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Nick Mercer: Impromptu Expectations

28 Mar

The thing about expectations is that they presume a certain course of events. In July 2003, I assumed that I would start my co-op job in Ottawa in September and I based my expectations for the coming years on that presumption – my previous post, Finding yourself after a brain injury. First step: Recon. Brain injuries themselves are unexpected, so you don’t know what presumptions to make that will allow you to generate expectations. You’re already starting off on the wrong foot. It’s not so much the issue of living up to, not meeting, or exceeding expectations, it’s more about the expectations themselves that I will write about.

After considering a patient’s health/medical history, age, other essential factors and the severity of most injuries, conditions, or diseases, doctors can only base their ultimate prognosis on probabilities. This is where expectations begin to go awry. Not to get into statistics or anything, but if the probability of surviving a coma of a certain length and severity is low, it’s because it hasn’t happened very much, therefore there will be few cases upon which to build expectations. The fewer cases, the fewer reliable prognoses can be made, hence few, if any expectations.

Those are for others to make. The most important expectations are the ones you make for yourself. I had been making those ever since
I can remember. When I was a kid and used to catch insects, I had Continue reading →

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Concussion Conglomeration “Road Marker” (UPDATED FREE ARTICLE LINK)

27 Mar

A paramount review of concussions and their “long-term” effects has been published (or soon will) in Nature Reviews Neurology that I certainly hope does not slip past the masses.  Not only is the information somewhat of a “where we stand”-moment of clarity, it is authored by a very underrated and proficient researcher; Dr. Barry D. Jordan.

Jordan, B. D. Nat. Rev. Neurol. advance online publication 12 March 2013; doi:10.1038/nrneurol.2013.33 (note you need a log in).  Here is the FREE DOWNLOAD LINK

Acute and chronic sports-related traumatic brain injuries (TBIs) are a substantial public health concern. Various types of acute TBI can occur in sport, but detection and management of cerebral concussion is of greatest importance as mismanagement of this syndrome can lead to persistent or chronic postconcussion syndrome (CPCS) or diffuse cerebral swelling. Chronic TBI encompasses a spectrum of disorders that are associated with long-term consequences of brain injury, including chronic traumatic encephalopathy (CTE), dementia pugilistica, post-traumatic parkinsonism, post-traumatic dementia and CPCS.

Dr. Jordan also discussed CTE in further detail including the limitations of possible antemortem detection; including imaging and categorization.

In this Review, the spectrum of acute and chronic sport-related TBI is discussed, highlighting how examination of athletes involved in high-impact sports has advanced our understanding of pathology of brain injury and enabled improvements in detection and diagnosis of sport-related TBI.

The overriding theme I gathered from this review article is one that I have been hammering home for a very long time: the mismanagement of the original sequale may be the largest factor in discussion the multiple faces of “chronic TBI” that result from concussion.  This paper is also very succinct in demonstrating the massive amount of work that still needs to be done.

I urge you to find a copy or pay for a subscription for this article, it should be one that we look back on in 5 years as the “where have we come from” moment in this issue, regarding chronic issues from sports related concussion.

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Zurich 2012 In Writing

12 Mar

If you all recall I went to Zurich in November to attend the “Concussion Conference”; mainly as an observer, but there was enough time and opportunity to impart my questions/knowledge as a practicing athletic trainer.  Here are the links to DAY 1 and DAY 2 of my live blogging.  By the way, the live blogging was WELL received and continues to provide great insight into what went on.  I hope that I am asked back for the next conference, or any other conference that wouldn’t mind my attendance.

Now the information gathered at the conference has been hashed and rehashed and now appears as the 4th Consensus Statement (tweeted previously).

As part of the initiative the Standardized Concussion Assessment Tool (SCAT) was looked at and changes were made to the 2nd version from 2008.  You can now find the new version by clicking SCAT3.

A new wrinkle was an assessment tool for the younger ages, the group decided on the “Child” version of the new SCAT3, that can also be found by clicking Child SCAT3.

Also included in the addendum of the Consensus Statement was a recognition pocket card, found by clicking Recognition Pocket Card.

All of the above is free and intended to be used as a resource for better concussion assessment and even early management of concussion.  Please read the Statement regarding best practices.  As always this blog is NEVER to be used to diagnose or treat a concussion.  There is a lot to be absorbed and read; one thing is for sure we as athletic trainers and concerned/educated individuals now have the most recent information at our fingertips.  I guess this blog is actually doing some good work :)  A side note; how about this appearing during National Athletic Trainers Month?  It might be a coincidence, but I find it serendipitous.

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Team Gleason PSA – Hey NFLPA Please Read

31 Jan
I received this from an anonymous source and was asked to spread this news, hopefully it will reach those it is intended for…  How bout you watch the video first then go to the Team Gleason website;
Subject: PSA release: NFL Players and Coaches stand together to cure ALS
Hi everyone…I hope this email finds you well…
Just wanted to let you know that beginning today, we at Team Gleason are rolling out a new ALS awareness campaign to be introduced this week in New Orleans for the Super Bowl.
Here’s a link to the video, which takes viewers directly to the Team Gleason website:
This is important, please spread if you get the chance…  This is NOT JUST A FOOTBALL PROBLEM, this is a problem for everyone!

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Matt Chaney – Tireless Worker

18 Jan

SpringGame1984Sideline
If you have been around enough you have seen the stylings of Matt Chaney on this blog, he is someone I call a friend.  In some circles that discounts me as a professional, which is both stupid and dumb.  I don’t always agree with Matt, heck him and I have been known to battle via electronic and phone communications.  However, his opinion is a valuable one – often his work is based in so much fact it makes your head spin as to why some of its missed.  Regardless, Matt has published two recent articles on his blog, for all to consume, here are some excerpts.

Part 1, published January 7th;

Historic football excuses thrive in modern debate over brutality

Lawsuits, criticism explode and officials project blame onto individuals

Old talking points of football apology resonate yet as officials tout anti-concussion measures like trainers along sidelines, new rules for safer play, injury reduction and expert consultation—same type of promises heard from gridiron leaders during the Victorian Era

American football gets lambasted in public for maiming and killing, denounced by an influential movement of critics, and game officials pledge safer play based on their new concepts of prevention, including:

*Qualified trainers and doctors will patrol sidelines.

*State-of-art medical response will treat the rare severe casualties.

*Limits will govern length of practices.

*Injury tracking will cut rates already on decline.

*Coaches will properly train players.

*Every player will undergo medical prescreening.

*Experts will lead safety reform in rulemaking and research.

*Referees and coaches will enforce new rules of experts.

*Players will follow new rules of experts.

Sounds familiar, these steps, a practical recitation of talking points for contemporary “safer football” promoted by the NFL and commissioner Roger Goodell, in face of lawsuit frenzy against the league and sport in general, along with festering disgust in the public.

Except the football rhetoric is 119 years old, from 1894, a packaged response during the game’s initial siege against formidable opposition seeking abolishment. Continue reading →

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Coach & AD Magazine Cover Story

17 Jan

cover picIn January’s edition of Coach and Athletic Director Editor-in-Chief, Michael Austin wrote the cover story on concussions; titled “What you’re missing when it comes to brain injuries”.  A very well researched and written article on concussion issues at the high school level.  Austin looked at the changing protocols, safety issues and legal concerns that will be facing the sports of our community schools now and in the future.  Here are some excerpts;

This isn’t just a football problem.  Media coverage focuses on the gridiron, but any time a player’s head is placed in harm’s way, a brain injury is a potential result.  “From what I see, football leads the pack by far but we’re also seeing more girls and boys soccer players sustaining concussions,” says Dr. Michael C. Koester, MD, ATC, who is the director of the Slocum Sports Concussion Program within the Slocum Center for Orthopedics and Sports Medicine in Eugene, Ore. “Interestingly this year, and this could just be a statistical blip, but it’s worth noting we are seeing more girls volleyball players as well.”

That comment struck me as in the fall I saw more junior high school volleyball concussion (5) than high school football concussions (4), I have no idea what that means.

In the area of classification, Austin does a good job of trying to put ‘mild’ to rest with concussions;

Dr. Gerard Gioia, the director of the Pediatric Neuropsychology Program at Children’s National Medical Center and the director of the hospital’s Safe Concussion Outcome, Recovery & Education (SCORE) Program, says the medical community has “dropped the grading system” when it comes to concussions.  He adds a common misnomer is the
suggestion you must have loss of consciousness to sustain a concussion, which is not true.  “You can’t call a concussion
‘mild’ just because someone isn’t knocked out for 10 minutes. Most concussions do not involve a loss of consciousness,” Gioia says.

Regarding the state legislation and protocols;

“The No. 1 goal is to get the student-athlete back to school without symptoms or ramifications before even thinking about a return to the sport,” Fink says. For coaches anxious to have the player return to the field, Fink tells them every athlete Continue reading →

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Concussion Symposium March 2nd

15 Jan

I received the following press release about a Concussion Symposium coming up in March.  The faculty is not your “usual suspects” rather some very good and known people in the medical field.  If you get the chance to head down to Texas for that Saturday I believe you will not be wasting your time or resources.  I would love to make it, however I have a prior commitment; that being said someone take good notes for me.

I would also like to add that having athletic trainers on the program list legitimizes this symposium in my mind.  Here is the presser;

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Austin, Texas (PRWEB) January 10, 2013

Concussion Compliance presents “Bridging the Gap on Best-Practices in Concussion Management.” This day-long exchange, sponsored by St. David’s HealthCare, brings together leading medical experts and practitioners to discuss the issues dominating today’s best-practice concussion management and how to incorporate the guidelines as well as the use of several tools into clinical practice.

The national symposium will be held March 2, 2013, at the Norris Conference Center, Austin. Registration is now open

“Communication and education that crosses traditional boundaries are key factors to providing good concussion treatment for our young athletes,” said Theodore Spinks, M.D., chair of the symposium program planning committee. He is a board certified neurosurgeon seeing patients in Austin, Round Rock, and Georgetown, Texas. Dr. Spinks currently serves on the CDC Expert Panel for Pediatric Mild Traumatic Brain Injury. He also served on the Texas Medical Association Committee on Concussions in Athletes during the last session of the Texas Legislature.

The symposium program provides an overview of the current best practices and consensus statements on concussion management, the latest scientific research, an update on tools available to practitioners, and perspectives from experts in concussion management.

  •     Featured Topics – The Physician’s Perspective; An Athletic Trainer’s Perspective; Head to Head: Cognitive Testing; Beyond Cognition: Balance Testing; A Look Into the Future: Vision Testing; Neurosurgical Management of Head Injuries and Concussion; Implementation of Best Practices Into Clinical Practice
  •     Keynote Speaker – Dr. Steven Erickson will present on the latest best practices in concussion management. Dr. Erickson is the medical consultant for Major League Baseball caring for the umpires and serves on the Major League Baseball Medical Advisory Committee and the Major League Baseball Mild Traumatic Brain Injury Committee.
  •     Reading of Proclamation from Governor Perry’s Office – March Concussion Awareness Month in Texas
  •     Exhibit Hall – Featuring the newest in technology, practice services, practice information, and pharmaceuticals

In addition, Governor Perry has Continue reading →

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Matthew Gfeller Neurotrauma Symposium

12 Dec

Loudermilk_picsIn Zurich I had the chance to speak to many people; I enjoyed my brief time speaking with Jason Mihalik – fellow athletic trainer.  He reminded me of the previous Symposium in North Carolina and the upcoming second version.  I asked him to send along an email and I would put it up on the blog.  Here it is, and he is right, make sure you register NOW, it fills fast.

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It is with great excitement that my colleagues and I will be hosting the Second Matthew Gfeller Neurotrauma Symposium at the University of North Carolina at Chapel Hill on March 8-9, 2013. We have lined up another great list of local, regional, and national speakers. For additional information regarding a schedule of topics, invited faculty, and links to negotiated hotel rates, please visit us at http://tbicenter.unc.edu, and click on “TBI Symposium” in the header. A direct link to register for the symposium is as follows: http://tinyurl.com/c576kdu.

Our first symposium sold out 2 months prior to the scheduled event, so register early! Current Early Bird rates in effect until January 8, 2013 are as follows:   Continue reading →

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Zurich Day 2… And We Are Live

2 Nov

I have figured out the power situation so I will be trying to update the blog ASAP after each session…  For the time being make sure to follow on Twitter…

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1030 CST: Session 7, final session: The Sharp End

First debate between Dr. Cantu (yes) and Dr. Herring (no): is no RTP same day the best management paradigm?  Is keeping a player out one week long enough and is the graduated RTP protocol sufficient…

THERE WILL BE NO RTP on same day in the new statement!!!

Change of direction on Session 7, questions with panel answers, pro-con (if available)

Do 3 concussions end your career?

  • its comedy hour
  • Aubrey – treat each athlete individually
  • Dvorak – it has to be based on timing and complexity of each recovery – case-by-case basis
  • Putukian – if we can’t agree on dx how can we agree on a number
  • Overall theme is it is individualized, not all concussions are the same (Cantu)

Who is best qualified to make the sideline decision?

  • Cantu – multiple members working under a physician can make the call
  • Herring – concerning to him that some information is intrinsic to doctors so need to be careful
  • better question is who best qualified – person with most experience
  • Dvorak – looking at spectrum of games played, doctors are best qualified in most instances, but are they there in all matches?  We should aim all this to the “grass roots” as the professional level there is more than adequate coverage.
    • comedy about football versus american football
  • Ellenbogen – those that know the athletes should be making the decision, maybe a parent in youth sports, or athletic trainers, understanding the patients baseline is important
  • Putukian – balancing act, in a perfect world its a team approach (Athletic Trainer mention), and she says in the US the athletic trainer should be making the decisions on the sidelines…
  • Aubrey – Hockey Canada has a safety person (volunteer) in lieu of an athletic trainer
  • Cantu – brings up possibly training school teachers in concussion
  • Herring – if you are team physician do you need someone else to make the decision if you are on the sideline?  Panel – no

Is there a role for grading concussions?

  • Cantu – not perfect, but informing patient is important about severity and duration of recovery, after the fact
  • McCrory – we have moved from grading, look at the recovery – perhaps look at the SCAT/serial testing
  • Putukian – looking at history is more important than arbitrary “grade”
  • Herring – may help with continual care from one place to another, but again important to understand history

Should we be returning on the same day of concussion?

  • Aubrey – what about the NHL player in the playoffs (rhetorical question)
  • Cantu – no once recognized
  • McCrory – what about the players that clear the SCAT, so no concussion, but you know something is amiss?
  • Putukian – example of hockey player with delayed symptoms
  • McCrory – concussion is often an evolving injury
  • Ellenbogen – it is a traumatic brain injury, is the game worth it?  No.
  • Panel – consensus is NO RTP same day
  • McCrory to Aubrey about playoff example – what about a regular season, and Aubrey is being very honest, and he feels the player push back is greater
  • Ken Dryden from the audience – why are we treating professional athletes different from the youth or non-elite athlete
    • We are starting to move away from that, all athletes should be treated the same

Should there be helmets in woman’s lacrosse and field hockey?

  • Cantu – yes, because of stick and ball causation of concussion
  • Putukian – no, change nature of the game, no reports of intercranial bleeds in women’s lacrosse, weary of unintended consequences (BTW, probably has the most experience with this)
  • Cantu and Putukian discussing this topic
  • Change gears – what about football?
    • Dvorak not in FIFA’s plans to recommend, many reasons including the false security of wearing head gear
  • Audience Q: should we discourage the use of the head bands/head gear
    • Dvorak – your own prerogative but data does not support the use of them as recommendation (Czech goalie wears one)
    • McIntosh – Rules are more important at this time

Should there be age restriction on tackling in American football, heading in soccer and checking in ice hockey?

  • Cantu – his words speak for themselves, youth sports needs to look at how the game is played because of the differences between older
  • McCrory – in Australia you cannot get to the gladiatorial aspect of Aussie Rules until they are “of age” (13 if I heard correctly)
  • Ellenbogen – risk of activity, most concussions via CDC information is from wheeled sports and recreation, does not make sense at this time to him, advise accordingly
  • Cantu – youth sports don’t have the good data, personally he does not believe learning a sport at age 5 will make you elite, it is a genetic disposition in his opinion
  • Putukian – it makes sense to decrease exposure, US Lacrosse has put age 13 on checking, her take on soccer is that there is no data to support this when using proper sized ball and equipment
  • Dvorak – young soccer players learn sport first, and fundamentals of “football” its not “headball”, studies done on heading ball and with study there was no increase in biomarkers they were looking at it.  They don’t force kids to head ball until skills are sufficient.
  • Herring – false warranty?  Arbitrary age is concerning, take head out of the game rather then taking the game away from youth athletes.  The limit to exposure is accurate, but complete removal of the sport may not be necessary.
  • Cantu – sport needs to be safer for younger athletes
  • Aubrey – ice hockey has set limits on age for body checking, research is very important, it will help make decisions

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Dr. Jamie Kissick speaking on “From Consensus to Action”

  • Knowledge is power
  • “There is an app for that”
  • Knowledge Translation (KT) Concepts Continue reading →

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Call it what you want, just don’t panic

25 Oct

Confidence, arrogance, or indifference. It doesn’t matter which term you use, as long as you understand what it means to show any  of those characteristics. The popular conception is that confidence encapsulates valuing yourself, being proud of what you’ve accomplished and ‘standing up for yourself’. The unfortunate circumstance is that the word ‘confidence’ (as used in the phrase, ‘Have confidence in yourself’) appears to have been corrupted and used to connote an arrogant, narcissistic attitude. People who have been affected by brain injury, or any other health condition that has had detrimental effects on self esteem, are encouraged to  show confidence, with the hope that they will feel good about themselves when they go out into society. This is well-meaning, but perhaps, not the best way to go about instilling true confidence.

Confidence is defined by the Oxford Dictionary as: the feeling or belief that one can have faith in or rely on someone or something; the state of feeling certain about the truth of something; a feeling of self-assurance arising from an appreciation of one’s own abilities or qualities.

That is what confidence means. What’s often impressed on people – recovering from brain injury or not – is that Continue reading →

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Why do I write?

17 Oct

Nick Mercers provides some insight into why he chooses to write for us and his blog.

Because, as much as it lets others ask questions, it encourages me to ask questions of myself.

Granted, I have always questioned myself, I’m hyper-self-critical. In general, it’s not necessarily a good thing. I hesitate or stop completely. I waste opportunities. I’ll pass up a good chance (with a woman, for a job,…) for a safer, if not longer, chance. However, in writing, my exhaustive self-analysis, is probably beneficial. It means I take longer to write, because I’m always correcting what I wrote and how I wrote it. There aren’t many sentences in this post that haven’t been ‘renovated’ in some way. That’s not to say there aren’t mistakes, or that I catch-all of those errors on the first, second, or even third read. I’m cognizant, but maybe not enough, of the propensity of my self-criticism to take the emotive punch out of what I write. So I try to guard against that. I try to be open, and I hope that shows through, but since this personality trait has been with me my whole life, it’s not completely natural for me to silence it. It is at constant odds with the my ‘newly’ acquired (9 years ago) impulsive nature.

My impulsive side has not completely balanced out my patient and measured side (or vice versa), but it has made some headway. That said, I’m certainly calmer and less anxious than I was before my brain injury, which could have more to do with the severity of my brain injury than with the injury itself, however I don’t know, I’m just speculating, and I don’t have any medical information to back up such a claim. See that? That was Continue reading →

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Book Review: Concussions and Our Kids – Dr. Robert Cantu

17 Sep

Due out tomorrow, Tuesday, September 18th, is Dr. Robert Cantu’s most recent writing on brain trauma; more specifically the concussion and how it relates to the ‘kids’.  Dr. Cantu is THE expert when it comes to concussions, heck his CV is so expansive it would take up like 7 pages on here.  The man knows his stuff; collaborating with Mark Hyman I believe he has written a book that is worth the read for everyone interested in this topic.  By writing this book they not only address the concussion issue but the “iceberg below the surface” the youth athletes and their care.  Obviously the millions that partake in sport and recreation are not privy to the top of the line medical staffs that the professional and high college athletes have at their disposal.

With Dr. Cantu’s wealth of knowledge there was a chance this book could have been written above the audience – so to speak – but after reading it twice I have found it to be perfectly succinct and to the point.  There is no beating around the bushes and you definitely get the feeling of where Dr. Cantu stands on this pressing issue.  All of that being said there are some points that I disagree with, but remember my favorite Japanese Proverb: “None of us is as smart as all of us.”

The book begins with the most important topic, in my opinion, “what is a concussion?”, delving into the brain and its physiology.  Don’t be scared, it is a well written chapter and explains to the layman how and what we feel determines a concussion.  Highlighting that section is the explanation of linear and rotational acceleration and why one is way more important than the other.  If you have read here enough you will note that the rotational aspect of the traumatic force to the brain bucket is the most troublesome, Cantu agrees.  In this chapter Cantu also discusses the term “rest”, and what we are all trying to convey, especially to the youth.  Rest is both physical AND cognitive, meaning not using your brain.

The next two chapters deal with collision sports Continue reading →

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Reflection on the Weekend

6 Aug

While away on a family vacation I don’t get to the researching/data mining I usually do, inevitability there are events and happenings that occur that get push back in coverage.  The nice thing is that the media and other sources are doing a wonderful job of highlighting the issues that come about.  There are a few instances of concussion related news that I would like to now opine on.

First and most concerning was the Olympic woman’s soccer match between the United States and New Zealand and this;

Not only can you clearly see the keeper get hit in the head and having a violent deceleration, then her head smashes the turf, not only that she was CLEARLY unconscious after this hit, yet she was allowed to continue.  If the governing bodies of sports want to get a handle on the concussion issue then cases like this must be handled with supreme independence and a player should be removed.  Take a look at this picture and tell me she should have continued…

I will be as obnoxious and abrasive as possible with this next statement:

IF ANY PLAYER IS KNOCKED OUT FOR WHAT EVER REASON THEY SHOULD BE REMOVED FROM ACTIVITY, PERIOD.  SCORE AND CIRCUMSTANCES SHOULD NOT HAVE A BEARING ON THIS DECISION.  SAID PLAYER SHOULD NOT RETURN TO ACTIVITY UNTIL CLEARED BY A PHYSICIAN AFTER AT LEAST 24 HOURS.

We are talking about a disruption of the brains activities so “gross” Continue reading →

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Multiple Concussions Cause Delay Deficits, says new study

13 Jul

The study was done with the mouse model as the human analog, however its results could lead researchers down the path of what most believe about multiple insults to the brain;

We did it in mice. We gave them one mild concussion, so mild that they had no problems with learning or memory afterwards and then did it over and over and over again,” said Meehan, the study’s first author.

The mice were then tested for learning and memory, using what’s called a Morris water maze.

“Under the surface of the water is a hidden platform. And every time the mice find that platform, we reward them,” said Meehan. “The mice that are uninjured, have not been concussed, find that platform within five seconds after they do it several times. But mice that are injured take 20 to 25 seconds.”

And with each concussion, Meehan said it just got worse.

“Once they’ve had three concussions, or five, or 10, they develop profound deficits in their ability to learn and in their memory. And of course, mice don’t use steroids, and they don’t abuse drugs and alcohol,” said Meehan

The study appears in Neurosurgery and highlights not only the compounding effects of multiple traumas but takes out the other “factors” some seem to be grasping at for a reason as to why the brain is suffering.  While we are looking at the text, it seems Continue reading →

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Players and Owner Perspectives on Concussions in the NFL

12 Jul

Time in the summer has seemingly been slipping away from me fast.  Honestly, most of the traffic ’round here tails off in June, July and August.  However I do feel an obligation to make sure y’all keep informed.  Today here are some links from the past few days;

Priest Holmes explains that some of the concussions caused some weird side-effects/symptoms;

In some instances, the concussed can feel very much like he’s on another planet. The sky itself can change to colors the sky shouldn’t be at a particular time.

“This color obviously isn’t going to be blue. It can be a color that can be orange. It can be red. The sky could turn green,” Holmes told Chris Corbellini. “There’s even an episode where you see a clear light, like light at the end of the tunnel.”[...]

“As much as I loved it [football], that same love now has put me in situations that I have to live with,” he said.”The frontal headaches, the migraines. Laying in bed, it’s tough to get out mornings just because of the pain that is setting in with an arthritic condition, it’s things like that that you never would have really thought about.”

Accepted risk by Holmes, no doubt, however not grasping the long-term effects and really just wanting to play a sport he loved has put him in a position that makes it tough.  In related news Stephen Davis, also a former running back, recently made statements about concussions in his time as a player; Continue reading →

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Bombshell Found in Sports Illustrated Vault

4 Jul

Thanks to @ConcernedMom9 I was sent an article from Sports Illustrated written by Michael Farber.  Before I tell you the year and provide the link I want so share some quotes from it;

“People are missing the boat on brain injuries,” says Dr. James P. Kelly, director of the brain-injury program at the Rehabilitation Institute of Chicago and an assistant professor of neurology at Northwestern University Medical School. “It isn’t just cataclysmic injury or death from brain injuries that should concern people. The core of the person can change from repeated blows to the head.

“I get furious every time I watch a game and hear the announcers say, ‘Wow, he really got his bell rung on that play.’ It’s almost like, ‘Yuk, yuk, yuk,’ as if they’re joking. Concussions are no joke.”

That sounds very similar to what we are discussing now in 2012.

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•Of the 1.5 million high school football players in the U.S., 250,000 suffer a concussion in any given season, according to a survey conducted for The American Journal of Public Health.

•A player who has already suffered a concussion is four times more likely to get one than a player who has been concussion-free. Quarterbacks, running backs, receivers and defensive backs are most vulnerable, [...] that special teams players were at the highest risk per minute spent on the field.

•Concussions are underreported at all levels of football. This is partly because of the subtlety of a mild concussion (unless a player is as woozy as a wino, the injury might go undetected by a busy trainer or coach) but primarily because players have bought into football’s rub-dirt-on-it ethos. “If we get knocked in the head, it’s embarrassing to come to the sideline and say, ‘Hey, my head’s feeling funny,’ ” says San Francisco 49er quarterback Steve Young, who has suffered at least a half dozen concussions. “So I’m sure we’re denying it.”

•Football’s guidelines for players returning after concussions are sometimes more lenient than boxing’s. The New Jersey Boxing Commission requires a fighter who is knocked out to wait 60 days and submit to an electroencephalogram (EEG) before being allowed back into the ring.

•According to Ken Kutner, a New Jersey neuropsychologist, postconcussion syndrome is far more widespread than the NFL or even those suffering from the syndrome would lead us to believe. [...] Kutner says that the players fear that admitting to postconcussion syndrome might cost them a job after retirement from football.

Hmmm, we all thought this was information new to us – new being 2008.

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That, however, doesn’t console Lawrence and Irene Guitterez of Monte Vista, Colo. “He just thought it was something trivial,” Irene says of her son, Adrian, who was a running back on the Monte Vista High team three years ago. “He had a headache and was sore, but it seemed like cold symptoms. He wasn’t one to complain. He wouldn’t say anything to anybody. He wanted to play in the Alamosa game.”

He did play. At halftime Guitterez, who had suffered a concussion in a game two weeks before and had not yet shaken the symptoms, begged teammates not to tell the coaches how woozy he felt. When he was tackled early in the third quarter, he got up disoriented and then collapsed. Five days later he died.

Years later another Colorado high school football player, Jake Snakenberg, would unfortunately repeat history; leading to the concussion legislation passed in that state.

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Do you have a guess on the year… Continue reading →

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Former NFL CB hangs it up due to concussions

29 May

Randall Gay, formerly of the New Orleans Saints and the New England Patriots has decided that football is no longer his career of choice, due to concussions.  Gay is 30 years old and feels he is having effects due to too many head traumas;

“But then it gets to the point where you don’t know enough about head injuries to just say I can deal with it. You might be able to deal with it today, but you don’t know what tomorrow holds. That’s the scary thing about it. That’s the decision you don’t want to make.

“I love the game of football, and I feel like I can deal with the headaches or just being nauseous. Just being a little dizzy, I can deal with it, but you just never know what it’s going to bring later.”

Gay was particularly frightened when he heard about former teammate Junior Seau, Continue reading →

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Keeler Article

25 May

A very poignant and descriptive article about concussions in the NCAA.  Sean Keeler of Fox Sports penned this article with the perspective of a collegiate athlete and how the machismo of those that play and support cause the biggest issue;

Lazetich is 34 now. An old 34. He suffered seven concussions playing football in his teens and 20s, including five — by his count — during a two-year stretch at Manhattan. The doozy, he says, came against Temple in the 1999 season opener.

“My first memory of the day was coach Snyder coming to see me in intensive care,” Johnno recalls. “I don’t remember tying my tie. I don’t remember the game at all. And then (three) weeks later, I’m back starting again — it’s a (nationally televised) game with Brent Musburger announcing at Texas Stadium, just because I passed the concussion test at the time.

“We do a lot of stupid things. Looking back on it, it probably wasn’t the smartest thing I did.”

More than a decade later, the scars throb — and linger. Lazetich suffers lapses in concentration. The short-term memory comes and goes. The headaches are killer, although they pop up a lot less frequently than they did five years ago.

“Still, if you ask me to close my eyes and shake my head back and forth as hard as I can, I’d tell you to go (expletive) yourself,” says the native of Continue reading →

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Concussion Information from UB

8 May

Dr. John J. Ledy performed a webinar for the Brain Injury Association of New York State.  It is a very interesting topic; how to utilize controlled exercise in concussion recovery.  This video was published on YouTube by BIANYS, it is over an hour in length but like most stuff I put on here it is worth the listen.

Again this falls under the mantra “none of us is as smart as all of us.”

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The Reaction in Media to Seau’s Death

3 May

We have seen a snippet of what the former players have said, in this post I will pass along articles and samples of them.  The underlying current is troubling for football.  We have posted and posted and posted about this from the word go here, caution and education seem to be the tenants to keeping football safe, however it will never be completely “safe” but in regards to traumatic brain injuries there are answers.

If one wants to really divest themselves of emotion over the sport of football then the answers are clear.  However the current answers are only a STEP in the right direction.  Eventually finding all independent information about repeated blows to the head in sport may be a doomsday for some.

The first article to highlight is by Andy Staples of SI.com; Continue reading →

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Former Players Reaction to Seau

3 May

With all the illogical conclusions that are happening in the press there are some small positives already.  The biggest of which, less than 24 hours after the untimely death of a great individual is the former players speaking out about depression and post-career condition.  No longer has it become taboo to talk of depression.

Now players need to take stock of their physical and mental health, some players are such as Emmitt Smith;

“Depression & suicide are serious matters and we as current and former NFL players should demand better treatment. Lack of info … no more!!!,” former Dallas Cowboys Hall of Fame running back Emmitt Smith said on his Twitter account.

“And for you current players who think this issue doesn’t effect u. Get your head out of your but. Where u r 2day was his (Seau’s) yesterday.”

In the same article James Johnston Jr., had this comment on former NFL’ers; Continue reading →

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Now what?

2 May

So I turn 32 today. It’s kind of a non-age. In my mind, 33 is a bit of a milestone, 30 is an obvious milestone, but 32, that’s nothing. Of course, I couldn’t care less either way. Age means very little to me now, but I guess this is as good a day as any for me to reminisce/write about the past 9 years (8 years and 9 months, actually) and where I am now.

I’m fairly surprised about how happy I am now and how good I feel. On this day 9 years ago, I was with a friends in London, ON, on a inter-term break from my Master’s program (in Public Administration – MPA) from the University of Victoria. The next day, I would get picked up in Toronto and would get a ride  to the Ottawa River, near Cobden, to go whitewater rafting for the weekend (along with about 15 more friends). Good times!

I then went back to Victoria for term 2 of my MPA program and I continued training for triathlon, a sport I tried for the first time in January of that same year. Three months later, I crashed into a tree and my life changed.

When we were rafting/bouncing our way Continue reading →

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Possible treatment for concussion?

1 May

As we progress on the concussion front there are many aspects of this PROCESS that we are still finding out about.  One of the most pressing is how to treat the after-effects of the injury.  Current management can help abate the symptoms of roughly 85% of those suffering from the injury, for the other 15% there are few “treatments” that have worked across the board.  Off label use of FDA approved drugs has shown promise for some, like Hillary Werth;

Werth, a brakeman who was considered an Olympic hopeful, had her bobsledding career cut short by a series of concussions she suffered while competing in Germany and Canada.

Despite the injuries, she said she doesn’t regret her relatively brief time with the team. And she is thankful for the novel intravenous treatments she received after the concussions — treatments for which scientists are seeking Food and Drug Administration approval because they believe millions of stroke patients across the country could benefit. Continue reading →

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Innovative Concussion Care Concept

18 Apr

It seems that I often am applauding the efforts north of the border in Canada, it really seems that they have put a concerted COMBINED effort to seek out and implement innovative ideas.  I don’t think it says much about the United States other than we are all trying to do our best in our own little areas.  There is little consortium or conglomeration of effort, rather “‘A’ has found this”, “‘B’ has discovered this”, “‘C’ is saying this”, etc, etc, etc…

It may be the same up north but with the population centers mainly in fewer areas in Canada it seems that the Toronto, Ottawa, Montreal, and Vancouver areas seem to all be on the same page.  This could also be because of the overall influence of the Brain Injury Association of Canada and its influence on such things.

This idea is not from the BIAC, but it has some solid foundations none the less, including our partner in concussion awareness stopconcussions.com with Kerry Goulet and Keith Priemeau at the lead.  They have created a vision and group of like-minded individuals to create what they are calling Sports Concussion Care Clinic.  Here it is in a press-release; Continue reading →

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Now This is a Possible Game Changer

15 Mar

There have been many attempts to create a concussion “game changer”, something that will bring the assessment and/or recovery into better focus and provide more concrete answers for all of us.  One thing many people keep forgetting is that the human brain is not only very complex but it is also very individual.  Creating blanket statements, guidelines, and recommendations are very difficult; unless of course you use a multidisciplinary approach that touches on every part of the concussion sequale.

If you have read long enough and seen the comment section you will know that we have been clamoring for a more comprehensive, evidence-based, set of recommendations that broach all four parts of a concussion: physical, cognitive, sleep, and social/behavioral.  Perhaps the Ontario Neurotrauma Foundation has done just that (.pdf at end of post and in “Current Concussion Management Page” or you can go to the ONF website);

ONF is pleased to publicly release the Guidelines for Mild Traumatic Brain Injury (MTBI) and Persistent Symptoms.  The Guidelines were generated through a consensus process using existing evidence and clinical expertise. 10 to 15% of people who sustain MTBI do not recover well or as expected. The guidelines are therefore aimed at treating and reducing the impact of persistent symptoms following MTBI in adults.  On behalf of the project team that oversaw this work, ONF welcomes feedback on the Guidelines to info@onf.org

There have been other guidelines, one we hold as the standard (note not gold standard) Continue reading →

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