In the second of a three-part series on concussion in sports, Technical Foam Services' Duncan Geddes interviews Dr. Michael Grey - a neuroscientist specialising in neurorehabilitation at the University of East Anglia.
Dr. Grey runs the SCORES Project, an independent research study designed to better understand the cognitive health of athletes as they age.
In the second of a three-part series on concussion in sports, Technical Foam Services' Duncan Geddes interviews Dr. Michael Grey - a neuroscientist specialising in neurorehabilitation at the University of East Anglia.
Dr. Grey runs the SCORES Project, an independent research study designed to better understand the cognitive health of athletes as they age.
[0:01]
DG: Hello, and welcome to the Future of Foam Podcast. My name is Duncan Geddes and I run Technical Foam Services, the UK's finest foam conversion business based here in Corby.
I've been in the foam industry for 30 odd years, so I know a lot of the industry's key players. We're all part of the global manufacturing and purchasing community but in this busy world, many of us don't get the time to talk to each other, and exchange knowledge as much as we'd like to. This is the only podcast dedicated to the foam industry, so this is your chance to listen to the views of your peers.
However, these episodes are a little bit different. Over the past year or so discussions around head injuries in professional sport have become headline news, with rugby players taking governing bodies to court and in football, the Premier League introducing concussion substitutions. As the number of ex-professionals sharing their experiences continues to increase, I wanted to investigate how foam in protective equipment is commonly used for sport at all levels, and how headgear could be improved to increase protection for future generations.
Today's episode is the second part of a three-part series. I will be talking to Dr. Michael Grey - a neuroscientist specialising in neurorehabilitation at the University of East Anglia. Dr. Grey runs the SCORES Project, an independent research study designed to better understand the cognitive health of athletes as they age. Dr. Grey obtained his PhD in Biomedical Science and Engineering from the Centre for Sensory Motor Interaction at Aalborg University in Denmark, before joining the University of East Anglia in 2017.
Other episodes in this series featured conversations with former Norwich City striker Iwan Roberts on his experience as a former football professional, and his role in Dr. Grey's concussion research, and Saracens and United States fly-half Will Hooley about his relationship with concussion as a current rugby union international. If you like what you hear, you can subscribe to the podcast on your favourite podcast platform, or follow us on SoundCloud. You can also stay up to date by following us on LinkedIn and Facebook. I hope you enjoy the episode.
[2:31]
DG: I'm delighted to be joined by Dr. Michael Grey. Dr. Michael Grey is a specialist in conducting research into the link between concussion and dementia. So he's an absolute expert in the field of protecting heads and so forth within the sports world. So, Michael, please tell us more about yourself.
[2:59]
MG: Well, you'll tell from my accent that I'm Canadian. So I grew up in Vancouver, Canada, went to university to do Physics actually was my first degree and then decided I wanted to do something a little more engaging with humans. So I got more into Biology research. I went to Denmark to do a PhD in Engineering and Bio-Science and from there discovered that I've got a real love for understanding what's going on in the brain. So I started working in as a research assistant in hospitals and whatnot and I've been working now in brain injury research for a little more than 20 years.
[3:42]
DG: So you're a real expert in the field. Actually, before we go down that subject, do you miss Vancouver?
[3:49]
MG: I do sometimes. It's a... I mean, we get the similar Grey weather to what we've got here in England. But when it clears up, I've got mountains and ocean to see.
[3:59]
DG: I know we're going completely off the track here. I went to Vancouver because my father's side of the family a Canadian. My grandmother was brought up in Vancouver, we went there was a child. And it was a phenomenal, phenomenal place. And actually a few years ago, we did the whole route through the Rockies, we hired one of the winnebagos as a family. It was a fantastic trip.
[4:24]
MG: It's one of those, I mean, that trip that you talk about is something that most Canadians haven't done. And I'm, you know, I've been in Europe now for 20 years and I tell everybody Yes, you you've got to go and do this trip once in your life. It's it's...yeah, driving through the Rockies is brilliant.
[4:40]
DG: I believe you are leading a project into into the world of concussion and dementia known as SCORES. So could you tell us more about that please?
[4:50]
MG: Yes, the SCORES Project is all about looking at neurodegeneration. So what we're doing is we've got a group of people who are contact sport athletes, primarily we've been focusing on association football. And we're comparing them to people who have played sport at a high level but didn't have contact with balls or rugby balls, or you know, any physical contact that would induce head injuries. We are looking at people who are over 40 years old. They cannot have a diagnosis of dementia at the moment, when they join this study. We're looking for people who have been athletes, or at least very active. They don't necessarily have to be professionals, we're also looking at professional, amateur and recreational level athletes. And the idea is to do a set of online cognitive tests. They do these from the comfort of their own living room, on a PC or on a tablet. We ask you to do a set of cognitive assessments every three months. And then the idea is we track your health over time, so it's a longer study. It will track how your brain is performing over time. And we will then let you know if your brain starts to decline in a way that might be worrying.
[6:15]
DG: So what have you seen so far in your, in your studies? How long has the SCORES Project been going on for?
[6:24]
MG: So we've only just started. We're about six months into data collection now, so we've got two part sets of data. Not enough that we could actually say, you know... we don't have a result yet. In another six months, we'll actually be able to say a little bit about comparing contact sport athletes to non-contact sport athletes. We've got just over 250 people in the study now, we're actively recruiting, the idea is to have thousands.
[6:56]
DG: Right? Okay, and is it just physical sports, such as football, rugby, hockey, horse racing, that kind of thing? Are you looking at generally, you know, sports as a whole? If you see what I mean.
[7:11]
MG: Yeah, it is sport as a whole. We are focusing on football at the moment. The intention is to broaden that out to rugby football and then and then to other contact sports. We're also going to branch out into Europe. But the important thing that we're doing is comparing contact sport to non-contact sport, so we're also looking at sort of higher level athletes who have been running or swimming, or cycling, you know, those athletes that haven't had that head contact. What we do then is we match participants by their age, socioeconomic status, their athletic ability, and we try to rule out all of the other factors that might come in. Health histories like smoking, that type of thing. We match contact sport athletes with similar non-contact sport athletes, and then the remaining variable is that contact element of the sport.
[8:12]
Are you noticing much difference between male athletes and female athletes? It's early stages in the project, but is the difference between the two?
[8:21]
MG: Well, that's a brilliant question. We aren't yet because we haven't looked at the data. But we expect to see that and there are several reasons for that. I'll give you two. One is that is that when we look at brain injury, when we look at concussions, women experience concussions two to three times to a greater extent than to men. We don't fully understand why that is. And if we go to the on to the neuro degeneration side, if we look at the population in the UK of people who have dementia, 65% of those people are women. And that's not because women live older than men. There's something else. There is something about being female that makes them more predisposed to getting dementia.
[9:07]
DG: That's fascinating. That's one of those sort of like unknown statistics, you just wouldn't, wouldn't think of that, would you?
[9:13]
MG: It's an important one. I think when we talk about sport, we're typically always talking about men. I mean, my PhD student has a focus specifically on women. It's one of the reasons that we hired her. She came in, in her PhD interview, she said: "I want to focus on women, because nobody does women in this research". And that was an important part of our study that we're including both men and women.
[9:37]
DG: And, and I think, I mean, sadly, but most of the sort of high profile physical sports, that tend to have more publicity are male-driven sports. I'm thinking rugby, I mean, obviously, you know, female rugby is increasingly popular nowadays, but it tends to be more male orientated sports I think that have a higher profile.
[10:02]
No, it does. And that's a shame. Because frequently we have, you know, on the women's side at the professional level, those teams are frequently performing better than the males are, you know, on the world stage. You look at cycling and how brilliant our cycling teams are. Some of the women are some of the best in the world, similar in football, but I don't know why it is in our culture that we focus on men.
[10:36]
DG: In terms of doing the actual testing, how do the people participating in the study... How do they submit the information to yourself? What kind of things are you asking from them?
[10:46]
MG: Yes, it's really easy to do. Anybody that's interested just need to go to our website scoresproject.org. Because it's a research study, one has to do an informed consent, we call it. And then we launch into a series of demographics questionnaires. So we learn something about the types of sports you've played, health histories, that sort of thing. And then that day, can launch into the first set of cognitive assessments. And what we've done is we've taken very gold standard, we call it, neuropsychology tests that would traditionally be used in front of a neuropsychologist sitting in his or her office, and we've digitised it. So we can actually do that online. Our participants are telling us, it's actually quite interesting, they find it fun. Some of the tests are difficult, but they're intended to be difficult. We're not looking for dementia, we're looking for early signs of what we call mild cognitive impairment. And tracking every three months is really important. Because we don't ourselves don't necessarily notice signs of decline.
This is an important topic, I'll use a family example here. And I typically use my family when I talk about this. You know that I live in Canada, I'm from Canada, that means I don't see my parents very frequently. I see them probably every two or three years physically in front of me. And because of the long time gaps, I see massive declines in my parents health. My siblings who see them every day or weekly, they don't see the same thing. So they think I'm nuts when I talk about the, you know, the declining health of my parents, they just simply don't see it. And that's frequently the case. So what we've done with the SCORES Project, we've said, we'll do these cognitive assessments every three months, with the idea that we will catch things before the participant will even know it. You know, if we suspect that there might be a problem, go to your GP, have a proper physical exam, have a proper, you know, a full medical examination. Because there might be, it might not be cognitive decline, there might be other things that are wrong. For example, diet is wrong, not drinking enough water, a whole host of not having enough stimulus.
[13:09]
DG: So you're providing a real health policy for these participants, aren't you? Because if they weren't part of the SCORES Project, they wouldn't get this feedback from you every sort of three or four months?
[13:22]
MG: Yes, that's that's how I like to look at it. Over 40 we get an eye test every every couple years. Nobody's looking at our mental health...at our cognitive health.
[13:32]
DG: Yeah, exactly. So this is a real bonus for the participants. Have you gone down... I mean, obviously, the main purpose of this podcast is to talk about the impact of headgear within sports. So is wearing headgear one of the subjects that you focus on? Are you starting to notice sort of trends between people or sportsmen that have worn headgear during their sporting career? those that haven't? Is there any trends that you've seen in terms of wearing headgear?
[14:03]
MG: So the headgear one is a really interesting one. And I think we'll have a really good discussion about this. We don't ask that question in our survey, and there's a big reason for it. And that is that headgear alone, does not actually protect against concussion. The purpose of headgear is to prevent more catastrophic injury. So that's important, because frequently when I say that headgear doesn't protect against concussion. People get the wrong idea. And they say, well, then I shouldn't have to wear you know, a helmet when I'm cycling, for example. That's not the purpose of headgear in cycling. We really we all should be wearing helmets when we cycle. It protects our face against damage, and it protects against more catastrophic injury when the head comes in contact with cement, unfortunately, so it's protecting the skull.
Now, why do I say that? We have to think about the mechanism of injury in concussions. So the brain sits within a hard cranium, the cranium or the skull. The brain, you can think of it like a gelatin tissue. It's really wobbly. So if you were to make a bowl of gelatin, and let it set and put it on the table, and then you hit the side of the bowl, you'll see that gelatin wobbling, that's what's going on in your brain. And the challenge is, you're not seeing sort of translational wobbling, so it doesn't just go sort of back and forth, like we see in all the pictures, what it does is it goes back and forth, it translates to use the proper term, and it rotates. And it's those rotational forces in the brain that are creating the injuries. What we can do is we put a case on top of the so you could put, for example, a foam helmet around this bowl of gelatin, and that brain is still going to wobble around inside the helmet. So now there are two further issues in this discussion, because I'm actually not going to say that all helmets are bad for concussion. The big challenge that people have been saying is that it's the rotational damage that is the problem. And if we go into physics a little bit, there's something called a moment arm. If you go to open a door, you can push at the edge of the door with your finger and it will open. If you move your finger towards the hinges, it becomes more and more difficult to push that door open. So what you're doing with the helmet is... sorry, I should say...the hinge, the spacing where the finger is... that's what we call the moment arm, that distance away from the point of rotation. When you put a helmet on the head, you're increasing the moment arm. So any rotational forces that you'll get are multiplying the rotation that the brain is seeing. That's the challenge that we have.
So the challenge for the headgear industry is now to come up with technology that allows that rotation to be diminished. So if you could get a helmet that rotates on the head a little bit, that will absorb some of that rotational force. And this is one of the areas where people are looking. The old model that we have of you know, just doing a drop of a weight onto a helmet measuring that translational bounce, or that translation absorption of force. That's not enough, looking at concussion.
[17:42]
DG: Yeah, exactly. So there's a clear difference between protecting the skull and protecting the brain. And I get it, that you know, headgear, General headgear is good in terms of protecting the skull, I suppose along the logic that anything is better than nothing. In terms of protecting the brain is a different technology altogether, isn't it? So are you seeing headgear manufacturers out there making any progress in developing like a... you called it like a rotational helmet? I mean, is this kind of development work underway yet?
[18:15]
MG: Yes, it is. So if we take for example, in cycling helmets, and skiing helmets, there's this technology called MIPS, it allows for shearing forces for the outside of the helmet to rotate more than the inside of the helmet. I am aware of one headgear company that's creating a band for Association Football that is not on the market yet. But I am aware of one company that's actually done a fair bit of work looking into decreasing this rotational forces.
[18:50]
DG: That'll be an interesting design to see actually, because, as a company Technical Foam Services, we were involved in a project three or four years ago, where we were asked to supply the foam to go inside headgear, and it was called a toddler helmet. The idea being that toddlers are more vulnerable and precious than adults, that was the general gist of it. And the struggle that the designer of the helmet had was not so much the actual helmet itself, but the strapping underneath the chin. Because the concern was that if the helmet was fixed quite firmly on the skull of the toddler, that if the toddler fell over or had an accident, or there was a bit of sort of vibration, if you see what I mean, that the strap underneath the chin could affect the you know...could get caught and actually cause another problem, strangling almost, if you see what I mean. So the design of a helmet is a really, really difficult thing to do. Really difficult.
[19:55]
MG: No, it is, you're right, you're absolutely right. That in Children, it's even more of an issue that we get it correct. I mean, if we talk about concussion in children... that's my real worry actually with children is because the children's child's brain is still forming. And one of the things that hasn't yet developed in young children is neuro-protection. If we get a head injury, as you're getting a head insult, we call it as an adult, and you might get the same force of insult as a child, you'll do a lot more damage in the child's head than in the adult, just because it can't protect itself as well.
[20:33]
DG: On that theme, then, I mean, looking at sort of sports nowadays. And again, I'm talking about the physical, or the contact sports, such as football and rugby and so forth. You still don't see many kids wearing headgear, when they're playing those sports at a young age. Do you think they should become compulsory?
[20:56]
MG: I think what we've got to do...So at the moment, no, I do not. And, and the reason for that is a lot of the current devices that are out there on the market now...because this is an unregulated market. There's actually a really good website that people who are interested in this area should go to and it's the Virginia Tech helmet ratings website. And they've got a specific section there on soccer headgear ratings, companies will send their head gear to Virginia Tech in the US, they'll do all kinds of translational force rotational force, and then it'll give you a rating. At the very bottom of the rating would be things like simple EVA foam headbands. You can see in the testing, it just doesn't do any protection at all really, compared with some of the more sophisticated devices. It's a really good website, I think, to look at.
[21:48]
DG: I think it's interesting, actually, because I've got... my sons all played contact sport when they were young. And I think that simple headgear that's available from your local sports shop for 20 pounds, 30 pounds, that kind of thing. Some kids will wear it, they have the psychology that it's going to protect them. And it possibly makes them even more of a liability, for example, on the rugby field, because they'll then playing in a manner where they're even more reckless, because in their mind, they're wearing the headgear. It's going to protect them from anything, where it's actually probably not really giving them much protection at all. So I think there's definitely a psychology involved that, you know, lower quality headgear could actually...not cause more damage, but it certainly doesn't give any real benefit at all. And I think parents need to know that. Because parents give their young child you know, cheap and cheerful headgear and says "there you go, that will protect you, you'll be okay now" isn't necessarily a good move.
[22:56]
MG: I'll go one step further than that, and say that it can actually cause damage. Because you've nailed it. Actually, there are very good studies that show...very good psychology studies that show when people feel more protected, they take more risks. And if one feels more protective, and one is using the, you know, some of the cheaper, less technical headgear that will do more damage in terms of concussion. I'm not talking about more catastrophic injury, but in terms of concussion. It will do more damage, destroy more nerve cells, you've got the psychology that you feel more protected. Those two things are, you know, together are a recipe for disaster.
[23:39]
DG: Michael, I can't understand, and I was talking Iwan Roberts about this, and I said, if you look at the sport of football, shin pads have been in existence for, I don't know, since the sport was invented, even if it was rolled up newspapers shoved down your socks, you know, footballers wanting to protect their shins. As I say, it's been around for years and years and years. Yet there's a reluctance for footballers to wear headgear. It's just weird, isn't it? And you think your brains are probably a bit more important to you than your shins? I can't understand why there is a reluctance to wear headgear. I think what you and I possibly touched on was the fact that it might impede your performance. So at the very highest level, you know, is it going to be easy or as easy to head a ball if you're wearing headgear as if you're not? But yeah, sort of like, you know, at weekend level, amateur level, where there's a lot of sport played, surely, you know, there should be some sort of regulation in the not too distant future saying you've got to wear something that provides some protection to, first of all your skull, and then secondly, some protection to your brain. Maybe it's because the right headgear just isn't out there yet.
[24:57]
MG: That's my belief. That's certainly my belief. And when we get that head gear then I'm going to be all for that type of thing. I think that right now, though, what we have to contend with is a little bit of a culture of denial. There is a large proportion of the population that just do not think this was an issue. I actually get hate mail because of the research I do. People are saying, you know, you're trying to change our sport, you know...no, I do. Fortunately, not very much anymore. But it happens. There is a group of people who simply do not believe this is a problem and all people like me are doing is trying to change the sport.
[25:45]
DG: That's awful, that's genuinely awful, because you're just trying to protect people's well being and you're getting criticised for that. That's absolutely frightening. So looking at my personal sport is rugby. And, yeah, there've been several rugby players, even current rugby players that have had a number of concussions in recent years. And when you look at sort of fans forum sites, I think, most true rugby supporters, when they see one of those players that have suffered, take another hit to the head, go off in a game, fail to get a concussion test or whatever. Most rugby supporters will say that guy needs to take quite a period out of the game, and just get themselves sorted out. Because, yeah, I know playing sports at a high level can be very, very rewarding. But if you finish playing sport in your 30s, you've got a long, touch wood, you've got a long life ahead of you still.
[26:44]
MG: No, I completely agree with you. You know, what I will say is that five years ago, we wouldn't be having a podcast. I'm calling for cultural change. I'm calling for more of it. But to be fair, we have changed quite a bit in the last few years. I mean, just the fact that we're having this discussion, I think is really important. We've got a long way to go, but we will get there. You know, we didn't know that it was quite the problem that we know it is now. The warning signs have been there over the...if you look at boxing, for example, it was the late 1920s, when this concept of Punch Drunk Syndrome was first put forward. So we've known about this for nearly 100 years. But it's, you know, it's a cultural change, really. Changing sports is difficult.
[27:44]
DG: Yeah. And I think you're right, Michael. As you say, five years ago, we wouldn't have even had this conversation. So thank you so much for your time this morning. So, let me ask you the million dollar question. Where do you think headgear in sport will be in the next five to 10 years? There's obviously a lot of momentum now behind acknowledging there's a problem. Yeah, protecting players' welfare. How do you think this is going to pan out over the next sort of few years? What's your hopes?
[28:15]
MG: Well, my hope is that is that we get a lot more investment in the area, we get a lot more people taking interest. And then really designing technology that that will help us. I mean, this idea that we talked about, of the rotational... reducing the rotational forces, I think that's really, really important. So if we can look in those types of areas, I think there's a lot of ground to be gained. Once that happens, Once we have the right technology, then we'll have the issue of getting it in, getting people actually using it.
[28:54]
DG: Your research is obviously pretty vital. How is SCORES funded, if I may ask?
[28:59]
MG: I'm happy that you asked that. We have a very little bit of money from something called the NIHR Brain Tech. It's an organisation set up for Seed Corn Funding. So we received £10,000 from them to get the project started. My PhD is paid for by the university and we have a little bit of crowdsource funding that have started us and that's it at the minute. We're actively looking for funding to be able to get this this project going.
[29:33]
DG: Sort of like you know, the Football Players Association, you know, the Rugby Players Association, are those guys starting to talk to you yet about helping support your research for the benefit of their members.
[29:47]
MG: We have had discussions with the Football Association, with the Players Football Association and with the Football League Managers Association, and we've had, to their credit, the League Managers Association has been really good with us. We don't have funding from them yet, but we're hoping to... I think we'll probably get a small donation from the LMA fairly soon, discussions are underway with the FA and with the PFA, but I can't say what they'll do.
[30:21]
DG: Michael, let's hope those guys stand up. Because. I mean, it's about protecting the welfare of their members, isn't it? That's what this is all about. So, Michael, thank you so much for your time this morning. You did touch on a couple of websites earlier, you mentioned scoresproject.org. Can you just remind me again, what that was about?
[30:42]
MG: So that was our our project website. So it's the scoresproject.org. That's the website if people are interested in participating in the study. And then the other one that I mentioned is the Virginia Tech website. If you Google Virginia Tech, the big university in the US, Virginia Tech soccer headgear ratings is the first thing that will pop up.
[31:10]
DG: Okay, so that's the one that we will go to and then put our headgear details in and realise that what we bought isn't really actually doing any benefit.
[31:18]
MG: Well, that's the place I would go to look for the best performing one. Certainly, if we turn it around that way, I would say, you know, look for the five star rated headbands that are there.
[31:28]
DG: That's a good call. And the other one is just to confirm; scoresproject.org.
[31:34]
DG: Yes, thank you, Michael, thank you so much. It's been a real pleasure talking to you. And I actually think that the work that you're doing is going to become increasingly important, it's already very, very important, but it's going to become increasingly important in the next few years. I think you're going to become much more high profile in the sporting world in the next few years. So, Michael, thank you so much.
[31:53]
MG: Well, thank you very much for the opportunity to speak with you.
DG: Thank you to Dr. Michael Grey for taking the time to talk with me today. It feels like his research is going to have a dramatic impact on the way that people understand head injuries, and hopefully help to make competitive sport safer. For more information about his concussion research, please visit www.scoresproject.org. Next week is the final episode in our Foam in Sports safety series. I'll be talking to Saracens and United States' fly-half Will Hooley about his views on concussion as an active professional at the highest level of his sport. Thank you for listening to this edition of the Future of Foam podcast from Technical Foam Services and I hope you enjoyed it. If you like what you hear, why not share it with your colleagues, and don't forget to subscribe wherever you get your podcasts.