Dr Andrew Gardner

Dr Andrew Gardner

Post-Doctoral Research Fellow

School of Medicine and Public Health

Taking the field against concussion

An early career researcher, clinical neuropsychologist Dr Andrew Gardner is already emerging as a world leader in the field of sports related concussion.

Dr Andrew Gardner

Both Andrew’s clinical work and research deal with diagnosis and management of acute, sub-acute, and possible chronic problems associated with sports concussion in active and retired athletes of all levels of competition.

Andrew’s ultimate goal is to collect prospective longitudinal data that will provide definitive answers to questions around the mechanisms and consequences of concussions.

Already much lauded and awarded, Andrew is Co-Director of HNEH's Sport Concussion Clinic, an Executive Committee Member of the Priority Research Centre for Stroke and Brain Injury, and serves as a member of the Australian Rugby Union's (ARUs) Concussion Advisory Group.

With the UON Alumni 2016 Beryl Nashar Young Researcher Award and the 2015 Research Australia Discovery Award under his belt, Andrew’s research hasn’t gone unnoticed. In October 2016 Andrew was been awarded a 2016 NHMRC Early Career Fellowship to systematically evaluate the association between a single, and repetitive mild TBI and neurodegenerative disease in retired collision sports athletes by using advanced research methods to rigorously study the issue.

As well as working on the coalface within Australia’s first public health clinic for concussed athletes, Andrew’s expertise continues to directly inform policy and instruction in several leading organisations, from the National Rugby League (NRL) and Australian Rugby Union (ARU) and Brain Injury Australia (BIA).

The dose affect

Andrew states that negative media coverage surrounding contact sports has affected numbers of young people engaging in contact sport related activity.

But he argues there is insufficient scientific evidence on sports related concussions to make definitive connections between playing contact sports and long-term traumatic brain injury.

“The ageing population is not rife with former collision sport athletes with dementia,” Andrew notes.

“Long term outcomes for contact sport athletes are not uniform and universal, so we must look at the level of exposure and whether there is a threshold, or a trend or an association towards threshold and later life consequences.”

The so-called ‘dose effect’ of repeated concussions has been linked to chronic traumatic encephalopathy, but its definitive connection to chronic outcomes such as dementia and decreased cognitive function are not so clear.

A lack of uniformity in response to concussion and healing time for different athletes has also compelled Andrew to look closer at several other factors that may influence both long and short-term outcomes.

Influencing factors

To better understand this threshold and influencing factors, Andrew is conducting retrospective study on retired collision sport players, ranging in age from early 30s to 90s.

Taking into account age, genetics, vascular health, and mental health, as well as environmental factors such as drug and alcohol use, the study aims to pinpoint elements combining to affect long-term cognitive function relative to the number of self-reported concussions.

In early 2016, Andrew and international collaborators presented a systematic review of genetic risk factors for concussion and mild traumatic brain injury to fellow experts in their field at the Eleventh World Congress on Brain Injury.

“We believe different vulnerabilities and responses can be related to genetics, or related to existing pre-morbid disease or illness or personality characteristic,” Andrew says.

“We also know that people who have anxiety, depression, attention deficit disorder, or learning disorders, tend to be more susceptible to sustaining a concussion,” Andrew says.

“And once you have one concussion you are more likely to have another than someone who has never had one.”

“All these different aspects need to be explored and measured. If there is a difference, what is it? Is there a dose affect of self-reported concussion? What are the consequences of concussion in all the areas we are looking?”

Culture change

Having worked closely with the ARU and NRL, Andrew cites the banning of shoulder charges and introduction of the concussion interchange rule as examples of serious wide scale policy changes toward managing player safety.

With collaborators, Andrew has been working on a study assessing level of knowledge and attitude towards sport-related concussion among the public.

“The codes are doing a lot of good work, but as ninety plus percent of participants are at a grassroots level, education around concussion is still vital to ensure player safety is paramount,” Andrew says.

Data confirms anecdotal evidence that perception is slow to change within the rank and file of the rugby codes in Australia.

“It’s not a badge of honour to carry a concussion and continue to play, you’re not going to play as well as you can and should,” Andrew states.

“You are actually more vulnerable to getting another hit because you have slowed processing. And in rare circumstances, a second hit may be catastrophic.”

“Parents need to know this, coaches and trainers need to know this, sports administrators need to know this, and of course the players themselves.”

Video analysis

Andrew is currently working on validating the use of video analysis as evidence of concussive signs in National Rugby League (NRL) match play.

“Sometimes we need to protect players from themselves. They’re warriors and don’t want to come off field,” Andrew says.

He explains that players can exhibit transient concussive signs such as gait ataxia, vacant stares, loss of muscle tone, impact seizure or stiffening of limbs, as well as black outs.

These symptoms may resolve quickly and be missed in play but spotted by sideline staff on video playback.

To ensure a concussive injury is not mistaken for another injury or strategic action by a player, Andrew watched every game of the 2014 NRL season to record injuries and responses as a means to identifying base rates for concussive injuries.

This video analysis work is being done in league with the University of Ottawa, one of his many international collaborations.

Andrew credits Professor Grant Iverson from Harvard University as a vital mentor and values research partners at Cardiff University, Exeter and the University of British Columbia.

Closer to home, Andrew has collaborators at Southern Cross, the Universities of Melbourne and New England, as well as Macquarie and the Australian Catholic Uni.

Acute response

Working in a full-time capacity as a Neuropsychologist for the Hunter New England Local Health District in the Neuropsychiatry Service, Andrew’s research is an adjunct to his real priority - helping healthcare consumers manage mild brain related issues.

Before he even completed his PhD, Andrew was busy setting up Hunter New England Local Health District's Sport Concussion Clinic in consultation with local rugby league clubs, and in partnership with co-director Professor Chris Levi.

The clinic is accessible to all adult athletes who are managed on a case-by-case basis.

“Three people may have very similar concussions, one may need to sit out for one week, and one may not need to sit out at all. And one may have already received several concussions during the season so we will look extra closely at their injury and recovery time.”

Recovery plans involve a holistic approach to informed choice, with mental health an equal priority to physical health.

“We don’t focus on returning a player to the field, we focus on returning them to life,” Andrew says.

With the reputation of the clinic continuing to build, Andrew hopes it will eventually duplicate, spreading expert diagnosis and treatment for acute collision, combat or recreational sports related concussion across the country.

“The research program continues to grow and we are making advances and inroads,” Andrew reflects.

“But making a difference in the lives of the people that we are trying to study, that's the important thing.”

Taking the field against concussion

Dr Gardner is an early career research clinician, working as a Neuropsychologist for the Hunter New England Local Health District in the Neuropsychiatry Service

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Career Summary

Biography

Dr Gardner is an NHMRC Early Career Fellow with the School of Medicine & Public Health. He is also a Co-Director of the Hunter New England Local Health District's Sport Concussion Clinic, an Executive Committee Member of the Priority Research Centre for Stroke and Brain Injury, and serves as a member of the Australian Rugby Union's (ARUs) Concussion Advisory Group.

Dr Gardner has conducted research in the field of sports concussion for over a decade, having first worked as a research assistant for the New England Paediatric Head Trauma Program. He received first class honours in Psychology (University of New England) in 2005 and subsequently completed a Doctor of Psychology (Clinical Neuropsychology) degree at Macquarie University, Sydney, where he conducted research examining the acute and cumulative neuropsychological consequences of sports concussion in semi-professional rugby union players. His thesis received the prestigious award for the Most Outstanding Dissertation for 2011 from the National Academy of Neuropsychology (USA); the first, and still the only, time this award has been bestowed upon a student who studied outside of North America. During his post-graduate studies he also pioneered and managed the Macquarie University Sports Concussion Clinic. Following this Dr Gardner completed his PhD in the School of Medicine and Public Health, at the University of Newcastle, studying the potential long-term consequences of participation in collision sports.

Dr Gardner's research and expert opinion have also been sought for the development of policy papers produced by Brain Injury Australia “Concussions in Sport” (October, 2012), and Alzheimer’s Australia (NSW) “Football, head injuries and the risk of dementia” (March 2013/March 2016). In 2013 he was invited as a leading early career researcher to contribute to the Australian Academy of Science Theo Murphy High Flyer's Think Tank on 'inspiring smarter brain research in Australia'. He was also awarded an Australian Endeavour Research Fellowship to visit Harvard Medical School for four months in 2014. In 2015 Dr Gardner was awarded the Discovery Award from Research Australia as the national early career researcher of the year for 2015. In 2016 he was awarded the Beryl Nashar Young Researcher Award by the University of Newcastle alumni advisory committee, an award that recognises achievements of early- and mid-career researchers. In 2016 Dr Gardner also received an 'Emerging Health Researcher Commendation Award' from the Bupa Health Foundation, an award that recognises the valuable contribution of emerging health researchers to health outcomes for all Australians.

Dr Gardner has established strong research collaborations with international experts from Harvard Medical School, University of Ottawa, Cardiff University, Exeter University, and the University of British Columbia, as well as locally from The University of Melbourne, Macquarie University, and The Australian Catholic University. He has created strong relationships through community engagement and sports concussion educational programs and works at the interface of research and clinical application through the HNE LHD Sports Concussion Clinic. Dr Gardner is continuing to develop his research program by focusing on the investigation of the acute, sub-acute, and chronic problems associated with sports concussion in active and retired athletes of all levels of competition.


Qualifications

  • Doctor of Philosophy, University of Newcastle
  • Bachelor of Psychology (Honours), University of New England

Keywords

  • Ageing and Dementia
  • Brain Injury
  • Cognition
  • Neuropsychology
  • Sports Concussion

Fields of Research

Code Description Percentage
110999 Neurosciences not elsewhere classified 100

Professional Experience

UON Appointment

Title Organisation / Department
Post-Doctoral Research Fellow University of Newcastle
School of Medicine and Public Health
Australia

Professional appointment

Dates Title Organisation / Department
1/07/2013 -  Co-Director, Hunter New England Sports Concussion Program Hunter New England Local Health District
Sports Concussion Program
1/04/2009 -  Clinical Neuropsychologist Hunter New England Local Health District
Neuropsychiatry Service

Awards

Award

Year Award
2016 Beryl Nashar Young Researcher Award
The University of Newcastle Alumni
2016 Emerging Health Researcher Commendation Award
BUPA Health Foundation
2015 Research Australia's Discovery Early Career Award
Research Australia
2014 Endeavour Award
Australian Government
2011 National Academy of Neuropsychology (NAN) Outstanding Dissertation of the Year Award
National Academy of Neuropsychology

Scholarship

Year Award
2007 APA Post-Graduate Student Scholarship
Australian Government
Edit

Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Chapter (2 outputs)

Year Citation Altmetrics Link
2016 Gardner A, Iverson GL, van Donkelaar P, Ainslie PN, Stanwell P, 'Magnetic Resonance Spectroscopy, Diffusion Tensor Imaging, and Transcranial Doppler Ultrasound Following Sport-Related Concussion', The Oxford Handbook of Sports-related Concussion, Oxford University Press, Oxford 1-1 (2016)
DOI 10.1093/oxfordhb/9780199896585.013.12
Co-authors Peter Stanwell
2016 Gardner AJ, Zafonte R, 'Neuroepidemiology of traumatic brain injury.', 207-223 (2016) [B1]
DOI 10.1016/B978-0-12-802973-2.00012-4

Journal article (28 outputs)

Year Citation Altmetrics Link
2017 Hides JA, Franettovich Smith MM, Mendis MD, Smith NA, Cooper AJ, Treleaven J, et al., 'A prospective investigation of changes in the sensorimotor system following sports concussion. An exploratory study.', Musculoskelet Sci Pract, 29 7-19 (2017)
DOI 10.1016/j.msksp.2017.02.003
2017 Gardner AJ, Iverson GL, Wojtowicz M, Levi CR, Kay-Lambkin F, Schofield PW, et al., 'MR Spectroscopy Findings in Retired Professional Rugby League Players', International Journal of Sports Medicine, (2017)
DOI 10.1055/s-0042-120843
Co-authors Peter Stanwell, Peter Schofield, Frances Kaylambkin, Christopher Levi
2017 Panenka WJ, Gardner AJ, Dretsch MN, Crynen GC, Crawford FC, Iverson GL, 'Systematic Review of Genetic Risk Factors for Sustaining a Mild Traumatic Brain Injury.', JOURNAL OF NEUROTRAUMA, online first (2017)
2017 Gardner AJ, Kohler RMN, Levi CR, Iverson GL, 'Usefulness of Video Review of Possible Concussions in National Youth Rugby League', INTERNATIONAL JOURNAL OF SPORTS MEDICINE, 38 71-75 (2017)
DOI 10.1055/s-0042-116072
Co-authors Christopher Levi
2017 Manley GT, Gardner AJ, Schneider KJ, Guskiewicz KM, Bailes J, Cantu RC, et al., 'A Systematic Review of Potential Long-Term Effects of Sport-Related Concussion', BRITISH JOURNAL OF SPORTS MEDICINE, (2017)
2017 Iverson GL, Gardner AJ, Terry DP, Ponsford JL, Sills AK, Broshek DK, Solomon GS, 'Predictors of clinical recovery from concussion: a systematic review', BRITISH JOURNAL OF SPORTS MEDICINE, (2017)
2016 Gardner AJ, Iverson GL, Stanwell P, Moore T, Ellis J, Levi CR, 'A video analysis of use of the new ¿Concussion Interchange Rule¿ in the National Rugby League', International Journal of Sports Medicine, 37 267-273 (2016) [C1]
DOI 10.1055/s-0035-1565203
Citations Scopus - 2Web of Science - 2
Co-authors Peter Stanwell, Christopher Levi
2016 Gardner AJ, Shih SL, Adamov EV, Zafonte RD, 'Research Frontiers in Traumatic Brain Injury. Defining the Injury', Physical Medicine and Rehabilitation Clinics of North America, (2016)

© 2016 Elsevier Inc.With the continued advancement in technology, such as increasingly sophisticated neuroimaging parameters, and the ongoing development of various scientific fi... [more]

© 2016 Elsevier Inc.With the continued advancement in technology, such as increasingly sophisticated neuroimaging parameters, and the ongoing development of various scientific fields, like serum and blood biomarkers, genetics, and physiology, traumatic brain injury (TBI) research is a dynamic field of study. TBI remains a significant public health concern and research has continued to grow exponentially over the past decade. This review provides an overview of the frontiers of TBI research, from sports concussion to severe TBI, from acute and subacute injury to long-term/chronic outcomes, from assessment and management to prognosis, specifically examining recent neuroimaging, biomarkers, genetics, and physiologic studies.

DOI 10.1016/j.pmr.2016.12.014
2016 Dretsch M, Silverberg ND, Gardner AJ, Panenka WJ, Emmerich T, Crynen GC, et al., 'Genetics and Other Risk Factors for Past Concussions in Active-Duty Soldiers', Journal of Neurotrauma, (2016)
DOI 10.1089/neu.2016.4480
2016 Wright D, Liu S, van der Poel C, McDonald SJ, Brady RD, Taylor L, et al., 'Traumatic brain injury results in cellular, structural and functional changes resembling motor neuron disease.', Cerebral Cortex, (2016)
2016 Wright D, Trezise J, Kamnaksh A, Bekdash R, Johnston L, Ordidge R, et al., 'Behavioral, blood, and magnetic resonance imaging biomarkers of experimental mild traumatic brain injury', Scientific Reports, 6 28713-28713 (2016) [C1]
DOI 10.1038/srep28713
Co-authors Peter Stanwell
2015 Iverson GL, Gardner AJ, McCrory P, Zafonte R, Castellani RJ, 'A critical review of chronic traumatic encephalopathy', Neuroscience and Biobehavioral Reviews, 56 276-293 (2015) [C1]

© 2015 Elsevier Ltd.Chronic traumatic encephalopathy (CTE) has been described in the literature as a neurodegenerative disease with: (i) localized neuronal and glial accumulation... [more]

© 2015 Elsevier Ltd.Chronic traumatic encephalopathy (CTE) has been described in the literature as a neurodegenerative disease with: (i) localized neuronal and glial accumulations of phosphorylated tau (p-tau) involving perivascular areas of the cerebral cortex, sulcal depths, and with a preference for neurons within superficial cortical laminae; (ii) multifocal axonal varicosities and axonal loss involving deep cortex and subcortical white matter; (iii) relative absence of beta-amyloid deposits; (iv) TDP-43 immunoreactive inclusions and neurites; and (v) broad and diverse clinical features. Some of the pathological findings reported in the literature may be encountered with age and other neurodegenerative diseases. However, the focality of the p-tau cortical findings in particular, and the regional distribution, are believed to be unique to CTE. The described clinical features in recent cases are very similar to how depression manifests in middle-aged men and with frontotemporal dementia as the disease progresses. It has not been established that the described tau pathology, especially in small amounts, can cause complex changes in behavior such as depression, substance abuse, suicidality, personality changes, or cognitive impairment. Future studies will help determine the extent to which the neuropathology is causally related to the diverse clinical features.

DOI 10.1016/j.neubiorev.2015.05.008
Citations Scopus - 24Web of Science - 23
2015 Gardner AJ, Iverson GL, Quinn TN, Makdissi M, Levi CR, Shultz SR, et al., 'A preliminary video analysis of concussion in the National Rugby League', Brain Injury, 29 1182-1185 (2015) [C1]
DOI 10.3109/02699052.2015.1034179
Citations Scopus - 6Web of Science - 4
Co-authors Peter Stanwell, Christopher Levi
2015 Gardner A, Iverson GL, Levi CR, Schofield PW, Kay-Lambkin F, Kohler RMN, Stanwell P, 'A systematic review of concussion in rugby league', British Journal of Sports Medicine, 49 495-498 (2015) [C1]

© 2015, BMJ Publishing Group. All rights reserved.Objectives: Concussion remains one of the inherent risks of participation in rugby league. While other injuries incurred by rugb... [more]

© 2015, BMJ Publishing Group. All rights reserved.Objectives: Concussion remains one of the inherent risks of participation in rugby league. While other injuries incurred by rugby league players have been well studied, less focus and attention has been directed towards concussion. Review method: The current review examined all articles published in English from 1900 up to June 2013 pertaining to concussion in rugby league players. Data sources: Publications were retrieved via six databases using the key search terms: rugby league, league, football; in combination with injury terms: athletic injuries, concussion, sports concussion, sports-related concussion, brain concussion, brain injury, brain injuries, mild traumatic brain injury, mTBI, traumatic brain injury, TBI, craniocerebral trauma, head injury and brain damage. Observational, cohort, correlational, cross-sectional and longitudinal studies were all included. Results: 199 rugby league injury publications were identified. 39 (20%) were related in some way to concussion. Of the 39 identified articles, 6 (15%) had the main aim of evaluating concussion, while the other 33 reported on concussion incidence as part of overall injury data analyses. Rugby league concussion incidence rates vary widely from 0.0 to 40.0/1000 playing hours, depending on the definition of injury (time loss vs no time loss). The incidence rates vary across match play versus training session, seasons (winter vs summer) and playing position (forwards vs backs). The ball carrier has been found to be at greater risk for injury than tacklers. Concussion accounts for 29% of all injuries associated with illegal play, but only 9% of injuries sustained in legal play. Conclusions: In comparison with other collision sports, research evaluating concussion in rugby league is limited. With such limited published rugby league data, there are many aspects of concussion that require attention, and future research may be directed towards these unanswered questions.

DOI 10.1136/bjsports-2013-093102
Citations Scopus - 9Web of Science - 8
Co-authors Frances Kaylambkin, Peter Schofield, Peter Stanwell, Christopher Levi
2015 Silverberg ND, Gardner AJ, Brubacher JR, Panenka WJ, Li JJ, Iverson GL, 'Systematic review of multivariable prognostic models for mild traumatic brain injury', Journal of Neurotrauma, 32 517-526 (2015) [C1]

© 2015, Mary Ann Liebert, Inc.Prognostic models can guide clinical management and increase statistical power in clinical trials. The availability and adequacy of prognostic model... [more]

© 2015, Mary Ann Liebert, Inc.Prognostic models can guide clinical management and increase statistical power in clinical trials. The availability and adequacy of prognostic models for mild traumatic brain injury (MTBI) is uncertain. The present study aimed to (1) identify and evaluate multivariable prognostic models for MTBI, and (2) determine which pre-, peri-, and early post-injury variables have independent prognostic value in the context of multivariable models. An electronic search of MEDLINE, PsycINFO, PubMed, EMBASE, and CINAHL databases for English-language MTBI cohort studies from 1970-2013 was supplemented by Web of Science citation and hand searching. This search strategy identified 7789 articles after removing duplicates. Of 182 full-text articles reviewed, 26 met eligibility criteria including (1) prospective inception cohort design, (2) prognostic information collected within 1 month post-injury, and (3) 2+variables combined to predict clinical outcome (e.g., post-concussion syndrome) at least 1 month later. Independent reviewers extracted sample characteristics, study design features, clinical outcome variables, predictor selection methods, and prognostic model discrimination, calibration, and cross-validation. These data elements were synthesized qualitatively. The present review found no multivariable prognostic model that adequately predicts individual patient outcomes from MTBI. Suboptimal methodology limits their reproducibility and clinical usefulness. The most robust prognostic factors in the context of multivariable models were pre-injury mental health and early post-injury neuropsychological functioning. Women and adults with early post-injury anxiety also have worse prognoses. Relative to these factors, the severity of MTBI had little long-term prognostic value. Future prognostic studies should consider a broad range of biopsychosocial predictors in large inception cohorts.

DOI 10.1089/neu.2014.3600
Citations Scopus - 18Web of Science - 14
2015 Gardner AJ, Tan CO, Ainslie PN, van Donkelaar P, Stanwell P, Levi CR, Iverson GL, 'Cerebrovascular reactivity assessed by transcranial Doppler ultrasound in sport-related concussion: a systematic review', British Journal of Sports Medicine, 49 1050-1055 (2015) [C1]
DOI 10.1136/bjsports-2014-093901
Citations Scopus - 7Web of Science - 7
Co-authors Peter Stanwell, Christopher Levi
2014 Gardner A, Iverson GL, McCrory P, 'Chronic traumatic encephalopathy in sport: A systematic review', British Journal of Sports Medicine, 48 84-90 (2014) [C1]

Objective: To provide a critical review of chronic traumatic encephalopathy (CTE) by considering the range of clinical presentations, neuropathology and the strength of evidence f... [more]

Objective: To provide a critical review of chronic traumatic encephalopathy (CTE) by considering the range of clinical presentations, neuropathology and the strength of evidence for CTE as a distinct syndrome. Data sources: Seven electronic databases were searched using a combination of MeSH terms and key words to identify relevant articles. Review methods: Specific inclusion and exclusion criteria were used to select studies for review. Data extracted where present included study population, exposure/outcome measures, clinical data, neurological examination findings, cognitive assessment, investigation results and neuropathology results. Results: The data from 158 published case studies were reviewed. Critical differences between the older descriptions of CTE (the 'classic' syndrome) and the recent descriptions (the 'modern' syndrome) exist in the age of onset, natural history, clinical features, pathological findings and diagnostic criteria, which suggests that modern CTE is a different syndrome. The methodology of the current studies does not allow determination of aetiology or risk factors. Conclusions: The clinicopathological differences between the 'classic' CTE syndrome and the 'modern' syndrome suggest that the new syndrome needs a different nomenclature. Further research is required to clearly define the clinical phenotype of the modern CTE syndrome and establish the underlying aetiology. Future research needs to address these issues through largescale, prospective clinicopathological studies.

DOI 10.1136/bjsports-2013-092646
Citations Scopus - 63Web of Science - 57
2014 Gardner A, Iverson GL, Stanwell P, 'A Systematic Review of Proton Magnetic Resonance Spectroscopy Findings in Sport-Related Concussion', JOURNAL OF NEUROTRAUMA, 31 1-18 (2014) [C1]
DOI 10.1089/neu.2013.3079
Citations Scopus - 19Web of Science - 16
Co-authors Peter Stanwell
2014 Gardner AJ, Iverson GL, Williams WH, Baker S, Stanwell P, 'A systematic review and meta-analysis of concussion in Rugby Union', Sports Medicine, 44 1717-1731 (2014) [C1]

© 2014, Springer International Publishing Switzerland.Objective: The aim of the current review was to systematically evaluate the available evidence on concussion in Rugby Union ... [more]

© 2014, Springer International Publishing Switzerland.Objective: The aim of the current review was to systematically evaluate the available evidence on concussion in Rugby Union and to conduct a meta-analysis of findings regarding the incidence of concussion.Background: Rugby Union, a popular full-contact sport played throughout the world, has one of the highest rates of concussion of all full-contact sports.Methods: Articles were retrieved via a number of online databases. The current review examined all articles published in English up to May 2014 pertaining to concussion in Rugby Union players. The key search terms included ¿Rugby Union¿, ¿rugby¿, ¿union¿, and ¿football¿, in combination with the injury terms ¿athletic injuries¿, ¿concussion¿, ¿sports concussion¿, ¿sports-related concussion¿, ¿brain concussion¿, ¿brain injury¿, ¿brain injuries¿, ¿mild traumatic brain injury¿, ¿mTBI¿, ¿traumatic brain injury¿, ¿TBI¿, ¿craniocerebral trauma¿, ¿head injury¿, and ¿brain damage¿.Results: The final search outcome following the eligibility screening process resulted in the inclusion of 96 articles for this review. The meta-analysis included a total of 37 studies. The results of the meta-analysis revealed an overall incidence of match-play concussion in men¿s rugby-15s of 4.73 per 1,000 player match hours. The incidence of concussion during training was 0.07 per 1,000 practice hours. The incidence of concussion in women¿s rugby-15s was 0.55 per 1,000 player match hours. In men¿s rugby-7s match-play, concussion incidence was 3.01 per 1,000 player match hours. The incidence of concussion varied considerably between levels of play, with elite level play recording a rate of 0.40 concussions per 1,000 player match hours, schoolboy level 0.62 concussions per 1,000 player match hours, and the community or sub-elite level recording a rate of 2.08 concussions per 1,000 player match hours. The incidence of concussion in men¿s rugby-15s as a function of playing position (forwards vs. backs) was 4.02 and 4.85 concussions per 1,000 player match hours, respectively.Conclusions: Concussion is a common injury sustained and reported in match play and to a lesser extent during practice by Rugby Union players. Based on the available published data, there appears to be a variation in risk of concussion across level of play, with the sub-elite level having the greatest incidence of injury. Future research focused on studying the acute consequences and best management strategies in current players, and the potential longer term outcomes of concussion in retired players, is needed. A focus on the areas of prevention, injury identification, and medical management, and risk for long-term outcomes will be of benefit to current athletes.

DOI 10.1007/s40279-014-0233-3
Citations Scopus - 7Web of Science - 8
Co-authors Peter Stanwell
2014 Schofield PW, Moore TM, Gardner A, 'Traumatic brain injury and olfaction: A systematic review', Frontiers in Neurology, 5 JAN (2014) [C1]

Traumatic brain injury (TBI) is a common condition that is often complicated by neuropsychiatric sequelae that can have major impacts on function and quality of life. An alteratio... [more]

Traumatic brain injury (TBI) is a common condition that is often complicated by neuropsychiatric sequelae that can have major impacts on function and quality of life. An alteration in the sense of smell is recognized as a relatively common complication of TBI; however in clinical practice, this complication may not be sought or adequately characterized. We conducted a systematic review of studies concerned with olfactory functioning following TBI. Our predetermined criteria led to the identification of 25 studies published in English, which we examined in detail. We have tabulated the data from these studies in eight separate tables, beginning with Table 1, which highlights each study's key findings, and we provide a summary/synthesis of the findings in the accompanying results and discussion sections. Despite widely differing methodologies, the studies attest to a high frequency of post-TBI olfactory dysfunction and indicate that its presence can serve as a potential marker of additional structural or functional morbidities. © 2014 Schofield, Moore and Gardner.

DOI 10.3389/fneur.2014.00005
Citations Scopus - 13Web of Science - 10
Co-authors Peter Schofield
2013 McCrory P, Meeuwisse WH, Kutcher JS, Jordan BD, Gardner A, 'What is the evidence for chronic concussion-related changes in retired athletes: behavioural, pathological and clinical outcomes?', BRITISH JOURNAL OF SPORTS MEDICINE, 47 327-330 (2013)
DOI 10.1136/bjsports-2013-092248
Citations Scopus - 73Web of Science - 60
2013 Gardner A, 'The complex clinical issues involved in an athlete's decision to retire from collision sport due to multiple concussions: a case study of a professional athlete', FRONTIERS IN NEUROLOGY, 4 (2013)
DOI 10.3389/fneur.2013.00141
Citations Scopus - 5Web of Science - 4
2012 Gardner AJ, Kay-Lambkin FJ, Stanwell PT, Donnelly J, Williams WH, Hiles A, et al., 'A systematic review of diffusion tensor imaging findings in sports-related concussion', Journal of Neurotrauma, 29 2521-2538 (2012) [C1]
Citations Scopus - 47Web of Science - 40
Co-authors Peter Schofield, Peter Stanwell, Frances Kaylambkin, Christopher Levi
2012 Stanwell PT, Gardner AJ, 'Riskante gehirnersch¿¿tterungen. Chronisch traumatische enzephalopathie (CTE) als folge von kopfverletzungen', Medical Sports Network, - 22-25 (2012) [C3]
Co-authors Peter Stanwell
2012 Gardner A, Shores EA, Batchelor J, Honan CA, 'Diagnostic Efficiency of ImPACT and CogSport in Concussed Rugby Union Players Who Have Not Undergone Baseline Neurocognitive Testing', APPLIED NEUROPSYCHOLOGY-ADULT, 19 90-97 (2012)
DOI 10.1080/09084282.2011.643945
Citations Scopus - 9Web of Science - 7
2010 Gardner A, Shores EA, Batchelor J, 'Reduced Processing Speed in Rugby Union Players Reporting Three or More Previous Concussions', ARCHIVES OF CLINICAL NEUROPSYCHOLOGY, 25 174-181 (2010)
DOI 10.1093/arclin/acq007
Citations Scopus - 26Web of Science - 11
2009 Knight S, Northam E, Donath S, Gardner A, Harkin N, Taplin C, et al., 'Improvements in cognition, mood and behaviour following commencement of continuous subcutaneous insulin infusion therapy in children with type 1 diabetes mellitus: a pilot study', Diabetologia, 52 193-198 (2009)
DOI 10.1007/s00125-008-1197-3
2006 Gardner A, Mallet PE, 'Suppression of feeding, drinking, and locomotion by a putative cannabinoid receptor 'silent antagonist'', European Journal of Pharmacology, 530 103-106 (2006)

This study compared the effects of the putative cannabinoid receptor 'silent antagonist' O-2050 with the cannabinoid receptor inverse agonist SR 141716 on food and water consumpti... [more]

This study compared the effects of the putative cannabinoid receptor 'silent antagonist' O-2050 with the cannabinoid receptor inverse agonist SR 141716 on food and water consumption, and locomotor activity. Non-deprived male Wistar rats were habituated to the apparatus and testing procedures, then injected intraperitoneally with vehicle, O-2050 (0.03-3.0 mg/kg), or SR 141716 (3.0 mg/kg) prior to 4-h test sessions. Food consumption was significantly reduced by both drugs. Water intake and locomotor activity were significantly reduced only by O-2050. Results support the notion that cannabinoid receptor antagonists suppress feeding behaviour by blocking an endogenous cannabinoid orexigenic signal, rather than by inverse agonism at cannabinoid receptors. However, further studies are needed to confirm the status of O-2050 as a cannabinoid CB1 receptor antagonist devoid of inverse agonist properties. © 2005 Elsevier B.V. All rights reserved.

DOI 10.1016/j.ejphar.2005.11.032
Citations Scopus - 53
Show 25 more journal articles

Conference (35 outputs)

Year Citation Altmetrics Link
2017 Ignacy T, Post A, Gardner AJ, Iverson GL, Hoshizaki TB, 'Dynamic impact response of injury events leading to concussion in elite men's rugby league' (2017)
2017 Luoto TM, Raj R, Posti J, Gardner AJ, Panenka WJ, Iverson GL, 'A systematic review of the usefulness of glial fibrillary acidic protein (GFAP) for predicting acute intracranial lesions following head trauma.' (2017)
2017 Luz M, Terry DP, Gardner AJ, Zafonte RD, Iverson GL, 'Self-Reported Anger and Depression in Middle-Aged Men: Implications for Diagnosing Chronic Traumatic Encephalopathy' (2017)
2017 Gardner AJ, Wojtowicz M, Terry DP, Levi CR, Zafonte RD, Iverson GL, 'Video and Clinical Screening of National Rugby League Players Suspected of Sustaining Concussion' (2017)
Co-authors Christopher Levi
2017 Gardner AJ, Lee JH, Howell DA, Iverson GL, 'Effects of Exercise on SCAT-3 Performance in Professional Male Athletes' (2017)
2017 Gardner AJ, Chung Pin Yong JP, Howell DA, Lee JH, Iverson GL, 'Effects of Exercise on SCAT-3 Performance in Amateur Female Athletes.' (2017)
2016 Gardner AJ, Levi CR, Iverson GL, 'Video analysis of concussion in the National Rugby League' (2016)
Co-authors Christopher Levi
2016 Gardner AJ, Panenka WJ, Dretsch MN, Iverson GL, 'Systematic review of genetic risk factors for concussion and mild traumatic brain injury' (2016)
2016 Wojtowicz M, Gardner AJ, Stanwell P, Levi CR, Shultz SR, Zafonte R, et al., 'Cortical Thickness and Subcortical Brain Volumes in Retired Professional Rugby League Players' (2016)
Co-authors Peter Stanwell, Christopher Levi
2016 Kohler R, Makdissi M, McDonald W, Partridge B, Gardner AJ, 'A preliminary video review of in-game Head Injury Incidents (HII) and use of the Head Injury Assessment (HIA) from the 2015 Super Rugby season' (2016)
2016 Gardner AJ, Levi CR, Iverson GL, 'Video analysis of the evidence of concussive signs in National Rugby League (NRL) match play' (2016)
Co-authors Christopher Levi
2016 Gardner AJ, Kay-Lambkin F, Shultz S, Iverson GL, 'Level of knowledge and attitude towards sport-related concussion among the general public' (2016)
Co-authors Frances Kaylambkin
2016 Williams WH, Gardner AJ, 'Rugby and Concussion: Neuropsychological Assessment and Advanced Neuroimaging' (2016)
2016 Dretsch MN, Panenka WJ, Emmerich T, Crynen G, Ait-Ghezala G, Chaytow H, et al., 'BDNF Met/Met genotype is associated with increased risk for concussion in active duty soldiers' (2016)
2016 Dretsch MN, Crawford FC, Gardner AJ, Emmerich T, Crynen G, Ait-Ghezala G, et al., 'ApoE genotype and lifetime risk for concussion in active duty soldiers' (2016)
2016 Wojtowicz M, Gardner AJ, Stanwell P, Levi C, Shultz S, Zafonte R, et al., 'Cortical and Subcortical Morphometry in Professional Rugby League Players' (2016)
Co-authors Peter Stanwell, Christopher Levi
2015 Gardner AJ, Musgrove K, Iverson GL, McNeil D, Schatz P, 'Sensitivity and Specificity of CogSport for Detecting Poor Effort' (2015) [E3]
2015 Gardner AJ, 'Workshop: Sport-related Concussion and Chronic Traumatic Encephalopathy' (2015) [O1]
2015 Gardner AJ, Iverson GL, Wojtowicz M, Levi CR, Makdissi M, Quinn TN, et al., 'Sideline Use of the SCAT-3 for Screening Professional Rugby League Players Suspected of Sustaining Concussion' (2015) [E3]
Co-authors Christopher Levi, Peter Stanwell
2015 Gardner AJ, Iverson GL, Wojtowicz MA, Levi CR, Makdissi M, Quinn TN, et al., 'A Systematic Video Analysis of Concussion in the National Rugby League', Neurology (2015) [E3]
Co-authors Christopher Levi, Peter Stanwell
2015 Gardner AJ, Iverson GL, Wojtowicz M, Levi C, Kay-Lambkin F, Schofield PW, et al., 'Magnetic Resonance Spectroscopy findings in retired professional rugby league players.', Sports Psychology Society (2015) [E3]
Co-authors Peter Schofield, Peter Stanwell, Frances Kaylambkin, Christopher Levi
2015 Gardner A, Levi C, Stanwell P, Iverson GL, 'A video analysis of the use of the 'concussion interchange rule' during the first year of implementation in the National Rugby League.', International Neuropsychological Society (2015) [E3]
Co-authors Peter Stanwell, Christopher Levi
2014 Gardner AJ, 'Neuroimaging and Sports Concussion' (2014)
2014 Gardner AJ, 'Investigation of the long-term neurocognitive consequences of concussion in professional contact sport athletes.' (2014)
2014 Shultz SR, Vink R, Gardner AJ, McCrory P, 'Sports Concussion Symposia' (2014)
2014 Silverberg N, Gardner AJ, Iverson GL, Brubacher J, 'Systematic review of prognostic models for mild traumatic brain injury' (2014)
2014 Silverberg N, Gardner A, Millis S, Iverson G, 'The effect of attrition on post-concussion syndrome incidence: Initial findings from a meta-regression of mild traumatic brain injury cohort studies', BRAIN INJURY (2014) [E3]
2014 Baker S, Williams H, Sharp D, Gardner A, Harris A, Zeman A, Fulford J, 'Sports-related concussion and diffusion tensor imaging findings in rugby players', BRAIN INJURY (2014) [E3]
Citations Web of Science - 1
2014 Woodcock K, Stanwell P, Gardner A, Teesson M, Baker A, Mills K, Kay-Lambkin F, 'A systematic review of blast related mild traumatic brain injuries, posttraumatic trauma symptoms and substance misuse.', Australasian Society for Traumatic Stress Studies (2014) [O1]
Co-authors Frances Kaylambkin, Peter Stanwell
2013 Baker S, Williams H, Gardner AJ, Sharpe D, Zeman A, Harris A, et al., 'Mild traumatic brain injuries associated with, and diffusion tensor imaging findings in, rugby players.' (2013)
2013 Gardner AJ, 'Adult Grand Rounds. Sports Concussion: Neuropsychological Profile & Ethical Perspectives in Professional Athlete Retirement.' (2013)
2013 Gardner AJ, Stanwell P, 'Sports Concussion: Neuropsychological Profile & Ethical Perspectives in Professional Athlete Retirement.' (2013)
Co-authors Peter Stanwell
2013 Woodcock K, Stanwell P, Gardner A, Teesson M, Baker A, Mills K, Kay-Lambkin F, 'A systematic review of blast related mild traumatic brain injuries, posttraumatic trauma symptoms and substance misuse.', Australasian Society for Psychiatric Research (2013)
Co-authors Peter Stanwell, Frances Kaylambkin
2011 Gardner AJ, Shores EA, Batchelor J, 'Concussion in Rugby Union players: A Neuropsychological Perspective.' (2011)
2003 Donnelly J, Gardner AJ, Irle J, Rolfe S, Maund K, 'Bumps on the Head Can Lead to Bumps in the Road: Improved Pediatric Mild Traumatic Brain Injury Testing in Schools and Hospitals' (2003)
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Thesis / Dissertation (1 outputs)

Year Citation Altmetrics Link
2015 Gardner AJ, Concussion in Professional Rugby League, University of Newcastle (2015)
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Grants and Funding

Summary

Number of grants 13
Total funding $659,058

Click on a grant title below to expand the full details for that specific grant.


20173 grants / $461,814

An investigation of the potential association between sports concussion and neurodegenerative disease in collision sports athletes$319,814

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Doctor Andrew Gardner
Scheme Early Career Fellowships
Role Lead
Funding Start 2017
Funding Finish 2020
GNo G1600288
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Research Working Group on Brain Injury (RWGBI)$122,000

Funding body: GW4 Accelerator Fund

Funding body GW4 Accelerator Fund
Project Team

Derek Jones, Huw Williams, Martin Bunnage, Keith Stokes, Michael Jones, Andrew Gardner, & Grant Iverson.

Scheme GW4 Accelerator Fund
Role Investigator
Funding Start 2017
Funding Finish 2017
GNo
Type Of Funding External
Category EXTE
UON N

DVCRI Research Support for ECF$20,000

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Doctor Andrew Gardner
Scheme NHMRC ECF Support
Role Lead
Funding Start 2017
Funding Finish 2020
GNo G1700659
Type Of Funding Internal
Category INTE
UON Y

20163 grants / $29,500

Priority Research Centre for Stroke and Brain Injury Project Grant$17,000

Funding body: Priority Research Centre for Stroke and Brain Injury

Funding body Priority Research Centre for Stroke and Brain Injury
Scheme PRC Project Grant
Role Lead
Funding Start 2016
Funding Finish 2016
GNo
Type Of Funding Internal
Category INTE
UON N

Priority Research Centre for Stroke and Brain Injury Project Grant$10,000

Funding body: Priority Research Centre for Stroke and Brain Injury

Funding body Priority Research Centre for Stroke and Brain Injury
Scheme PRC Project Grant
Role Lead
Funding Start 2016
Funding Finish 2016
GNo
Type Of Funding Internal
Category INTE
UON N

Priority Research Centre for Stroke and Brain Injury Project Grant$2,500

Funding body: Priority Research Centre for Stroke and Brain Injury, University of Newcastle

Funding body Priority Research Centre for Stroke and Brain Injury, University of Newcastle
Scheme PRC Project Grant
Role Lead
Funding Start 2016
Funding Finish 2016
GNo
Type Of Funding Internal
Category INTE
UON N

20152 grants / $40,252

Greaves Family Early Career Support Grants$30,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Andrew Gardner
Scheme Greaves Family Early Career Support Grant
Role Lead
Funding Start 2015
Funding Finish 2015
GNo G1501385
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

Centre for Translational Neuroscience & Mental Health Infrastructure Grant $10,252

Funding body: Priority Research Centre for Translational Neuroscience & Mental Health

Funding body Priority Research Centre for Translational Neuroscience & Mental Health
Project Team

Gardner, A.J., Stanwell, P., & Levi, C.R.

Scheme Infrastructure Grant
Role Lead
Funding Start 2015
Funding Finish 2015
GNo
Type Of Funding Internal
Category INTE
UON N

20142 grants / $52,512

John Hunter Hospital Charitable Trust$27,512

Funding body: John Hunter Hospital Charitable Trust

Funding body John Hunter Hospital Charitable Trust
Project Team

Gardner, A.J., Schofield, P.W.

Scheme Unknown
Role Lead
Funding Start 2014
Funding Finish 2014
GNo
Type Of Funding Internal
Category INTE
UON N

Jennie Thomas Travel Fellowship$25,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Scheme Post-doctoral Fellowship
Role Lead
Funding Start 2014
Funding Finish 2015
GNo
Type Of Funding Internal
Category INTE
UON N

20131 grants / $43,200

Brain Foundation Research Grant for Neurotrauma $43,200

Funding body: Australian Brain Foundation

Funding body Australian Brain Foundation
Project Team

Levi, C.R., Gardner, A.J., & Stanwell, P.

Scheme Neurotrauma Award
Role Investigator
Funding Start 2013
Funding Finish 2014
GNo
Type Of Funding External
Category EXTE
UON N

20121 grants / $10,000

Jennie Thomas PhD Travel Funding$10,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Scheme Jennie Thomas PhD Travel Award
Role Lead
Funding Start 2012
Funding Finish 2012
GNo
Type Of Funding Internal
Category INTE
UON N

20111 grants / $21,780

NSW Sporting Injuries Committee - Sports Research & Injury Prevention Scheme Grant$21,780

Funding body: NSW Sporting Injuries Committee

Funding body NSW Sporting Injuries Committee
Project Team

Kay-Lambkin, F., Gardner, A.J., Stanwell, P. & Levi, C.R.,

Scheme Research & Injury Prevention Scheme
Role Investigator
Funding Start 2011
Funding Finish 2012
GNo
Type Of Funding External
Category EXTE
UON N
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Research Supervision

Number of supervisions

Completed3
Current5

Total current UON EFTSL

Masters0.15

Current Supervision

Commenced Level of Study Research Title Program Supervisor Type
2017 PhD Post-concussion changes in the pain processing system and cervical spine in athletes with and without headache Physiotherapy, Australian Catholic University Co-Supervisor
2017 Honours Exploring the possible long-term consequences of a career in professional rugby league among retired former players Medical Science, Karolinska Institute Principal Supervisor
2016 Masters Test re-test reliability of a new computerised neuropsychological test for sports concussion management Psychology, Macquarie University Co-Supervisor
2016 Masters Analysing Accelerometer Data in Relation to the Magnitude and Direction of Forces that Contribute to Concussion in Rugby League Players M Philosophy (Med RadiationSc), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2016 Masters Construct validity of a new computerised neuropsychological test for sports concussion management Psychology, Macquarie University Co-Supervisor

Past Supervision

Year Level of Study Research Title Program Supervisor Type
2017 Masters The effect of fatigue on male professional athletes' performance on the Sport Concussion Assessment Tool-Third Edition (SCAT-3) Medical Science, The University of Queensland Principal Supervisor
2014 Honours Validity of Computerised Concussion Testing: Detection of Motivated Poor Performance Using CogSport Psychology, University of New England Co-Supervisor
2014 Honours Effects of the Testing Environment on Baseline Performance on Computerised Cognitive Tests Used for Concussion Management Psychology, Charles Sturt University Co-Supervisor
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Research Collaborations

The map is a representation of a researchers co-authorship with collaborators across the globe. The map displays the number of publications against a country, where there is at least one co-author based in that country. Data is sourced from the University of Newcastle research publication management system (NURO) and may not fully represent the authors complete body of work.

Country Count of Publications
Australia 27
United States 18
Canada 7
United Kingdom 5
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News

UON awarded over $5.6 million in NHMRC funding

October 27, 2016

The University of Newcastle (UON) is delighted to announce the following successful researchers in the latest round of National Health and Medical Research Council funding. With the help of this funding, our researchers aim to tackle a range of health-related issues that impact our communities.

UON researchers shine in a glittering field of finalists

September 7, 2016

The University of Newcastle (UON) Alumni Awards Finalists have been announced, and we are delighted to see a broad range of UON researchers represented in the outstanding field.

Concussion researcher recognised for big impact

November 20, 2015

Neuroscience researcher Dr Andrew Gardner has been recognised for his significant contributions to medical research in Australia, winning the 2015 Griffith University Discovery Award from Research Australia.

Dr Andrew Gardner

Position

Post-Doctoral Research Fellow
School of Medicine and Public Health
Faculty of Health and Medicine

Contact Details

Email andrew.gardner@newcastle.edu.au
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