Concussion Interviews & Resources 2024

Conversations about the impact of concussion and traumatic brain injury have been increasingly prevalent in recent years. Patients, researchers, clinicians, and other stakeholders have spoken out to raise awareness for the risks associated with concussion. Last year there was a senate inquiry into repeated head trauma in contact sports, and just two weeks ago the Brain Foundation was part of an event in Canberra focusing on chronic traumatic encephalopathy (CTE).

Brain Awareness Week 2024 is an important time to continue these conversations, which is why we have interviewed several key concussion experts. We asked each of them several questions about their area of expertise, with interesting insights about CTE, research, sports guidelines, and more.

Click the headings below to jump to a specific section.

What is traumatic brain injury?

A traumatic brain injury (TBI) can be caused by a forceful bump, blow, or jolt to the head or body, or from an object that pierces the skull and enters the brain. It is quite a broad classification, used to describe a wide range of injuries.

Some general distinctions that are used to describe TBIs are based on the type of damage and the severity. Different types of damage include focal (confined to one area of the brain) or diffuse (happens in more than one area of the brain). Severity is described as mild, moderate, or severe. A TBI is considered moderate-to-severe if there is a loss of consciousness that is longer than 30 minutes and memory loss that lasts over 24 hours. Any lesser injury is considered mild, including concussion.

Symptoms of a TBI can vary, but may include slurred speech, headaches, confusion, dizziness, memory problems, and more. The duration of symptoms also varies between patients. In some cases symptoms may resolve in hours or days after the injury, but others may experience symptoms for weeks or months.

What is a concussion?

A concussion is a type of mild traumatic brain injury (mTBI) that can occur when the head or body experiences a sudden impact or jolt. It is a common sporting injury, particularly in body contact sports (e.g. football, boxing), and recreational activities where falls are common, such as horse riding, cycling, skiing and diving.

The impact causes brain strain with resultant inflammation, damage to neurons, and a change in your metabolic state. Your brain suddenly releases neurotransmitters that can either overstimulate or inhibit brain function, and there may be microscopic bleeding with a loss of brain cells.

There is also a type of injury called a ‘subconcussion’, which refers to head injuries that do not result in the clinical symptoms of a concussion but can carry less, equal or greater force than a concussion. Individually, these injuries seem minor because the person won’t show any noticeable symptoms. However, repeated subconcussions can compound over time and cause cumulative injury to the brain.

Brain diagram with one section coloured red, to illustrate inflammation in a concussion.

Expert Interviews

Dr Rowena Mobbs, Mater Hospital Sydney

Brain Foundation: Can you tell us a bit about your background as a neurologist? What drew you to specialise in concussion, CTE & dementia?

Rowena Mobbs: As neurologists we diagnose and treat all the non-surgical conditions like stroke, epilepsy, neuropathy, MS and dementia. We are often there to support patients through chronic illness and monitor their progression. Concussion is a recent area of focus for neurologists because traditionally these patients might have been seen by a sports medicine specialist or GP. We now have the benefit of multidisciplinary teams across these specialists but incorporating neurologists who can manage long term concussion and complications such migraine and CTE. I was drawn to this field because of a love of sport combined with a fascination about dementia, and recognition that Australia is facing a wave of dementia as we live well into older age. 

BF: What are the immediate and long-term symptoms of a concussion?

RM: Concussion is often mixed with whiplash or indirect forces strong enough to cause brain injury. Symptoms of concussion are so varied and complex that it is true when people state that ‘no two concussions are the same’, anywhere from headache to confusion to jolting vision. Concussion itself can be prolonged and cause persisting post concussion symptoms (PPCS) months after injury. Often migraine, which mimics all of the potential symptoms of concussion and is not just about headache, can overlap. It is important to know this because we have direct treatments of migraine, whereas we do not have a tablet to fix PPCS. That said, there are medications for psychological, sleep and general wellbeing in PPCS as part of ongoing holistic care. 

BF: How does a history of concussions impact the risk of developing conditions like Chronic Traumatic Encephalopathy (CTE)?

RM: It is really the total subconcussion exposure added to the lesser concussion history that comprises the risk of CTE, as it is thought due to thousands of repetitive brain injury events. This could be due to tackles in football, blasts or parachuting injuries in the military, or head impacts sustained in occupations such as mining that can increase risk. The longer the exposure the higher the risk. Other factors can come into the picture such as more severe brain injuries (bleeds, brain bruises), alcohol use disorder or smoking that can increase overall dementia risk and perhaps accelerate CTE.

BF: What are the most exciting or promising areas of research in the field of concussion right now?

RM: The field of biomarkers to detect brain injury looks promising for the coming 5 years. Also monitoring of subconcussion risk through mouthguard technology for example is of interest. In our research we are interested in CTE biomarkers so that earlier management is instilled and future treatment targets can be generated. There is a lot we can do to assist someone if they have CTE including mood and memory medication as well as support and tailored advice. This is where the Concussion Connect program of group support has been a success.

BF: In your opinion, what should we be prioritising to reduce the impact of concussion in Australia? 

RM: We ought to be looking to reduce Australia’s dementia risk overall through a good sporting culture of brain and vascular health. Kids learn so quickly and are interested in the human brain, so why not avert dementia risk from a young age where we can. Sports must themselves be open to independent advice and research, and this is why we need government involvement and other community stakeholders to ensure best practices are maintained on both concussion and subconcussion ramifications.


Dr Alan Pearce, La Trobe University

BF: Can you tell us a bit about your background as a neuroscientist? What led you to focus on sports-related concussion?

Alan Pearce: I’ve been involved in neuroscience for nearly 30 years now. I was born and grew up in Perth doing my PhD at the University Department of Medicine at University of Western Australia. I’m technically a neurophysiologist where I use a technique called transcranial magnetic stimulation (TMS) to investigate the integrity of the human central nervous system. TMS is well established and has been a key investigative technique for me to understand the acute and chronic outcomes of sports-related concussion and repetitive neurotrauma from exposure to sub-concussive impacts experienced in contact and combat sports.

When I finished my PhD and moved to Melbourne, I originally wanted to use TMS to understand the mechanisms of neuroplasticity following conditions such as stroke, Parkinson’s disease and other movement disorders. But I fell into concussion quite serendipitously around 2011 when I met a football player who said what about sports concussion? I had heard of cases in America but nothing was being done here in Australia on retired football and rugby players who were describing their symptoms but not being listened to. When I started using TMS in this group, I was quite surprised to see what I was finding in their results and decided this is what I need to focus my research interest on. I have since published multiple studies in acute concussion responses, those with persistent post-concussion symptoms, and those with long-term chronic outcomes as well as collaborating with the Australian Sports Brain Bank to publish studies on chronic traumatic encephalopathy (CTE).

BF: What are the most common misconceptions about concussions?

AP: There’s quite a few! The first is that concussion is not a ‘head knock’. Head knock as a descriptor downplays the serious of concussion which is essentially a brain injury. Another is that one needs to be knocked out to be concussed – there are nearly 20 signs/symptoms of concussion and loss of consciousness only occurs in about 10% of all concussion injuries. More recently, the science is telling us that concussions are not the main driver for risk of CTE. What we are seeing in the recent literature is that CTE risk comes from exposure from multiple smaller impacts that do not cause signs or symptoms of concussion (sub-concussive impacts). Those who have posthumously diagnosed with CTE were found to have long careers playing their sports, and the number of concussions didn’t seem to correlate to their CTE diagnosis.

BF: How long does it typically take for someone to fully recover from a concussion?

AP: Concussion recovery is a very individual response. But generally speaking, symptoms resolve around 5-10 days. However some of our research, and research by colleagues internationally, have shown that while symptoms resolve earlier, the brain takes around 20-30 days to recover. This may be a reason why we see in athletes, those who are concussed have a 2.5 – 3 fold risk in further injury after a concussion – we think that brain processing may be diminished during this time, even though the athlete says they are fine. 

Recently, the Australian Institute of Sport have published recommendations of a 21 day rest after a concussion – I’m hoping that our scientific work has contributed to this new decision.

BF: Are there any promising treatments or interventions being researched currently?

AP: At this stage there are preliminary studies, but nothing that will be available in the next few years. We certainly need funding support to investigate treatments or interventions following concussion. At present, the best recovery recommended is an “active recovery” where the concussed individual, no longer sits in a darkened room and does nothing, but rather is directed to undertake light aerobic activity and gradually increase the exercise intensity within symptom limits (so if symptoms are aggravated, the individual eases back the exercise). With colleagues, I am looking at nutraceutical interventions such as Omega-3 fish oils following concussion and in those with persistent symptoms. I’m hoping that the Brain Foundation will support us in trialling a study (fingers crossed!).

BF: Is there anything else you would like to highlight about concussion?

AP: It’s great to have the continuing interest in concussion and CTE. Traumatic brain injury is an epidemic, and mild traumatic brain injury (which concussion falls under) accounts for a majority of TBIs, yet the level of research support and funding is not proportionate. Many people with mild TBIs and concussions come to my lab and research program in tears because they are lost and are frustrated with the lack of knowledge in this area. As many are left disabled and struggle to find/hold work, the health economic impacts are significant. We appreciate the support of organisations like the Brain Foundation, but we need continued help in understanding this “silent injury”.


Dr Jennifer Makovec Knight, Monash University

BF: Can you tell us about your background and how you came to be a concussion researcher?

Jennifer Makovec Knight: I initially completed a bachelor of psychology where I developed a keen interest in all things brain and cognition. I then completed a doctorate in clinical Neuropsychology where my thesis was on headgear and concussion in junior Australian Football. That research allowed me to network with leading researchers, obtain a role as a research fellow where I now work on various studies including concussion and intimate partner violence, concussion amongst people under the influence of drug and alcohol, as well as work on therapeutic intervention.

BF: What is the current focus of your research?

JMK: I am particularly interested in high risk groups, with a focus on improving diagnostic certainty and optimising outcomes for concussion amongst those less likely to receive the support they need.

Read the project summary for Dr Makovec Knight’s Brain Foundation research grant >

BF: How reliable are current diagnostic methods in identifying mild concussions?

JMK: Current diagnostic methods rely on clinical judgement using standard subjective reports of the injury event and symptoms, cognitive testing and brain imaging (to rule out more severe brain injury). While in many cases these methods are reliable, there is limited utility when the patient is affected by alcohol or other drugs when sustaining the injury (which is quite common in presentations to Australian emergency departments).

BF: How has concussion diagnosis evolved over the years? Are there any new diagnostic tools or methods on the horizon? 

JMK: There have been significant improvements in early recognition of concussion particularly in sports settings with improved routine cognitive testing. Future directions are focused on advanced neuroimaging, blood biomarkers, genetic testing and other emerging technologies such as artificial intelligence. These will aim to provide objective diagnostic and prognostic information for optimal patient care. 


Professor Kevin Norton, University of South Australia

BF: What motivated you to pursue a career in exercise science? To what extent have you studied concussion? 

Kevin Norton: I have an interest in the physiology of exercise since my early undergraduate years at Flinders University. I undertook a PhD in the USA in the 1980’s looking at the effects of blood doping on performance. This was a big issue back then as some professional athletes were using synthetic EPO and there were many deaths, particularly among elite cyclists.

Photo of Prof Kevin Norton, contributor during Brain Awareness Week

Over the years I’ve focused on the limits of human capabilities. How big, fast, fit etc and how/why these are continuing to evolve. I’ve also been involved in the quantification of how sports evolve and the impact these developments have on players, injury potential and the game styles. I was a consultant to the AFL for 14 years (plus NRL, Rugby Union etc) on the link between rule changes and injury risk – for example, if a rule change might increase or decrease the speed of play or the risk of high-speed collisions, as well as the way a game would ‘unfold’ or ‘look’ as a spectacle. Collision and associated concussion / injury was one aspect of this work. 

BF: Last year you were involved in a study that measured brain activity following concussion. Can you tell us a bit about that study?

KN: In recent years I have worked with a couple of companies from the USA who have developed technologies to measure the disruption of brain function following mild brain trauma (ie. concussion). Our recent JAMA paper was the first in a series of concussion-related research in amateur Australian Rules football players (men and women).

We used a new piece technology to measure ‘Headpulse’. This is the ‘wobble’ in the brain as the blood flows from the heart into the skull. It is technically a resonance that involves micro g-forces. The technology can detect the g-forces using accelerometry and record changes in these patterns following an injury.

The published work involved attending amateur football games and waiting for a concussion to occur. We had measured hundreds of players pre-season who were not concussed so we had a good sense of what their brain function was like at baseline. Following a concussion (typically 1-2 days post injury) the wobble in the brain showed a ‘stiffer’ resonance pattern. This is likely due to swelling and/or other alterations in the brain. We also asked players how they felt and how significant their symptoms were in their recovery phase of up to 1 month.

Overall, the study found that there was about a 2-week disconnect between what players felt (ie. their symptoms) and what the headpulse was telling us. That is, many players were saying they were symptom-free but the brain headpulse showed this was not back to normal until about 2-weeks after the initial symptom-free phase. Therefore, a longer recovery time was suggested – perhaps up to 1 month. Note that in recent times the AIS have recommended 21-day mandatory recovery periods for community participants and children.

BF: It’s great to hear about how this study can inform return-to-play guidelines. Is there any further research you’d like to see in this area?

KN: Yes, there are some interesting dilemmas in the way people are instructed/guided in their return to play. Specifically there are conflicting guidelines, i.e. most guidelines suggest physical activity is important in the recovery phases (once significant symptoms decrease), but other research shows if the activity involves elevated g-forces – like running or bouncing-type activities – then this can exacerbate symptoms and cause longer recovery time. At the moment there is a lot of guesswork in terms of what the best return-to-sport activities should be and how this should be structured.

BF: What role do schools, sports organisations, and parents play in concussion prevention and management?

KN: I think everyone should understand the general guidelines and recommendations for acute care and longer-term management. I think we should think about first aid and CPR and imagine it is sort of everyone’s responsibility. Having said that, unlike CPR there are very few ‘courses’ workshops to reinforce these areas. Also, diagnosing concussion is not black and white and no one really relies just on a questionnaire. Often there are clinical signs/tests that go along with questionnaires in order to call a concussion. In our 2-year study attending hundreds of AFL games in the amateur leagues, I only ever came across one medical doctor involved in a concussion evaluation. Therefore, we have to rely on sports trainers, parents, physios, volunteers etc so there is a growing responsibility on the shoulders of these people.

Further information & resources

If you would like to learn more about concussion, CTE, and traumatic brain injury, you can check out the following resources: 

Support services

Below are some of the organisations and support services available for people living with long-term concussion symptoms or possible CTE. 

Concussion Connect – Macquarie University
Concussion Connect is a neurology and psychology group therapy program for those suffering the effects of repeated head injury, with risk of chronic traumatic encephalopathy (CTE).

Dementia Australia
An organisation that represents the more than 400,000 Australians living with dementia and the more than 1.5 million Australians involved in their care. They provide a range of support services, informative resources, awareness events, advocacy programs, and more.
National Dementia Helpline: 1800 100 500 

ConneCTErs Australia
This organisation provides support and community to people who have been affected by CTE. It was founded by Kayleen Doyle after her husband was provisionally diagnosed with CTE.

Synapse – Australia’s Brain Injury Organisation
Synapse provides a range of support services for people who have been impacted by brain injury and disability. These services promote quality of life, self-determination, and choice through information, specialist support, and targeted research activities.
Tel: 1800 673 074 

Brain Injury Association of Tasmania
83 Melville Street, Hobart, TAS 7000
PO Box 4580, Bathurst Street PO, Hobart, TAS 7000
Tel: 03 6230 9800

National Assistance Card
1 Liverpool Street, Hobart, TAS 7000
PO Box 4580, Bathurst Street PO, Hobart, TAS 7000
Tel: 1300 242 827

Australian Sports Brain Bank
The Australian Sports Brain Bank’s mission is to use expert diagnostic neuropathology, coupled with research, to understand chronic traumatic encephalopathy (CTE) and other brain pathology that is associated with repetitive head injury in sport and elsewhere. They empower families and loved ones by providing accurate diagnoses, and use donor tissue for biomedical research into CTE and other brain disorders.
Tel: (02) 9351 0943 

Brain FoundationThe Brain Foundation is the largest, independent funder of brain and spinal injury research in Australia. We believe research is the pathway to recovery.