FLAG Researcher Spotlight: Dr Josh McGeown

Dr Josh McGeown

“It's now about how we make the knowledge these tools give us accessible to patients and clinicians at scale so they can make a difference.”

So please tell me your name, title and research interest.

I'm Josh McGeown. I'm a Senior Research Fellow at Mātai Medical Research Institute in Tairāwhiti-Gisborne and I have an Honorary Academic affiliation with the University of Auckland. I am also a core member of the AUT TBI Network and a recipient of the Neurological Foundation First Fellowship. My work to date has focussed on translating advances in our understanding of the pathophysiological consequences of mild traumatic brain injury (mTBI) into clinical practice to improve patient outcomes. I am involved with international collaborations focussing on the prevention, assessment, and rehabilitation of mTBI. I am now leveraging advanced multimodal magnetic resonance imaging to create a complete picture of the brain’s state after mTBI and how changes in this state explain subjective symptom reports over the recovery period.

Where did your academic career begin?

I’m Canadian originally. I did an Honors Bachelors of Kinesiology and a Master of Science at Lakehead University in Canada. Then I did my PhD at the Auckland University of Technology.

Kinesiology is the study of human movement, and in Canada, it is the foundational course for pursuing a career in medicine, physiotherapy and other health-related fields. At the time I was aspiring to gain entrance to medical school to train to be an orthopaedic surgeon. In the third year of my degree, I was playing rugby for my university and suffered mTBIs in back-to-back weeks. I dealt with nasty symptoms for nearly two years and my grades really suffered. I went to several clinicians, and none of them really helped me. So, one day, I just went to the library and started searching for studies on how to heal a brain. I didn’t find much research on it, and I needed to boost my grades to have a chance to get into med school, so I selfishly decided to do a Master's on how to use exercise to boost neuroplasticity to help the brain heal itself.

I also founded my own neurorehabilitation business during my Master’s. I was learning a bit about research, working clinically, and seeing a fundamental disconnect between what we say is clinical research and the reality of clinical environments. It was at this point I decided to commit to a career in academia to try and close this gap. Then in 2018, I got the opportunity to move to New Zealand on a full scholarship to do a PhD at AUT with Professor Patria Hume.

So, tell me more about your PhD. Was this quite clinically based?

I was embedded at the Axis Sports Medicine Concussion Clinic, working alongside Dr Stephen Kara and physiotherapist Katherine Forch. My PhD was asking what we could do better in the first couple of weeks to prevent people from experiencing persistent symptoms like I did. In our work we asked what do we have to screen for? And what do we find when we screen? Now, how do we treat that? And does that change outcomes?

We showed that if you do this kind of acute model of care, about 96% of people recovered by eight weeks compared to less than 50% of people feeling better at the same timepoint following the rest-based “wait and see” approach. We also identified a simple prognostic model based on clinical data that helped us identify who was unlikely to recover in the first few weeks so they could be prioritised for follow-up appointments in the clinical service.

And tell me how you got involved in Mātai.

I decided to finish writing up my PhD thesis while exploring the country in my campervan. Early in this journey I was driving around the East Coast. I heard Mātai had just opened, and I had met the Director – Assoc Prof Samantha Holdsworth – once on Zoom. I just showed up in my van one day and said hello. Mātai were planning to do a study with young rugby players to study mTBI. I had done similar research and gave advice based on my experiences. I was offered a job to join the team and drive this study after finishing my PhD early in 2021.

So, what is your research focused on now?

As Mātai is such an excellent neuroimaging facility, I started working with MRI and other tools. I had never worked with MRI data until I started my first postdoc. In my PhD, I wanted to translate assessments that looked promising in the lab into the clinic, but learned the hard way why it’s so hard to translate things into clinical practice. Many of the reasons these tools didn't work is that we don't actually have a ground truth that we can validate these things off – this is what we’re hoping MRI can give us.

With the MRI scans, we're trying to answer what tools we need in our toolbox to measure and assess mTBI objectively, and how that evolves, if someone does or doesn't recover. Then, once we know what that looks like, we can bring in fluid biomarkers or other clinical tests and see how strongly they correlate with what we see on those brain pictures. This has been my main focus for the last four years or so.

I acknowledge that MRI is very expensive and accessibility can be a challenge, so the objective is to find a ground truth to validate more feasible and scalable assessments that we could get in clinics all over the country or worldwide. Because in NZ, we love rugby; in Canada, it's ice hockey; and in the UK, it's soccer, right? We can use these discoveries to improve patient outcomes and make sports safer.

How do you envision the future of neuroscience to change, particularly in New Zealand, over the next decade or so?

We, as a neuroscience community, are making technological breakthroughs and developing new exciting tools. It's now about how we make the knowledge these tools give us accessible to patients and clinicians at scale so they can make a difference.

I think the next step will be deepening collaboration across neuroscience disciplines and leveraging advances in statistical modelling and machine learning to identify complex patterns that span across clinical, fluid biomarker, neuroimaging, and pathological data like what Dr Helen Murray is working on at the Neurological Foundation Human Brain Bank. That's where I believe we're really going in the next 10 years. We're going to be able to leverage the new tech and the new analysis tools to embrace the complexity of the brain rather than trying to oversimplify it. The goal is that we will eventually get to a point where we'll have clinical decision support tools that take 100 different input variables and tell the clinician, OK, this person needs to go down this treatment path.

This all requires collaboration between bench scientists, clinical scientists, bioengineers, clinicians, and patients. Therefore, I think people need to take the lead in fostering these collaborations. This is something I am trying hard to develop – where I am a jack of all trades, and I can facilitate this crosstalk. In NZ, we have all the talent and knowledge to solve this problem, but oftentimes we don't know how to speak each other's language. If I'm speaking French and you're speaking German and we can't find that common ground, we can't get over the hump to make these discoveries. This is the niche I am trying to fill.

Interviewed by Lily Bentall (University of Otago)