A/Prof James McLoughlin, PhD — Chief Academic Officer, Your Brain Healt

By Associate Professor James McLoughlin

Concussion isn’t simply a brain injury – it’s a biomechanical event.

As Professor Mike Loosemore, MBE, aptly puts it: concussion is a “rapid head acceleration injury”. In practical terms, this means the impact is not confined to neural tissue alone. The same acceleration–deceleration forces can strain the cervical spine, disrupt vestibular networks, and impair proprioceptive control. These interconnected systems explain why patients often present with overlapping symptoms—headache, dizziness, balance disturbance, and neck pain—that cannot be attributed to brain injury in isolation.

New Research in Elite Female Athletes

A new Australian study published in Journal of Science and Medicine in Sport (Sept 2025) examined 94 elite and pre-elite female athletes (soccer, water polo, rugby-7s) using three key concussion screening tools:

SCAT6 (Sport Concussion Assessment Tool)
VOMS (Vestibular/Ocular Motor Screening)
Manual cervical spine assessment including joint proprioception

Athletes also reported concussion history over the past 12 months. The study highlights how cervical and vestibulo-ocular screening can reveal subtle dysfunction in athletes—particularly in groups with high exposure to collision and repetitive head acceleration events.

Importantly for us at Your Brain Health: every single one of these assessments can be digitised, tracked, and reported through ScreenIT, ensuring clinicians and researchers can measure outcomes transparently and consistently.

Why the Cervicovestibular System Matters

The evidence is now clear: concussion is rarely a single-system injury. Whiplash-type cervical involvement and central vestibular disruption often coexist, producing overlapping symptoms such as dizziness, headache, balance impairment, and neck pain.

Persistent Symptoms: RCTs (Schneider et al., 2014) show that patients receiving combined cervical physiotherapy and vestibular rehab were nearly four times more likely to be medically cleared within 8 weeks compared to rest plus aerobic exercise alone.
Objective Gains: More recent trials in adults demonstrate that while symptoms may improve similarly with aerobic exercise, the addition of cervicovestibular rehab improves objective function (vestibulo-ocular reflex, cervical ROM, proprioception).
Prognostic Relevance: Cervicogenic pain and dizziness in the early days after concussion are strong predictors of prolonged recovery. Early, targeted treatment may shorten this trajectory.

Clinical Application

So, what does this mean for practice?

1. Assessment

Combine SCAT6, VOMS, and cervical proprioceptive tests to identify system-specific deficits. We encourage physiotherapist to keep refining their cervical palpation, screening and manual therapy skills.
Use structured tools that capture both subjective symptoms and objective measures.

2. Rehabilitation

Address impairments directly with manual cervical therapy, vestibular rehabilitation, neuromotor control exercises, and graded aerobic progression.
Tailor interventions to the individual’s profile—acknowledging that no two concussions are the same.

3. Tracking & Integration

With ScreenIT, clinicians can now assess, track, and report on all these measures, creating a longitudinal record that supports both clinical decision-making and real-world research.

Conclusion

Concussion is heterogeneous. For some athletes, symptoms are driven primarily by vestibular dysfunction; for others, cervical whiplash is dominant; and often, both systems are involved. The new study in elite female athletes reinforces the importance of screening both domains systematically.

With the right tools and training, health professionals can identify cervicovestibular dysfunction early, target treatment precisely, and track recovery transparently. At Your Brain Health, we’re committed to equipping clinicians with the skills, confidence, and technology to make that possible.

References

Leung, F., Warner, E., Currie, B., King, M., Oostenbroek, T., Pearce, Y., Stiles, G., Brown, D., Mendis, M. D., & Hides, J. (2025). Cervical spine and vestibulo-ocular screening in elite female athletes with a history of concussion. Musculoskeletal Science & Practice, 103406, 103406.

Alsalaheen, B. A., Mucha, A., Morris, L. O., Whitney, S. L., Furman, J. M., & Sparto, P. J. (2021). Vestibular rehabilitation for concussion: Clinical evidence and theoretical rationale. Sports Medicine, 51(6), 1053–1068. https://doi.org/10.1007/s40279-021-01469-y

Langevin, P., Frémont, P., Fait, P., Sirois, M.-J., Beauchamp, M.-H., Mercier, C., Boulanger, Y., … Gagnon, I. (2022). Aerobic exercise for adolescents and adults with persistent postconcussion symptoms: A randomized controlled trial. Journal of Neurotrauma, 39(7–8), 516–526. https://doi.org/10.1089/neu.2021.0061

Langevin, P., Frémont, P., Fait, P., et al. (2022). Cervicovestibular rehabilitation for adults with persistent postconcussive symptoms: A randomized clinical trial. World Physiotherapy Congress Proceedings. https://world.physio/congress-proceeding/randomised-clinical-trial-cervicovestibular-rehabilitation-adults-concussion-0

Patricios, J. S., Schneider, K. J., Dvorak, J., Ahmed, O. H., Blauwet, C., Cantu, R. C., Davis, G. A., Echemendia, R. J., Makdissi, M., Broglio, S., Emery, C. A., Feddermann-Demont, N., Fuller, G. W., Giza, C. C., Guskiewicz, K. M., Hainline, B., Iverson, G. L., Kutcher, J. S., Leddy, J. J., … Meeuwisse, W. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695–711.

Schneider, K. J., Meeuwisse, W. H., Nettel-Aguirre, A., Barlow, K., Boyd, L., Kang, J., & Emery, C. A. (2014). Cervicovestibular rehabilitation in sport-related concussion: A randomized controlled trial. British Journal of Sports Medicine, 48(17), 1294–1298. https://doi.org/10.1136/bjsports-2013-093267

How We Support Clinicians

At Your Brain Health, our Essential Practical course devotes significant time to hands-on cervicovestibular rehabilitation. We know that physiotherapists and allied health professionals are uniquely positioned to address these impairments—but confidence and skill in assessment and treatment are essential. The reality is that many physiotherapists that have experience in sports and musculoskeletal practice are less confident when it comes to vestibular practice. While many vestibular and neurological physiotherapists have less experience with cervical assessments and treatments. However, it does not take long for us to upskill both groups!

By Associate Professor James McLoughlin, Chief Academic & Founder at Your Brain Health

In 2022, Your Brain Health (YBH) was in its embryonic stages as an organisation. At that time, we held clear ambitions to promote a multimodal, community‑focused approach to brain health. By combining clinical experience, domain expertise, and emerging technologies, our goal was to enable better, evidence‑informed care.

We recognised an urgent need for integrated brain‑health solutions across diverse settings—concussion, mental health, ageing, and neurorehabilitation. This vision became the foundation for developing digital tools and clinical pathways that empower both healthcare professionals and the people they serve.

YBH was born from the belief that optimal outcomes are achieved when brain health is assessed and managed using a collaborative, multidisciplinary, and data‑driven model. From this initial vision, our future direction began to take shape.

In 2023, we expanded our work by creating and updating educational resources in partnership with global leaders in concussion care. At the same time, we responded to growing demand for multimodal baseline concussion screening in sporting clubs and schools, particularly in Australia and South Africa. Combined with education and clinical support, baseline testing became a key strategy for organisations seeking to engage with rising standards of care. Evidence supporting baseline screening was building, demonstrating that the process is more than the sum of its parts. Despite this, logistical barriers such as limited resources and cost remained significant. For example, in March 2024 the AFL Community Concussion Guidelines in Australia stated that “Baseline testing can be useful but is often time‑consuming and expensive.”

By this point, YBH had addressed part of the problem: baseline screens of online surveys and key objective tests had become efficient, affordable, and informative even for large groups, thanks to new assessment technologies. More clinics were partnering with us to provide an end‑to‑end solution—baseline screens, follow‑up assessments, and rehabilitation—for people who had sustained concussion. Nonetheless, multimodal screens still needed to become more streamlined, combining diverse tests into clear clinical reports and tracking recovery over time. Longitudinal brain‑health monitoring was also an unmet need, both for personalised care and for high‑priority research.

Driven by this unmet need and our clinical insights, we developed ScreenIT software to address these challenges. ScreenIT is designed to:

Easily capture previously fragmented data from validated questionnaires and objective multimodal outcome measures, alongside emerging assessment technologies. A selection of trusted tools allowing for clinician choice and autonomy to suit their contextual needs.

Automate comprehensive reports within seconds, saving administrative time.

Track measures longitudinally with intuitive timeline graphs.

Support clinics, clubs, and organisations through flexible permission structures for clinical and administrative staff, enhancing multidisciplinary collaboration.

Securely store a scalable, real‑world longitudinal database that can power future research and AI/machine‑learning insights.

We are excited to announce the release of ScreenIT in July 2025. This early version aims to meet the clinical needs of our first adopters in elite sports and community-based concussion care. We are proud to work with some of the world’s leading sporting organisations to ensure ScreenIT evolves to meet their specific requirements, including performance optimisation. At the same time, we feel a deep responsibility to include measures that are relevant for other populations, where brain health screening for concussion, healthy ageing, falls, frailty, functional decline, and modifiable risk factors linked to dementia and other neurodegenerative diseases is critically needed.

Brain health screening has shifted from a ‘strongly recommended’ option to an ‘expected requirement.’ At release, ScreenIT includes approved digital Concussion in Sports Group tools such as the SCAT6® and the first ever digital SCOAT6® at no additional cost. It also integrates a growing list of many validated assessment tools and technologies to further enhance your clinical practice needs and reputation.

We look forward to ScreenIT becoming an integral part of Your Brain Health’s mission to support best-practice care.

At Your Brain Health, we take concussion in sport very seriously.

As one of the most common injuries in contact sport, it is also potentially one of the most devastating to long term health and quality of life. Your Brain Health has put together this list of facts on concussion you should know following the advice released from the Australian Sports Commission, partly addressing the recommendations from the Australia Parliament Senate inquiry into concussion and repeated head trauma contact sports.

Your Brain Health offers many services to help sporting clubs including education, multimodal baseline screening and clinical support.

Here are some facts about concussion in sport you should know……

13.4 concussions per 1000 hours played Rugby union (1). In Rugby, concussion injury rates are high for both ball carrier and tackler (2).

There are 6 concussions per 1000 hours played in AFL (3,4).

Concussion is also common in sports such as basketball (5) and netball (6).

Incidence of concussion and games missed is on the rise, likely due to improved recognition and early care. For example, concussion without loss of consciousness is more likely to be recognised, and more players are now more likely to be removed from play and assessed.

Concussion increases risk of further musculoskeletal injury (7,8).

Concussion is the most common injury requiring hospitalisation. Concussion is about 1 in 8 injuries in community Australian Rules Football. (Australian Institute of Health and Welfare).

There is a higher incidence of anxiety and depression in those with persistent symptoms following concussion (9).

Adverse mental health and sleep has been found in former rugby players with higher numbers of previous concussions (10).

Concussion is linked to worsening mental health, including depression (11,12).

Slowed reaction times are common after concussion 13 and can lead to increased risk of further head impacts (14,15).

Vestibular-ocular changes can occur in over half of sport related concussions (16).

Vestibular-ocular dysfunction (17), mental health (9) and sleep quality (18) is associated with prolonged recovery and should be included in baseline screening.

Concussion and repeated head impacts are associated with increased risk of developing Chronic Traumatic Encephalography (CTE) (19).

Females are more susceptible to concussion and suffer worse symptoms (20).

Multimodal baseline screens help with interpretation of post-concussion assessments (21).

Tools like the free digital SCAT6 make standardised screening more accessible for sporting clubs at every level.

Early interventions combining vestibular, ocular and neck treatment and sub-threshold exercises improve outcomes with earlier return to play (22–24).

Associate Professor James McLoughlin, Co-Director, Your Brain Health

References

1. Union, R. F. England Professional Rugby Injury Surveillance Project. 2014-15 Season Report. Preprint at (2016).

2. West, S. W. et al. It Takes Two to Tango: High Rates of Injury and Concussion in Ball Carriers and Tacklers in High School Boys’ Rugby. Clin. J. Sport Med. (2023) doi:10.1097/JSM.0000000000001118.

3. Orchard, J., Seward, H. & Orchard, J. J. AFL Injury Survey 2014. , Victoria, Australia: AFL Doctors Association, AFL … (2014).

4. League, A. F. AFL Injury Survey 2015. Melbourne, Victoria, Australia: AFL Doctors Association (2015).

5. Patel, B. H. et al. Concussions in the National Basketball Association: Analysis of Incidence, Return to Play, and Performance From 1999 to 2018. Orthop J Sports Med 7, 2325967119854199 (2019).

6. Downs, C., Snodgrass, S. J., Weerasekara, I., Valkenborghs, S. R. & Callister, R. Injuries in Netball-A Systematic Review. Sports Med Open 7, 3 (2021).

7. Howell, D. R., Lynall, R. C., Buckley, T. A. & Herman, D. C. Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A Scoping Review. Sports Med. 48, 1097–1115 (2018).

8. McPherson, A. L., Nagai, T., Webster, K. E. & Hewett, T. E. Musculoskeletal Injury Risk After Sport-Related Concussion: A Systematic Review and Meta-analysis. Am. J. Sports Med. 47, 1754–1762 (2019).

9. Sheldrake, E. et al. Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review. Front. Neurol. 13, 850590 (2022).

10. Hind, K., Konerth, N., Entwistle, I., Hume, P. & Theadom, A. Mental health and wellbeing of retired elite and amateur rugby players and non-contact athletes and associations with sports-related concussion: the UK …. Sports Med. (2021).

11. Rice, S. M. et al. Sport-Related Concussion and Mental Health Outcomes in Elite Athletes: A Systematic Review. Sports Med. 48, 447–465 (2018).

12. Gornall, A., Takagi, M., Morawakage, T., Liu, X. & Anderson, V. Mental health after paediatric concussion: a systematic review and meta-analysis. Br. J. Sports Med. 55, 1048–1058 (2021).

13. Eckner, J. T., Kutcher, J. S., Broglio, S. P. & Richardson, J. K. Effect of sport-related concussion on clinically measured simple reaction time. Br. J. Sports Med. 48, 112–118 (2014).

14. Harpham, J. A., Mihalik, J. P., Littleton, A. C., Frank, B. S. & Guskiewicz, K. M. The effect of visual and sensory performance on head impact biomechanics in college football players. Ann. Biomed. Eng. 42, 1–10 (2014).

15. Mihalik, J. P. et al. Collision type and player anticipation affect head impact severity among youth ice hockey players. Pediatrics 125, e1394-401 (2010).

16. Kaae, C., Cadigan, K., Lai, K. & Theis, J. Vestibulo-ocular dysfunction in mTBI: Utility of the VOMS for evaluation and management – A review. NeuroRehabilitation 50, 279–296 (2022).

17. Whitney, S. L. et al. Association of acute vestibular/ocular motor screening scores to prolonged recovery in collegiate athletes following sport-related concussion. Brain Inj. 34, 840–845 (2020).

18. Magliato, S. N. et al. Sleep Problems After Concussion Are Associated With Poor Balance and Persistent Postconcussion Symptoms. J. Child Neurol. 08830738231170721 (2023).

19. Daneshvar, D. H. et al. Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males. Nat. Commun. 14, 3470 (2023).

20. McGroarty, N. K., Brown, S. M., & Mulcahey, M. K. (2020). Sport-Related Concussion in Female Athletes: A Systematic Review. Orthopaedic Journal of Sports Medicine, 8(7), 2325967120932306.

21. Resch, J. E. et al. The sensitivity and specificity of clinical measures of sport concussion: three tests are better than one. BMJ Open Sport & Exercise Medicine 2, e000012 (2016).

22. Reid, S. A., Farbenblum, J. & McLeod, S. Do physical interventions improve outcomes following concussion: a systematic review and meta-analysis? Br. J. Sports Med. 56, 292–298 (2022).

23. Leddy, J. J., Haider, M. N., Ellis, M. & Willer, B. S. Exercise is Medicine for Concussion. Curr. Sports Med. Rep. 17, 262–270 (2018).

24. Hutchison, M. G. et al. Randomized controlled trial of early aerobic exercise following sport-related concussion: Progressive percentage of age-predicted maximal heart rate versus usual care. PLoS One 17, e0276336 (2022).

Sports injury in Australia, Australian rules football. (2023). Retrieved 4 September 2023, from https://www.aihw.gov.au/reports/sports-injury/sports-injury-in-australia/contents/featured-sports/australian-rules-football.

Dr James McLoughlin, Co-Director of Your Brain Health answers our 10 most common questions about concussion.

How common is concussion?

It’s more common than most people might think. In Australia we estimate that around 180,000 concussions occur each year. In the US that number could be well over 2 million!

Why do you think concussion is now a such a big issue?

It’s interesting to see the change in media and community messaging around concussion. It has improved awareness around brain injury and brain health which is great. But there is also plenty of misinformation out there too, which means we need to work extra hard around community education.

Research around the effects of concussion and brain injury has helped us understand the negative impact it can have on so many people’s lives. The most alarming is the effects of repeated head impacts on increasing risk of degenerative neurological conditions like Chronic Traumatic Encephalography (CTE). But the effects of concussion have also been termed the ‘silent epidemic’ where people live with persistent signs and symptoms of traumatic brain injury, where their quality of life is impacted by mental health, cognitive effects, and physical impairments, often without appropriate clinical care and support. These people still fall through the cracks unfortunately, but I see their stories are starting to come out through the media over the past few years.

In sport, players sustain a concussion and often continue to play on. Is that such a big problem?

When the brain and brainstem is subject to biomechanical forces, it leads to stretching and shearing of brain cells. These injured cells begin to change their activity, they become inflamed and there are additional changes to blood supply as well. The injured brain at this point is working exceptionally hard to adapt and recover, which leads to an ‘energy crisis’. If your brain is subject to further activity at this point, it leads to worsening symptoms which can be delayed, and persistent symptoms and worse outcomes are more likely. The slight confusing thing is that, during this stage you can continue to function, and run, jump and kick etc, but the stressors on the brain at that stage are causing harm. This means you will be making a mild brain injury worse. Also, the risk of anther hit to the brain at this stage could be potentially disastrous.

So, if you play on with sprained ankle or knee or with a shoulder tendinopathy, these structures are also not getting the rest they need to recover and in later years these joints may remind you of the sacrifices you made with pain, degenerative change, and arthritis! However, the brain also ‘keeps the score’ and that can leave people with issues that are extremely serious such as depression, dementia, and suicide. So, it makes sense that we like to minimise brain injury and ensure adequate recovery before returning to sport.

Is it difficult to diagnose a concussion?

No! You might think that assessing a complex brain function is difficult, but it is not! Everyone can diagnose suspected concussion. If after a knock or fall someone looks stunned or dazed, off balance, has visual symptoms, confused, emotional, slow, or has problems with memory, headache, dizziness – these are common signs of concussion that we can all diagnose. These signs and symptoms might be very brief or might be delayed. Also remember, in only about 10% of concussions is there a loss of consciousness. The most important message is to ‘make the call’ – yes you suspect concussion, now we must monitor recovery and guide the best care earlier rather than later. And the good news is most people will make a full recovery within 3- 4 weeks.

What are red flags?

Red flags require immediate medical attention, which means calling emergency services and getting to hospital. Red flags are not always related to concussion injury, but rather other very serious conditions that require immediate and appropriate care such as spinal cord injury, brain bleeds, and brain swelling. Some red flags include.

Neck pain
Vomiting
Seizures, convulsions, or involuntary posturing
Severe or increasing headache.
Weakness, sensor loss or pins and needles
Double vision
Loss of consciousness or deteriorating conscious state
Increasing agitation, restlessness, or emotional state

What is the difference between ‘mild traumatic brain injury’ and ‘concussion’?

Currently experts have agreed that if there is normal neuroimaging such as MRI or CT scan, the terms ‘mild traumatic brain injury’ or ‘mild TBI’, and ‘concussion’, can be used interchangeably. It is much more common to have a normal brain scan. Personally, I like to use ‘mild traumatic brain injury’ when I want to reinforce the seriousness of this issue, because sometimes the impact of the term ‘concussion’ has historically been underplayed!

Are there treatments that help people recover from concussion?

Yes. This is a message that is missing from recent awareness campaigns. Early treatments help. For example, early prescribed aerobic exercise that limits symptom provocation helps even in the first week. Also, neurological physiotherapy treatments that blend neck treatment with eye and vestibular exercises help reduce persistent symptoms and speed up return to learn and play. But is doesn’t stop there. Early monitoring of mental health, cognitive changes, headache, and sleep allow health professionals to be proactive in providing the best care. In the case of more moderate and severe brain injury, multidisciplinary neurological rehabilitation is needed, and early intervention and referrals improve outcomes for these people too.

How long does it take to recover from concussion?

Well, you are going to hear different answers here, depending on what defines ‘recovery’. For most people the brain physiology will recover in 3-4 weeks, yet symptoms can settle within 2 weeks. In our clinical teaching, we say if symptoms stay beyond 3 weeks you have ‘persistent symptoms’ and you need specific treatment. About a third of people (new research suggests possibly more) have persistent symptoms that last anywhere from 3 weeks to many months, even years. While this is concerning, even in these people we do see improvements and recovery if they received appropriate rehabilitation.

Schools and sporting clubs are recommended to use baseline screening. What is the best type of baseline screening?

Your Brain Health has been following the scientific evidence on baselines screens closely over recent years as we have seen a shift in thinking. The main focus now for baseline testing is to help identify signs and symptoms that help guide the best early treatments, especially in signs and symptoms that are associated with poor recovery if not managed appropriately. Therefore, at You Brain Health, we believe multimodal assessments that screen medical history of concussion, migraine, learning disorders, mental health and sleep is vital, symptom reporting is still important, as well as objective tests of vestibular-ocular functions, cognition, and balance. This is a change from many recent trends that have focused mainly on symptom reporting and brief cognitive tests (some computer-based). These tests, while useful for diagnostic purposes, have limitations in relation to informing the actions for best care. My advice is to look for multimodal screens that use objective tests, including vestibular-ocular assessments in addition to relevant medical history — ScreenIT’s multimodal digital assessments are designed with exactly this approach. Baseline tests also need to be feasible and time efficient, so Your Brain Health Screens take only 15 minutes!

What makes a school or sporting club ‘concussion ready’ at Your Brain Health?

Education is by far the most important factor. That means that teachers, trainers, coaches, students, and players are all aware of the latest information about the ‘end-to end’ management of concussion. First aid response, identifying red flags, correct advice and referrals are key. This also includes a clear plan for return to learn and return to play protocols that are updated.

Schools and clubs can offer the opportunity for multimodal baseline screening each year, to help improve concussion assessment when they occur and to help with the best brain health tracking. Baseline testing is also another opportunity to educate and discuss health issues at an individual level, such as improving the management of sleep, migraines, and mental health, and we can discuss what to do in the event of a concussion.

Concussion passports allow us to help track your brain health over time to help provide informed decisions for return to learn, work, and play if they are signed off by a medical practitioner.

So, education, offering multimodal baseline screening and following latest ‘return to’ protocols will mean your organisation is ‘Concussion Ready’ with Your Brain Health!