Concussion research helps to protect kids’ brains

Ravi Menon (left) is a Principal Investigator at Robarts Research Institute. Credit: Mac Lai, Schulich School of Medicine & Dentistry
Ravi Menon (left) is a Principal Investigator at Robarts Research Institute.
(Photo Credit: Mac Lai, Schulich School of Medicine & Dentistry)

By Alison Palmer, Evaluation and Special Projects Lead, CFMM
Special to Schulich Medicine & Dentistry Communications

A growing number of kids’ brains have likely been spared injury thanks to enhanced safety guidelines informed by a large-scale Brain Canada-funded research platform.

A series of studies made possible by the Centre for Functional and Metabolic Mapping (CFMM) at Western University found that even minor concussions cause changes to the brain’s structure and function. These findings from the CFMM, which operates some of the most sophisticated magnetic resonance imaging (MRI) instrumentation in the world, informed a series of policies to protect youth while playing contact sports like soccer and hockey.

“Our platform allowed a dramatic increase in cohort size for MRIs in a series of important concussion studies, one with bantam hockey players – which is the first year Hockey Canada allows body checking – and another with female university rugby players,” said Principal Investigator Ravi Menon, PhD, and professor of Medical Biophysics, Medical Imaging, Neuroscience and Psychiatry at Schulich School of Medicine & Dentistry. An unprecedented cohort size and sophisticated imaging technology allowed Menon and Kathryn Manning, who was a PhD candidate at the time of the work, to study the brains of concussed players in a non-invasive way at a large scale and at high resolution.

Uncovering new knowledge about the effects of concussion

The studies showed that concussion causes clear changes in both structure and function of the brain. They also found that changes persist at least six months after an injury. Even smaller, mild head injuries common in contact sports such as hockey and rugby produced cumulative damage over the several years these studies took place.

Another key finding of these studies was that the simple cognitive tests used to assess concussion shortly after injury returned to normal long before the MRI signals did. The results raised the question of whether athletes are being returned to play too soon. The simple cognitive tests did not detect any symptoms in those who received multiple mild head injuries caused by hits, while the MRI testing did.

Changing policy

Study results were cited by the governing body for youth soccer in the UK to ban heading under the age of 10 and discourage it in practices for those under the age of 13 years old. The U.S. Soccer Federation also limited headers for players aged 11-13 years old. In hockey, Canada has maintained its ban on body checking in youth below the age of 13 years old, something that Menon discussed with former MP and hockey legend Ken Dryden.

In addition to informing policy at national and international levels, these studies on concussion have already been cited more than 200 times in the scientific literature, illustrating their impact on the research field. The results also received significant media attention, influencing conversations in Canada and around the world about whether concussion protocols in youth sports go far enough to protect developing brains. Return-to-play policies and protocols could become more stringent in the future, involving concussed players sitting on the sidelines for longer periods.

“A lot of concussion management has been based on anecdotal experience or qualitative assessments,” explained Menon, who is also scientific director of the CFMM. “Our imaging studies show that quantifiable structural and brain network changes occur in the brains of young adults and that these changes persist far longer than was previously suspected. Since these changes are occurring in still developing brains, it suggests we should be more conservative in our return to play guidelines, and we should perhaps shift the beginning of impacts in sports to a point where the brain is more mature.”

The findings of Menon and others illustrates the value of brain research in developing evidence-based policy that prioritizes player safety and their long-term brain health in the context of sport.

Advancing research

  • Brain Canada has supported the CFMM platform since 2016. During its first four years of support, a total of 294 researchers accessed the CFMM, 84 principal investigators and >400 trainees were supported by the CFMM across seven faculties at Western and other external institutions; a total of 261 unique projects were undertaken; and >240 publications were generated.
  • The CFMM was cited as a key factor in Western receiving a $66 million Canada First Research Excellence Fund Award (BrainsCAN), co-directed by Menon and Lisa Saksida, PhD, (who also leads a Brain Canada-supported platform), and most recently a $24 million New Frontiers in Research Fund Transformation Grant to identify and predict the success of drugs in human trials, led by Menon.
  • CFMM capabilities developed with support from Brain Canada were also essential to Western University receiving two Canada Excellence Research Chairs valued at a total of $18 million, used to recruit internationally regarded neuroscientist Adrian Owen, PhD, from the University of Cambridge in the U.K. and neuroimmunologist Dr. Robyn Klein from Washington University in St. Louis.
  • As is a requirement for platform grants supported by Brain Canada, CFMM follows an Open Science framework. All technical developments are open source and made available online and in publications for the purpose of advancing research.

Economic benefits

  • The team has sold intellectual property to Siemens, and generated spin-off companies to commercialize radio frequency (RF) coil technologies such as Ceresensa.
  • Pfizer, Merck, Bristol-Myers Squibb, Janssen Pharmaceuticals, Sanofi Genzyme, and Biogen have used CFMM staff expertise to develop imaging protocols for their clinical trials for drugs targeting the central nervous system.
  • The CFMM employs 15 highly trained staff members who enable state-of-the-art MRI/MRS studies; they offer specialized expertise in MRI protocol development, image reconstruction and analysis, radio frequency coil design and MRI safety evaluation, and include several veterinary technologists with the expertise to conduct experiments in various animal models of neurological function and dysfunction.