Forest for the trees

12 Apr

Everybody knows about the ‘concussion issue’ in the NHL, NFL and hockey and football in general (youth-pro levels). It’s all over the media. Occasionally it will be discussed somewhere else, but it rarely holds attention for much longer than it takes to read or watch the story. Unfortunately, brain injury is so widespread and can be so debilitating that it is overwhelmingly ignored and, unless there’s a feel good story, or someone to blame for the injury, it never gets coverage. Concussion, and brain injury in general, is not a sports story. It’s a health/medical/human interest story with a sports angle, but it’s not a sports story.

There are plenty of stories about people who have been brain injured and how they’ve recovered, but you have to look for them. Stories about pro athletes or children being concussed are much more prevalent, and they’re what most people will read. I began writing this blog because I’m dealing with issues from my brain injury in 2003, I like writing and I like playing and watching sports. I was injured while cycling but the things that I find the most difficult are not sports issues, they’re day-to-day issues. The concussion issue has become prominent in hockey and much attention has been paid to brain injury because of the importance we place on the sport. Unfortunately, I think Canada’s obsession with hockey may be clouding our view of the problem.

The problem is not the lenient rules in hockey. The problem is not that players are bigger and stronger now. The problem is not fighting or illegal hits. The problem is brain injury. Once concussions were recognized as an issue to be addressed, our next step was finding a solution. We (society) skipped the whole part about understanding brain injuries. Hockey’s relationship with brain injury is not society’s. Hockey leagues are looking for ways to avoid brain injury and still leave the sport physically tough and fun to play, but hockey is not general society. When Sidney Crosby (or anybody who has had a concussion) has a headache, feels ‘off’ or otherwise feels that his body is not reacting the way he would like, he has those same symptoms regardless of whether he’s playing hockey, getting groceries or spending time with friends and family.  His concussion is a problem, not because it makes skating, shooting or checking difficult, but because it makes his life more difficult.

Hockey is looking for a specific solution to its specific problem – concussions in hockey. That should not, and almost certainly cannot be society’s goal. Brain injury can happen to anybody. While there are no opportunistic (or, as many commentators would say, “tough”) defencemen waiting to knock the heads off pedestrians crossing the street with their heads down, there is everything else. As physical and rough a sport as hockey is, not everyone who plays it  and not everyone who gets hit, is brain injured. As easy as it is to imagine vicious and senseless violence by players gripping sticks and wielding blades on their feet, there’s really only so much that can happen within a confined space (indoors, for the most part), during a set time. During a game, a player isn’t likely to fall off a ladder or hit their helmet-less head on a low hanging light fixture.

Life is not confined. Shit happens. It’s not your fault, my fault, his fault or her fault, it just happened. Blame and punishment are, for the most part, pointless and distract attention away from the real issues.  If you’re brain injured, you’ve got problems to deal with and blaming or punishing someone else is not going to fix them. Last year, Tara Bradbury, a reporter for our local newspaper did a 6-part series on brain injury. It was very well received and it really helped to raise awareness of brain injury. It is important for hockey and all sports to work on the brain injury/concussion problem in their sport, but it doesn’t have to frame society’s understanding.

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40 Responses to “Forest for the trees”

  1. Birgit Diederich April 12, 2012 at 18:40 #

    I know you’re in Canada, but this post really resonated with me since my brother plays hockey and has suffered from 2 concussions. I recently read a blog about how Pennsylvania made a law for young athletes so that they are unable to play if they show signs of a brain injury until they are cleared by a doctor. It also said that there is an effort to educate athletes, coaches, trainers and parents about brain injuries after research showed that 40% of athletes return to play too soon after their injury. I think efforts like this need to be made early on, and hopefully this effort can carry on through adulthood. If you want to read more about it, here is the link: http://www.traumaticbraininjury.net/pennsylvania-enacts-concussion-laws-for-young-athletes/

    Thanks so much for your blog, I really appreciate reading the content you post!

  2. A Concerned Mom April 13, 2012 at 07:57 #

    Accidents happen, and there are no guarantees in life. Even if someone is proven negiligent, the injured party often can’t be made whole. That’s just life. Sometimes you just have to be thankful the accident wasn’t worse.

    However, I’m not sure if “accidents” are our primary problem when it comes to concussions in youth sports. Kids try to play like the professionals, and when you go all out like that, injuries are more likely (it’s a part of the sports saga that’s been kept quiet – no one paid attention to the price professional athletes were paying with respect to brain trauma). When you start looking, you can find concussion stories everywhere, but many parents, coaches, students, and schools are still in the dark (greater awareness may come from the NFL lawsuits).

    Children and teens have been allowed to play certain sports based on the belief that the benefits out weighed the risks. Repetitive brain trauma wasn’t factored in when society decided it was acceptable for kids to play some of these more aggressive contact/collision sports. Now that we know more, it may be time to re-evaluate which sports kids can play at different ages as well as how. Perhaps some sports could be modified to reduce the incidence of brain trauma (recognizing it can never be brought down to zero). Perhaps others shouldn’t be played by children under a certain age. Maybe some of the smaller schools shouldn’t be allowed to sponsor certain sports if they don’t have the resources to support them (professionals get the best treatment, our kids often get sub-standard care). I don’t think we have all the information yet, but I certainly think we shouldn’t stick our heads in the sand for a few decades while researches try to determine exactly how many impacts to the head a child can take before sustaining permanent damage.

    I’m disappointed that better information isn’t available and that schools and youth leagues haven’t been keeping better track of injuries. At the very least, I believe parents should now be informed that we really don’t know how safe it is for kids to play certain sports – that they could be sustaining impacts which could cause problems or developmental issues down the road. Based on a number of stories I’ve read, I also believe youth leagues, schools and coaches have to be put on notice to be more careful with their athletes. I read stories on a daily basis where it’s obvious that a really bad decision by a coach resulted in serious life altering injuries for a student athlete (basic stuff, like don’t have flag football practice in a cafetaria).

    “The story begins on a rainy Friday afternoon, Sept. 24, 2010, when Stewart and her teammates were practicing in the cafeteria. Stewart hit a pillar while going for a pass. She doesn’t remember the impact or the pain, only that she felt something hard in her mouth.”

    Read more here: http://www.thenewstribune.com/2012/04/13/2105915/concussion-plagues-teen.html?storylink=fb#storylink=cpy

  3. Don Brady, PhD, PsyD, NCSP, Licensed Psychologist April 13, 2012 at 10:52 #

    The terms ACCIDENT and FLUKE are misnomers when it describes a sport-related concussion.

    Please read the below definition of an accident:

    =========================================================================

    Definition of ACCIDENT- Merriam Webster (obtained online)
    1
    a : an unforeseen and unplanned event or circumstance

    =========================================================================

    Sadly, ignorance manifests itself when the adjectives ‘accidental’ or ‘fluke’ are used to describe a presenting concussion/brain injury.

    ‘ACCIDENTAL’ or ‘FLUKE football injuries and deaths’….. ARE FORESEEN, PREDICTABLE and EXPECTED every year…and clearly are neither improbable nor unforeseen.

    Though a so-called ‘small statistical percentage of children’ may die each year…each death is both clinically and humanly significant!!!!

    Our children are being placed ‘in harms way’ when they walk onto on the football fields, and for some youngsters their fields become their ‘sports graveyard”…for what logical reasons????

    It is becoming more apparent that we are playing Russian Roulette with children’s brains, emotions and other parts of their bodies.

    Perhaps parents should read this following mantra to their child:

    Today as you enter onto the football field…it may be the last time that I know you as my son/daughter. Statistics state you may be brain-damaged or die as a result of participating in football.

    Some advocates of football argue football creates physical health…suggest they honestly examine the financial, physical, social and emotional costs of a sport-related injury to their child. Also encourage parents to ask numerous pro and amateur players who retired (planned or injury-induced) from football re their current injury status and related adverse implications.

    (with apologies for repeating portions of a recent post)

    • A Concerned Mom April 13, 2012 at 12:13 #

      In any collision sport, there will likely be a certain number of head injuries – the injuries are a direct result of how the game is played and practiced – they’ll probably range from the rare catastrophic injuries to subconcussive damage that isn’t fully understood yet (don’t think subconcussive damage is on the average parent’s radar).

      There are other activities that children participate in, such as playground activities, basketball, bike riding, softball/baseball, horse back riding, soccer, hockey, hiking, boating, bounce houses, etc., that can also result in injury. Experts could probably figure out how to modify some of these activities to make them safer for children (for instance, the youth soccer leagues my children participate in don’t allow slide tackling/rough contact, which reduces the chance of injury).

      • Don Brady, PhD, PsyD, NCSP, Licensed Psychologist April 13, 2012 at 13:22 #

        There is an inherent, and often not readily acknowledged, risk of suffering a brain injury via contact sport participation…insurance companies reportedly are becoming more concerned re liability insurance risks re this sport participation…perhaps skyrocketing and prohibitive insurance premiums will serve to be the demise of some organized contact sports?

    • A Concerned Mom April 13, 2012 at 16:24 #

      Did you see this article?

      http://vitals.msnbc.msn.com/_news/2012/04/13/11183481-opinion-youth-hockey-injuries-border-on-child-abuse?lite

      “As evidence grows about the toll concussions take on the pros, the chance that a parent will let a child take those risks gets smaller every day.”

      • Don Brady, PhD, PsyD, NCSP, Licensed Psychologist April 13, 2012 at 21:57 #

        Thank you for sharing the article.

        The issue of child abuse related to collision sport participation apparently continues to gain momentum…and hopefully will eventually be listened to, reflected upon, and responded to accordingly…to protect the brains of our youth.

        Although the article focuses on hockey, similar concussion/brain injury rates/stats have been reported for football, soccer and hockey.

        My wife and are curious why parents who responsibly protect their preschoolers later allow their children to be let loose on the various school sport fields and engage in dangerous collision sports… especially while their brains are yet fully developed. Sadly, children are being needlessly being placed ‘in harms way’…and a brain is a terrible human component to waste.

        It is time to stop ‘normalizing’ both sport-related brain injury and other athletic injuries.

        I recently spoke with an MD who believed that collision sports will significantly decrease when mothers and lawyers become activists against these youth sports.

        Furthermore, I believe rising insurance liability premiums will necessitate the dropping of some collision sports.

        Finally, I think it would be interesting to grasp how much money schools and colleges were paying over the past few years and are presently paying for liability insurance /medical insurance coverage for each specific sport offered…

      • A Concerned Mom April 14, 2012 at 16:42 #

        http://www.youthfootballonline.com/coachs-corner/safety-matters-players-equipment-check-list/

        “It is important that all coaches and parents are educated on concussions. Concussions aren’t as prevalent in youth football because the youth body is not as strong and developed as high school, college and NFL players. For more information on concussions, visit the Pop Warner safety page.”

    • A Concerned Mom April 14, 2012 at 10:50 #

      Many of todays parents were brought up in an environment where sports concussions weren’t viewed as a serious injury (with the assumption that most kids were fine after a mild concussion). My kids have been involved in sports since they were toddlers (classes at the YMCA, etc.), and the programs were always modified to make them safe for children (this was our first injury requiring medical attention). My son had a friend who had played bantam football since kindergarten, and he really wanted to play. He tried a week of football camp and loved it. During the parent meeting in the gym at sign-up, we were told the primary objective was for the kids to have fun, and that they would concentrate on fundamentals. The topic of injuries and/or concussions was never brought up.

      Once my son was injured, I was shocked by the information I discovered on-line. Knowing what I now know, I probably either never would have signed him up or would have pulled him from the first practice.

      Since the bantam program was run by a board of directors who had entered into a facilities rental agreement with the school corporation, they truly felt they had no obligation to step in (no liability). The bantam program is run by volunteers, so they all assume they’re free from any liability as well. I documented my concerns in writing to the point where the issue should be reviewed by the corporation’s insurance carrier. I have no idea what the insurance carrier’s response has been. The only change I’ve been made aware of so far is that the school board approved a new facilities rental agreement.

      I’ve shared information with the school and other parents, but I’m not sure how receptive they’ve been to it. The NFL lawsuits may increase awareness, but at this point, it seems as though even the experts can’t agree on whether or not children should play (I’ve seen some claims that youth football is relatively safe). Realistically, I believe tackle football will continue to be played by young children at least in the short to mid-term. My goal is to facilitate the extension of our youth concussion safety law to the youngest levels of play so that parents, coaches, and athletes are at least informed of the risks. I also hope that the state department of education takes steps to make sure schools put in place concussion management protocols/procedures.

      • Joe Bloggs April 14, 2012 at 15:39 #

        Who said youth football was relatively safe and compared to what?

        Research is strongly suggesting that children should not be involved in collison sports until they are more matrue. There is almost no evidence that putting on a pad and helnet at six makes better players. Flag and touch football teach most of the skills without that damage.

      • A Concerned Mom April 14, 2012 at 16:38 #

        I’ll look for links … off the top of my head, I read something about youth football being safer (or at least resulting in fewer injuries) than youth soccer at the Pop Warner website some months back. Cantu and Guskiewicz disagree on whether youths under 14 should play. I believe Guskiewicz’s sons play youth football, and he said something about it being safer for them to learn better technique while they’re young.

        http://www.momsteam.com/health-safety/contact-collison-sports-okay-if-emphasis-developing-protective-skills-says-guskiewicz

        “Kevin Guskiewicz, PhD, ATC., Kenan Distinguished Professor and Director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at The University of North Carolina at Chapel Hill, argues that, while there are trade-offs, contact and collision sports are relatively safe for younger athletes as long as the coaching emphasis is on protective skill development. He notes that there are very few catastrophic injuries at the youth level, with most occurring among 16-17-18-year-olds who are playing contact and collision sports without having developed such protective skills. “We need to find ways to keep our kids physically active so they don’t become couch potatoes,” Guskiewicz says.”

        I don’t advocate playing at a young age, based on my son’s experience and what I’ve read, I highly suggest that other parents not allow their children to play …. but, I think most of the kids on my son’s team are signing up again next year. The reality in my state is that these youth leagues are not even required to provide any concussion information at all (there’s no oversight, volunteer run youth leagues have strong liability protections, and as a parent I’m disgusted by the entire situation).

      • A Concerned Mom April 14, 2012 at 16:44 #

        http://www.popwarner.com/football/footballsafety.asp

        “In Pop Warner Football, there is “an absence of catastrophic head and neck injuries and disruptive joint injuries found at higher levels.”

        The injury rate in Pop Warner Football is:

        less than one-third the injury rate in high school football (AND) less than one-fifth the injury rate in college football (AND) less than one-ninth the injury rate in professional football.”

      • A Concerned Mom April 14, 2012 at 16:50 #

        http://www.momsteam.com/football/choosing-sport-family-decision-weighing-risks-benefits

        … american football under age of 14 … relatively low injury rate (he’s not pushing football though, and clearly states it has a high injury rate for older players)

      • A Concerned Mom April 14, 2012 at 17:03 #

        http://moms.today.msnbc.msn.com/_news/2010/08/30/4983070-youth-football-is-it-safe-to-play

        “Youth football is a relatively safe sport prior to puberty. Injury incidence increases dramatically in high school, college and professional football. At each increasing level of competition the rate of injuries nearly doubles. If you want your son to experience the joy and camaraderie or football and remain free from serious injury, have him play youth football.”

      • Joe Bloggs April 14, 2012 at 19:23 #

        Kevin Guskiewicz, PhD, ATC is out of his league. His PhD is in Athletic Training, Cantu and Winston (CHOP) and numerous other parties with much higher degrees of education and expertise feel differently.

        I realize Kev got a Genius Grant but his contibution to science would not even warrant an entry on the CVs of real scientists and engineers. Kev is out of his deptth and is not qualified to issue guidence on the childrens health.

        Be concerned were you sources advice and the qualificatgions of the parties making such suggestions.

      • Jake Benford April 14, 2012 at 20:32 #

        Also remember that the lower the level of play, the less medical staff on site. The less medical staff on site, the fewer injuries that will be identified. This does not mean they are not happening.

      • A Concerned Mom April 14, 2012 at 20:47 #

        I didn’t include the links in support of youth football, rather I just wanted to illustrate that parents are being presented with conflicting information. How are parents supposed to make informed decisions when it’s so difficult to get good information (we don’t even have accurate figures on the number of concussions sustained in youth football)? How are parents supposed to advocate for their children and help managed their concussions when so often they aren’t provided with the information they need from pediatricians or emergency room doctors? How is the lay person expected to sift through all this information and determine which source, study or expert is accurate? How come no one is challenging the claims made on the Pop Warner website?

        I happen to agree with Cantu, but I bet a lot of parents will listen to Guskiewicz (they aren’t thinking about years of concussive/subconcussive impacts – that’s not on your average parent’s radar – at least in the mid-west).

        Oh, and was it Collins who just said concussions aren’t the boogie man? How does that help parents? For some unfortunate kids concussions are a boogie man that steals their future potential.

        http://www.knowconcussion.org/2012/04/13/expanded-concussion-treatment-centre-highlights-need-for-treatment-across-the-nation/

      • Joe Bloggs April 14, 2012 at 21:39 #

        Jake is on the mark that reporting in youth sports is grossly inaccurate.

        Concerned mom as far as Mickey Collins, Mark Lovell, Joe Maroon; they have done more to obfuscate the conceussion issue than anyone in sports medicine. They are scientific embarrassments. All one needs to do is consult the 58 lawsuits filed against the NFL for concussion mismanagement and the numerous Riddell Helmet lawsuits for education about their behavior. In reality Team UPMC/Impact will probably spend the balance of the natual lives being sued by former professional athletes. The courts will make public the true nature of their behavior.

      • Educator Mom April 15, 2012 at 21:17 #

        Education and laws are a start but how much good are they really doing? Just this weekend I was attending an indoor youth soccer game. Within a five minute period time, two players took a blow to the head from a ball kicked at close range. The first player staggered and grabbed her head for nearly a minute before the game was stopped and the player left the field in tears. I was stunned when the player was put back in the game within five minutes (and continued to be sluggish and somewhat off balance). And the other player was also sent back into the game. All this, in spite of the fact that state law is in place to protect the youth athletes from returning to play following a possible concussion. I contacted the league and was told that they were completely unaware of the law. Again I was stunned. Concussions and concussion law have been on the forefront of the television, print, and internet media in our state. How can a soccer league have missed it? How do we keep missing what we are doing to our kids? And when we did we stop doing what was best for them instead of what will win the game? My own son’s concussion was before the law was passed and there were only “guidelines” (that were NOT followed). It just turned my stomach to see that even a law was not protecting these kids. Changing the youth sports culture in our country may be like trying to move a mountain…

      • Dustin Fink April 15, 2012 at 22:16 #

        The need for athletic trainers… If you cannot afford one, you should not have collision/high contact sports…

  4. Chuck Manning April 13, 2012 at 11:40 #

    Having been involved in sports all my lif, I can truthfully say that concussions can be hidden for quite some time. Going on with you normal life as usual until the sudden headaches and nausea appears.

  5. Jake Benford April 14, 2012 at 17:11 #

    Accidents do happen, but I see a big distinction from life’s accidents and accidents in organized youth sports. When a kid hits his head while skating around and does not feel well afterward, he stops skating till he feels better, he listens to his body.

    When a kid is in organized sports, they stop listening to their body and listen to the coach. Coach says to play through pain/discomfort. Coach says they need to get back to practice or in the game for the team. Without this external pressure, I do not think most kids would get back to playing when they had a headache, felt nauseated, or could not remember everything. This is a learned behavior.

    As a society we need to understand that a concussion is a brain injury and ensure that the people we are trusting with our children understand the significance of this injury. How many of us would let our children play for a coach that did not allow water breaks? We as medical professionals and parents need to be the one to educate the coaches and other parents and limit participation if the coaches are not listening.

    • Dustin Fink April 15, 2012 at 15:56 #

      Ding-ding-ding!

      • A Concerned Mom April 16, 2012 at 09:10 #

        Dustin, Jake Benford’s comment is on target. Kids are being pushed to play in ways that result in injury (based on how they see professional athletes play, based on how they’re pushed by coaches and sometimes parents, they are being encouraged to engage in risky behavior without realizing there can be serious consequences). I liked the blog entry you wrote a month or two back where you discussed your personal “white paper” for addressing the problem. We need more than concussion laws, we need a greater understanding of the problem. There are good people involved in youth sports (along with some bad apples), most would do better if provided with the information and tools to do so.

  6. Don Brady, PhD, PsyD, NCSP, Licensed Psychologist April 14, 2012 at 23:18 #

    I agree with Joe… ‘relatively safe’ is a nonsensical phrase which attempts to discount the injuries and deaths that do occur from football participation each year.…

    Damaged childrens’ brains may unfortunately be apparent soon after the concussion injury occurs or the brain damage may manifest itself during a later developmental period. Though a so-called small statistical percentage of children may die each year… each death is clinically, humanly and spiritually significant!!!! Try telling a mom and dad who child has died on the gridiron that football is ‘relatively safer’…

    Our children are being placed ‘in harms way’ when they walk onto on the football fields, and for some youngsters their fields become their eventual ‘sports graveyard”…for what logical reasons????

    Concerned mom… it’s obvious you are gathering info re concussions. Suggest you also be fully aware of the obvious ‘professional’ conflicts of interest (COI) that exist re sport-related concussion (SRC) assessment and management … and that have also existed in the past. In addition, the illusion of ‘safer football’ has been a mantra since the President Teddy Roosevelt days….circa 1905.

    Furthermore, some “experts” are conspicuoisly silent regarding the notion that individuals with learning disabilities or other developmental disabilities should not participate in collision / contact sport as their already neurologically damaged brain may be further compromised…and/or more easily further compromised due to a prexisitng dysfunctional brain .

    If you are interested in obtaining an historical background perspective re concusions…suggest you read my 2004 Disserttion research completed as partial requirements for my PhD in the area of Clinical Psychology.

    “A Preliminary Investigation of Active and Retired NFL Players’
    Knowledge of Concussions”

    Also read concussion authors, Dr. Evans and Dr. Gronwall, that I mentioned to you in a previous blog comment.

    • Joe Bloggs April 15, 2012 at 07:51 #

      Brady has made a serious point. Little data has been taken on the association or/and causation with differences in behavior, academic, manifestation of learning disabilities between children exposed to head trauma and lifetime medical illness and those that have not. While genetics does certainly play a role, the environmental exposures have not been investigated. This is the 800 lb gorilla.

    • A Concerned Mom April 15, 2012 at 09:19 #

      After my son was concussed, I started reading everything I could find on-line in an attempt to help him recover and to provide feedback to the bantam program/school corporation. When I first starting sharing information I was met with skepticism and was mocked by school personnel. I consulted with our attorney and took steps to document the problems with the bantam program, the school’s lack of awareness, and to identify the concerns with both concussive and sub-concussive impacts for youth players.

      I wrote to my state legislators approximately two months ago and copied in the superintendent of public instruction. I requested that our youth concussion laws be extended to the youngest levels of play and that the department of education create model concussion management protocols/procedures for schools to adopt. To date, I haven’t received any substantive responses. I’m not exactly sure what my next steps should be. (If my efforts result in education for these younger players, limitations on contact drills, and concussion management protocols, then I will feel as though I accomplished something, even if the results are less than ideal – as in no collision sports under 14.)

      Cantu has a book coming out in September, but youth football camps and programs start in July around here. By September kids will be in their second month of the program (my son was concussed in September). I’m concerned about the parents who sign their young boys up for these programs without knowing the risks. Football is kind of like apple pie here, and many parents will probably believe the concerns about repetitive impacts are overblown nonsense, but at the very least they should be informed. (Some of the kids from the bantam program went from 3 months of hitting their heads at football practice to signing up for the youth wrestling club.)

      One of the reasons I decided to comment here was because I saw an absense of voices speaking for the youngest players. So much of the research and legislation has all been geared towards high school players and above. I wish there were more voices calling out for change in how youth programs are run.

      • Don Brady, PhD, PsyD, NCSP, Licensed Psychologist April 15, 2012 at 23:29 #

        Am curious,

        1- How old was your son when he suffered the concussion?

        2- How was the occurence of his concussion first noticed / determined / diagnosed?

        Thank you.

      • A Concerned Mom April 16, 2012 at 06:02 #

        My son was about 8 1/2 years old when he was concussed during football practice. He tackled high, clashed face mask to face mask, and then rebounded to the ground. He was hauled up to his feet, and was left standing and crying on his own – coaches restarted the tackle drill, so I had to go get him.

        He had an immediate headache, but didn’t exhibit any signs I took as indicators to bring him to the emergency room (his headache decreased in intensity with time). I called the pediatrician the next morning. Unfortunately, because his headache was so mild (he looked and sounded normal), I wasn’t advised to keep him out of school – just to watch for worsening symptoms and to schedule an appointment for the next day or two. I told the nurse and his teacher that he had a dull headache and was going to go in to see the doctor in a day or two, and asked what to do about recess. It was sugggested that he be limited to walking around. I was concerned when he still had a headache at the end of the school day, so I scheduled his appointment for the next afternoon. When I picked him up from school for appointment, he told me he had been sent to gym class even though he still had a headache, and that he had had a hard time running as fast as normal. During his evaluation, his headache was rated as mild, his cognitive assessment seemed fine, but his balance (vestibular system) was really off – couldn’t stand on one foot, swayed when he shut his eyes, etc.

        The school didn’t really know how to put in place academic accommodations. One of the major problems was that he was able to do the work – but he was really tired by the end of the school day and got mild headaches throughout the day. The headaches, fatigue and balance problems lasted into November. He’s being withheld from contact sports for a year because his symptoms lasted so long and because of his age.

  7. Matt Chaney April 15, 2012 at 10:30 #

    Concerned Mom, I love your commentaries and passion for getting to root of JUVENILE football crisis at hand, which, incidentally, will relatively soon leave this mythologized, incorrigible blood sport in radically down-sized form (and not the NFL). Regarding Camp Cantu, however, you’re following the wrong lead for any real answers at this point. Expect Robert Cantu’s new book to offer absolutely nothing relative to prime questions currently facing tackle football. Better to trust your instincts and follow your questions through e-searching information available online. You’re free to ponder questions, rationalize and report facts–Cantu lost that option about fall 2009, when he sold himself to the NFL and its agenda to keep fat feeder systems intact. Not to mention part of Cantu’s legacy relies on the outrageous Safe Football garbage he’s pushed since the 1970s in this country. I mean, what a stale act, Hero for Safe Football, dating to Teddy Roosevelt, another paper man of alleged game reform. Incidentally, INTERNAL INJURIES killed the most football players in supposedly barbaric football of 1905, from organ rupture to non-cerebral blood clots of impacts. Cardiac arrest of CHEST IMPACT also killed, apparently. So much for teaching kids “proper contact” today, aiming hits below the neckline. Look, I played this game and committed dastardly acts commonly to do so, as a boy and young man: you cannot last otherwise. Today, without costly modern med response and trauma care, long-term care, we would KILL A HUNDRED players of contact alone, mostly kids and mostly of BODY SHOTS, minimally every year in this stupid ‘sport,’ including 5-year-olds. See ChaneysBlog.com for hundreds of severe to fatal cases of year 2011 in football. What a joke, any discussion at this point about “concussion management” as saving kids in football. Moronic! Believe what you see in tackle football, folks, not the pounding mythology of goodness and safety reform said to be ALWAYS JUST AROUND THE CORNER. It’s always been that way, Victorian Era to present, the institutional BS of not only football but of American news media, medicine, education, government, and even religion–all, to this day, collectively cover and capitalize the obvious barbarity of this ‘pastime.’ And false hope is essential, don’t you see, a cultural coping mechanism, JUST TALK for handling lethal health menace in tackle football, which should be notorious by now for an array of grave risk and horrific outcome, bodily maiming to drug abuse. Utterly disgusting, our suspension of common sense about tackle football and especially involving children; it’s travesty for this country and our alleged values.

    • A Concerned Mom April 15, 2012 at 20:09 #

      Matt Chaney, I enjoy reading your blog and have found valuable information there. I still hold out hope for Dr. Cantu and Sports Legacy (I especially liked the youtube of the presentation they gave this past fall at Williams College). Nowinski and Dr. McKee have done much to raise awareness with respect to the dangers of repetitive head trauma. Although it could be argued that hit counts aren’t sufficient, at least some limitations on hitting would be far better than what we have now. Sometimes I wonder if they are just trying to avoid being marginalized (as attempts were made to marginalize/discredit Dr. Omalu, who I believe was the first to recognize CTE in a football player).

      Much of what I’ve read has made me question whether or not football can be made safer, especially for kids. Little kids don’t have the neck or core body strength to keep their heads from moving back and forth on impact. And, my son said he was instructed to put his face mask on the ball to tackle, which concerned me after reading that the face mask can magnify forces under certain circumstances (the biomechanics are beyond my understanding – but, I can’t help but wonder what’s happening to their brains, even when there is no helmet to helmet or helmet to ground contact).

      Reading your injury reports was especially sobering – I had no idea of the risks I was exposing my son to when I signed him up for football – biggest parenting mistake so far – literally gut wrenching. I don’t think your average football parent is aware of the actual number of serious and catastrophic injuries (sports programs really should be made to track and report injuries rather than just wins and losses). The parents I encountered through football really wanted what was best for their children. They just haven’t been provided with the information they need to make informed decisions. Unfortunately, since so often sports seem to be an avenue for success (high school popularity, scholarships, etc.), I anticipate many will be reluctant to accept the concerns about repetitive subconcussive impacts.

      It should be interesting to see what impact the NFL lawsuits have. You never know how information will be spun. The bountygate tape release seemed to turn into a self promotional film maker betrays ALS stricken player narrative.

  8. Don Brady, PhD, PsyD, NCSP, Licensed Psychologist April 16, 2012 at 13:07 #

    Concerned mom,

    Appreciated you responding to your son’s age, etc. You mentioned that ‘his cognitive assessment seemed fine’,

    Do you recall the name(s) of specific screening technique(s) that were used ?

    • Don Brady, PhD, PsyD, NCSP, Licensed Psychologist April 16, 2012 at 13:28 #

      PS…you and your 81/2 year old son’s concussion experience supports Jake B’s above comment re concussions being underreported at the youth level…

      and based on what you shared re his reactions to the concussion, his initial symptoms were not subtle.

      • A Concerned Mom April 16, 2012 at 14:05 #

        There were 3 diagnosed concussions and one case of whiplash from injuries sustained at practice in under two months. I suspect that there may have been undiagnosed concussions (one parent suspected the whiplash case was also a concussion, and there were a few other kids who had taken hard hits). I’m not pleased with how my son’s concussion was managed. I’m speaking out to hopefully make it better for other childen.

        I will say that he looked very normal. If he had looked like he was in pain, I would have kept him home.

    • A Concerned Mom April 16, 2012 at 13:49 #

      At that point in time, I knew nothing about concussions (other than basic stuff from parenting books/magazines – such as looking for changes to pupils, vomiting, speech irregularities, and increasing headache as requiring emergency treatment). Based on what I’ve learned since, I think the questions were similar to the SCAT-2. (The night he was concussed, I had also asked him questions from a concussion website – can’t recall site – and he didn’t seem to exhibit any confusion or memory impairment that I could pick up on – obviously, I’m not a medical professional.) He was run through numerous balance tests – standard type of postural stability testing and BESS type stances. His pediatrician is qualified to provide ImPACT testing, but told me most of his concussion patients were generally high schoolers (he didn’t see many concussed eight-year-olds – standard ImPACT testing starts at age 11, so my son wasn’t tested). Overall, I would say his evaluation lasted at least 45 minutes, perhaps longer.

      Six days after his concussion he took a standardized test at school. The test was broken into two segments. He was very tired after school on the first day of testing, and he told me the test had given him a headache. I tried to get him out of testing for the next day, but he had gotten one of the highest scores on the first part of the test, so the school took that as evidence that he didn’t need to be excused from the second day of testing. (Through testing last year, he was identified as a high ability student, so it would be expected that he would do well on most standardized tests.)

      Overall, I believe he’s gotten straight A’s this year so far. He did really struggle with homework for weeks afterwards (he probably shouldn’t have had any homework – I did the best I could to modify it and help as much as possible – if I had to do it over again, I would insist on no school the first few days, no tests, half-days, then a reduced workload).

      • Don Brady, PhD, PsyD, NCSP, Licensed Psychologist April 16, 2012 at 20:09 #

        There is research documentation (read Dr. Dorothy Gronwall) that indicates a person may do ‘well’ on a test after suffering a brain injury…but more of the brain needs to work to obtain the performance.

        Thus the brain is being stressed to complete a task…when the brain should be resting.

      • A Concerned Mom April 16, 2012 at 21:39 #

        I’ve read about Gronwall’s research. Every parent should be made aware of the true risks of concussions before signing their children up for high contact/collision sports.

        I think all teachers and administrators need to be educated about the importance of cognitive and physical rest for concussed students as well as the need to protect them from re-injury. Personally, based on my son’s experience, I believe schools aren’t safe places to send concussed students unless concussion management procedures are in place and the staff is educated.

  9. Don Brady, PhD, PsyD, NCSP, Licensed Psychologist April 16, 2012 at 23:13 #

    there is also a need for emotional rest…as emotions are a component of brain functioning…

    • A Concerned Mom April 17, 2012 at 08:13 #

      Thanks for all the feedback. Your NASP is a wonderful resource. Emotions are equally important, but to be honest, I suspect many concussed students don’t even get sufficient physical or cognitive rest.

      Hopefully, we’ll see some positive changes as concussion awareness increases, and as those impacted by concussions speak out.

      http://www.salemnews.com/local/x611955676/Teen-suffering-long-term-effects-of-concussion

      “”The focus is always on getting back to playing sports, but school is way more important. I do think students are rushed back to school and sports too quickly.””

  10. Don Brady, PhD, PsyD, NCSP, Licensed Psychologist April 20, 2012 at 23:17 #

    Dustin,

    The immediately above entry is a draft that inadvertently was placed in the Reply section….

    thus the immediately above reply should be removed from your blog

    The below entry is my response for the blog…thanks.

    ============================================================

    1– Perhaps it is semantics…but if the life of one youngster is adversely altered due to a sport-related brain injury…to me it IS HUMANLY and SPIRITUALLY CATASTROPHIC…for the injury becomes a needless waste of a developing youthful human brain.

    2– Sadly it is not surprising to hear mention of children sustaining multiple concusions…
    As many sport injuries are often “normalized and minimized”…and thus sanctioned and not critically questioned.

    Within this framework of ‘illogical thinking and acceptance’, concussions / brain injuries also easily become ‘normalized and minimized’ or even discounted as being ‘flukes’ of the game…

    Finally, it appears that the the inherent risks of sport participation, including sport-related brain injuries, are often minimized or not questioned by those who have idealized the value of sport participation…

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