There is still a range of opinions among specialist medical personnel, medical associations and other representative bodies concerning the link between head injuries and longer-term neurological deficits. It is a complex area that obviously is difficult to accurately diagnose and monitor during life, and is subject to numerous lifestyle confounders. Nonetheless, a conservative approach based on the consensus of opinion means the recommendations of the Senate Committee should be adopted.

I note Recommendation 9 encourages national sporting organisations in Australia to explore further rule modifications for their respective sports in order to prevent and reduce the impact of concussion and repeated head trauma. This is a research area that I have focused on over the last 20+ years including working with the AFL, NRL and European SL to document collision types and rates and the impact of rule changes on these, and other, variables.

There is growing awareness that a concussion is not a single one-off event, but rather can have long-lasting consequences for at least a subset of individuals. This is particularly true for those with a history of repeated concussions, such as contact sport athletes. While it is difficult to definitively establish causality, as there can be several mitigating factors, those with a history of playing contact sports, even at the amateur level, are at significantly greater risk of developing dementia than the general population. Importantly, this risk is not limited to dementia alone, but extends to other neurodegenerative diseases, including Parkinson’s disease, dementia with Lewy bodies and even potentially motor neurone disease.  Given this, I welcome the release of the report by the Australian Senate for shedding light on this important issue.

It is important to note, however, that there is much that we still don’t understand about how a history of head injury may lead to neurodegenerative disease or which individuals may be most at risk for such an outcome. Further research, particularly longitudinal studies that follow individuals over time, is critically needed to answer these questions. In fact, this is the current goal of our currently ongoing MRFF (TBI Mission)-funded study at the University of Adelaide, the FIND-TBI study. Only by answering such questions will be able to formulate recommendations to ensure that contact sports are as safe as possible for athletes at all levels of play.

There is a real need for well-resourced research programs so that all levels of sport, from grass roots clubs right up to elite professional sporting bodies can better understand, prevent and respond to concussion and repeated head trauma.

Australia is well-positioned to instigate holistic research programs that centre on advanced imaging techniques combined with cognitive clinical assessment. Concussion research needs consistent dedicated funding to progress into sizeable studies that will have lasting benefits for people engaging in both community and professional sports.

There is growing evidence showing that multiple head traumas over a lifetime, including those that do not result in loss of consciousness, increase risk of developing chronic traumatic encephalopathy (CTE). I echo the views of the medical professionals and scientists referenced in the report that there is at least an association between concussion and repeated head trauma and long-term neurological conditions.

However, comprehensive prospective and longitudinal research tracking the development of these neurological conditions in a living brain is necessary to establish causation. I commend the Senate committee’s recommendation of a National Sports Injury Database, as this will be a crucial resource for such longitudinal research.

By collecting various biological data from people that have experienced a concussion overtime, researchers will be able to identify early diagnostic markers of neurodegeneration and targets for treatment.

The Australian Senate report into Concussions and Repeated Head Trauma in Contact Sports is a landmark document because it results from the world’s first whole-government examination of the concussion crisis in sport. Recommendation 1 is arguably the most significant and strongly worded aspect of the report. It calls for a National Sports Injury Database ‘as a matter of urgency.’

This database is vital if we are to capture consistent and comprehensive epidemiological data on the incidence of concussion and sub-concussive head injuries across the full spectrum of Australian sporting activities – at elite, recreational and junior levels alike. Doing so will aid the development of clinical and treatment guidelines for sporting brain injuries and will also provide a stronger evidence base for causal links between repetitive brain injury and neurodegenerative diseases like chronic traumatic encephalopathy.

From an historical perspective, the time is now for the Australian Government and peak sporting bodies to work collaboratively to implement the National Sport Injury Database. This recommendation was included in the 1994 NHMRC Report into Football Injuries of the Head and Neck and was ignored for 30 years. Not acting on this recommendation, or the other 12 recommendations, risks repeating the mistakes of the past and rendering this landmark inquiry a wasted opportunity.

The Senate report and recommendations have cut to the core of why Australia needs immediate action on concussion and what steps can be taken to improve safety, especially for our youth in sport. For the players of yesteryear already affected by brain injuries and those at risk of decline, recommendations to see fast-tracked research under a national, independent body provide hope.

The establishment of a National Sports Injury Database would revolutionise concussion research and protocols in this country. It would drive policy shifts and set the tone for cultural awareness on concussion that will have innumerable benefits for generations to come.

Brain research is highlighted, along with the importance of players receiving adequate care and a national strategy showcasing prevention. The inquiry recommendations are tough hitting for some, a soft landing for others, but either way they are the culmination of a process Australian contact sport had to undergo for its own benefit, if not survival.

After participating in the Senate’s enquiry I believe the report is an important milestone in Australia’s approach to and management of concussion and repetitive head trauma in sports. Sports are an integral part of Australian culture and we need to make sure that participation is safe for all ages, genders and levels of play.

This report, with its guidelines, is the first step towards understanding, managing, funding, researching concussion and repetitive head trauma in sports. I am very proud to have had the opportunity to voice my concerns over the lack of understanding and research on concussion and repetitive head trauma in women, despite the fact that we know women have higher incidences of concussion, take longer to recover and experience more severe symptoms compared to males. My research aims to address this shortfall.

There are now clear indications of a relationship between repeated head injury and long-term neurodegenerative conditions including Parkinson’s and Alzheimer’s diseases, and chronic traumatic encephalopathy (CTE). Despite this, we have no effective way to monitor this degeneration in the living, and no interventions to prevent its onset. 

The recommendations of this Senate enquiry are important for the future of concussion research in Australia, and will go a long way to support our understanding of the long-term effects of traumatic brain injury. 

The committee have called for increased funding and support from the Australian Government and sporting organisations to coordinate research efforts into the long-term effects of concussion and repeated head trauma incurred during participation in sport. Increased funding will enable us to identify clinical features, progression and interventions to prevent development of CTE. In particular, increased funding for research will allow scientists to understand whether there are different risks and trajectories for children, women and Aboriginal or Torres Strait Islander peoples.   

Because CTE is currently a post-mortem diagnosis, almost all that we know about it is from brains donated to brain banks. The committee have made important recommendations for the Australian Government to encourage Australians to consider donating their brains upon their death to aide scientific research.

The link between repeated head injury and neurocognitive symptoms, psychological disturbances and dementia is accepted as established generally as well as in the medical and scientific community.

The recommendations listed in the report are excellent. I endorse the report’s recommendations to address the need for more research on how to prevent, detect and treat head injuries and their effects including rehabilitation.

Additionally, more training is required for sportsmen, women and children as well as referees and sports officials about the effects of repeated head injury and the importance of detecting when and for how long it is advisable for players to stop engaging in activities which threaten further trauma.

As a specialist who has run a memory clinic for almost 40 years, I am acutely aware of this issue and have seen many football players with dementia, other neurological conditions and psychiatric problems in late life which is tragic for them and their families.

The Senate concussion inquiry has highlighted the complexities the vast complexities of concussion. It is pleasing that the long term affects of concussion on overall brain health have been acknowledged and discussed in a public forum, with input from researchers and medical specialists, sports administrators, and those who have been affected by repeated concussions. 

Yet it is also clear that much work needs to occur. The inquiry highlights the difficulties in diagnosing and managing concussion. It is encouraging that alternative and additional diagnostic tests to complement the sport concussion assessment tool is needed, however, this can only occur with ongoing research and support from all parties. Thus it was encouraging that proper framework around research was also discussed. 

Ultimately, this inquiry has only scratched the surface, but it was an itch that was not going away.

Our research findings and those of other leading concussion researchers have highlighted:

• Community messaging regarding child concussion and its consequences is often sensationalised by the media, with scientific evidence discarded, resulting in increased child and parent anxiety regarding child participation in sports and return to activity after injury
• In children, most concussions occur outside of contact sports (e.g., falls, non-contact sports: cycling, snowboarding, skiing)
• Evidence-based guidelines are not adequately disseminated to front line sports and health professionals leading to unnecessary or inappropriate concussion management
• Accurate diagnosis and evidence-based acute management can accelerate recovery and reduce child and family distress, and decrease unnecessary health service utilisation
• Attention to robust predictors of slow recovery (e.g., sex, age, pre-injury neurodevelopment and mental health problems, acute symptom burden, child and family anxiety) is important for early identification of children who are at risk for slow recovery
• Multidisciplinary, symptom-targeted treatment methods maximise accelerated children’s recovery post-concussion, and provide an individualised, safe return to activities, including contact-sports
• The physical and mental health benefits of continued sports participation are critically important in childhood development and disease prevention (eg obesity, diabetes, stroke)