Mild injuries to head shouldn't be shrugged off

Every year more than 20,000 New Zealanders suffer a "mild" head injury or concussion. Most of them fully recover after a day or two.

But some lives can be plagued for months, or even years, by debilitating symptoms, including headaches, dizziness, nausea, mood swings, sleep-disruption, fatigue and loss of memory and concentration.

It has been impossible for clinicians to predict how well patients will recover, or how quickly - until now.

Researchers at the Christchurch School of Medicine and Health Sciences, University of Otago, have developed a world-first computerised assessment program, which can measure the effect of concussion on brain function.

The man heading the study, Dr Marcus Heitger, said roughly 20 per cent of people who suffered mild head injuries had ongoing problems.

"Some people cope quite well, whereas someone else, with what appeared to be a less serious injury, can suffer long-term problems."

The "she'll be right, mate" attitude was not helpful when it came to head injuries, he said.

"It's not an injury to be shrugged off and ignored."

Without clear clinical evidence to the contrary, sportspeople - particularly professionals - could put themselves under pressure to return to the field too soon, Dr Heitger said.

According to New Zealand Rugby Union guidelines, a player with concussion should stand down for a minimum of three weeks - yet studies show these rules are often flouted at local clubs.

Rugby league clubs have also been slated for cavalier attitudes to head injury: In the Anzac Day match against Australia last year, two Kiwis players, Robbie Paul and Nathan Cayless, were knocked out but returned to play later in the same game.

Without medical proof, employers may not be sympathetic to absences from work, while ACC may be reluctant to accept claims.

These patients have been a puzzle for clinicians because the existing diagnostic methods - neuro-psychological testing and imaging by MRI or other scanners - were not accurate enough to pick up subtle brain damage.

Dr Heitger's team at the Van der Veer Institute for Parkinson's and Brain Research have spent three years investigating the link between motor function and brain injury.

The computerised test is a more sophisticated version of the "follow the finger" method that doctors used to diagnose initial head trauma.

They found eye movements and eye-hand co-ordination could be affected following concussion, and secondly, that by measuring eye movements and eye-hand co-ordination in the first week after injury, scientists could gauge how severely brain function could be affected.

"We found a close relationship between the level of motor function a week after a head injury and whether people were likely to be still suffering symptoms three to six months later."

The researchers used infrared oculargraphy, an "off-the-shelf" technology which is already used for other neurological tests, in which participants wear a head-band fitted with a sensor to track their eye movements while they complete tests on the computer.

Dr Heitger said the test could revolutionise the prognosis of recovery after mild head injury, and be developed into a package that could be sold to health care providers world-wide.

"For instance, we may be able to use this technology to do screening for athletes who have been concussed.

"For people who have been told to go back to work because neuro-psychological tests show there's nothing wrong with them, this test may allow us to determine with greater accuracy the extent of their injuries."

He emphasised that research was still at an early stage.

- NZPA