solution.

By contributing to global research and refining clinical practices, we’re helping clinicians and athletes make smarter, evidence-based decisions. Whether it’s through new insights into brain health, targeted rehab, or innovative training approaches, we’re working toward a future where athletes can thrive without sacrificing their long-term brain health.

For those looking to stay ahead of the curve, our courses dive deep into the latest research, offering actionable strategies for managing concussions at all levels of sport.

The bottom line? Knowledge is power. And with the right tools, we can give athletes the support they need to play smarter, recover better, and protect their most valuable asset: their brain.

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See how Fergal O’Brien’s yard is leading the charge with cutting-edge concussion testing and a renewed focus on athlete welfare.

By Sam Peters, author of Concussed.

It is often purported that the growing band of brothers and sisters championing the need for improved athlete welfare through a more caring culture in professional sport are blind to its number one imperative: winning.

Those of us in rugby who have spent decades calling for greater protections for players as the sport’s risk profile has sky-rocketed have been labelled ‘soft’ or ‘not rugby people’ while the mere mention of ‘player welfare’ is snarled at in certain quarters as evidence of an invidious woke culture creeping into the game.

It is, of course, utter tosh. But that does not stop those whose interests are best served by ignoring the long-term health and wellbeing of those we cheer on from the stands parroting the same old tired lines.

Call for change and be prepared to be shot down by some uneducated but very loud voices. Such is life today, I suppose.

Professional sport is a tough world. Anyone who has been within a cricket ball’s throw of a sports dressing room or training ground knows that. No quarter is ever asked, let alone given.

In the wrong hands, it can be a world where machismo reigns, bullying can fester and being honest about emotions or personal health can be sacrificed on the altar of protecting a contract or your place in the starting line up. Short-termism reigns. The future? It can wait.

Meanwhile, in schools sports, players and parents themselves can be their own worst enemies when pushing for faster return to play times.

Medics can also be pressured into burying their morals by coaches and owners more interested in today than tomorrow while those calling for improved workplace culture are dismissed as romantics who don’t understand the cold, hard reality.

Brain health inevitably suffers as concussions are denied and mental-health problems hidden.

 

And there are few sports where the participants have traditionally been expected to ‘suck it up’, ‘grin and bear it’ or ‘take one on the chin’ more than in professional horseracing where the owner is king and young, vulnerable jockeys compete for rides.

In a sport where concussion is an everyday risk for jockeys and stable staff tasked with moving the horses around their yard and the country, the temptation to hide symptoms of concussion or mental health concerns is ever present.

“There’s times in my career and I think every jockey has had times where they know and you go into the instant mode where you’ve always got to beat the doctor,” explains Max Kendrick, a seasoned jump jockey with almost 500 rides in the past five years.

“Yeah I think you have to break it down and understand the sport if you think about like every single lad in that change well most lads in that change room are self-employed so I mean if you’re stood down, it’s not like you’re playing for Arsenal or Chelsea if you’re injured.

“There is insurance so you’re getting paid for but you know you miss rides you might not get back on the horse the next day. So automatically the mentality is straight away no matter what the injury is not just head – whatever it is – can I get away with riding. Yeah, so in that sense like I think the power has got to be kind of taken out of the jockey’s hands because like I don’t think I can see a world where you’re ever gonna shift that mentality.”

Kendrick is speaking with me on a crisp December day outside the office of the Grade One National Hunt trainer Fergal O’Brien’s yard in the stunning surrounds of his Ravenswell Farm in the heart of the Cotswolds.

We are in racing country, where tradition and hierarchy are prized. But here, at one of the most successful and well-known yards in the land, there is a real sense of change in the air. Progress even.

I’m here at the invitation of Your Brain Health, an Australian owned company on a mission to improve the education of medics and physiotherapists around the world about the importance of better concussion management,  brain health awareness and improved brain function.

Critically, they are seeking to take the guesswork out of return to play protocols following a concussion, where historically decisions have been made either by the subsistence of demonstrable symptoms, or even worse, on the athletes word.

“When we’re treating an athlete with a hamstring injury there are tests we perform so we know precisely when it has returned to full function,’ YBH’s chief operations officer and current Welsh Fire physio David Bartlett tells me.

“Just because the patient is symptom free does not necessarily mean that hamstring has recovered. The same is true of brain injuries but historically we haven’t treated them with the same levels of objectivity and reasoning as other parts of the body.”

Bartlett and his YBH team, include experienced physiotherapists Simon Shepard and Emma Edwards, a chartered physiotherapist and member of the jockey injury management team which looks after professional jockeys on the racecourse, have been invited to the yard by Dr Simon Gillson, a close confident of O’Brien’s founded Concierge Medical and has worked at the yard for nine and a half years.

Gillson describes the concussion risk in racing as ‘an occupational hazard’.

“It would basically be impossible for a jockey to go through their career without sustaining a concussion,” Dr Gillson explains.

“I think the stats on fallers have changed over the years. It used to be one in 10 races you expected to fall off as a race rider. I think that might be down to one in 20. They’ve (authorities) have improved jumps safety and other things which is great and there’s improved equipment but you are still having rotational injuries, you’re falling at speed, horses are rolling on top of you, being kicked in the head, the neck, the chest.

“So your chances of getting through any lengthy career without having a significant head injury and concussion are, I would say, a zero. I mean, absolutely zero.”

Edwards nods in agreement.

“When it comes to testing for concussion so much has been based on some fairly basic orientation questions. As a physiotherapist something I’ve looked at is eye movements, as being something that even when someone’s denying having a concussion, you can pick up on eye movements. It provides an objective measure to tell a jockey, ‘this is what I’ve seen, do you think you’d be safe, seeing the stride to the fence, and making the right decision in that split second?

“More often than not they’ll put their hand up and go, ‘actually, now you’ve said that, I’m not really feeling 100%’.

“They’re not stupid. They know their every move is being scrutinised. They just want to perform well.”

The plan, with O’Brien’s blessing, is for all 37 of his yard staff to undergo a ‘multimodal’ baseline screening of their brains by the Your Brain Health team, with tests ranging from balance, and reaction times to a digital evaluation of the vestibular ocular motor system.

From force plates to measure balance, to a reaction mouse, to the use of a VR headset, the key thing seems to be the use of technology to provide better quality data.

“With multiple functions the brain is a complex organ and what we are doing is not going to cover everything.’ said Shepard. ‘However, put this data alongside other tests and clinical examination, and it may well lead to better understanding, better decision making and a personalised approach to care.”

The tests are carried out in a highly professional but light-hearted manner, which puts the jockeys and yard staff at ease and encourages them to take a full part in the testing. The participants seemed genuinely interested in both the testing and the reasons that sit behind it.

I undergo the tests myself and am pleasantly surprised to read the graph afterwards which shows my eye tracking to be in pretty decent order.

Much more importantly, the presence of the YBH team indicates a shift in mindset which is looking to place the brain health of staff far higher up the priority list than it has been historically in horse racing. It is forward thinking in every sense.

It also has the added benefit of potentially improving the performance of jockeys who after all, need great balance, great eyes and great decision making, if they are to optimise their performance and that of their prized equine assets.

“It’s been shown in cricket there is a correlation between certain helmet strikes and a drop in batting averages,” Bartlett explains.

“By generating more objective data, and adding a ‘gamification’ element, not only do we see better compliance than with historic testing, but we are also being able to identify individuals function, and as such ensure a return to performance, rather than trying to ‘beat’ the system and return before they are ready.”

Improved athlete welfare and improved performance. Now that really is something worth going the extra yard for.

Your Brain Health is proud to partner with CONCUSSED Media to bring the inaugural Ahead of the Game event, to be held at St Paul’s School in London on February 12, 2025.

This highly anticipated evening, created by award-winning author and concussion campaigner Sam Peters, promises a powerful discussion about the future of sports. Featuring a world-class lineup of speakers, the event will unite guests for panel discussions, networking, and debate centered on how to ensure sports remain both safe and accessible.

World-Leading Speaker Lineup

Ahead of the Game will bring together an extraordinary panel of experts, including:

  • Catherine Bishop, former World Champion rower, Olympic silver medalist, and author of The Long Win. Catherine will share her unique insights on the role of sport in fostering resilience and long-term success.
  • Professor Willie Stewart, one of the world’s leading authorities on concussion research, from Queen Elizabeth University Hospital.
  • Professor Mike Loosemore MBE, a pioneer in sports medicine from the English Institute of Sport.
  • Dr. Lisa Ryan, head of the Department of Sport, Exercise, and Nutrition at Atlantic Technological University and an expert in youth sports safety.

The event will be co-hosted by Sam Peters and former Mail on Sunday sports editor Alison Kervin OBE, who together spearheaded the paper’s Cudlipp Prize nominated concussion campaign. The pair will lead the evening’s discussions with their unparalleled expertise in sports journalism and safety advocacy.

Former professional rugby players Nick Greenhalgh and Sam Smith will join Kervin for the second panel of the evening, alongside current Welsh Fire Physiotherapist David Bartlett and professional cricketer Tom Kohler-Cadmore.

What to Expect

The event will feature two engaging panel discussions addressing the challenges and opportunities facing grassroots and school sports today. Topics will include:

  • Innovations to improve player safety and prevent injuries, including concussion.
  • Balancing competition, inclusion, and well-being in school sports programs.
  • The evolving role of administrators, medics, and educators in shaping the future of youth athletics.

Following the panels, attendees will have the chance to ask questions and contribute to the discussion during an extensive Q&A session.

Networking and Exclusive Access

Guests will also enjoy unique opportunities to network with the speakers and fellow attendees, fostering connections and collaboration. As a special highlight, attendees can purchase a signed copy of Sam Peters’ award-winning book, Concussed – Sport’s Uncomfortable Truth, which has been instrumental in raising awareness about concussion in sports.

Join Us to Shape the Future

Whether you’re a parent, coach, athlete, educator, or policymaker, this event is your chance to join a critical conversation about the role of sport in schools and the measures needed to make it safer for everyone who plays.

Event Details:
📍 Venue: St Paul’s School, London
📅 Date: February 12, 2025
🕒 Time: 1815-2200

Tickets are limited, so reserve your spot today to be part of this landmark event. Together, we can help shape a brighter, safer future for school sports.

Book your tickets here!

By Associate Professor James McLoughlin.

 

I have been asked recently my opinion about disappointing recent research with regard to the effectiveness of neurocognitive and VR eye-tracking tests in diagnosing concussion.

I could rant on about research methodology, types of tests, samples sizes and patient selection criteria. However, the answer to this complex question is simple – bad research questions!

Unidimensional Diagnostic Clinical Concussion Tests Are Doomed to Fail.

Picture this: you’re on the sidelines of a soccer game, and your friend—who just got bonked on the head by an overzealous defender—is getting asked a series of questions by a medical professional. The questions go something like, “What is your name?”, “What venue are we at today?” and “Who did we play last week?” Your friend squints at you, thinks for a second, and says, “Adelaide?” The medic gives them a thumbs-up, and suddenly they’re cleared to play again. Hooray?

Yeah, nah. Unidimensional tests, the one-trick ponies of concussion diagnosis, are hilariously doomed to fail. Let’s dive into why these outdated methods are less effective than using a paper umbrella in a rainstorm.

Concussions Are Like Bad Roommates: Complex and Unpredictable

Here’s the thing about concussions: they don’t fit neatly into one little box. They’re like that roommate who leaves dishes in the sink, hogs the bathroom, and sometimes mysteriously vanishes for days. They mess with your mood, memory, motor skills, and just about everything in between. So, expecting a single question like, “Do you know where you are?” to capture the full scope of this chaos is a bit like trying to catch some spilled soup with a strainer

Concussions mess with multiple dimensions of your brain. They affect your ability to think straight, your sense of balance, your visual processing, and—let’s not forget—your mood. If you try to diagnose that whole symphony of confusion with one simple test, you’re just going to miss the tune. And probably most of the instruments too.

The One-Test Wonder: Not So Wonderful

Imagine trying to determine if someone is drunk based solely on how well they can say the word “pineapple.” Sure, it might work for the extreme cases, but most people are going to skate by with a “pineapplish” that sounds about right. Concussion tests that focus on just one aspect—like memory recall or a basic visual task—are like this “Say pineapple” trick. They’re simplistic, easy to beat, and maybe not reflect the types of brian injury. I think sometimes sports are more concerned with convenience than accuracy.

The brain is far too crafty for these kinds of “gotcha” questions. A concussed person might nail the “What’s the score?” question but still struggle to walk in a straight line or remember why they went into the kitchen five minutes ago (and okay, to be fair, the latter could just be normal).

Multidimensional Problems Need Multidimensional Solutions

Here’s a radical idea: if concussions affect your brain in multiple ways, maybe—just maybe—we should assess them in multiple ways. Crazy, right? A strong concussion evaluation should involve balance tests, cognitive tests, eye tracking, and even mood assessments. It’s like forming a crack team of experts to tackle a complicated heist. Each one has their specialty, and together, they might just figure out what’s going on.

Plus, let’s be real: the stakes are high. A misdiagnosed concussion isn’t just a “fail” on the medical professional’s part—it could mean a person goes back out into a contact sport, takes another hit, and ends up with serious long-term damage. Concussions aren’t something we can afford to get wrong.

Let’s Leave Unidimensional Tests in the Past

The unidimensional test is the medical equivalent of trying to solve a Rubik’s cube by just staring at one side. Spoiler: it’s not going to end well. Concussions need a more nuanced approach—something that acknowledges the fact that the brain is not a simple machine but a symphony of electrical chaos, prone to occasional weird, delayed or subtle signs and symptoms. And all our brains are different before a concussion, with our own individual levels of eye movement control, skill, processing speed, headache symptoms, anxiety, sleep and memory. This is why multidimensional concussion baselines can be so useful.

Blood and saliva tests that confirm some brain damage are almost upon us, and symptoms and symptom provocation remain the cornerstone of the most sensitive tests following injury, with a mixed bag of physical, cognitive and psychological signs of injury. Currently symptoms carry the most weight in current concussion diagnostic tests and symptom resolution defines recovery! However multidimensional objective signs guide better decision making and gives everyone greater confidence moving forward.

If we’re serious about keeping athletes, children, and anyone else who takes an unfortunate knock to the head safe, we need to start treating concussion assessment like the complex issue it is. Please, no more research of these one-dimensional tests to confirm diagnosis. To be honest, the brain deserves more respect.

Pioneering Technology for Rehabilitation

In an exciting development for physiotherapy and neurological rehabilitation, Your Brain Health, has partnered with innovative tech firm HeadX to introduce HeadX Kross to the healthcare market. This collaboration centers on a new, state-of-the-art, head-mounted laser system designed specifically to enhance and support physiotherapists in their rehabilitation programs.

The new laser technology aims to revolutionise the way therapists can work with patients recovering from neurological and musculoskeletal injuries, including concussion. The HeadX Kross head-mounted laser device, offers precision targeting and hands-free operation through a cross-haired laser, providing therapists a novel tool to target both the brain and cervical spine.

Designed with input from academics, engineers, and rehab specialists, the device integrates a head-mounted wearable cross-haired laser, opening new doors for hands-free, real-time applications during physiotherapy sessions.

How the Head-Mounted Laser Enhances Rehabilitation

Assoc Prof James McLoughlin, Co-Founder of Your Brain Health said:

“Feedback of head position in space using head torches or lasers has become an integral part of our vestibular and cervical rehabilitation. Standard head torches and lasers provide useful positional information in the pitch (up and down) and yaw (rotational) planes of head movement. However, the new HeadX Kross also gives feedback in the roll (lateral tilt) which adds a new dimension to our ability to train head and neck control. Feedback of movement in the roll plane helps us retrain lateral head stability which is incredibly important for functional gaze needed for accurate perception of size, verticality, motion and depth of objects. It also activates specific neck and trunk movement strategies for balance and postural control training. This includes everything exercises to improve performance in sports, to rehabilitation from neck pain, headache, concussion, dizziness and balance/falls!”

View Video

The HeadX Kross head-mounted laser device, offers precision targeting and hands-free operation through a cross-haired laser, providing therapists a novel tool to target both the brain and cervical spine.

Benefits for Patients and Practitioners

The introduction of this laser technology offers promising benefits:

  • Enhanced Recovery: The head-mounted laser’s ability allows for a more targeted rehabilitation approach means it can work with neural-visual feedback mechanisms. This is particularly valuable for patients recovering from concussion, traumatic brain injuries, alongside a range of cervical spine injuries.
  • Increased Precision: Unlike other head-mounted lasers, the HeadX Kross cross-haired laser promotes feedback for the patient stable cervical positioning, making it easier to maintain precise targeting over longer periods. This improves both the quality and consistency of treatments.
  • Efficiency in Therapy Sessions: With a hands-free device, physiotherapists can work with other parts of the patient’s body, perform manual adjustments, or document progress while the laser is active, maximising productivity and facilitating more comprehensive care.

A New Era in Neurorehabilitation

As the global need for effective, efficient rehabilitation solutions grows, the partnership between Your Brain Health and HeadX signals a promising leap forward. For patients recovering from serious injuries, surgeries, or neurological conditions, access to such advanced technology offers hope for faster and more effective recoveries.

Your Brain Health’s commitment to clinical excellence, paired with HeadX’s innovation in wearable tech, is likely to create a ripple effect in the field of rehabilitation. The companies are optimistic about the head-mounted laser’s potential applications in both in-clinic settings and remote rehabilitation, providing accessible and adaptable solutions to support various therapeutic needs.

Richard Wheatley, Founder of HeadX said on the collaboration:

“HeadX Kross is a testament to the power of collaboration between technology innovators and clinical experts. Our partnership with Your Brain Health united us around a shared commitment to addressing real, clearly defined clinical needs, propelling us from concept to launch in just three months. And this is only the beginning—with aligned goals and complementary strengths, this collaboration marks the start of an outstanding partnership, poised to bring groundbreaking technology to the clinical neuroscience sector and transform brain health care for clinicians and patients alike.”

What’s Next?

Currently in the pilot testing phase, this device is expected to launch widely within the next year. With trials underway, Your Brain Health and HeadX are confident that this technology will set new standards in physiotherapy and neurorehabilitation.

For therapists interested in the launch of HeadX Kross, they can join the waiting list here. UK Therapists can also pre-order at a discounted rate!

As the medical community continues to push the boundaries of rehabilitation science, partnerships like this pave the way for innovative therapies that can profoundly impact patients’ lives. The future of rehabilitation is here, and it looks brighter than ever.

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Do you understand BEST practice when it comes to concussion management?

We think we do.

That’s why we’ve come up with our BEST practice model of concussion care.

Watch the video to find out why it matters!

Persistent symptoms

Many people will experience symptoms after a concussion beyond 4 weeks. These are ‘persistent symptoms’ that will require help from health professionals. Up to 25% of people still experience symptoms at 3 months(Polinder et al. 2018), and with those who attend hospital after concussion, nearly 12% of children and 31% of adults experience symptoms beyond 3 months, with more than 50% still report some symptoms at 12 months(Machamer et al. 2022).

We estimate that 36,000 people in Australia

90,000 people in the UK

And 470,000 people in the US will experience persistent symptoms each year!

 

Academic Performance in schools.

1 in 5 children will suffer a concussion by the age of 10.

  • A history of concussion in the past 12 months was significantly associated with a higher risk of poor academic standing during the same period.
  • Young people hospitalized with concussion had 30% higher risk of not reaching the national minimum standards for numeracy, 40% higher risk for reading.
  • In years 3-9, hospitalisation with concussion leads to 64% higher risk of not completing year 11 and 75% not completing year 12.(Lystad et al. 2022)
  • Concussion leads to an increased risk of mental health issues with to a 2-fold higher risk of suicide. (Fralick et al. 2019; Ledoux et al. 2022)
  • Children who have previously suffered a concussion are four times more likely to sustain another concussion (Fitzgerald et al. 2022)
  • Concussion results in a 65% increase in lower limb injury for up to one-year post-concussion (Avedesian, Covassin, and Dufek 2020)
  • There is increasing interest in the role in concussion recovery and sporting performance too.

 

What about employment?

  • Concussion is associated with reduced income. For those who attend emergency, 17% were still not working at 12months, however this improved if support is provided within the first 3 months (Gaudette et al. 2022)

Baseline screening

We have removed time and cost limitations by designing fast and cost-effective multimodal screens that focus on key measures monitored and compared at an individual level to inform best care following a concussion.

Education

We have developed a world class programme of three critical courses for anyone involved in concussion management. From parents and teachers through to medical practitioners wanting evidence-based updates. Knowing the most up to date developments saves lives.

Support

We facilitate support by providing opportunities for global networking within our custom designed online community of experts. Knowledge around concussion continues to evolve rapidly from the fields of neurology, vestibular, musculoskeletal and sports rehabilitation. Collaboration and sharing are key to innovation and best practice moving forward.

Technology

We are at leading the way in the selective use of the very best technological advances. From specific software, apps, virtual reality, eye-tracking, balance, movement, heart rate and cognitive testing devices, we know what people need and when.

Avedesian, Jason M., Tracey Covassin, and Janet S. Dufek. 2020. “The Influence of Sport-Related Concussion on Lower Extremity Injury Risk: A Review of Current Return-to-Play Practices and Clinical Implications.” International Journal of Exercise Science 13 (3): 873–89.

Daneshvar, Daniel H., Evan S. Nair, Zachary H. Baucom, Abigail Rasch, Bobak Abdolmohammadi, Madeline Uretsky, Nicole Saltiel, et al. 2023. “Leveraging Football Accelerometer Data to Quantify Associations between Repetitive Head Impacts and Chronic Traumatic Encephalopathy in Males.” Nature Communications 14 (1): 3470.

Fitzgerald, Melinda, Jennie Ponsford, Natasha A. Lannin, Terence J. O’Brien, Peter Cameron, D. James Cooper, Nick Rushworth, and Belinda Gabbe. 2022. “AUS-TBI: The Australian Health Informatics Approach to Predict Outcomes and Monitor Intervention Efficacy after Moderate-to-Severe Traumatic Brain Injury.” Neurotrauma Reports 3 (1): 217–23.

Fralick, Michael, Eric Sy, Adiba Hassan, Matthew J. Burke, Elizabeth Mostofsky, and Todd Karsies. 2019. “Association of Concussion With the Risk of Suicide: A Systematic Review and Meta-Analysis.” JAMA Neurology 76 (2): 144–51.

Gaudette, Étienne, Seth A. Seabury, Nancy Temkin, Jason Barber, Anthony M. DiGiorgio, Amy J. Markowitz, Geoffrey T. Manley, and TRACK-TBI Investigators. 2022. “Employment and Economic Outcomes of Participants with Mild Traumatic Brain Injury in the TRACK-TBI Study.” JAMA Network Open 5 (6): e2219444.

Ledoux, Andrée-Anne, Richard J. Webster, Anna E. Clarke, Deshayne B. Fell, Braden D. Knight, William Gardner, Paula Cloutier, Clare Gray, Meltem Tuna, and Roger Zemek. 2022. “Risk of Mental Health Problems in Children and Youths Following Concussion.” JAMA Network Open 5 (3): e221235.

Lystad, R., A. McMaugh, G. Herkes, G. Browne, T. Badgery-Parker, C. Cameron, and R. Mitchell. 2022. “The Impact of Concussion on School Performance in Australian Children: A Population-Based Matched Cohort Study.” Journal of Science and Medicine in Sport / Sports Medicine Australia 25 (November): S36–37.

Machamer, Joan, Nancy Temkin, Sureyya Dikmen, Lindsay D. Nelson, Jason Barber, Phillip Hwang, Kim Boase, et al. 2022. “Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury: A TRACK-TBI Study.” Journal of Neurotrauma 39 (5–6): 358–70.

Polinder, Suzanne, Maryse C. Cnossen, Ruben G. L. Real, Amra Covic, Anastasia Gorbunova, Daphne C. Voormolen, Christina L. Master, Juanita A. Haagsma, Ramon Diaz-Arrastia, and Nicole von Steinbuechel. 2018. “A Multidimensional Approach to Post-Concussion Symptoms in Mild Traumatic Brain Injury.” Frontiers in Neurology 9 (December): 1113.

The autonomic nervous system can be complicated, which sort of makes sense as it is often responding to the complex challenges of life!

From heart rate to hormone, blood pressure to breathing, this is the part of the nervous system that unconsciously recognizes, reacts and regulates so many systems in our body. A conductor of our physiological orchestra, where the sympathetic nerves are activated at times of stress and demand, and the parasympathetic branches are key drivers for recovery and restoration.

However, for all of its nuances, there is increasing evidence that highlights the importance of understanding the autonomic system and how it can be disrupted following an mTBI.  Whether it is due to stretching and shearing of axons, inflammation, a change in the levels of neurotransmitters such as adrenaline, noradrenaline and acetylcholine it is not uncommon for patients, who remain symptomatic at 3 weeks, to be experiencing an autonomic component.

So, what to look out for?

If we think of what the autonomic nervous system controls these are the things that can go out of kilter. And whilst the following symptoms may be triggered from other systems, it is worth considering

Cardiovascular: Changes and fluctuations in blood pressure or heart rate

Gastrointestinal: Nause, vomiting, bowel disturbances, loss of appetite

Sleep: Insomnia, excessive sleep, ineffective, non-restorative, sleep

Thermoregulation: Changes in body temperature and sweat response

Eyes: Unequal pupil size (anisocoria), sensitivity to light

How to assess?

Aside from clinical questioning there are a whole host of tests that can be used to help form judgement. Here are three that you may find useful.

Buffalo Concussion Treadmill Test: This test can also be done on a static bike and looks at how heart rate, perceived exertion and symptoms vary with a graduated increase in physical demand. The outcome is a modified heart rate threshold that is relevant to a patient at that moment in time and this allows for greater accuracy in exercise prescription.

NASA Lean Test: A useful way to evaluate excessive changes in heart rate that can be seen with patients who are experiencing postural orthostatic tachycardia syndrome (POTS). If POTS is detected interventions may include medication, nutritional (fluids), compression garments and graded exercise.

Firstbeat Lifestyle Assessment: This brings together physiology and context. A monitor is used to collect changes in heart rate variability and whilst the monitor is worn the patient will keep a diary of actions / feelings. A report is produced that details intra-individual changes in autonomic response and these are mapped, minute by minute, against a timeline. This data is useful in understanding the demands of daily life and lead to lifestyle interventions.

How to Treat?

I have already touched on some of the possible interventions that could be considered on the road to recovery.

Sometimes the symptoms can be obvious, sometimes subtle but consideration of the autonomic system has a role to play in a multisystemic approach to assessment. As for the treatment here are three things to consider:

Medical – Potentially medication can be used to influence blood pressure and heart rate.

Physical – Graded exercise that respects the current heart rate threshold and any symptom provocation is generally accepted as an appropriate intervention.

Lifestyle – There is often a focus on structuring the loads (physical, mental and emotional) that a patient is placed under. Fatigue management is important and so is recovery optimization.

Autonomic deregulation can be seen in concussion, in particular those with persistent symptoms.

Recognition and a proactive approach to the management of autonomic irregularity is something to be considered by all members of the multi-disciplinary team.

The balancing act between the demands of life and the way we cope and recover from these demands is a skill. A bit like a soufflé – undercook it and no progress is made; overcook and collapse occurs – balance is everything!