IN a laboratory in Boston, Massachusetts, the foundations are being laid for a pioneering, potentially revolutionary study of the brain of an NRL player.
The end game is this: discovering just how much long-term damage, if any, the brain sustains from the head knocks and concussion that in a collision sport can be mitigated but not avoided. The finish line, of course, is some way away.
Andrew Gardner is a young researcher from the University of Newcastle and a doctor of clinical neuropsychology whose interest is in the consequences of head injuries in sport, primarily rugby league. He is three-quarters the way through a study tour centred around Boston University’s Center for the Study of Traumatic Encephalopathy - for the layman, the ‘‘brain bank’’ where neurosurgeons have been examining the remains of former NFL and NHL players in an effort to explain why, in those sports, there has been an increasing frequency of tragic early deaths.
Robert Cantu and his research team there have spent several years looking closely at the brains of deceased athletes from contact sports endeavouring to find evidence of chronic traumatic encephalopathy (CTE). A degenerative condition that can lead to depression and early dementia it was formerly known as ‘‘dementia pugilistica’’ or ‘‘punch-drunk syndrome’’ - that is, when the medical fraternity thought such damage was only sustained by boxers.
American sport is in a frenzy about the latest death, that of former San Diego Chargers linebacker Junior Seau, aged 43, last week. He shot himself in the stomach, like others before him apparently in a bid to preserve his brain for study. His family have subsequently agreed to donate it for research.
Then there is the litigation. Only yesterday it was revealed that the Washington Redskins Hall of Fame wide receiver Art Monk was suing the NFL and a helmet manufacturer over “short term memory loss, headaches and speech difficulties”. More than 2,000 former NFL players are now reportedly engaged in such lawsuits.
The NRL, and the Australian football codes in general, have been spared the tragedy befalling the NFL. Players continue to be concussed and knocked out cold - the most recent was Test star Johnathan Thurston, levelled by the elbow of Dragons forward Matt Prior in Townsville eight days ago - but in terms of long-term ramifications there is a black hole of information. Several players including Cronulla forward Reece Williams and ex-Cowboy Shaun Valentine have been forced into retirement as a result of concussion - and Valentine has spoken before about post-career seizures he has had - but there is no evidence as yet of CTE in Australian sportsman, former or current.
That is where Gardner comes in. Others, such as the Melbourne neurologist Paul McCrory, have looked into the effects of concussion in boxing and the AFL, but what Gardner and his colleagues at the Hunter Medical Research Institute want to do is significantly more extensive.
Upon his return from the US next month Gardner is scheduled to meet with Brian Canavan, the Rugby League Research Board chairman, and the ARL Commission’s chief medical officer Ron Muratore about an ambitious project the Newcastle researchers are in the preliminary stages of undertaking.
With the permission of the game’s administrators and the clubs Gardner hopes they can closely examine current NRL players, as well as former ones, who have been concussed. It is understood they already have a relationship with one club.
‘‘We want to look in detail cognitively, doing tests of attention, concentration, processing speed, memory as well as psychiatric work-up in terms of their mental status and how they are feeling about life,’’ Gardner told the Herald from Boston.
‘‘On top of that, we’re also going to be conducting some neuro-imaging which we hope will replicate what they’re doing over here. We would like to have a look at current players versus retired players and see if there is any difference between those groups cross-sectionally.’’ The researchers would also recruit non-athletes to compare results.
League medical bosses have already begun moves to further their knowledge on the impact of head knocks, commissioning Sydney neurosurgeon Richard Parkinson to study concussion rates in the game and, as reported by the Herald yesterday, drafting a 17-page health questionnaire to be sent soon to more than 400 former State of Origin players.
There are further suggestions that Parkinson is planning to bring out special mouthguards from the US that could be worn by players to test levels of acceleration leading into heavy contact.
Gardner, who happens to have gone to school with Newcastle captain Kurt Gidley, hopes to also be able to perform a much larger data collection on concussions by liaising with club doctors, looking at video footage of incidents and establishing common themes behind head knocks. The goal is a policy paper that could potentially bring about more changes to concussion rules, governing when players can re-enter a game, in the NRL, and if they can return the following week.
‘‘Ideally, what will happen is that we get all the data from all clubs...we might go back five years, it just depends on how frequency the concussions occurred,’’ he said.
There is caution about making comparisons between the NFL and the NRL and other Australian codes and making the connection that CTE will automatically be found among some league players.
Says Muratore: ‘‘Their game is completely different. The aim of their game is to crash into people with their heads, although they are now starting to change the rules. It’s quite possible that a lot of the time they’re playing concussed.
‘‘Our game is a collision sport and their will be injuries but we try and protect players’ heads.’’
At an operational level several changes have been made to assist with player safety and welfare. There is the crackdown on concussed players returning to the field - they must be given the all-clear by the club doctor - and in playing the week after a concussion, with the uniform introduction of the CogState Sport testing in mid-week. Then there is the clear move to marginalise supposedly dangerous tactics like the shoulder charge with harsh penalties like the bans dished out to Canterbury-Bankstown’s Frank Pritchard and Brisbane’s Ben T’eo this season.
Former Australian team doctor Hugh Hazard is on record demanding the shoulder charge be eradicated altogether but believes the evolution of the game’s rules has served to better protect players in general.
‘‘When I was a kid you had people that went out and deliberately coat-hangered people,’’ Hazard said. ‘‘If you do that sort of stuff now you’re going to end up on the sideline. Those changes have certainly reduced the number of head injuries in the game.’’
The work of Gardner and others at the Hunter Medical Research Institute is not confined to rugby league, nor indeed sport. But their desire to delve into the brains, figuratively, of current and former players stands to increase dramatically the intelligence the game has about the cognitive consequences such a physical game has on its subjects. Their ultimate target is the elusive and foreign beast that is CTE.
‘‘The study of CTE is in its infancy,’’ Gardner said. ‘‘According to the latest literature you can’t make a diagnosis of CTE until [you have] the neuropathology results, until the post-mortem determination has been conducted. They’re saying you can’t diagnose it in living athletes.
‘‘Having said that what the guys over here at BU are trying to do is to use the technology we’ve got these days...to find a profile [in living athletes] of what looks like CTE.
‘‘The future potentially could be that you make a diagnosis through the MRI technology...make a diagnosis in life.’’