Finding colour in the grey

“Two minutes into the game, I copped a big head knock to the back of the head, I’m pretty sure it was a shoulder, I just can’t really remember anything after that... I remember coming off the field and stuff but before that I don’t remember... you blank out for a bit, I think I was stumbling and then just seeing stars really, you know it feels surreal... then I just get headaches”

Randwick Rugby first grade player, Jack Johnson, suffered a concussion on Saturday 29 April, 2017 at the Shute Shield derby against Easts Rugby at Coogee oval. Once Jack was taken off the field that day he was assessed by the clubs’ trainer. Then he admits he didn’t go out to the Coogee Pavilion that night. “I just go home and sleep hey, just try and sleep it off and drink water. That night I still feel a bit surreal”.

Jack has had two or three concussions in his four years playing rugby for Randwick. Overall there could be more but he doesn’t know because there has been no way of diagnosing, measuring or monitoring them. After the knock, Jack had one week completely off training so that’s no running or gym or anything that’s going to over-work the brain. But Jack says the symptoms can linger, “I still go to work but sometimes I get a few headaches, and I still feel a bit out of it”.

The haziness surrounding the diagnosis and recovery of concussion is one of the reasons Doctor Adrian Cohen of Concussion charity , Headsafe, thinks concussions are so problematic.

“There is currently no objective accurate diagnosis”, he said in a recent interview.

“Questions like do you have sensitivity to light or memory tests are by their nature very subjective and this has implications”.

Head of Randwick Rugby, Nick Ryan, says the concern is in the “medium sized impacts and the hits you can’t see from the grandstand”.

“Long-term we are seeing an undeniable link between repeated concussion and chronic neurological disorders like early dementia and CTE (Chronic traumatic encephalopathy)”, Dr Cohen said.

Dr Cohen remembers learning Isaac Newton's Second Law of Motion, Force = Mass x Acceleration, like it was yesterday.

“It’s knowledge of the forces involved that is key to this. We know that the masses are getting bigger, players at all levels are getting larger and they’re getting faster and more trained, so there is more force in every collision”.

Dr Cohen preparing a Randwick rugby player with a sensor behind the ear as part of a study into measuring the impacts during a game.

Dr Cohen’s curiosity lead him to undertake a first-ever study in conjunction with Randwick Rugby Club which sets out to measure the ‘G’ and rotational forces on players during a game using small sensors placed on the skin behind the players’ ear.

The results are part of a broader dedication to solving the concussion puzzle.

“It’s about giving us the information, objective signs to make decisions. If you want to understand what’s going on, you have to measure things”

When Dr Cohen was going through university and subsequently working in orthopaedics, he started volunteering on a rescue helicopter. For over ten years he witnessed countless neck and head injuries and became the first full-time doctor on the Westpac Rescue Helicopter Service. Dr Cohen later found his niche in pre-hospital medicine, a fabric of medicine that would later prove critical in the diagnosis and treatment of concussion.

For over two years Dr Cohen and his research team been trying to find objective answers.

“And we’ve just got it”, Dr Cohen pontificates. “We have developed a device called the Concussionometer, an accurate, objective, reliable measure of concussion. It is our solution”

The device uses established technology to tell whether the brains electrical activity is normal.

“The custom, patented head set flashes light into the person’s eyes and the sensors at the back measure the brains response to the visual stimulus. It takes just 2-3 minutes”.

Dr Cohen with the new Concussionometer.

Importantly concussion can cost the community, and that’s not only in sport.

“Misdiagnosis of concussion can cost the community up to $50 million dollars per year in lost productivity”, says Dr Cohen.

“We are looking for potential other uses - in the school playground, around motor vehicle accidents, home falls and even the military”.

Expected to be on the market by the end of the year, Dr Cohen says the device will give players the confidence to know when to come off the field and when to return safely.

“Back in the day it was a sign of toughness to stay on the field, to not let your mates down, to not be soft”, adds Dr Cohen.

At 22 years of age, Jack is of a different mind, “For my general well-being I want to look after myself better as I get older. When I was younger I probably would just keep playing. But now from all the research I’d just come off. I want to be able to walk and speak when I’m 45”.

A hard-hitting game of rugby between Sydney clubs, Randwick and Eastwood.

Down at Coogee Oval on a mild Autumn afternoon in May, the Randwick ‘Wicks’ are preparing for their match against top of the table leaders Eastwood. It’s Ladies Day and women flock excitedly through the entry gates. The atmosphere is relaxed. Children play. It’s a good turnout. Over the other side of the field ladies cluster around tables laid with fruit and cheese and the Chandon is flowing. The match begins and so do the tackles, lineouts, scrums, and impacts. For a full 80 minutes the action persists. There we no concussions reported that day, but then again who knows?

“There’s been a need for this because it’s so unclear”, declares Dr Cohen.

“Medicine is going to technology for the answers. We’ve got the ability to look beyond a conversation with someone, and we can start to get objective parameters and reinforce what we see clinically. Objectivity is key”.