International Summit on Female Concussions and TBI

I am very excited to inform you and implore you to attend this first of its kind conference. Katherine Snedaker – a good friend and ally – along with her planning committee have done a wonderful job of creating a great place to discuss a subset of this head injury issue.

The International Summit on Female Concussions and TBI will be held a month from now at Georgetown University in Washington, DC. This summit is unique because this will only be about sex and gender-based research on females, from pediatrics to the elderly.

As much as we think we know about head injuries and concussions we don’t know squat, globally. Let alone in one gender over the other; females have been painfully overlooked/lack of attention because most of the noise and spotlight is on male dominated sports. Although, females choose to play many of the collision sports (rugby, hockey, lacrosse) there are other issues we know that impact females differently.

The summit is over two days and will eventually culminate in a consensus statement about female issues surrounding and within the concussion paradigm. This is also going to be a first of its kind, and appreciated at least from me.

The Topics (briefly summarized):

  • Menstrual Phase and its impact
  • Age and Sex and its impact on symptoms
  • Domestic Violence
  • Female Soldiers
  • Pediatrics
  • Female Sport Concussions
  • Concussion Recovery male vs. female
  • Female RIO Data
  • Clinical Spectroscopy of Female brain
  • Return to School
  • Social Interactions
  • Ice Skaters
  • Psychology of Concussoin
  • And more

Here are the presenters, moderators and planning committee members (as of this post):  Continue reading

Thoughts on everything we are hearing and will see: An opinion

Certainly we are nearing a “too much” point in terms of concussion for most of the country. For others this is just the continuation of what we have been doing for years. From a personal perspective I do like the attention that the discovery process is getting. I am all for people getting all the info possible to make informed decisions.

I want to take this particular space in this post to assert that I am not – nor have I ever – been against any sport including football. I am, transparently, supporting flag and non-tackle football until high school. Yes, no scientific evidence proves this helps/hurts, but in all my work and research I am of the opinion that less dosage of repetitive brain trauma is better for humans.

That is where we stand, the issue really is one of repetitive brain trauma (RBT), not of sports or accidents or leisure activities. As Dr. Omalu clearly stated in his interview with Matt Chaney in 2011 and again today with Mike & Mike (hour 4); the brain does not heal itself. Damaging it, even on the microscopic level can and will leave a lasting impact. This is not just assumption, it is noted in many different studies regarding brain health after activities (see Purdue).

I am confident that with proper healing time and avoidance of re-injury the brain will find a way to function at or even better (proper learning and congnitive functioning) as people get older. The management of not only the “gross” injury of concussion and TBI is one that is getting better and as we get more research the management of the subconcussive hits and exposure, that too will be satisfactory.

What we all must do is take off the “emotional pants” and wade through the muck to find out what is important for us to make decisions for those that are not capable or even legal. Part of this is discourse and discussion (civil would be best). Everyone will be challenged intellectually and morally with this – it’s OK.

I noticed an article written by Irv Muchnick yesterday Continue reading

Before ‘Concussion’ Omalu was still Omalu

In two weeks time people will be going to the movies to see the screen adaptation of a forensic pathologist that unintentionally made the giant business of the N.F.L. weak in the knees. In the movie ‘Concussion‘ mega-actor Will Smith becomes a little known West African doctor, Bennet Omalu.

To many Dr. Omlau has been a recent discovery due mainly to this movie but also the discussion surrounding it, including Dr. Omalu’s op-ed piece in the New York Times. To a small circle of people his work and voice has been around much longer.

Early in 2011 Matt Chaney – a tireless cataloger of football catastrophic injuries and outspoken author/journalist – had an interview with Dr. Omalu. In this interview you can see that Dr. Omalu is still the same concerned medical practitioner as he is now.

With permission from Matt, I am publishing the transcript of his interview. Do with this what you will but Dr. Omalu takes on all sorts of issues surrounding the concussion discussion.

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BENNET OMALU

January 15, 2011 by telephone with Matt Chaney

Q. What football likes to do; this is what I learned in 20 years in the anti-doping issue, where we have so-called testing, and protection of players against drug use. Foremost, it’s very clear now, according to a host of experts worldwide, that so-called testing for steroids is bogus. It does not work. It’s invalid. It has huge faults in terms of its applications. Well, point being, football especially—but other sports too, especially the Olympics, and baseball, are learning by their example—football likes to [chuckle]… When it has a problem for which it’s being criticized for, it likes to go out and stable the science. It likes to go out and fund and/or hire scientists, to put together its prevention packages, and act like everything’s hunky-dory. And they do not share their science. They say they have a test, but they do not open it up to [peer review]—

Omalu: [he interrupts] A very good example, because WWE’s guilty of the same thing.

Q. Oh, really?

Omalu: This so-called ImPACT testing. That is a fraud, in my opinion. ImPACT testing is not a diagnosis tool. It is a forensic followup [model] to monitoring, to quantify or to evaluate the amount of damage. And to monitor, to see how a patient is improving.

Using the ImPACT testing in the acute phase of injury, to determine the amount of damage, actually makes the damage worse. Am I making sense?

Q. Oh, yes. Yes.

If anything, it actually makes the damage worse. OK.

I can allow you to re-cord if we’re going to talk about the science of concussions. You can re-cord, yes [pronouncing like ‘hit record’] …strictly the science ..… Just ask me questions specifically on the science.

Q. Yes, that’s kinda what I’m—what I’m interested in is the science. Let me say straight up I totally agree with your link of brain damage to football. I’m not even worried about that. I, I am, I totally agree with it, I have expert scientists, especially Chuck Yesalis of Penn State, who loves your literature, he loves your evidence, and he is also an historian on boxing injuries. He is well-familiar—he knows much of the literature that you’ve often referred to from boxing, as far as long-term brain damage—

Omalu: Why don’t you re-cord about, keep your questions strictly of the science. …

 

Continue reading

Vector Mouthguard Season Wrap Up: Product Review and Impressions

I find myself in a peculiar situation in regards to the Vector Mouthguard; I have indeed benefited from the relationship as mentioned in the first post about this product. However, I have also been honest and blunt with them while dealing with the product. I have made every attempt to be as objective and neutral on any product or research on this blog, in cases where my integrity may have been perceptually challenged I have noted such.

However, I have looked at many blogs about various products and come to the conclusion that this post is going to be an in-depth product review with my honest feedback. You, the reader, will have to trust – hopefully based on my track record – that it is an unbiased assessment. Heck this is just like the YouTube toy reviews that my and your kids watch constantly, minus the video and my ugly mug.

Enough with the mental hand-wringing and on to the after-season report on the Vector Mouthguard (you can catch up from previous posts with “It’s Actually Happening…“, “Day 1“, “Seeing Is…“, “Practical Application…” and “Ready for Primetime“). The last post about the mouthguard was prior to the first game and our team went on to play 10 games so there were a lot of happenings in regards to the Vector, I could write 3000 5000 words on it but no one would read all of it. I will try to bullet the ups and downs as well as noteworthy case uses. At the end I will attempt to address the common questions I had about this from other professionals, parents, coaches and kids. In advance, thanks for your time and if you have further questions hit up the comment section or my inbox.

Immediately the system had media attention about what we were doing for player safety at the high school as the “strange-looking” mouthguards were on the kids as well as a radar looking device on the sideline. Still in the quasi-euphoric/excitement stage of the process there was this interview that I did (completely independent) and captured the first three weeks of the regular season.

During that time we did have some individual mouthguards that were not functioning as planned/expected and some charging issues with the base units. Through conversations with the tech team at i1biometrics we were able to get everything going that was outside the norm. This is a key piece to note; the customer service was unbelievable and agile. Granted there were not thousands of systems in use and none of them had a loud-mouthed blogger running them, it was still what I can see this company continuing to provide for anyone with this product. A lot of the service could be done remotely or via mail. The grasp of the system and the actual engineers that are part of the solution team make it what it is.

As mentioned I didn’t quite know how or if this was going to change how I “did” things as an athletic trainer. Upon the month-long reflection and review after the season I noticed that I did change what I did. I started using the information provided to put a watchful eye on certain players and to confirm what I did see with my eyes. Or in one case I used it to see what happened to a player that I did not witness but my coaches told me about happening in a game. The system had started to provide me eyes that I don’t have but I never really relied on those eyes, but was happy they were there.

During games I started to Continue reading

Gridiron Heroes and the Movie

mv5botqxotq2ntixmv5bml5banbnxkftztgwotazotu3nte-_v1_sy317_cr60214317_al_Being part of the concussion space there are many different things that come to my inbox. Much of that is garbage and thinly veiled attempts at advertising for something that I am not interested in.

A couple of weeks ago I received an email about a movie that I had heard of in passing; Gridiron HeroesI did not know what it was all about but the co-director, Seth Camillo, encouraged that I see this. He never said it was ground breaking but told me it is “documentary about the important issue of brain and spinal cord injuries that are sustained on the football field.”

I was given the opportunity to screen the film and I must say that I was not disappointed by the hour and 17 minutes. (Trailer below)

It begins with a overview and reason for a foundation called Gridiron Heroes Spinal Cord Injury Foundation; the injury and subsequent paralyzation of Chris Canales. Although rare in occurrence this type of injury does happen on the football field. Instead of being overwhelmed by this difficult situation and blaming the game the Canaleses went about helping others that found them selves in this unfortunate situation.

Catastrophic injury and death should never be tolerated in sport, but like in life there are circumstances where they happen in freak accidents. This is not unlike car accidents that are no fault of anyone and understanding that life comes with some risk. The Gridiron Heroes Spinal Cord Injury Foundation set upon trying to heal and help those that have no clue what is happening and how to come to grips with the “finality” of these injuries.

The movie interviews former professional players – most notably Decon Jones’s raw and honest opinions, “players in the game” like Alan Schwarz, as well as those afflicted regarding the sport and where it sits in their eyes. The movie even takes on the issue of repetitive brain trauma and concussion.

This movie is not about tearing down the game/sport it is about facing the realization that football can be a risky endeavor for some and that instead of ignoring and looking past the issues, taking them on is the better way to approach this.

I am not a movie reviewer, per say, but I can tell you that this is worth your time and money (all profits from the film go to the Gridiron Heroes Spinal Cord Injury Foundation). This would be appropriate for anyone that is around football a lot like coaches and parents. It is not intended to scare but to inform, mainly about the foundation, but about the sport.

Seth Camillo and Andy Lauer did a fine job of telling a trying story not only of Chris Caneles and those like him, but of the sport of football.

You can get the movie on iTunes, Amazon Instant Video, Walmart Entertainment, Google Play and Dish Network.

If you have seen it feel free to comment on it, here.

The Case Keenum Case: Why It Matters

Adam Schefter said it well on ESPN this morning “This is an abject failure,” in referring to this:

As you may have already have seen and heard about this incident in the St. Louis and Baltimore game yesterday I will not go through all the mechanics of what happened and why this was so utterly ridiculous.

What I would like to focus on with this post is why this matters.

As evidenced by Twitter there are many fans – I would hazard more than who tweeted – who could care less about this. The overriding theme is that the players are professionals and this is no big deal because they are paid to play and they know the risks.

I tend to agree with this, but only at the professional level, they are adults and have as much info as possible. However, in the moment of injury and the few seconds following it the player must be protected from themselves and from further injury. This is why the vaunted and much promoted concussion and injury surveillance protocols are in place.

If there are not people in place to make the decisions that a player cannot make of sound mind, in that moment, then why even have it. Although this is one failure and there have been cases of players being removed due to the policies in place; this one incident goes to show nothing is perfect, even in the face of a most obvious situation.

At some point the players are going to have to put their foot down and demand that the medical personnel take care of them; playing time and winning the game be damned.

This failure on a spectacular level also has ramifications beyond the NFL and even the sport of football.

Allowing Keenum to play, not even missing a snap, sends the wrong message to other players of the sport or sports that are not at the professional level. Can you imagine Continue reading

Ready For Primetime

This post is a continuation of the ongoing in the wild review of the Vector Mouthguard System. You can see the previous posts about what I have experienced to this point by clicking on the hot links. As always if you have questions please comment, email or tweet I will do my best to answer.

The system has been on site and in the hands of the kids and I for the past nine days; the good is far outweighing the bad at this point. However, there is plenty of things that I have yet to figure out or apply, rather figured out how to apply. Tomorrow is the first game action, a point in this trial that I am both scared and excited about for the Vector Mouthguards. Time for the bright lights.

I am not scared or apprehensive about the overall performance of the data that I have been seeing thus far. One thing that I can firmly state at this point is that the perceived accuracy and consistency of impacts below 50g is all that I hoped and more. As the practices have progressed and I have reviewed the hitting drills by film, the hits of the interior lineman and linebackers seem to show on almost every play where there is full effort. This would match up with my line of thinking about football (as a reminder I have my system set up to report impacts of 10g or greater), this is a collision sport. I guess at this point I wonder if I am collecting a lot of “noise” in the system because the amount of hits it is recording. I do want to see the overall number of hits collected by the kids but if the 10-20g range of linear impacts are doing nothing other than that, it makes me think. On the other side I do want to have that data in case a kid were to be injured and it was a very low threshold.

The not so awesome thing at this time is the frequency of the anomalies I have seen. The last number I remember seeing for total hits that the system had captured was nearly 2,000 (4o players for 8 days of practice, about 6/player/day) and that number seems about right to me. But, the real issue is of that nearly 2,000 data set there are 12 hits that have exceeded 80g on the monitor and none of them “looked” like an 80g hit on film, in fact some there was no contact. Granted this can happen with technology, some part of an algorithm that didn’t weed out this report. Upon review I was able to identify four of these instances: one was previously mentioned with a player yelling (I have since reboiled the mouthguard and have not seen from that sensor), one was a player whipping out his mouthguard and kicking it while it still had some spit on it, and the other two were the cause of a coach tapping – rather slapping – the mouthguard on the helmet after taking it out of a players mouth to mess with me. In regards to the last two instances the good thing is that this only happens one time because the mouthgurad deactivates when the slobber is off.

Continue reading

Practical Application of Data: VMG

Before practice the coach, I should say coaches, wanted a report from me about what I had seen and how the system was going. I showed them the video from the previous day and where on the head the hits were registering for our worst offenders of dropping their heads at contact (verified). I also noted that some of our starters were getting more hits collected than the average teammate.

The head coach made it a point to tell the assistants to address the players that were leading with their head to correct that during our form tackling and to reinforce during live action to get the eyes up. Then after that was all done he came to my training room and asked me about how many hits and how big some of the players were getting.

I had noticed the previous two days what these 30 and 40g hits looked like and they were above “normal” collisions but not “make the crowd go oooh” type hits. He inquired about the big hit that the LB/RB took in that drill mentioned in the earlier post. I told him it was below 50. He wanted a number of hits that the kids had taken, for what other than his information I had no idea, and boy was I wrong and in a good way.

It was pretty simple the RB/LB combo players had taken the most with an average 22 in two days (day one shortened due to lightning), next were the RB only with an average of 15, then the DL with 14 and the OL with 11. Not as many as I expected, but then again our coach is very limited in hitting drills. In a five-minute segment they maybe get off 12 plays at the most and there are no more than six of those a day.

This is a good point to also tell you that these are “thud” drills, we have had one five-minute of live all season so far to go along with our 1’s vs. 1’s for four plays at the end of the day.

At most you could see 72 impacts a day, if you were in on every single rep of thud action in a practice. The starters probably see about 70% of the reps so we could expect to see at most 51 impacts in a practice. And in day two most any starter registered was Continue reading

Seeing Is… Starting… To Believe (Video Link)

Inside DrillWith one day of the Vector Mouthguards in the book – a lightning shortened one – and a warp speed implementation it was time to get this puppy up and running.

The players had not lost a mouthguard overnight, which is quite amazing because they always seem to lose their other ones, and all were on the chargers overnight. The clock struck 5:30 and it was go-time. The antenna receiver on the sidelines and players not wondering what it was going to feel like, just getting to practice.

As the system fired up the tiny computers in their helmets were reporting to my laptop, one green light after the other, it was working as promised. A few of the mouthguards took a minute to “warm up” with spit, I guess, but when it was time to hit I had nearly all on-line. Of the 40 issued, 32 were communicating with 2 of them on injured personnel (not concussion), we will get more in-depth about that later.

As practice started I did not want to be tethered to the computer so I could do my job as an athletic trainer so I left the base station and went about my business. The way our coach practices is in five-minute segments, flying around. It is high intensity and constant moving on my part to keep a keen eye on where it is needed and on who it is needed. I basically forgot it was over there other than the occasional parent or media asking what that “radar” looking thing was.

At the first water break I stepped over to see the computer and the hits it had captured. I was able to scroll through all the registered hits in about two seconds and only stopped on any that were above 40g. The graph like output of the system makes this a breeze. I also had noted that every hit is time stamped so when there was a hit that I thought should be captured I made note of the time and cross referenced that in the system, and yes they were there.

As the team went to a segment with inside run drill work it happened to be next to my base station for filming purposes. I yelled up to the camera operator and asked if the film time stamps and he said no. Because I had two students with me I was able to hold the tablet and look at that between reps. After every play the screen changed with more impacts; the DL, LB and RB getting the lions share of the notices. I was impressed at the speed and accuracy of the information given to me in real-time. But, one of the LB’s who was delivering the hits on D was also rotating on O as a RB and his mouth guard was not communicating, I was a bit concerned. Was this really going to keep the data in the mouthguard until it was able to communicate, like they promised? Was I going to miss out on some of his hits. And just then…  He was smashed by the defense right to the left earhole. He was none worse for wear but it was a noteworthy hit as the team yelled out due to the collision like all other teams do when that happens. He was just fine and I didn’t even take a step towards him.

As practice progressed all was going well, I was taking notes on times of hits and they all looked good and none that I found concerning in viewing them live or on the data. That’s when I scrolled across a player that had taken the largest hit seen, a Continue reading

Vector Mouthguards – Day 1

Don’t get to excited, I don’t think I will give you daily updates about the Vector Mouthguards but I do feel that the first day is important on many fronts, including: customer service, supplies, and ease of use out of “box”.

I had previously met with the kids individually and emailed the parents to open a line of communication about what was coming and what we could expect. I also told everyone about my expectations for this system. I received many questions from the kids that I could easily answer (looks, weight, how it works, “will my braces mess it up?”). The parents really only cared about performance and many were excited about it, even the parents of the kids that were not selected to wear them.

We ended up getting enough money to outfit 40 players so I had so select a group of kids that I thought would be a good cross section for what I wanted to know from this. I chose the following people: all varsity starters on both sides of ball except for QB, the 2’s that would be getting the most work on the scout team, players that would play both JV and Varsity, and the remaining were players that are probably not going to see much action – mainly on their own volition in practice or games (if you know what I mean). Within that group I have 4 players that have previous history of concussion, including two that have multiple concussions in their past. This I feel represents the kids that will see the most possible impact throughout the season.

I received the shipment yesterday and included were the mouthguards (lanyards number stickers), the chargers, a computer, the antenna for the system with a tripod and a carrying case for it. All was set up and ready to rock after getting the players and mouthguards into the system.

Today, Tanner Nussbaum from the Green Bay area drove down to help with the fitting and getting system up and running, and hew as on time and ready with all answers to any questions I had conjured up over night. We had the 40 players meet at 1:30 for fitting and computer inputting with final instructions, the last players were done after an hour and 20 minutes. It all went rather smoothly, minus some Continue reading

It Is Actually Happening, Impact Sensors At My School.

Over the years I have researched many, tried a few and heard all about impact sensors, and for the time the blog has been going you have all known I have had a “standoffish” approach to them. That is not because I don’t think they may have a place but it is because of what they can actually do and how reliable they actually are.

I have made it well-known that the “most applicable” system I have seen is the HITs system that is exclusive to Riddell helmets. It is not the best because of factors that include: cost, helmet exclusivity, and it – like all other sensor systems – is not without scientific flaws.  However, what makes HITs near the top is the information that can be gained as well as the feedback/real-time information. There are other types of impact sensors you will see “certified this, certified that” but many of them attach to the helmet making the NOCSAE warranty invalid as well as some helmet manufacturer warranties. Most, if not all do not take center of mass into effect either, making some of the objective numbers askew. As you can see I have had issue trying to adapt to one or the other, enough so that I would be willing to try it out on our teams.

I and our school cannot afford the HITs system and we promote the use of any helmet that fits properly on each kid, because of that I have been looking for other sensors and complete systems that may actually be of help to me as an athletic trainer. I did remember that I have always been intrigued by a mouthguard sensor and when the Vector Mouthguard started making its debut in colleges I started doing more and more research about it. That led me to a conversation – a very honest and blunt one – with CEO Jesse Harper.

After that conversation I did even more dirt digging on what I could and asked many people about the system and what it purportedly could do and all the scientific and mechanical engineering stuff I could comprehend. I came away satisfied, satisfied enough to invest some time and resources to try to procure this system for use in the Fall. Basically, I am ready to dive into this sensor phenomena head-on (pun not intended), finally.

Key Support

Before getting this event set in motion, school administration needed to be apprised of the plan and they would ultimately have to say yes. That conversation occurred in May when I approached the Principal and Athletic Director about this.

It did not take long to explain the benefits of this, not only from a player safety issue but from a coaching aspect as well. They both liked the idea of us looking out for player safety and showing it by being innovative, if nothing else than in perception.

They only had one statement/question for me, “there are not any drawbacks to this, unless we are missing something?”

Hurdle cleared.

Fund Raising

With most any product, good ones, the biggest barrier for most is going to be cost; that was no different here. Starting in early May I started to ask around for donations and support for this system. Although I really only had to get enough for the Continue reading

Triumph Over Trauma

In the beginning it was hard to find a lot of people to share real world examples of what I was trying to describe here on the blog. It is one thing to have the knowledge and experience but entirely another to parse that down to something people can grasp and understand.

Luckily I happened across a great person and advocate that was able and willing to share some stories that made this blog a little more personable. Her name is Tracy Yatsko and she is definitely not just a face in the crowd.

Recently she has joined the blog space with her very own called “Triumph over Trauma” and as she describes in her tag line;

Triumph Over Trauma is a website/blog devoted to concussion victims, survivors, and their families to hopefully lead them into the right direction of recovery, give them hope through stories of others who have struggled yet triumphed, and give them the one thing the concussion community lacks or can’t find: Support.

As mentioned she has been featured here at The Concussion Blog with a wonderfully written story about her from one time contributor John Gonoude and one of her first PSA’s about concussions.

If you have the time you should head over to her blog and see if you can help in any way!

May Mailbag

As the sports season winds down at the high school I am finally getting to the various emails I have received. I do truly enjoy the many stories and questions I get here, often times they are very learned for me; which translates to more information for you the reader.

I picked out one such email and gained permission to reprint it here. The sole purpose of this email is to get feedback about the return to learn aspect of concussions. Tom would like you to give it a read and make comments below.

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Return To Learn in the High School

I am an athletic trainer in a high school in the north suburbs of Chicago. We have a concussion program in place and see about 80 concussion a year in our athletics. I am fortunate to have some control over the return to learn side of concussions in my school. I have found that this is essential in order to properly manage a concussion. I find when physicians only see an athlete once and set accommodations for a determined amount of time, it does a disservice. The same is true if the time between physician evaluations is too long, especially when kids are kept out of school for long periods of time. I find many concussion students don’t need to be out of school, and those that do usually have their symptoms decrease significantly within 1-3 days.  Many times concussions progress rapidly and Continue reading

When and How ‘Not a Concussion’ Becomes a Concussion: Klay Thompson Injury

The Western Conference Finals not only provided an opportunity for the Golden State Warriors a chance at winning an NBA title it has provided a wonderful opportunity for people to learn more about concussions. The knee-jerk reaction to incidents like we have seen in Games 4 and 5 are often a mix of truth, hyperbole and eye-rolling; however what is clear they are cases that we can use to forge further understanding and education.

Last night in the would be close-out game of the WCF, Klay Thompson shot faked and the defender rose as he [Thompson] ducked and the defender’s knee blasted the side of Thompson’s head right in his right ear.

Unlike his teammate from the game before, Steph Curry, Thompson did not show overt signs, to my trained eyes, of a concussion. His face was “scruntched” in pain and he immediately grabbed for his ear, plus after the incident he immediately rose to his feet and walked straight to the locker room without assistance. As noted in Tuesday’s post signs are paramount when making critical in-game decisions about return to play; if they are there, there should be no doubt about removal.

The next report we received on TV or Twitter was about Thompson having an ear laceration and that they didn’t need to do a concussion evaluation. Which is entirely possible but unlikely, because I do believe they did a concussion “screen” at the time. The Warriors med staff probably didn’t do the full-blown evaluation because five minutes would not have been sufficient for that, but that was enough time to go over any symptoms and quick balance assessment (think roadside sobriety test). It is also important to know that because concussion are mainly subjective that a massive portion of any concussion evaluation is the interview: talking, questions and mental challenges about venue/score/date/etc.  Continue reading

“Contussiongate”*: The Steph Curry Incident

*I will admit that I could not come up with a catchy title for this post so I ripped this from Mike Freeman’s twitter feed (@mikefreemanNFL) last night:

But not only is this funny but it is about as accurate as it could have been when summing up the Steph Curry incident last night in Game 4 of the Western Conference series. So, thank you Mr. Freeman for your insightfulness and wonderful wordplay.

Those that were watching the game last night and happened to be on Twitter should know the entire process this sequelae; because of that I will be as brief as possible while injecting the overriding issues and thoughts on this.

It all began in about halfway thought the second quarter as the Warriors were getting throttled by the Rockets;

There is not speculation when looking at that vine, Curry hit his head on the court after taking an uncontrolled fall. What is not seen in the vine is Curry laying prone on the floor for a few minutes as the medical staff took a look at him (even noted checking his c-spine). When the world was brought back to the game from commercial we saw Steph getting assistance off the floor to the locker room, where further evaluation was to be done, obviously.

The first point to note in this event is that Curry not only immediately grabbed his head where it contacted the floor but he also was “down” for some time, that is obviously not normal. He hit his head and very hard so of course he would be slow to get up, but it was the amount of time that would and did have me concerned.

Before we go further we should define concussion for all of you out there, if you want the drawn out and dictionary definitions you can find it HERE, but for the simplest and most poignant way: a concussion is a disruption of normal brain function after a traumatic event. Notice there is nothing about getting hit Continue reading

The “Mild” Concussion

Mild

This post was written originally in 2011, but has been re-posted numerous times, it will continue to be posted until we all get the message…

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Hogwash!  There is NOTHING mild about a concussion, period.  However media, teams, players and even medical staffs continue to use this nomenclature with this injury.  It is simply counterproductive to label this injury with a “mild” tag, and hampers the effort of everyone trying to increase awareness.

When public speaking I often times compare a mild concussion to being mildly pregnant. It is rather simple you are concussed or you are not, just like being pregnant.

Granted, those that have extensive training in the area of injuries, and particularly head injuries, understand the term “mild” when it is in concert with concussion.  This subset of the population is not the one that needs the education, rather it is the general public, which includes players, coaches and parents.  A common problem amongst people who are educated in a particular field is that they forget about both who they are servicing and the education level of people other than their peers.  It’s a fine balance to educate without talking down to others, but understanding the stigmas of the topics help with that effort.

One serious stigma is the “mild” tag that is placed on concussions.  Those that watch and participate in sports are so used to using that clarification when assessing and addressing injuries as a whole, that perhaps it carries over to the traumatic brain injury just sustained by the athlete.  We as athletic trainers and doctors Continue reading

Play Smart. Play Hard.

PSPHlogo

Today the Illinois High School Association (IHSA) launched a national initiative for overall student-athlete safety and participation in sport. It is called Play Smart. Play Hard. 

The campaign will focus on education and equipping athletes, parents, coaches and schools on ways to better safeguard the heath and welfare of student-athletes, including minimizing the risk of head injuries.

The main function of this campaign is to have readily available information and tools for player safety; taking on the current issues/risks as well as being forward-thinking and discussing and formulating plans for other issues that are of concern in sports. At the center of Play Smart. Play Hard. are the resources including a Player Safety Toolkit which is directed at concussions at this time. When going to the Play Smart. Play Hard. page (www.playsmartplayhard.org) in the resource tab you can find all the current Illinois and IHSA concussion information as well as the National Federation of State High School Association (NFHS) and Centers for Disease Control (CDC) concussion info.

Play Smart. Play Hard. may have been trumpeted by the IHSA and Illinois but there are many other state high school association supporters of this innovative approach, 27 to be exact, check the site to see if your state is part of it.

As mentioned on the blog yesterday Continue reading

Illinois Advisory Council on Player Safety

It was last month and I was routinely checking the inbox when I noticed a correspondence from the Illinois High School Association (IHSA) with the subject line “IHSA Request”. Of course this piqued my interest because it is not often I get information from the state high school organization and the ‘request’ portion may have been dealing with athletic training. As I opened the message I simply thought this was a blasted email with necessary information from the IHSA…  I was wrong, on so many levels.

This is how the email opened;

Good morning, Dustin.  I hope things are going well.

I wanted to write you today to invite you to be a member of the Illinois High School Association’s (IHSA) newly established Illinois Advisory Council on Player Safety, which aims to influence, shape and strengthen the IHSA’s commitment to protecting the welfare of all those involved in interscholastic competition in Illinois.

Needless to say I was kind of taken aback, but after that fleeting moment I was honored and excited and quickly read the entire correspondence and even more quickly responded to the IHSA with a definite yes (I didn’t want them to second guess my invitation, hahaha).

The Illinois Advisory Council on Player Safety aims to be a well-rounded plenary body – with much and varying expertise – that can guide discussion on ways the Illinois high school athletic community can improve, advance, set initiatives and create higher standards for player safety. This body cannot create policy but it can influence decisions and create internal debate. Initially the main focus will be on head injuries, however, it is thought that the Council will eventually take time to look at all player safety issues going forward (heat illness, sudden cardiac death, and many more). The Illinois Advisory Council on Player Safety is a part of a greater campaign that the IHSA is unveiling tomorrow (more on that then).

The Council is going to be made up of eight members from across the state; student-athletes, coach, official, athletic trainers, alumni and state legislators.  Below are the quick bios of the Council at this time: Continue reading

It. Has. To. Stop. (revisited)

This is one of my more outspoken and shared opinion pieces about concussions, it originally was penned in August of 2013.

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There is a lot of belief and trust each and every one of us has in those that are medical professionals.  The further you go up the chain in those professionals our trust is greater and our belief is stronger that they know more.  The sad fact that in some instances those near or at the top of the chain don’t know enough and are putting people, in this case a kid, in danger; not only in the near future but the long-term.

Compared to a physician (MD/DO) I would say my medical skills are pale in comparison, and rightfully so; their schooling and experience far outpace what I have learned in the medical field.  Because of this the athletic trainer (I) am not held as in high regard when it comes to decisions about the care of an athlete; which I am fine with… 97.43% of the time (I just made up that number, ha).  However there are times when a MD/DO – those making the final and binding (in parents and patients minds) decisions – make a mistake.  This is not just some Monday morning quarterbacking either, its FACT.

Just recently I had an athlete take a blow to the body and head in a practice, and they immediately came to me distressed.  How distressed?  Well that is one advantage I have over a MD/DO, especially the ER doc, I know the kids and have the resources of his/her peers as well as coaches who have known the kid for many years.  In this case the Continue reading

Concussion = Brain Injury (revisited)

This post originally appeared in February of 2012, it is a good summation of the minutiae surrounding concussion.

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For years we in the medical community have been struggling with the terms “concussion” and “traumatic brain injury”; is there a difference?  The simple answer is no.  As you have seen on the blog, we use the term interchangeably, however just like anything in life semantics make a difference.  The perception of a “concussion” is that of sports and “not really that big of a deal”, and that would be horribly wrong.

As Broken Brain — Brilliant Mind posts today this injury is to the brain and confusion about semantics need to be cleared in order to gain a firm grasp on the issue at hand;

I’ve been giving a fair amount of thought to concussions over the past couple of years. In the course of my tbi rehab, my neuropsych has referred to my mild tbi’s as “concussions” and oddly, I never really thought of them that way. I’m not sure why I didn’t make the connection. I guess I thought, like so many others, that concussions are not that big of a deal — just a bump on the head. Getting your bell rung. Getting dinged. Big deal, right? Then, when my neuropsych talked about all the concussions I’ve had, the light went on.

My mild traumatic brain injuries were concussions. Concussion sounds a lot less dramatic than TBI, but essentially, it’s the same thing (I won’t go into the distinctions that SUNY-Buffalo Concussion Clinic people make).

By the way if you have not been going to BB–BM you should, as his/her perspective on dealing with brain injury is a massive resource.  Needless to say, whether you use the term “concussion” or “brain injury” the results Continue reading

Concussion by Sport (revisited five years later)

This was another very early post of this blog back in 2010, September to be exact. As you can tell I was very green to the whole linking of articles and writing. However, this is an important article regarding concussion statistics by sport from five years ago. I would be interesting to do a follow-up to this with what we know now. Looking back at my observations have not changed much in the five years, I may move wrestling above cheerleading but that is about all.

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Concussions are not exclusive to American football, although it is the most covered sport as it relates to concussions.  This is a good time to note that in the United States the next most concussive sport, is soccer, the number one sport in the world.

A reasearch project by University of North Carolina reported concussion rates by 100,000 athlete-exposures Continue reading

The Need for Sleep

This post appeared in the infancy of this blog back in October of 2010, I have made some editorial changes since that time.

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It used to be that doctors would tell you to keep people awake with head injuries.  That has changed, quite a bit.  Keeping someone awake might be indicated for a possible brain bleed, but concussions need the sleep and recovery time.

Sleeping is first. If you’re not sleeping, forget it,” said Cara Camiolo Reddy, the co-director of the UPMC Rehabilitation Institute brain program and the medical adviser to the Sports Medicine concussion program. Sleep is vital in the recovery process because the injured brain needs rest to begin to heal itself. The concussion program and Camiolo prescribe medications, however, only to post-concussion syndrome sufferers who are three weeks or longer into their injury.

This quote was from and article by Chuck Finder of Scrips Howard News Services and appeared on NewsChief.com today.

In the article you will find that this prescription is not widely accepted by the community that deals with concussion management.  However in my experience it is vital to let the brain rest.  When I am debriefing with the athlete and their parents, the most often question I get is “can you sleep too much?”.  My answer is no. Parents often time are apprehensive if they subscribe to the old method of waking every hour, but I try to educate using the snow globe example. If the must wake their child I encourage it at infrequent and few times as possible.

With my experiences at the schools I’ve been an AT at, the kids and parents that abided by the recommendations of sleep and complete brain rest have recovered at a much quicker rate.  The kids and parents that did not listen often times have delayed recovery.

I know that is not a research study in its most proper form, but the observational evidence tells us, and those in the above article that sleep is indeed needed.

Time to Heal: Tracy Yatsko’s Story (3/22/11)

Last June, I had the pleasure of speaking at a press conference at Lincoln Financial Field in support of Pennsylvania State Representative Tim Briggs’ proposed concussion management legislation.  I was an eighteen-year old who had been researching concussions in sports for nearly ten months at that point—a task that I engaged in to further educate myself and others on the subject at hand; a project that would essentially close many doors in my past that had been left open for too long.  But as I situated myself beside the podium at this press conference, I had no idea what kind of story the young woman sitting to my left had to say.  Of course, throughout my research, I understood that others have been through worse—much worse—than what I had experienced, but never did I think I would meet someone I could relate to.  It was even more than just relating to, for this individual shared a heartbreaking story to the public.  She was at the press conference for the same reason as myself, and that was to promote the need for concussion legislation in our state, but she did more than that.  Her words were more than the cover to a bill.  Her words were the voice of the sports concussion crisis.

Today, Tracy Yatsko, a twenty-three-year old woman from Tamaqua, Pennsylvania, is still fighting the repercussions of an injury that ended her high school athletic career.  Six years removed from the moment of her last concussion, Yatsko represents the qualities of strength and motivation, for her battle has not been one that has been easy.  Sure, I have heard of stories in which athletes have sustained decisively fatal blows to the head.  But when I talk to this woman, and when I think about her story, the only words that I can describe how I have perceived her story is hell on earth.  Why did this situation in which Yatsko found herself within come to be?

2005 was a year, with regards to concussion awareness, that was still present in the sports’ ‘Era of Good Feelings.’  There was not much to worry about, and though there were stories creeping out of the media regarding concussions in football, there was not much of a worry in other athletic activities.  There really wasn’t much consideration as to what a concussion was.  It was merely an injury that was ignorantly summarized as a headache; a distraction; a joke.  And with such stigma comes tides of the familiar phrase that claims pain to be weakness leaving the body.  Only did we, or rather, do we, come to open our eyes to what a concussion is until the moment of a tragedy personally affects ourselves or those who we consider to be close to us. Continue reading

The Future is Good. Things are Changing.

Sq 300 JHello, once again, let me reintroduce myself. I am Dustin Fink, an athletic trainer in Illinois that has made it a special interest and hobby of mine to learn and talk about concussions [/sarcasm].

It has been some time since I have delved back into the blogosphere and I don’t feel I owe an explanation (to be honest many of you wouldn’t care, it’s rather boring), however things are about to change.  I cannot promise that this space will be as prolific as it once was with concussion news and commentary however I think it will be more active that it has been the past year or so.

The exact details about how and why this change is occurring I cannot say quite yet, all I can tell you is that nearly five years of work has been realized and this now gives me the reason to get back to this part of my life. To say I am excited is a vast understatement at this point.

While I have been away I have seen my growing family get more active and my resources as an athletic trainer get more useful and respected within my workplace/school. It has been quite the adjustment going from covering a small school to a medium school with all the events and time constraints. And back to the kids, my kids, they are crazy busy with baseball, volleyball, basketball, softball, flag football, etc. it will be entertaining trying to watch this family juggle three kids in all of that (will take unsolicited advice from parents any time).

Concussions have not and will not go away from the sports scene no matter how much snake oil we throw at it. Simply, concussion is a risk associated with activity – any activity – not just sports. It seems that the general media (those beyond the taboo “blogs”) have become a bit more familiar with it and there are plenty of organizations and people stepping in dog doodoo when handling the actual injury or the public relations portion of it, so coverage has been decent. We have continued to field interviews and speak to classes and groups about concussion as well as advise those that ask, in reality The Concussion Blog has not gone anywhere (still Tweeting up a storm).

There are many opportunities coming down the pipe in terms of concussion legislation, concussion rehabilitation, concussion identification, and a myriad of other things related to this brain injury (including the shams and rhetoric about the danger). This provides a chance for us to discuss those many things; highlight the positives and critically examine the questionable topics.

I am looking forward to letting you all in on the news, next week, but for the time being you will be seeing many old posts come back to the top of this blog as a reminder of where we stand and where we are.

I appreciate all of you that have stuck with this blog for so long and continue to click on it even though the content is not as fresh as it once was. I don’t know how long this adventure will last but lets take advantage of the time while we have it!

Athletic Training: Why I Love My Job

A great read! And excellent write up!

I Train Therefore I Eat.

I’m an Athletic Trainer.

Oh, so you’re a gym teacher? NO. 

Oh, so you’re a personal trainer? NO

Oh, so you’re a strength coach? NO

Wait, so what do you do?

Believe it or not, this type of exchange actually happens a lot.  It’s funny, because athletic trainers (ATs) are everywhere. Most high schools, colleges, semi-pro teams, Olympic teams, professional teams, and basically any organized athletic association has them. Athletic Trainers work for corporations, for the military, as physician extenders, and in the performing arts (Yes, Cirque du Soleil employs athletic trainers for the performers).

Athletic Trainers are on TV all the time. Although they’re usually being called “trainers” by the talent at ESPN or your local news organization, so I don’t blame you if you don’t know who we are.

athletictrainer

I work at a small Division III college in Boston, and along with my colleagues, am responsible for the…

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