Episode 007: Lauren Sergio

Prof. Lauren Sergio is a neuroscientist who studies concussions in contact sports. We talk about how the brain works, the impact of an impact injury on brain functioning, and the implications of her research for our understanding of ageing and dementia.

Transcript

Cameron Graham: My guest today is Prof. Lauren Sergio of the School of Kinesiology and Health Science, at York University in Toronto. Prof. Sergio studies brains. Specifically, she studies how the brain works to coordinate how we move our hands and use our eyes to accomplish tasks, and what happens when an apparently temporary injury like a concussion interrupts this process. It should be pretty obvious that this is a really important topic in the field of sports. Lauren welcome to the podcast.

Lauren Sergio: Thank you, Cameron, thank you for having me.

Cameron: I'm interested in how academic researchers choose their topics -- it is one of the questions that keeps coming up when I'm talking to people on this podcast -- and how your focus shifts over time, because you have a career in in research and you don't just study the same thing over and over again. So it's let's go back to the 1990s...

Lauren: Ah, Depeche Mode. Yeah, I'm there.

Cameron: [laughs] Before you got directly into the concussion research, you were doing more basic research on things that, to me, seem almost too obvious. Like, "How come we have to have to study that? It seems so obvious to me!" You were looking at what happens in the brain when people reach for things. So why did that topic interest you? How did you  get into that?

Lauren: "What up with that?" Thanks for asking. So, first, it seems like a simple thing. It is not a simple thing. The simplicity with which we reach or interact with objects in our life belies the extraordinarily complex process that has to happen. Starting at the eyeball with you looking at something, and ending with muscles in your arm getting out to that thing.

Cameron: And hopefully ending up in the same place.

Lauren: In theory, getting to where you're supposed to go. There's a lot of the miraculous swirling around that that takes place in between those two events. I was initially interested because I was a sports person and I played soccer at McGill for years. I always loved running around chasing balls and things like that. So I was interested in applying that, and neuroscience seemed really cool, so I went down that path. So yeah, it's "go with what you love," basically. With research, you have to do something you really like and are interested in. So yes, that is true, I did start with fundamental research, and I actually consider myself a fundamental scientist. All this stuff I've been doing lately, all these applied things, this is kind of new and bewildering. How did I end up here? Because I really always thought I just liked basic research. But, it turns out that's one of the places to start, actually, then from there you can find things that can apply to different situations. But if you don't get the fundamentals, then it doesn't always work.

Cameron: This is interesting. You know that as an academic, I think part of your role is to enter into a conversation that others are having, with something to contribute, and doing that in a way that should bring some value, but also is being done from a position of humility because you're join someone else's conversation. I think this is really a challenge for academics.

Lauren: Yes, there's so much out there and we always have that grad student angst of, "Oh, I'm just a small cog in the big wheel." But you have to get comfortable with knowing that the little bit you are grinding out there is hopefully, eventually, going to get out into the world to contribute.

Cameron: Let's start with your most cited publication, according to Google scholar, which is where I start. This is 1997, it's a paper with Kalaska, Scott and Cisek. The title of it is "Cortical control of reaching movements." It's about the parts of the brain that are involved -- that's the cortical part -- so, what parts of the brain are involved when you're reaching for things. I've read this article and I'm no expert in your field, right, but I am really interested in academic publishing and how people communicate stuff. So there's several things here that interest me as an observer. First off, how did you get involved with this team of people?

Lauren: John Kalaska was my postdoctoral supervisor. I did my PhD with David Austry at McGill on basic movement and stuff. Then I went to John's lab over at the University of Montreal for neurophysiology. At the time, Steve Scott and Paul Cisek were other postdocs that came into the lab while I was there. It was a wonderful environment, the postdoc. I find myself about once a week saying, "Gosh, I miss my postdoc!" So any postdocs listening out there, just savour it. It is the most wonderful time of life. I don't know if you feel the same, but it's so great. You don't have all the big responsibilities, you can just do research all day.

Cameron: Tell me about the role of this postdoctoral position in an academic career. Because it's a phrase that people throw out, everyone has heard the phrase "post doc." What is that? It's an in-between position.

Lauren: Well, it’s sort of equivalent to you going through med school, and then they don't say, "Okay,off you go, you get to practice now. Go ahead, operate!" No, there's always a residency, and then there's an internship. There's post-getting that medical degree, where you do more and you basically add to your toolbox. And it's essentially the same thing in science -- in humanities as well -- but definitely in science, there's a lot of post-docking that has to happen before you can land another job, typically. And you basically get to expand your toolbox. It's a chance, and it's great. It's a once in a lifetime chance to bring together a different angle to what you might be doing, or a  different technique. And so then, when you do go on to try to become an independent scholar, you've now got a broader range of things you can do. Plus, you're also exposed to really awesome people, as I was with that article. Steve and Paul and John, they're just really great people to bounce brains with. I always do something in my lab now, as well, whenever working and we're sitting around talking about science, our research, or something we're doing, a specific experiment, and I always make everybody stop what they're doing, hunched over the computers, and we all turn around and I say, "The more brains, the better. I need more brains here. We're having trouble with something. We're trying to come up with these hypotheses here. We need more brains." I find being able to work in that lab environment like that, be it at the PhD level or the postdoctoral level, or now in my own lab, it's really useful to have all those brains. That's why that article came out. It was a review article of a number of things we'd done. I guess people liked it!

Cameron: Yeah it's certainly well cited. Review articles often are. But it just means you did a good job of it. The second aspect of this paper that intrigues me is actually the title of the journal. The journal is called Current Opinion in Neurobiology.I like the word opinion. Aren't you guys scientists? Don't you have facts? What's this "opinion" business?

Lauren: So yeah, science. Science is funny. You can think you have all the facts and all the evidence, but that makes you realize that no, you don't know it all. Particularly with neuroscience. The brain is so massively complicated, there's just ... it's going to take a long time. Don't worry folks, our artificial intelligence overlords aren't ready to take over yet, because the brain is so complicated that no matter how many big systems you've got going, the brain is still winning. Actually, the most useful thing -- and at the time I was gobsmacked and alarmed and horrified -- but the most useful thing John Kalaska, my postdoc supervisor, ever said to me was, when we'd just gone through everything and finished the discussion on our article, and we had all these ideas about how things were working, and he paused a moment and said, "But hey, you know, we could be wrong!" And I was floored! Because that happens in grad school, you just get so tied into a certain way of thinking, and what your lab is thinking, and what you think is right, and you really get tied to your hypotheses. You start investing your ego in your hypotheses, and I see this all the time with graduate students. When they have a negative result, they're just crestfallen. And it's okay, it's really important -- and I think a lot of people lose sight of this -- it's okay to be wrong. The important thing is that you got the idea. You could be wrong, but you just keep going back and keep trying.

Cameron: Yeah. There's lots of people in our society right now who are not okay with being wrong. And there's something really appealing to me about this kind of an academic process, that remains perpetually open to new evidence, new information. Holding ideas passionately -- we're interested in the work! -- but loosely enough that if something else comes along we're willing to let go of the old idea and move to the new one. And it is not easy to do. But to me, that's a skill set that would be really great, if we could seed that in our democratic discourse.

Lauren: I know. You just have to have faith that the system itself works. And so even if the details aren't quite right, eventually it's not a disaster if you're not right. And again, it's just something I keep coming back to: We could be wrong. It's okay.

Cameron: There's a theme of respect for other research this that weaves through this, that you respect results coming after you and the work that other people done that may contradict what you found, and you learn from that. But also, when you doing your own research, trying to challenge what others have done because you're thinking there's something else going on there. That is showing respect for their work, by challenging it.

Lauren: Yeah, and again, it's really important. And we're getting even more that way, I think, as a backlash to what were seeing online, with people not having respect. In the scientific world, we're starting to move towards things like identified reviewers, open reviews. Because you can't just troll someone in the review by trashing their work.

Cameron: Explain what we're talking about here. The review process that I'm used to, when I submit a paper to a journal, I get review comments back and I have no idea who the reviewers were. They made by happenstance find out who I am, because if I'm presenting the paper at a conference and they are in the audience, they're going to know, "Hey, that's the paper I'm reviewing." But I I've never had anyone stand up and identify themselves.

Lauren: They're not supposed to.

Cameron: No, but it's supposed to be a double-blind review. At the very least,it's blind in the sense that I don't know who the reviewers are, and I never do find out. You're talking about a process of open reviews?

Lauren: Yes, so it becomes more of a dialogue. Yes, I do see your point. That is a good point. And so yes, we will address that, but we still think that this is ...

Cameron: [interrupting] So have you put papers through that kind of a process?

Lauren: No, I've served as a reviewer on one of them. So I had to be comfortable. Suddenly get you get very polite [laughs] and very careful, and make sure, geez, is this criticism okay? It's an interesting process.

Cameron: Wow. So that changes the tone of the discourse. Okay, so far I've asked you about the title of the paper, then I asked you about the title of the journal. [laughter] Maybe we can actually talk about the contents of the paper. So the paper is about hand-eye coordination, right?

Lauren: No, actually it's about eye-hand coordination. I know that's what most people say hand-eye, in the sports world.

Cameron: I say hand-eye!

Lauren: I'd love to know why. Anyway, the reason those of us in the field call it eye-hand coordination is because your eye typically gets there first, and in fact, you are even instructed to look before you reach, or look before you kick. Look before you leap! And so the eye usually gets there first and then the hand follows. So in our field we think of it as eye-hand. It's hard for people to switch.

Cameron: Eye-hand. So that went well. [laughter] Eye-hand coordination. I'll probably make the error again.

Lauren: No worries.

Cameron: I'm interested in how the kind research that you're doing, which is very specialized, can be understood by someone who is not a specialist. So let me give you what I thought was going on paper, and you can tell me how close I came to it.

Lauren: Whether or not we failed at trying to get our point across!

Cameron: Well, it's an interesting thing, right? Partly it's on me, If I'm not making an effort to understand. Partly it's on you, if it's not communicated. But you're not writing to me in that journal, you're writing to other specialists, which is fine, right? So let me take a stab at it. From my nonspecialist's reading of the paper, I think what you're saying is that there is an interaction between the part of the brain that stores our mental model about where things are, that three-dimensional model of space around us, and the part of our brain that actually moves the hand to new positions. So one's kind of a mental map in 3D, and the other is kind of an executive thing that actually moves my hand to a specific point in space. And you're trying to map the relationship between those two parts?

Lauren: Yes. Basically, that sort of mind-map, spatial representation of where things are relative to you and relative to each other, a lot of that's happening in the back part of the brain, behind the ears, "crown back." And then the part of the brain that deals with executing the movement, a lot of that's happening sort of "crown of the head forwards," more towards the front. 

Cameron: I'm wishing this wasn't a podcast, because then people could see your hands moving.

Lauren: I know! I am making exciting wavy things around my head right now! You need to have those parts communicating about where things are, but then the biomechanical details of how you might actually deal with getting at this arm or foot or whatever, out to the cup or out to the tennis racket.

Cameron: I played soccer when I was young, and I know exactly what it's like when you think you can reach the ball and it turns out you can't. 

Lauren: Theory and practice, so far apart! Yes, sports is a great example. And in terms of reductionism, trying to keep things simple, you know, "this part talks to that part and then kaboom, you move," that is, yes, a quite simple way of explaining things. But it's quite useful to be able to nail down individual parts, (a) clinically, because when somebody has lost use of that part through a stroke or damage, then you have an idea of what the problem might be, then (b) from a theoretical point of view, it's also interesting to know how the different brain parts contribute as a whole, as a big network. But you really do have to break it down. In fact, what we do as eye movement control neuroscientists, and what someone like a robotics engineer does, we're basically doing the same thing from opposite ends. So a robotics engineer has the chipboard of the computer and a little robotic arm, with little servomotors to move it, and say a little tennis racket, say you want to get the robot to play tennis, and a little camera on the top. Basically, that robotics engineer starts with nothing, trying to figure out what commands can I program in to give this thing, to be able to sense that ball coming in, and then move it. And then what we're doing is, we're looking at a system that's spectacular and sophisticated and works really well: the human brain. And we're trying to figure out how it's doing that. So we're doing same thing from different ends. So there are simple approaches we can try, to see if that works for us.

Cameron: One of the things you did in this review article was to summarize the different analogies or descriptions that people had for how this fits together. And I think your conclusion was that those attempts to describe the interaction between the parts are always going to fall short of the real thing, but they're still useful in some way.

Lauren: Yeah, gotta start somewhere. And again, this is a good message for all those [researchers] feeling overwhelmed with their choice of topic, what they're studying, or overwhelmed in their life, they're trying to figure some. I mean, same thing in the labs: we're just trying to break it down, to start simple and build it up from there. So you know, since that article came out -- geez, '97 that's vintage!

Cameron: It's classic!

Lauren: Not yet! Since then, we've learned so much more about how there's individual parts but they really act as a network. And not a one-way street either, there's this whole recurrent network of talking back-and-forth amongst parts. And it gets complicated superquickly.

Cameron: I don't want to make false analogies, but the work that I do in studying the roles of accounting in society, I'm dealing with this super complex phenomenon, as well. You're doing with the brain, I'm dealing with society. And you know, we always want some way of describing what's going on that reduces that vast complexity to something we can talk about. And you don't want to reduce it too far. It's not black and white, right? So there is this challenge, this tension between the simplicity and the complexity, that you have to hold in tension. You don't want it to resolve.

Lauren: Yeah, yeah, and particularly if you're in charge of teaching 700 first-year neurophysiology students, as I am, in kinesiology. I have one of those big core courses where you have to teach how a brain cell works. You try to keep it simple, out of pity, really. [laughs] But every time, you're left going, "But, but ... oh, take my fourth year course." [laughs] That is generally what you have to say every time, because it's actually not useful, especially if you're trying to gather evidence and then try to explain the evidence to the world, it's not useful to get too complicated, because you'll lose folks fast.

Cameron: And then in your fourth year course, you're telling students, "Come back as a grad student!" [laughs] I want to ask you a question about research subjects, because you're in a field that is so completely different than me. A lot of the papers that I encountered as I was going through your review article, they use primates: monkeys, chimpanzees, other primates, as research subjects. I'm not sure if you're aware of this meme that's on Twitter right now, called "... in mice." What they do is they take these studies that have been, like on cancer research, or are things with a headline like, "Common food additive found to affect gut bacteria." And they take that and they just add the words "in mice," because it turns out the study was actually done in mice, and our headlines never mention that. We think it's about people. So when you're studying, I guess you would call them "other primates than humans," right ...

Lauren: Yes, nonhuman primates.

Cameron: ... nonhuman primates ... when you're studying nonhuman primates, what can you learn there about the human brain? What's the usefulness of studying nonhuman primates?

Lauren: So, studying nonhuman primates in order to understand primates. In neuroscience and biology, there is a lot of overlap, particularly once you get to the nonhuman primate level. A lot of what their brains do, our brains do. A lot of what their systems do, ... Same with mice. In some of the more basic functions, like respiratory systems and kidneys and things like that, a lot of what they do, our kidneys do as well, which is why those studies can to some extent get generalized on to what might be happening in humans. But you really have to do the study with the humans, to make sure it's working right. You don't want to go straight from mice into "Let's try injecting that in you now! Oops, they grew a tail." [laughter] With the nonhuman primates, just to be clear, society, we're always drawing a line in the sand when you switch from being an animal model to being a participant. So humans right now, we call them "participants," whereas when we use animal models, those are more your "research subjects," as we refer to them. But the line in the sand right now is between monkeys and apes. So you won't see experiments with apes, other than observational ones. We do have people right here at York who hang out in Borneo and sit in the trees and observe. So you can observe them. But society has now deemed that no, we really shouldn't be doing invasive things with these animals.

Cameron: Does an "invasive thing" necessarily have to be physical? Suppose you wanted to study how an ape reaches for things.

Lauren: No, you just measure what they're doing.

Cameron: Is that okay?

Lauren: Yeah, it's all fine. You measure what they're doing. But usually it's because you can get physiological measures from animal models that you can't get from humans easily. So you can do brain recording from humans in very specific situations. For example, if they're about to undergo surgery for epilepsy, and their skull just happens to be open, and you've got a few minutes, you can run some electrodes in there and wave some colours and make some noises to see what's happening in there. But that's a pretty special situation, and they're somewhat anaesthetized, right? So you won't actually get at certain physiological measures. That's when you turned animal models, to be able to answer questions about how any body system works, not just brains.

Cameron: So that's a feature of your field. Is that a feature of your work at all?

L; Not now. Obviously in my postdoctoral work, it was. And then just to chime in, these days with technology you can use brain scans to figure out where exactly you were recording from, and then retire your animals. And when I say "retire," I'm not even being euphemistic. You can literally send them to the farm, where they will live out there days, lying around scratching.

Cameron: How's the retirement plan? It's okay?

Lauren: Yeah, yeah. I wouldn't mind having that sort of retirement plan. We should all be so lucky! Things are coming along, but there are still certain questions you just can't ethically answer, initially, with people. So it's not that it's easier. Gosh, it isn't. And it's not that it's cheaper. Nah, gosh, no, not so much. But it is kind of fun. [laughs] But there's just a range of questions you can't get at initially with people. So that way, in terms of fundamental science, it lets you get a handle on what's going on at the first level, and then you go and apply it. So yes, they should be pointing out that these studies are in mice, but then they should also be pointing out that, however, there is a clinical trial, right? So usually then what happens is, okay, it works in the mice, now we can move it into a Phase I clinical trial.

Cameron: I think is a part of the meme is a critique of media, that they are jumping to conclusions about it.

L; Oh, neuroscience is a disaster with that! Yeah, they report, "Look, here's a brain part that got excited when somebody made some sort of financial decision or economic one!" Now you have people jumping in, talking about brain waves being able to predict what accounting principles people should be using -- just to bring our fields together. And there is a lot of bad brain science out there. So people completely over interpret brain scan data.

Cameron: I think, if I'm right, you're continuing to do this research on eye-hand coordination. It continues. But something that has really begun to fascinate you is this whole work on concussions. So when did the work on concussions start and what got you into that?

Lauren: Yeah, so there I was, toodling along, doing my fundamental research. And we actually didn't start with concussion, we started with, "Well, why don't we look at folks," (we had a clinical connection at the time) "why don't we look at individuals who are having problems with dementia?" At the time, we naïvely thought that it was just an issue of their frontal lobes weren't working very well because the science back then was just saying, oh, if you have dementia, it's a frontal lobe issue. It's the front of the brain that does all of your higher order thinking and judgements and things like that. And so we thought, okay, so we'll see how. We were doing tasks that involved not just moving, not just basic eye-hand coordination, but eye-hand coordination when you had to think at the same time. So I started bringing -- and this is work I saw being started when I was doing my postdoc -- of moving around when it's complicated. So like, have you ever watched those guys operating the backhoes?

Cameron: Yeah, my spouse was in construction.

Lauren: I mean, I think if I got in there, I'd immediately wipe out five or six construction workers, 'cause I'd be swinging that thing around! But basically they're wiggling their hands one way, to move this big scoopy thing a completely different way. 

Cameron: Right the controls move in a certain direction that's not related to the movement of the arm.

Lauren: Yeah, or if you're playing with that drone -- which you now have to have a licence for, I believe -- but you know, if you're playing with the drone, or those folks who do the professional airplane flying with the controls. Those brains astound me! What they can do! So I was really interested in those kinds of skills. So it's eye-hand coordination when what you're looking at isn't the thing you're reaching for, right? So drone piloting, backhoe operating, things like that.

Cameron: A very simple example of this is, if you've got a room remote-control little car that races off, and then you turn it around and make it come towards you, now the controls in your hand are now operating in the mirror-image, and your brain has to make that switch.

Lauren: Do you use a PC or Mac?

Cameron: I use a PC.

Lauren: You're a PC. I too am a PC person. However, those annoying Mac people seem to be infiltrating our lives and have you ever had to use a Mac where  the scroll pad is the opposite direction?

Cameron: Yup.

Lauren: Yeah, and "Aaggh!" So I'm really interested in what happens, in the terms of those brain networks we were talking about, when now suddenly you have to remember, ah, right now it's my friend's Mac and I gotta flip my fingers the other way. So I was interested in that sort of thing. And so we thought, well, let's just look at folks who we naïvely thought at the time were just having some frontal lobe issues, to see how that brain part contributes to this trying-to-move-when-you-have-to-think-at-the-same-time. The first thing we discovered was that they couldn't do the task! And that's sort of like, you just look and say, "Wow, they really can't move their finger right to get the cursor to move left." We essentially just flipped their mouse upside down. So the next time you're sitting in front of the computer, take your mouse and just physically turn it upside down, look up at your screen, and move around, and try to put something in your recycling box, and you'll know exactly what we asked people to do.

Cameron: It's like trying to cut your hair in the mirror.

Lauren: Yeah! And there you are, stabbing your own eye out! And you come out looking like inverted Sid Vicious. So that kind of kicked off the whole, "Huh, maybe there's something to this, looking at clinical populations!" So we started looking at that. I still do that work. But at the same time, our own York Lions sport medicine team, they were getting frustrated, our sport med docs, that they didn't have really solid measurements or metrics, ways of knowing whether the athletes were really ready to get back on the field. We had some really basic tests they could do, but when you talk to the athletes, they'd say, "Well, I am passing these tests but I still don't feel myself. I still don't feel quite right." And you're the best judge of how your brain's working. So the docs were frustrated, and the whole clinical staff, the athletic therapy team. They were just thinking, "Are there better ways?"  And I thought, well, I just found out my little test I'm doing with thinking-and-moving-at-the-same time is being completely bombed by folks who are having some brain issues. So that's what launch that whole thing. I'm like, "So, if you'd like, I can sit and just ...." We literally tested them in the little side closet in the clinic on campus. We had them come in with a little computer and have them try to make movements where left and right were switched, they were looking one way and moving another, like you do with your PowerPoint in a lecture, where you have to around and look at the board.

Cameron: Do you have to have observed them at the beginning of the season before there's any problems?

Lauren: So there's a couple things, I guess, like how do we get our data?

Cameron: Yes. You can't just decide, "I'm going to bonk those people on the head and not bonk those people."

Lauren: But that is what they do with the mice, in a very gentle way. They basically have a very gentle drop of a very light weight, bonk!, on a little mouse on a platform that spins, so that as soon as they get hit, they spin around and land on a puffy foam thing. They seem just fine but you've recorded the impact, so that it seems similar to what somebody might get during a football practice or something. So that's what they study with the mice.

Cameron: We're going to get emails from animal rights activists.

Lauren: I know, I know. They're all treated pretty well, with dignity and respect.

Cameron: We bonked them on the head with dignity and respect!

Lauren: Yeah. They're getting treated better than the cats are going to treat them in your backyard! [laughs] So we don't do that [with athletes]. And this is where the "vulture" aspects to my job come in, where basically we try to test as many incoming rookies as we can, preseason.

Cameron: [laughs] Shouldn't that be a clue to them? That they're likely to end up back there for another reason?

Lauren: [laughs] We test as many as we can, and then basically we hang out -- now my building on campus is just south of the football field, just north of the rugby field, and just east of the hockey rinks. So basically I just stand there, looking around, waiting for the research participants to stream in. So that's the vulture aspect: one aspect is where we then, if they do get concussion, we try to retest them and monitor them returning. And it's true, they do return a lot more slowly in these more complicated tasks that they did before. The other thing we do is cross section: I've tested now over 100 athletes and so many of them have a history concussion but are deemed completely recovered by current standards, and a whole other pile of them self-reported never having had a concussion. and we just compare how they do on various things.

Cameron: Okay. If I was to follow you around for a day, what would I see? You've got someone ...

Lauren: Well, first there's the espresso machine, right, and then we get going! If we are doing a study, we go out. My stuff is fortunately quite portable, most of my stuff, and so we go out there with our laptops and tablets, and we get them wherever we can. If I'm working with kids, we try to get there an hour before their practice. We have asked the parents and coaches, "Hey, can you bring them a little early? We're going to have them do a series of tests before the practice, and then can go up and get dressed and go on the ice" -- or the court or whatever. We just have them come and do eye-hand movements, and they're either doing them on an iPad, directly on a little screen, or we make them look up and they have to move their hand in the opposite direction, so they're going upside-down and backwards.

Cameron: Is this like that thing that we used to do at parties, where you pat your head and rub your tummy?

Lauren: Exactly! You pat your head and rub your tummy.

Cameron: It's harder than it looks.

Lauren: It is. It is. And so that's what we're finding. These kids, though, they think, "This is not even close to Fortnite, let me tell you." And again, it's tricky, because with this population, when you work with kids now, they are all just superstars at these sorts of skills, because those who are sitting a couple hours a day on their controllers, Xbox or PlayStation or what have you, they're really good at this sort of thing. So you always have to be careful to compare gamers with gamers. We are always very careful to say, "How much videogame usage do you to?" Even with the elite athletes, there were some who didn't play all, and some who played video games. You can really see the difference with these sorts of skills. So, yeah, we have them do these games, and then we go back and analyse the data, and compare those who had a history of concussion with those who haven't, and we see differences.

Cameron: Is the difference with the gamers profound enough that if you had a gamer who had a recent concussion and me, that he might still outperform me?

Lauren: Oh yeah. And in fact, we recently published a paper on that. We have a couple of studies were we have stuck hard-core gamers into magnets, and they're always tired because they've been up all night, right?

Cameron: I have them in my class!

Lauren: Yes, but we get them in there. What we found with the kids was that they were all performing worse if they'd had a concussion, relative to their non-concussed peers. And that was a bit surprising for me. It could even be two seasons later, and still. They were all cleared to play. They were all back there bouncing around. But if you really push the system and make them do these kinds of super complicated things, they were just a slight bit slower than their non-concussed peers. But, there was a subgroup of them that weren't so bad. They seemed to have recovered just fine.

Cameron: Do you know why?

Lauren: Well, we do now because we did a lot of statistics and when we try to factor things like age, male-female, all these different things, the one thing that stood out was the number of years that they had played sports. So there seems to be a strong experience component. You know that idea of "cognitive reserve," where if you think a lot or are really smart or have multiple languages, you then have this reserve that seems to be protective later in life when you are losing your cognitive ability?

Cameron: Oh, okay.

Lauren: We think there is a motor skill reserve as well. So when you get really good at something, you look at elite athletes, it only takes them a couple of neurons to do something that it takes the rest of a couple of million neurons to do. And so the idea, we think, is that these kids -- and we found it was about seven years -- the kids who had played seven years or more, in any sort of coordinated activity, even though they might have, at some molecular level, still been affected by the concussion, their sports performance wasn't being affected. So we think that that might be protective: when they're out on the field playing with kids who aren't concussed, they won't be slower relative to those kids. So we think that there's a motor skill reserve, where they are just able to get their coordination back sooner.

Cameron: What's the implication of that for the team and the physician, then? Do you say, "You're going to be fine, you've got lots of reserve! Away you !"

Lauren: No. Take care of it. We know that the the biggest risk factor for getting a concussion is having had a concussion. We think part of this is because, when you're back out there on the field, even though you've passed all the current tests, you're still actually failing when you have to think and move at the same time. This makes you vulnerable. You're a bit slower. But if you've had a lot of experience, you might not be doing as bad because you might not be as vulnerable. You might have enough skill to overcome it. So hey, folks, don't take your kids out of sport. You just have to keep them in for 7 years!. But then, the scarier message beyond that is they might be okay, this could protect them getting another concussion, but we are still learning that there are long term molecular events that can build up. And then, who knows, it might actually be once they're out there, because they are more skilled and they're playing more, well now they have more exposure. Now that you're playing more, you also might be more vulnerable to a concussion just because you're out there longer, right? The athlete who plays most of the game. So, it's complicated. Sorry. But it can't hurt to have those skills.

Cameron: Is part of the goal to come up with better protocols for doctors to use right on the field?

Lauren: Yes, and that's always what has motivated us, from the very beginning, when our sports med doc says, "Hey, we need better metrics before we send them back." We are trying to come up with things that we can test, that are simple and portable and fast, and say, "You know what, you may be a 14-year-old female soccer player, but you're doing that test not like the other 14-year-old female soccer players. You're doing that test like an 83-year-old person who's in the early stages of dementia. And I'm sorry, you're going to sit on the bench now." Right? To some extent we have some of those, but they're not very good.

Cameron: The  thing is that there is such an incentive to continue to participate, for the athletes. I never want to suggest that a team doctor would ever act unethically, but it's obvious if there is an incentive for the team to get that player back out on the field, especially if you're paying the player million bucks.

Lauren: Yeah, but honestly, I see it as an issue with youth sports. The problem is with the adults, and their expectations. "Oh, but my child loves this and I'm going to be letting them down as a parent if I don't let them play, because they clearly want to play." Yet there is a saying: the worst person to ask about concussion ... is the person with a concussion! The brain's not working! Of course they're going to tell you they're great and they want to go back and everything is fine. Kids have no perspective whatsoever, let me tell you. So really it's the adults. And things are getting better, I've found, in my years of doing this. Parents are waking up to the fact that, you know what, maybe there is something else my child can do besides ice hockey, they've had two concussions. And I can tell you from the mouse studies, you don't want to get a third concussion. Things go bad when that little mouse gets conk! -- weight number three gets dropped on them.

Cameron: Ohhh.

Lauren: Yeah, so you don't want that poor little mouse to be your poor little 8-year-old. It is an issue where I think the adults have to step up. And then in terms of pro sports, again, that's the league that has to take the high road, and obviously when there's a business interest, that's going to be driving a lot, where there's a profit motive. That's going to be be determining a lot, despite what physicians might be saying.

Cameron: We talked about soccer, and there's this real problem in that sport because there's a limited number of substitutions. So if you got a player who is concussed, to take them off the field for a few minutes to let them sit down and and see whether you can evaluate them more thoroughly, you've only got three substitutions and the team has got a decide early on whether to replace them. If you gave the team doctor the authority, or if you had a neutral doctor there, if you gave them the authority to award the team an extra substitution -- "We are going to take this player off, we are insisting that you take them off!" -- it sounds great in theory but I know what's going to happen. The teams are going to game it.

Lauren: Right. "I don't care if you hurt your ankle. Grab your head!" "Oh, I've got a head injury!"

Cameron: Right, because we need to take a forward off and put a defender on. It would get abused.

Lauren: That's the truth.

Cameron: We've been tossing the word around, but I'm not sure that I really know the answer to this: what is a concussion?

Lauren: The first rule of concussion definition is: There is no concussion definition! It's a tough one because there is no one "concussion." It's not like breaking your thumb. "Oh, you've broken your thumb. Guess what? You've broken your thumb!" But with concussion, there's all these different mechanisms they call. You could get hit from the side, it could be a twisty kind of hit, it could be a front-back kind of hit where your brain kind of rattles around inside there. It could be a light one, it could be a heavy one. You could have genetic factors which make you much more vulnerable and take a lot longer to recover. It could be a concussion that causes you to get dizzy. It could be a concussion that causes you to not want to look at lights. It could be a concussion that gives you a headache. You could have all of those things, you could have none of those things. You just could be a little nauseous. We haven't nailed down a solid definition, because it's a concussion event that then can have a number of different clinical symptoms. So we haven't really figured out exactly what is, which makes it really hard to study. Because if you group together people who have had concussion, you've got a really heterogeneous population there, so that makes it difficult to study things when everybody is having five different effects.

Cameron: Mm-hmm.

Lauren: Sorry. Couldn't define that one for you.

Cameron: Oh okay.

Lauren: But by definition, it's when you've had a head impact. Or not even.

Cameron: You've had your bell rung!

Lauren: You've had your bell rung! You don't actually have bells, but yeah, that's actually a myth as well. You can actually get a concussion by shoulder to shoulder contact. So essentially, all that has to happen is your brain has to hit the inside of your skull. If the brain hits the inside of your skull for whatever reason -- so often there is whiplash in there, and well -- then they say, well, that's concussion. Because it's all based on symptoms. And also, by definition, by current standards, if a brain scan doesn't show any bleeding or any tissue damage. Because at that point it's not mild, it's a more moderate or severe brain injury. But if it's just a concussion -- "just" a concussion, no such thing as "just" a concussion. Another group I study is women, working age women with postconcussion syndrome, and they can tell you, it is not "just" a concussion. It really messes up your life. So until we are able to categorize different types of concussion, at that point we will probably have a better handle on what exactly is going on at different levels. But usually, it looks like there's a little molecular [effect] -- it's because your brain is going to hit inside the skull. (Those of you in Podland, I keep smashing my hands together.) Your brain doesn't like that sort of thing. I mean, if you hit your arm, it gets bruised, right? Cell tissue gets damaged, gets unhappy, your immune system comes along and tries to clean everything up. You have swelling on your arm if you hurt your arm. If you have swelling in your brain, that's actually going to cause more problems, because it's a hardshell case, not a soft-sided luggage you got up there! There's no where to go so it pushes and causes even more damage. So the brain gets cranky and puts in all these molecular protective effects to try to hunker down and stop using energy. But then, that's going to cause you to have a brain that's not working quite right, because it's hunkered down and trying not to use it energy, because it feels it's under attack, so it's trying to recover. 

Cameron: You'd think that pro sports would be showing an interest in the kind of work that you're doing. Is there a take-up, like amongst equipment manufacturers, or the league, or maybe a specific sports franchise?

Lauren: I wouldn't say yet. We've come up with some tools that we're trying to get out there, and so we're hoping. I know the military is interested in taking up that sort of tool, so they're interested. But so far, the best uptake and the biggest uptake has been from our athletic therapists. The trainers. They're the ones who get very enthusiastic when they see this sort of thing, because they too want better metrics. They want better ways of being able to assess their athletes, being able to monitor how well they're recovering. So they are very excited. But thus far, it's been a bit of a challenge to actually get beyond that to the folks who control access. 

Cameron: Do you work with the NHL draft in some way?

Lauren: I used to, yeah. For years, there was a group of us here at York that would work for Central Scouting out at the combine and do various tests.So they'd bring them all together from all over, and test them in various ways.

Cameron: And that data would get shared with all the teams?

Lauren: Yes, and then that data gets shared with all the scouts, like everybody. And so then that would, in theory, help refine decisions around draft pick order.

Cameron: Interesting!

Lauren: Yeah, it was really neat. It was a lot of physiology tests, and then I was doing the eye-hand coordination tests.

Cameron: But the concussion stuff hasn't been taken up in that same way?

Lauren: Not officially through those leagues, but we'll be approaching them again. We were waiting at our end, to get enough data. And now we have, and we've published it. So the evidence is out there, that even though they [the concussed athletes] seem to be recovered. they are still a bit slow. Knowledge is power. Things to know. So now we are hoping that we've got something, a format and the evidence, that can help things.

Cameron: If I'm correct, you've done a fair number of media interviews around your work. If you could give any advice to a young scholar starting out about media relations, what would it be?

Lauren: Oh gosh! I guess the main thing is try to speak slowly, which I have trouble with. Try not let your voice go up into the stratosphere. But for me though, the hardest thing I had to learn how to do was to avoid field-specific jargon. You get so wrapped up, especially in grad school and postdoc, you get so into it. You're so buried in your own fields terms that you will lose somebody in 10 seconds. So it's really useful. Speaking to the media is the same as if you can get out there and speak to the community. These days, because I do work with dementia, I'm out giving talks to long-term care facilities, or chatting with the day programs, and it's really useful to help you keep in practice. Keep it real, man! Keep it at a level where people can get actual useful information.

Cameron: Good. Lauren, thank you for joining us on the podcast. It's a really fascinating topic, and we haven't even got into the whole implication for aging. I would love to talk to you for another hour! We will come back to it. Thank you so much for being here. It's been great.

Lauren: You are welcome!

Links

Prof. Sergio’s faculty profile at York University.

Credits

Host: Cameron Graham
Producer: Bertland Imai
Photos: York University.
Music: Musicbed
Recorded: May 30, 2019
Location: York University