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Exclusive: First Law Suit Filed in Canada Over Concussions

16 Jul

Terry Ott has filed this BREAKING NEWS in regards to Canadian Football and the Concussion Issue.  We here at The Concussion Blog are pleased to bring this information to you…  You can find the FILED CLAIM HERE.

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FORMER CANADIAN FOOTBALL LEAGUE PLAYER SUES LEAGUE MEMBER TEAMS FOR CONCUSSION RELATED INJURY

Lawsuit on Behalf of Star Arland Bruce III Alleges “Fraudulent Concealment” and “Negligent Misrepresentation” By 9 CFL TeamsLeague Commissioner, CFL Alumni Association and Others

Contrary to (popular) opinion, the sports press likes to fling incense, be part of the show, create stars, and to that end prints and televises a fraction of what it knows.” -Mark Kram, formerly of Sports Illustrated 

July 16, 2014
Hamilton, Ontario

The first lawsuit brought against the CFL member teams and others for concussion injury has been filed in Vancouver, British Columbia in the Supreme Court on behalf of Arland Bruce  III, a veteran of 12 seasons as a speedy wide receiver who last played for the Montreal Alouettes in 2013 and also starred on two different Grey Cup winning teams as well as spending the 2003 season with the San Fransisco 49rs.

Bruce, noted in the claim as an “unemployed football player,” is the holder of the record for most receptions in a CFL game (16) and is a three-time CFL All Star.

The claim, so far for unspecified monetary damages, asks for general damages, special damages, general and special damages “in trust” for the care and services provided by his family, and punitive and aggravated damages.

In the claim filed by the Vancouver law firm of  Slater Vecchio LLP and lawyer Robyn L. Wishart, it is alleged that Bruce suffered a concussion and was knocked unconscious in a game played in Regina, Saskatchewan on September 29, 2012 between the BC Lions — Bruce’s team at the time — and the Saskatchewan Roughriders.

Bruce subsequently returned to play for the Lions in a playoff game on November 18, 2012 and it is alleged that he was still suffering from his previous concussion and it is also alleged he suffered additional concussive and sub-concussive hits during the  Nov. 18 game.

From a copy of the claim, not proven in a court of law, it alleges in part:

  1.  The plaintiff reported concussion signs and symptoms to the BC Lions medical personnel and coaching staff including but not limited to the following:
    1. fogginess;
    2. headaches;
    3. sensitivity to light;
    4. sensitivity to sound;
    5. memory loss;
    6. confusion;
    7. dizziness;
    8. anxiety; and
    9. personality changes.

After the 2012 season, Bruce left the BC Lions and was signed for the 2013 season by the Montreal Alouettes.

Also from the claim: “Further, despite the fact that the plaintiff was displaying the ongoing effects of concussion to medical professionals  and coaching staff, he was permitted to return to play in the 2013 season for Montreal.”

In a 2011 Yahoo! Canada  Sports 55 Yard Line  article by Andrew Bucholtz,  and so noted in the claim, commissioner Mark Cohon said “I am convinced that every concussion is being reported and dealt with. I trust our  doctors. I trust our therapists. I trust our teams to report that.”

And in the 2011 Canadian Football League  concussion “Campaign” directive to the CFL clubs from Cohon advised to “err on the side of extreme caution” when dealing with suspected concussion injury.

Those familiar with my series “3rd Down, CTE To Go,” for the Concussion Blog in 2013 will recall former CFL player Leo Ezerins, now communications director for the Canadian Football League Alumni Association, and Dr. Charles Tator, of the University of Toronto, Krembil Neuroscience Centre, and the Canadian Sports Concussion Project. 

Both Tator and Ezerins believed there were “more questions than answers” between concussion and brain trauma and that “extreme caution” be used in any subsequent diagnosis of CTE.

Accordingly, Ezerins and Tator are named as defendants in the lawsuit and perhaps the most revelatory allegations — again not proven in a court of law — made in the claim are that Bruce continued to play CFL football after suffering concussion  and sub-concussive injuries because:  Continue reading

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Arkansas Looks Into Hit Limits

18 Jun

Over two years ago I sent an open letter and proposals to the Illinois High School Association (IHSA) regarding hit limits in football.  Some took this as a “candy ass” approach and one that was not needed.  I disagreed with that assessment, in fact, I felt that what I wrote at the time was proactive and could be a way for this state to be a leader in the area of protection in concussions;

I am writing this letter to address the growing concern of concussions in sports, mainly in football.  It should be noted that football is not the only sport with a concussion issue; however this sport combines the highest participation, highest risk, and highest visibility.  This letter should not be construed as an attack on the sport of football, but rather a way to keep the sport continuing to grow.[...]

Recent evidence suggests that even the subconcussive hits – those that effectively “rattle” the brain but do not produce signs or symptoms – become problematic as the season wears on, let alone a career.  As the researchers in this field gain focus and more specific diagnostic tools, I feel we will see damning evidence that will put collision sports in jeopardy as they are currently constructed – the key being “as they are currently”.  There can be a change, both positive and proactive, that will signal to everyone that the IHSA is taking this matter seriously and can set a nationwide standard.

Needless to say it was brushed aside and was ignored, except for a kind email saying things were happening behind the scenes.  Now, two years and one month later there could be a 12th – TWELVE – states that have contact limits in place for high school football; as Arkansas looks into the matter;

According to reports, the Arkansas Activities Association has passed a recommendation to ask school superintendents to cut full contact practice time to just three times during game weeks. With one of those being the game itself, it leaves just two days of tackling if the proposal passes.

Jason Cates is the lead trainer for Cabot High School, and the former President of the Arkansas Athletic Trainers’ Association, he says, “Something has to be done.”

“The more studies that are showing that hit counts do count and add up.”

The Arkansas proposal limits the full contact days to three, opposed to the two I proposed, but it seems to me that others have seen the light.  That light is both the end of the tunnel and the oncoming freight train.  Kids need Continue reading

Refreshing Words From an Athlete

24 Apr

It’s my “off-season” of sorts here on the blog.  Add into that a growing, young family and time just seems to be hard to come by (not to mention my real “day job” of taking care of hundreds of athletes at a high school).  However, I am always listening and reading.

Today I stumbled across an Australian Rules (Footy) article about a knee injury but what I found in the article was a quote, from a professional athlete, that made me smile.  It seems that self-awareness and concussions is starting to take root (emphasis mine);

“I went to lunge to tackle Dangerfield and I remember Jimmy coming the other way and he sort of clipped my head and at the time, I didn’t think too much about my knee, I was more worried about my head,” Armitage told AFL.com.au after he was released from hospital on Wednesday.

If you read about the knee injury and the subsequent teammates horror over that you would wonder why he was thinking about his head.  David Armitage, without realizing it, has shown people, athletes are cognizant of concussion and in this instance placing that injury above a knee injury (albeit a laceration – significant enough to warrant a nine-day hospital stay).

This is where we need to get to, acceptance of the injury.  Understand that this will and can happen and then move on from there.

Its not the injury of concussion that is the real issue, rather it is the mismanagement of the concussion that is the real problem.

TCB Commenter Highlighted in Canadian Press

18 Mar

If you visit here enough and take the time to look at the comments at the end of the posts you might notice a person named “Phil”.  He especially took time to comment on the work of Terry Ott and his seven-part series about CTE in the CFL.  Thanks to Terry and this blog we are all able to get the genuine views of a former player in the CFL, Phil Colwell, via The Record from Canada and Terry Ott;

Colwell’s brief CFL career ended in 1981 after a violent on-field collision in a game at Winnipeg Stadium. He was playing for the Toronto Argonauts on that crisp and sunny day in October.

Covering a kickoff, Colwell, a solid six-two, 195-pounder with sprinter speed, was blindsided through the ear hole of his helmet by a Winnipeg player and was knocked out cold. He lay motionless on the field while a trainer ran to his assistance. No penalty was called on the play.

This is the type of story that Ott has sent out to tell from the beginning, placing faces and human behind the issue that has become one of the preeminent problems with football.  Yes, this is not isolated to football but we would be remiss if we didn’t expose and tell the stories of the most oft afflicted in the “head games” we now find ourselves knee-deep in;

Colwell, who graduated from Laurier with a psychology degree, found work with a Scottish government agency but continued to suffer bouts of depression and mood swings. He says accompanying anger issues and self-medicating led to moderate bouts of short-term or primary memory loss. Colwell says he frequently “loses the right words.”

The Scottish doctors he consulted were not familiar with professional football Continue reading

Research That Should Stop You In Your Tracks

6 Feb

OK, that title may be hyperbole, but the new research out of Canada should make you take a step back and realize what our fine researchers are now able to discover.  Considering the context of hockey it shouldn’t be shocking that this was found in Canada (since posting we have been informed that work was done on both sides of the border), but really for a long while now some of the best work on concussions is coming from the North, for whatever reason (no disrespect to the US scientists).

Now that I effectively pissed off a few readers with the last comment, here is what was found by Dr. Paul Echlin and team:

  • concussions alter the white matter of the brain
  • structural damage can now be seen
  • MRI was used
  • this is both males and females
  • brain vascular changes were noted in males only, but resolved at two months
  • comparison with control counterparts showed that concussed individuals had white mater changes at end of season (upon being fully resolved from injury)

From the CTV News article (video at jump);  Continue reading

The OTL Investigation on ‘Heads Up’ Football

14 Jan

It may have slipped some of your reading or viewing, but ESPN’s Outside the Lines did a piece on the USA Football Heads Up Program.  The article and video were presented last Sunday morning – I cannot find a YouTube version of the OTL show but you can find that part HERE.  The seven minute presentation is great for a quick overview of the issues ESPN has found.

For more in-depth coverage you should read the article by Steve Fainaru and Mark Fainaru-Wada, the same authors that penned League of Denial.  There are some wonderful points brought to light by the Fainaru’s;

The program teaches concussion awareness and proper helmet fitting, but its central tenet is the soon-to-be trademarked Heads Up Tackling program. When executed properly, proponents say, Heads Up Tackling literally takes the head out of the game. Players are taught to keep their heads up and lead with their shoulders when tackling.

[...]

But critics view Heads Up as a cynical marketing ploy — a repackaging of old terminology to reassure parents at a time the sport is confronting a widening health crisis.

There is a reason I have been “relatively” quiet on this topic; it’s because they are doing some very good things in the way of education and helmet fitting.  As you may know I am huge on the topic of awareness when it comes to concussions.  I have stated many times that the injury itself is not the “ice burg we can see above the water” rather it’s the mismanagement of the concussion that is the massive ice chunk we cannot see from the surface.

That being said, with the actual tackling technique being taught I too feel this is a repackaging of an old mantra.  Rules were even put in place as early as the 70’s to accomplish this task of taking the head out of the game.  Face tackling, spearing and butt blocking all have been on the books as penalties to help avoid using the head as a weapon.

The problem being that those are not called very often, when they are called they are inconsistent at best, and what has it done for the game over nearly 40 years?  I am not nearly as critical as others;  Continue reading

Canadian Journalist Seeks CFL Alums (UPDATE)

28 Nov

UPDATE (11/28/13): It a appears this post and Tweet have provided Mr. Ott some good contacts!  Thank you.  However… Those willing to speak are Canadian CFL’ers, interestingly enough those that are American former CFL players have not reached out or are unwilling to talk.  This strikes me as odd but not so odd.  I feel that here in the US we still view this as taboo, to talk about concussions/head injuries.  If you would please be so kind as to find some American former CFL’ers Mr. Ott and myself would be very thankful!

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In the wake of ‘League of Denial’ by the Brothers Fainaru, many others are trying to dig deeper into the convoluted mess that we seem to find ourselves.  Of course, this is in regards to professional football.  Interestingly enough I have been contacted to seek such alums to speak with Terry Ott; mainly because there is still a veil of secrecy and some general stonewalling from those that played.  Terry passes along this note;

I am a Canadian journalist 6 months into an investigation on football concussions and brain injury and their aftermath.

My focus is on former players from the Canadian Football League (CFL).

Any former CFL player who is dealing with concussion issues is welcome to contact me at tjo55@yahoo.com

All replies in confidence unless specified by the responding individual.

I will also offer to be a conduit for those that want to speak but feel that confidence is of the utmost importance.

Tottenham Hotspurs; More Like Tottenham Hotmess

4 Nov

The center of the club soccer world resides in England (two teams in Wales) with the Barclay’s Premiere League (BPL).  Being the “best” soccer league has allowed the BPL to be televised live here in the States as the sport is showing some growth in participation and in viewership.  I have recently found myself watching more matches and even choosing “a side” – as they call it across the pond (it should be noted that soccer it called football everywhere else but here).  Through research and general information gathering as I get further into the sport the BPL or other European soccer leagues are not much different in its fandom.  Supporters of teams and players are similar to the fanatics that follow football here in America; critical of team play, ownership, players effort and results.  One area where the fans and the sport of soccer is well behind, in terms of knowledge, is concussions.

The readers of this blog know quite well that a concussion is simply an event that alters normal brain function.  Being primarily subjective it may be hard to distinguish a concussion by simply looking at a player or person.  However, the vast majority of sports fans here in America and participants know that there are tell-tale signs of concussion that cannot be disputed.  When one of those objective signs is observed it is and should be understood that said player was concussed and requires immediate removal from the game/practice/activity.  The reason is simple, concussions are a brain injury and bad.  Research has shown that playing through a concussion is very detrimental to short-term and long-term mental health.

Years ago, pre-2004, getting knocked out or displaying signs of a concussion was a mere nuisance and even a “badge of honor” among the top-level sporting participants.  It was known back then that something as obvious as someone losing consciousness was not a good thing for the younger participants, however it wasn’t looked upon as it is now.  When a sports participant absorbs enough force to effectively “reboot” the body’s central nervous system that is NOT A GOOD thing.  As the information about concussion has become more clear through the years if a player is KO’ed that player is removed from play immediately and does not return for the period determined by the medical staff.  In the NFL the soonest anyone has returned to practice or game after being knocked out, since 2010 has been six days.  Even that may not be enough time for the brain to recover.  Heck, in boxing and MMA, fighters that are KO’ed are medically suspended for 90 days.

This leads me to the bloody mess that occurred in Everton, England yesterday.  Continue reading

Report Hidden in Foreign Press

30 Oct

This report was brought to my attention by Matt Chaney, it details a study of former NFL’ers;

Unusual activity in the frontal lobe, observed in former National Football League (NFL) players as they carried out a cognitive test, matched records for heavy blows they had received to the head while on the field.

“The NFL alumni showed some of the most pronounced abnormalities in brain activity that I have ever seen,” said lead author Adam Hampshire, a neuroscientist at Imperial College London.

“(The) level of brain abnormality correlates strongly with the measure of head impacts of great enough severity to warrant being taken out of play.

“It is highly likely that damage caused by blows to the head accumulate towards an executive impairment in later life.”

NFL games have come under growing scrutiny for what critics say is a dangerous rate of concussions after hard blows to the head.

Some have drawn links between the on-field physical traumas and later neurological problems such as Alzheimer’s or Parkinson’s, which in turn have been blamed for depression and suicide.

The new study does not find evidence of disease, but highlights brain areas that may have been affected by repeated, severe impacts. And it says standard tests do not pick up this subtle damage.

This has been reported on by several “non-sports” media outlets but I cannot find it on a link to a popular sports news source, if you have let us know in the comments…  This link is from ABC, Australia…

Here is a LINK to the full text, titled: Hypoconnectivity and Hyperfrontality in Retired American Football Players.

AAP Confirms What We Have Been Saying For Some Time

30 Oct

This past Monday, the American Academy of Pediatrics released their findings of a research project on helmets and mouth guards in high school aged football players, the lead was this;

High-tech helmets and custom mouth guards do not reduce concussion risk for high school football players any more effectively than low-cost helmets or off-the-shelf mouth guards, a new study says.

This is a point we have been trying to hammer home since the inception of the blog; simply Physics does not allow for current technology to reduce or attenuate the true forces that cause concussion in the vast majority of the cases.  Those would be: acceleration, deceleration, rotation and angular vectors that cause the brain to shift inside the skull.

The most important thing about a helmet is that it’s well-maintained (regularly reconditioned) and has a proper fit.  Certainly there is some merit to the newer helmets padding designs for helping with the true linear forces reaching the skull; however helmets are doing what they’re designed for – preventing skull fractures and facial injuries.

It is unlikely that a helmet – as we currently know it – will abate those pesky forces attributed to concussion.  In reality if that is where the fix needs to come from then we will most likely be looking at some sort of apparatus that is attached to the shoulders that basically harnesses the head down.  The issue there, of course, is the range of motion to allow a player to see and move in a safe way.  Regardless this information presented by the AAP is nothing new but wonderful because it comes from a group that has “clout”.

What is more interesting to me – and a bit of an endorsement of our words – is that simple Continue reading

I Echo the Call From Cantu

17 Oct

Dr. Robert Cantu recently wrote an article for the Health & Science section of Time that discussed some of the obstacles for true understanding of cumulative effects of collision sports.  As he notes some of it is ambivalence but the main reason is that we truly don’t have the hard data, only tiny snapshots.

Cantu begins his article by cementing his thoughts on youth football, it should be flag until age 14.  Although this is an arbitrary age the reasoning seems sound, immature brains do react differently than fully developed brains.  Research does indeed suggest that adolescent brains – especially prepubescent – are more susceptible and take longer to recover.  Granted if they are not playing tackle football there is a good likelihood that some will sustain a concussion riding a bike or jumping on a trampoline; doing general “kid stuff”.  The massive difference between that and organized sports is that concussions that happen in the playground or in a park are accidents.  Some of our sports mandate that you hit or create collisions.  As we should all be keenly aware, it doesn’t take a direct blow to the head to create the concussive injury.

Moreover, once a child had sustained a concussion getting the vital information from them in this subjective injury is difficult.  Children and young adults are not very good at describing or even acquiescing to what is wrong.  This puts them behind the 8-ball, so to speak, as the proper management is often delayed or not even sought.  Mismanagement is the true elephant in the room on this issue.  As seen above many concussions occur, by accident, outside of organized sports.

In no way has he, nor I, even remotely been associated with banning of organized sports; if anything we have championed ways to get MORE children involved through less potentially harmful ways.  If people would Continue reading

Princeton, New Jersey Makes Peculiar Move

7 Aug

In a very unusual move by a school board the Princeton Regional School District – servicing one high school, one middle school and four elementary schools – has made it mandatory to wear head-gear in sports not known for head-gear.  In a proactive move the board has voted to make this a must in their school district;

The requirement, one that is not used teamwide for those sports anywhere else in New Jersey, will be mandatory initially for the sixth grade only, officials said. For children in grades seven to 12, the headgear is optional, although parents or guardians will have to sign a form saying they have declined to have their children wear it.

Still, officials were clear this week that with each year, the headgear would become mandatory one subsequent grade level at a time, so that all athletes in those sports eventually will have to wear it if they want to play.

This move strikes me as both good and forward thinking and as a waste of money as well.  Let us examine, first with the not-so-good ideas/thoughts.

First, the premise for this move was in part due to concussions (although they did also state it is for facial and oral injury protection as well) and the thinking on this is wrong in my humble opinion.  Many researchers, doctors, athletic trainers agree that helmets do not prevent concussions.  Sure there is disagreement on whether they protect – for focal-direct-linear forces they do have validity in this premise (as you will see below) – but the general consensus on concussion attenuation is exposure limitation.

Secondly, the addition of head-gear in soccer Continue reading

Why Are We Here? Confusion and muddy water

17 Jun

With all the work that has been done up to this point with concussions I truly believe that we should have a better grasp on this injury.  Recently, we have seen some very confusing information come forward, I feel the message has been mixed and may lead to further issues when handling concussions.  Patrick Hruby, in his article on Sports on Earth, takes a very critical look at the Collins research as well as other studies that have pointed to the players being the problem in this concussion issue.

It is not the players fault, it’s not the referees fault, it’s not the coaches fault, it’s not the sports fault.

I do think that football and collision sports do require some sort of “full” practices in a controlled environment.  Although the actual speed of a game is difficult to replicate in a practice, full-go is needed for players to understand the closing speeds, angles and decision-making of the sport.  Without a full grasp on this the player may be at further risk for overall injury in sport.  It would be insane to have a football, hockey Continue reading

Series from the Pittsburgh Post Gazette on CTE

16 May

Mark Roth of the Pittsburgh Post-Gaette put together an informational series on chronic traumatic encephalopathy; “a brain disease that afflicts athletes”.

In the first part that came out this past Sunday, Roth took a look at the global perception of CTE through the examples of Chris Henry and the possible case of still living Fred McNeill;

Chris Henry was a fleet wide receiver for the Cincinnati Bengals. During his five seasons with the team, he developed a reputation as a talented athlete on the field but a bad boy off it, even though those who knew him well say he was typically quiet and respectful. [...]

Fred McNeill played 12 seasons for the Minnesota Vikings in the ’70s and ’80s. After retiring, he finished law school and became a successful attorney in Minneapolis, helping to win major class-action lawsuits.

Henry would end up dead after an accident that was predicated with some unusual actions by him, McNeill now has full-time care takers as dementia has stripped him of everything he worked hard for.

Roth begins the second piece with those that can be easily called the experts in this area, Bennet Omalu and Ann McKee; Continue reading

Downplaying brain injury is not the way to attack this

6 May

Concussions have gained so much attention that the news is almost inundated with story-after-story of occurrences, recovery, litigation and people trying to mitigate the injury.  There seems to be a shortage of press clipping and stories on how to handle this injury.  More often I have witnessed stories downplaying the injury or the oft cited “Heads Up Football“.

The former, downplaying the injury itself, is not a good thing it is exactly what put us in the spot we are in now.  Patrick Hruby also took note of this while reading an article from Andrew Wagaman in the Missourian;

Still, when it comes to the single most head-scratching public statement I’ve seen regarding brain trauma and football, University of Missouri neuropsychologist Thomas Martin takes the pole position. Hands-down. In a piece about youth football and cognitive risks published this week in the Columbia Missourian, Martin compares brain damage to … knee injuries[...]

This blew my mind. I had to read it twice. And then a half-dozen more times. It still blows my mind as I’m typing this. Here’s why people react differently to brain and knee injuries, and why football is in a world of potential trouble: because the potential harm resulting from a brain injury is nothing like that resulting from a knee injury.

If you read Hruby’s article you will see he makes a strong case for this analogy being utterly false; Continue reading

A Chuckle and Video

10 Apr

I really don’t have much for this quote found in this article;

“I have a theory on concussions,” he said. “I think the reason there’s so much more of them — obviously the impact and the size of the equipment and the size of the player — but there’s another factor: everyone wears helmets, and under your skull when you have a helmet on, there’s a heat issue.

“Everyone sweats a lot more, the brain swells. The brain is closer to the skull. Think about it. Does it make sense? Common sense?” said Carlyle, who said he’d never talked to a doctor about his premise, which he was introduced to by Jim Pappin, the former Leaf who also played his career helmet free.

“I don’t know if it’s true, but that would be my theory. Heat expands and cold contracts. The brain is like a muscle, it’s pumping, it swells, it’s a lot closer to the outside of the skull.”

Stick to coaching hockey, eh!

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The ESPN article and video (click link or below) regarding the NFL Concussion Litigation; Continue reading

ESPN OTL Article Sparking Quite A Debate

8 Apr

On the surface this article may be innocuous to many, but the the minutia of concussion research and information is coming to a head very quickly, especially pertaining to the NFL.  Tomorrow is the first hearings in front of the judge – and the possibility of total dismissal – for the concussion law suits filed by thousands of former NFL players.

ESPN and its Outside the Lines department (in conjunction with Frontline) filed this article taking a look at two of the most prominent people in the concussion research/awareness arena, Dr. Robert Cantu and Chris Nowinski;

Two prominent concussion researchers — including a senior adviser to the NFL — served as paid consultants to law firms suing the league for allegedly concealing the link between football and brain damage, according to interviews and documents obtained by “Outside the Lines” and “Frontline.”

The article written by Steve Fainaru and Mark Fainaru-Wada sheds light on the very issues the research community faces with this problem.  Some of this information can be classified as “not new” to people who participate in the constantly shifting arena of litigation and research, while some information can be deemed as scathing.  There is a very tight and ubiquitous line in this matter;

Researchers often are asked to appear as expert witnesses in legal proceedings related to their fields. The NFL suit, with the potential for billions of dollars in damages, has created a large demand for researchers with expertise in the science of concussions.

But some researchers said they have turned down such requests despite the potentially lucrative payoff out of concern the perceived conflict could compromise their research.

Conflict of interest (COI) is something we all need to pay attention to, although it applies to this current article, the COI in this field is rampant and often unchecked.  This is nothing new, players have talked about COI, other journalists have noted it, and one of our prominent commentators (Dr. Don Brady) on the site has even devoted some of his dissertation to COI.

It would seem this is nothing “new” in the world Continue reading

Latest Research on Concussions; Rather No Concussions = Changes

7 Mar

Certainly the research is flying in; mostly the investigations are now looking at either ways to detect the injury or objective ways to determine recovery.  There are a bunch of other designs and angles out there but the most important are the above.  Although it would be great if we had an objective way of determining concussion, it is really not the pressing issue (with solid education and conservative approach to injury – sit them out).

As I have stated over and over, the BIGGEST issue we face with concussions is the mismanagement of concussion from the beginning; therefore the need to identify when it is safe to return is more paramount in my opinion.

The newest research is out from the Cleveland Clinic, it looked at 67 college football players, more specifically it looked at their blood, report from WKYC;

In a study of 67 college football players, researchers found that the more hits to the head a player absorbed, the higher the levels of a particular brain protein that’s known to leak into the bloodstream after a head injury.

Even though none of the football players in the study suffered a concussion during the season, four of them showed signs of an autoimmune response that has been associated with brain disorders.

There we go again, telling and showing people that the hits that don’t elicit a concussive response are also a culprit in the brain injury crisis we are facing.  Coaches, particularly in soccer and football, will tell us that we are wrong and that it is either unproven or not a possibility because of how “safe” they practice or the equipment they have.

Back to the research, the group looked for the S100B protein that should only be in the brain;

Typically, S100B is found only in the brain; finding S100B in the blood indicates damage to the blood-brain barrier. While the exact function of S100B is not known, it is used in many countries to diagnose mild traumatic brain injury when other typical signs or symptoms are absent.

Studies in Janigro’s lab revealed that once in the bloodstream, S100B is seen by the immune system as a foreign invader, triggering an autoimmune response that releases auto-antibodies against S100B. Those antibodies then seep back into the brain through the damaged blood-brain barrier, attacking brain tissue and leading to long-term brain damage.

They also did some PET scans to Continue reading

Athletic Trainer Removed from Post for Standing Ground on Concussions

1 Mar

This is one heck of a way to start out National Athletic Trainer Month…

Paul Welliver, a name that should be remembered and learned about.  Welliver is a certified athletic trainer in Maryland and was until a few weeks ago the athletic trainer at Winters Mill High School.  The only one the school has ever known; being outsourced from Maryland SportsCare & Rehab.  The admin at the High School asked his employer to have him no longer provide service for them.  Welliver (at time of post) has not been fired from Maryland SportsCare & Rehab.

Why, you ask?

Because this athletic trainer stood up for what he believed and knows about concussions.  Unfortunately, this scene is all to familiar with us high school athletic trainers.  The story is from Carroll County Times;

The Carroll County Public Schools Supervisor of Athletics Jim Rodriguez and Winters Mill High School Principal Eric King told Welliver’s boss at Maryland SportsCare & Rehab that they did not want him to continue his position at Winters Mill, according to Welliver. After 10 years as the school’s athletic trainer, his last day was Feb. 12. [...]

Welliver said on four different occasions in the last 18 months, he refused to begin the protocol that is meant to gradually release student-athletes back into sports participation after a concussion. The protocol, also known as Return to Play, is supposed to begin once a student-athlete returns a medical clearance form after their injury has been classified as a concussion.

In this school district they have a pretty solid concussion policy and protocol  highlighted in the story, however when the one person – and last line of defense for the student-athlete – stands up for the protection of the children he is summarily dismissed;

He said the athletic trainer has to sign off on a student-athlete’s return to full contact and competition following a diagnosed concussion.

Welliver’s refusal to start the protocol all four times was because he was concerned about the safety of the student-athletes, he said. He is worried about their short- and long-term health, he said.

“There are times when I do not believe they should return to the sport,” Welliver said. “It is not safe.” [...]

“I treat all those athletes like they are my children,” he said. “Sometimes I spend more time with other people’s children than my own.”

He is exactly correct!  As if he had to really explain it to people who should not be part of the process he did for the article;

“I take into account many factors, including the number and severity of previous injuries and the age and grade of the student,” he wrote on Facebook. “It would be much easier to go along with the pressure of returning the student A.S.A.P., but I have seen way too many poor outcomes after multiple head injuries.” [...]

In addition to his decision to keep student-athletes from playing their sport after a concussion based on age, grade and the severity and number of previous concussions they have experienced, he also takes into consideration the sport or sports the athlete would return to. Their return could take longer if they play high-collision sports.

Shockingly, the school district and those that put the separation is motion had no comment.

Welliver did and does it right based on all accounts, the man – athletic trainer – father Continue reading

Quick Hits on a Cold Thursday

31 Jan

American Medical Society of  Sports Medicine Position Statement…

I had seen this but caught it again in a below article, the AMSSM released its position statement on concussions recently.  Most of those involved in writing this were in Zurich last November and this comes out about two months before the consensus statement is released in the British Journal of Medicine.  (pssssst – it is also going to have a release in Australia, in conjunction with the AFL Concussion Conference and first round of games and I am still looking for a sponsor)

I found one piece of this position statement very encouraging and made me smile for all the hard work others have done;

Return to Class

* Students will require cognitive rest and may require academic accommodations such as reduced workload and extended time for tests while recovering from concussion.

The rest of the statement is not really “Earth shattering” but there are interesting points in there;

* In sports with similar playing rules, the reported incidence of concussion is higher in females than males.

* Certain sports, positions, and individual playing styles have a greater risk of concussion.

* Youth athletes may have a more prolonged recovery and are more susceptible to a concussion accompanied by a catastrophic injury.

* Balance disturbance is a specific indicator of concussion but is not very sensitive. Balance testing on the sideline may be substantially different than baseline tests because of differences in shoe/cleat type or surface, use of ankle tape or braces, or the presence of other lower extremity injury.

* Most concussions can be managed appropriately without the use of neuropsychological testing.

* There is increasing concern that head impact exposure and recurrent concussions contribute to long-term neurological sequelae.

* Some studies have suggested an association between prior concussions and chronic cognitive dysfunction. Large-scale, epidemiological studies are needed to more clearly define risk factors and causation of any long-term neurological impairment.

* Primary prevention of some injuries may be possible with modification and enforcement of the rules and fair play.

* Helmets, both hard (football, lacrosse, and hockey), and soft (soccer, rugby), are best suited to prevent impact injuries (fracture, bleeding, laceration, etc) but have not been shown to reduce the incidence and severity of concussions.

* There is no current evidence that mouth guards can reduce the severity of or prevent concussions.

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X-Games, D on coverage…

Anyone catch the X-Games this past weekend?  Action sports are on the rise and the X-Games Continue reading

UCLA Tau PET Study

23 Jan

If you paid attention yesterday you saw that a very preliminary study was unveiled about identification of tau proteins in the brain.  This is significant on two fronts

  1. up until now this has been non-existent with current imaging technology
  2. tau is the #1 culprit in chronic traumatic encephalopathy

If, in fact, this PET scan can find and map out the tau in living brains this would be a “watershed” moment in the treatment of CTE.  This would be because we have not been able to treat CTE, the only way to find CTE is via a posthumous examination.

I believe this is very exciting, but remember like all things in life, caution is needed – the study was only five former NFL’ers and to fully confirm the information gathered the researchers could be waiting a long time, hopefully.

A quick side note here, Dr. Bennett Omalu is a co-author on this study, which isn’t ironic as some have suggested, rather a product of his good work in this area.  For those in the “know” surrounding research in concussions and CTE finds this part of the story – Omalu – “interesting”.

What a great start, and I am willing to be scanned if anyone wants to pass that along!  I would even write a blog about my experiences with it.

Concussions 201

23 Jan

The Concussion Blog, has for years, presented you with the basics of concussions and other issues surrounding this particular brain injury.  Most of it was factual information/research that I opined about.  Others were original information that was seen here first.  Regardless our aim – and continues to be – is to keep everyone aware and educated about this topic.

I was passed along a great article on concussions, it was beyond the “basics” but not so in-depth that you get lost in the mumbojumbo;

In other words, concussions are not caused by a brain doing back flips within the skull. In fact, miniscule amounts of movement might be to blame.

The article was written in response to the Stevan Ridley “Fencing Response” producing injury this past weekend and Dave Siebert colored this situation perfectly; Continue reading

Claiming Ignorance No Longer Allowed for Parents says Doctor

16 Jan

Thanks to the good – and tireless – work of Matt Chaney I get sent plenty of emails about the happenings on the concussion front from a media perspective (stories and whatnot).  A lot of them have vast information, but for a while I thought they were all reaches and looking to “grab the headline” to get readers.  Sure, there have been plenty I have posted on here, but what is becoming concerning is the amount of pubs I get, not only from Chaney, but others that are starting to tell the story of major issues.

We all know and should have known that concussions were going to be a concern for all sports, but the tide is shifting against the most popular sport we have in ‘Merica.  It is a fundamental problem we must wrap our collective heads around if we want to enjoy football and all sports for that matter.

One such article that caught my attention is centered around parents no longer having the ability to be naive about the sports we and our kids play.  With all the information out there parents no longer have the ability to claim ignorance about concussions;

Dr. Joseph Ciacci loves football, but he fears it. He can’t get enough of the game he prevents his son from playing.

He is in the business of repairing brains. He has seen too much to maintain neutrality.

“The more you know about the issue, the more you think about the issue, the less inclined you are to take a chance,” the UCSD neurosurgeon said. “Because you can’t claim ignorance.”

It’s one thing, Ciacci says, to enter a mine field inadvertently, but quite another to do so when you recognize the risks. Ciacci has had an intimate understanding of those risks since 1977, when his own football career ended with a severe spine injury sustained while covering a high school kickoff.

Amid an avalanche of disturbing new data and harrowing case histories, Ciacci is trying to steer his older son toward water polo.

When you read the above article note how Tim Sullivan did excellent work by interviewing the family in 2011 and 2012 about the same subject.  Although this story is from May, it gives good perspective about the thoughts many of us are dealing with.

Possible Biomarker? Possible Definitive Imaging?

27 Nov

Biomarkers are the next frontier in the concussion realm, really any specific and reliable objective measure to confirm a concussion.  Currently we can view concussion a “diagnosis in absence”; meaning if you have head trauma and there is no remarkable imaging the default diagnosis would be concussion.  This can be effective if there were enough signs that warranted the exam or the individual was truthful about symptoms; but what about the population that either does not respect/believe concussions or refuses to accept that they are a brain injury?

That is why the race is on to find either a biomarker or imaging technique that someone can say; “look, see these numbers/images, it means you have a concussion.”  This is great if the process of evidence based practices (EBP) was swift and widely accepted; the sub-issue is that there is ALWAYS “more research to be done”.  The first study deals with not a blood drawn biomarker, rather an imaging measured biomarker.

Dr. Michael Lipton of the Albert Einstein College of Medicine in New York presented this information recently;

In a single-center, case-control study, patients with mild traumatic brain injury (TBI) who had more abnormally high fractional anisotropy (FA) had fewer concussive symptoms and better quality of life a year after their injury than those who had less of the biomarker, [...]

“If abnormally high FA represents neuroplastic effects, and if that’s how people recover from brain injury, it would be possible to use this in translational studies to identify the underlying mechanisms of pathology and to identify therapies that don’t look at how we fix the damage, but how we enhance the brain’s ability to compensate for that damage,” Lipton said during the briefing.

[...]
Overall, all patients had detectable areas of abnormally high FA: some had more, others had less, Lipton said.

But those who had higher levels of abnormally high FA had fewer post-concussive symptoms and better health-related quality of life a year after their injury, he reported.

Higher levels significantly predicted improvements in concussive symptoms (P=0.01), as well as better outcomes in terms of the quality-of-life outcomes of mobility control (P=0.024) and psychological functioning (P=0.007).

This suggests that the “brain is compensating for its injuries,” Lipton said, and that high FA “may be a manifestation of neuroplasticity.” Because the brain does not form new axons, he said, it could be that the connections between existing axons are changing or strengthening.

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At the same time  a group led by Dr. Yulin Ge found and published in Continue reading

Ding, ding, ding!

16 Nov

I recently read a story in the Globe and Mail, “Stampeders backpedal on concussion talk” about Calgary QB Drew Tate who was hit in a head-to-head collision in the 2nd quarter of play on Sunday, November 11. At halftime, Tate said that he had his “bell rung” and couldn’t remember the first half of play, generating this comment from Eric Francis of the Calgary Sun, “All the questions Monday will and should revolve around the apparent silliness of letting Tate play after his halftime admission to TSN.” (emphasis added) Not to worry though, according to Tate all that really happened is that he was “dinged” and “felt some fuzziness”, besides, as Tate says, “As far as talk about a concussion, I didn’t get what the fuss was because I felt fine and just wanted to play.” The Stampeders administered concussion tests during the game, after the game, and Monday morning. Tate was ruled to be symptom free.

It seems fairly clear that Tate was concussed. However, not according to Dave Dickenson, Calgary’s offensive coordinator and a former QB, whose diagnosis was that  he “can tell when I look into someone’s eyes if they are concussed or not,” and he didn’t see any symptoms. Nevertheless, Chris Nowinski knows a thing or two about concussions, concussion management, and the Continue reading

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