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The Journal of Law, Medicine and Ethics Issue Worth Bookmarking

24 Sep

Twitter is such a wonderful thing!  You can get so much information is such a short time; sure there is a ton of unsolicited information that one may have to weed through, but the benefits outweigh the bad – at least for us here at The Concussion Blog.

Such an instance was getting a tweet at me about a journal and a particular issue.  The Journal of Law, Medicine and Ethics, Volume 42:3 to be exact.  In this volume all of the pages are filled with concussion related issues, after all it was titled: Concussion and Sports.

I cannot speak to the “prestige” or “reach” of this particular journal, however I can post the link here (above) for you to bookmark for some reading on where the tone of med-legal is going in relations to concussion and sport.

Topics include:

  • Youth Concussion Laws
  • Requiring receipt of concussion related materials (a study)
  • Coach Support
  • Informed Consent

At the link you can download, free, the journal and its articles.  It might be worth some time to investigate and look into what we may be facing.

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Concussion Trends 2010-2012; TCB Original Research

26 Aug

The National Football League is nine days away from the kickoff of its regular season.  If social media, fantasy sports, and hype are any indication 2014 is set up to one of the most watched seasons in history.  There are plenty of story lines abound: from each division, to playing time of newly drafted players, to veterans returning from injury, and of course concussions.

The league is doing its best to keep concussions from overriding the game itself, as they should be.  Concussion is but just one of a myriad of injuries sustained in the sport; plus it is not unique to just American Football.  However this issue continues to gain/keep traction because of the relatively late and “slow-footed” response to this topic.  Even though the settlement with the players has been all but signed-sealed-delivered (there are some interesting issues posed by Patrick Hruby that are worth noting), the youth arm of the league is promoting and teaching a “safer” way of tackling, and the talking points about this injury are becoming more evident from players and the league; there still is a shroud of secrecy.  In all the hand-wringing and court battles and public relations scuffles the leader of this glorious sport has yet to “rip the band-aid off” and assess the situation.

How can you assess the situation?  I think it is rather simple: gather data to find out the “true” value of actual concussions sustained in the NFL over a season.  Then and only then can you see if any changes brought forth are actually helping the cause.

Sure the league has its own data and is probably doing just that, but it is so far behind a curtain, tucked in a corner where light has no chance of hitting it.  I have always thought we should be transparent on this issue; or at least have a truly (Pollyannaish) independent data collection group for it.  At the very least an Ombudsman should be hawking this situation, for this is not going to go away over night.  It won’t go away until we can definitively say ‘X’ is the way to play this game with ‘Y’ & ‘Z’ at the professional level; then each subsequent level below the pro ranks need to modify based upon age and development.

The NFL probably doesn’t want this responsibility for it comes with some liability, not only on the medical front but in the public relations department…  SO WHAT!  When I chose to have a child I didn’t have the choice to be a role model and change the way I played life in order to make sure my children grew up safe and learned a better way to live.  The NFL is basically the “father figure” for the other levels of this great sport.  I have heard a great saying, it was applied to business in general: “the tree rots from the top”.  This is exactly the case in a family, in a business and in sport.

When the blog began in 2010 there was no way to find out how many concussions were occurring in the NFL without Continue reading

#C4CT Concussion Awareness Summit Reconvenes Next Week

25 Jul

Brewer Sports International and Amarantus Bio Science is continuing their efforts to collaborate and discuss the issue of traumatic brain injury, in particular concussion.  In this version the focus will be on Alzheimer’s;

The #C4CT Concussion Awareness Summit is being convened on July 31, 2014 to explore the potential link between TBI and Alzheimer’s disease.  A diverse working group of clinicians, medical researchers, policy makers, international diplomats, athletes, celebrities, and philanthropic organizations will be assembled to raise awareness, advance clinical research, and develop public policy in order to address this major unmet medical need and public health issue.

The #C4CT Summits have a stated goal to collaborate information and ideas to try and further both understanding and proper response to this issue at hand.  I described it as – using a Japanese proverb – “none of us is as smart as all of us.”  Which is definitely the case for just about anything in life.  However, with so many egos and generally smart people there seems to be a ton of hand-wringing and chest thumping without a lot of resolution.  Jack Brewer and Gerald Commissiong are trying to find a way to get everyone on the same page.  Evidence of this was asking me to be a panelist during the last UN visit in January.  You can see the recap below;

There is still time for you to attend this wonderful event, littered with some great minds and speakers.  If you cannot attend you should follow their twitter feed next Thursday (unfortunately I will be away on vacation so I will not be live blogging the event this time around).

DYK Helmets Do Not Stop Concussions: An article that must get traction

25 Jul

I can tell you there is more coming on this issue – from here and other platforms – but this Regressing (part of Deadspin) article really needs to be highlighted here for those seeking accurate concussion information.  I would be remiss if I didn’t – virtually – give Kyle Wagner a “good game” for writing a beauty!

‘Hockey’s About To Get The Bullshit “Anti-Concussion Helmet” Treatment’ appeared 7/23/14, here are some great excerpts.

Lets begin with the opening salvo;

Virginia Tech thinks hockey helmets are bullshit, which is more or less true. In turn, it wants to look at the differences between hockey’s helmets and football’s recently evolved versions, and bring the concussion-stopping advances to hockey. This is pretty much bullshit.

Then the all-important – simplistic – overview of the concussion process (emphasis mine);

The brain floats suspended by fluids in the skull, and when it suffers concussion, it both smacks into the inside of your skull and incurs rotational force, irreparably damaging the brain stem.

Why we wear helmets;

Helmets, meanwhile, are there to protect your skull from fracturing in the impact of a collision. They provide this protection, and the best helmets have interior mechanisms that can offer some small aid in decelerating a collision.

A wonderful note in the article, that may be glossed over by most readers, but it very peculiar to many of ‘us’ in the know and actually understand/grasp both the concussion injury and the statistics that are thrown out about them;

If the above numbers seem low to you—a combined 64 concussions for eight college football teams over six seasons, or just about 1.3 per team per season—then you’ve likely read enough to have seen players talking about getting their “bell rung” often enough that those Virginia Tech numbers wouldn’t just represent a decrease in risk by half, but exponentially. If the available data say anything, it’s that they are hugely incomplete.

Further on the above excerpt, 1.3 concussions for AN ENTIRE TEAM for AN ENTIRE SEASON is just asinine, Continue reading

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

General Dentistry Publishes a Bombshell About Mouth Guards (ADDENDUM)

5 May

Is it a bombshell or is it just a plain dud?  I say bombshell, but not in a good way for anyone involved with this “research”.

Last week I was inundated with emails regarding this “new” research about mouth guards and concussions.  There were roughly 16 emails in a one hour time span; some wanting comment, some telling me I have been wrong all along, some promoting the research.  This was a “huge” development in my area and my little corner in the blogosphere.  To fully understand perhaps some history is needed (“mouth gear” search on this blog) when it comes to my feelings on mouth gear and concussions.  Here are some selected comments attributed to me;

The basic fundamentals we should be cognizant of here are: concussion is a BRAIN injury, the BRAIN floats inside skull, Physics dictates that the BRAIN will move depending on the forces applied to the skull/head (not always from a blow to that area), mouth gear cannot stop the BRAIN from moving, mouth gear cannot attenuate any forces to the skull/head that are not in the oral region, mouth gear does nothing for the skull/head when forces are placed on it in rotational, angular, acceleration or deceleration fashion.

Now that we have that all out-of-the-way this is the General Dentistry article I was asked to comment on.  On face value and from a “peer-reviewed” angle it Continue reading

Where is Tech Going With Concussions

7 Feb

Technology is ever-expanding in all areas of our life; in my short time we have gone from land line phones and massive desktop computers that could play “Lemonade Stand” to handheld personal computers that is also a phone.  The point being that technology is amazing.  In the previous post we discussed how MRI now can actually see damage to the white matter in the brain after concussion.  Until that information was presented the changes in the brain were only theorized about.

Yes, it is true that we are trying to find an objective measure, but people need to understand that this objective measure is not necessarily needed to find the concussion.  An athletic trainer with their years of education and experience are pretty dang good at finding concussions; with or without the help of “tools.”  The need for objective measures is for the TRUE PROBLEM of the “concussion crisis”; the mismanagement of the injury – mainly returning too early.

Conrad Wilson wrote up a good article on technology that is emerging, focusing on balance 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

Hit Count® Has Come To Fruition

27 Jan

Prevention of concussion is a bit of an oxymoron; nothing we know about concussions can stop them from occurring while in action.  HOWEVER, there is one way to prevent concussions – limiting exposure to the collisions that create a concussion.  Moreover, research suggests – as well as observations – that being exposed to subconcussive hits can have detrimental effects on brain function.  The subconcussive hits may even predispose someone to getting a concussion later on; this is obvious if you look at the data we have collected on NFL concussion over the past four years, (305 concussions in weeks 1-9 vs. 377 concussions in weeks 10-17) greater than a 20% increase as the season wears on.

Sports Legacy Institute has announced a certification program to further the Hit Count® initiative during a press release during Super Bowl week in New York City, today (along with the SLI Hit Count White Paper – see link below press release);

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Sports Legacy Institute Launches Hit Count® Certification Program in Collaboration with Leading Concussion Experts and Head Sensor Device Companies to Make Contact Sports Safer

Using Hit Count® Certified Products to Monitor and Minimize Brain Trauma Could Eliminate 500 Million Head Impacts in Football a Year, with the Goal of Reducing Risk of Concussion and Long-Term Brain Damage

New York City – January 27, 2014 – The non-profit Sports Legacy Institute (SLI) announced a major advance in the effort to prevent concussions and brain damage in contact sports today with the launch of the Hit Count® certification program after two years of development, which was unveiled at a press conference at the 2014 Super Bowl Media Center in New York City.

Hit Count® builds on the progress that head sensor device companies have made in developing devices that can measure acceleration of the head. Current products used on the field are focused on  alerting coaches, medical professionals, and parents when a potential concussive impact occurs.

Inspired by Pitch Counts baseball, which set limits to the number of times a player throws from the  mound to prevent arm injury, Hit Count® Certified Devices will have a second function that measures and “Counts” impacts that exceed the Hit Count® Threshold, set by a committee of  leading scientists, with the goal of minimizing brain injury.

“Research using sensor devices has revealed that each year in the United States, there are over 1.5 billion impacts to the heads of youth and high school football players,” said Chris Nowinski, Founding Executive Director of SLI who launched the Hit Count® initiative in 2012 with SLI Medical Director Dr. Robert Cantu. “Most hits are unnecessary and occur in practice. By utilizing  Hit Count® certified products as a teaching tool for coaches and a behavior modification tool for athletes, we can eliminate over 500 million head impacts next season.”

Committee member Gerry Gioia, PhD, of Children’s National Medical Center and Continue reading

#C4CT Concussion Summit 2014

7 Jan

In a little over three weeks, Brewer Sports International (BSI) along with #C4CT (Coalition for Concussion Treatment) founding partner Amarantus BioScience will be hosting their 2nd Concussion Summit in New York, at the United Nations.  There have been many press releases on this event, and I have mentioned it a time or two on Twitter (and will continue).

Sure, there are many “summits” around concussions and head trauma – which is great as it keeps the dialog going – but few are populated by people with ideas on going forward.  Often, we find ourselves sitting, listening to bright people talk about what was done and can’t be done; rarely do we find the same bright people addressing the issues going forward.  Whether that be with tactical changes or with management or even the possibility of intervention with traumatic brain injury.

This edition of the #C4CT Summit on January 29, 2014 will hear from some people in many fields – you can see the current line-up HERE – focusing on the burgeoning topics of chronic traumatic encephalopathy (CTE), general neuroscience, pharmacology among other topics.

Interestingly enough, yours truly, was invited to sit on a panel and discuss how all of this information has been translated to the high school level – as an athletic trainer.  I was not only surprised by the invitation but feel it is VERY OPPORTUNISTIC for a “boot on the ground” athletic trainer to provide input.  I feel that not only have athletic trainers seemed to be seen and not heard, the vast majority of us practice in the high school setting, where the adolescents are playing sports.  I can assure you I will do my very best to be a quality representative of not only athletic training (it appears I am on the only AT in a speaking role) but those of us working with the most kids/athletes.

Anyhow the cast of speakers/presenters is indeed “star-studded” and even has some opposing view points on where we should be headed; which should make for some quality discussion.  If I can get my technology working and to NYC I will attempt to live blog/tweet the event for those that cannot make it.

Speaking of that, I know that time is short but I encourage anyone who is going to be in NYC during Super Bowl Week try to attend this event.  If there are scribes out there I am sure the wonderful support staff at BSI can arrange for you to cover and meet the star of the show – me, of course – hahahahaha, I kid.  Seriously, you can register HERE and if you have questions feel free to contact them.

I hope to see you all there!

Hot And Heavy Monday

9 Dec

With Rob Gonkowski and Wes Welker injuries there is a ton a debate today on the interwebs about concussions and other injuries in the NFL.  I figured I would link up some information that would help with the background and even further thinking for the topic de jour.  It would also help if you read my editorial on Everyone Pumping Their Brakes.

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1st for posterity sake, here is the current NFL Concussion Protocol, found at the NFL Players Association website.  It is worth reviewing and I am sure the NFLPA is monitoring this closely.

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2nd is a link to Concussion Myths from Nationwide Children’s.  Although aimed at youth participants and parents, these myths are very prevalent all the way up to the professional ranks.  One would assume that it should not be predicated there, but alas it is.  Read this and pass it along to all that you know concerned about concussions.

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3rd is a link to some very interesting research about ACL injuries.  It seems the authors are thinking that cognitively impaired individuals (females in this research), may be predisposed to ACL injuries.  I just came across this but it makes logical sense to me.  Here is why; part of a concussive episode the brain can be effected in a way that impairs your spatial awareness and reaction time.  This research could be a waterfall for expected injuries and recovery as well.

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4th is a MMQ article on ACL injuries in the NFL.  There have been 50 thus far this year, an all-time high, but only half are due to contact.  Perhaps the above link may be more poignant after reading this and putting your thinking cap on…

A Very Interesting Finding That Deserves a Mental Bookmark

9 Dec

Yes this is in mice, the human skull is much more dense/thick.  However the important take away from this video is; that there may be help for injured brain cells that can passively find their way to particular areas.  This definitely warrants keeping an eye on, it could become a treatment.

Sidebar, who ever unlocks this key first will be a rich person…

C3 Logix: Practical Application and Use (It’s Freaking Awesome)

13 Nov

Last year while in Zürich I was approached by a group of people from the Cleveland Clinic and they had a poster they wanted to show me.  It had numbers, graphs and pictures – your normal poster at a conference – but what caught my eye was an iPad strapped on the back of a patient that was measuring movement.  I asked very basic questions and to be frank I was a bit overwhelmed at the entire company I was keeping in Zürich, so the poster was a blur.

After that chance meeting and getting back to the States I really forgot about the project until the spring when I started to hear more about it in the underground.  This testing platform was starting to get noticed and being from one of, if not currently the most, prestigious concussion care centers only helped matters.  I wanted to learn more; and in August that chance finally presented itself as the company selling the C3 Logix, Just Go Products, was able to connect with me for a webinar.

I was very blown away with what they were presenting to me – which is probably what the development team in Zürich was telling me – so much so that I wrote a glowing post on it.  Since that time I have worked hard to find a way to procure the system for use; if nothing more to test it out and see if my perceptions were reality.  This goal of mine finally became a reality, not only was I able to get the iPad needed and the app, C3 even offered to send out a technician (really that may be underselling David, he is a nerd but a very good nerd) to help me get accustomed to it.

This past Friday I scheduled the winter sports concussion testing for my high school; the freshman and juniors that have not already done so completed a popular version of the computer based neurocognitive testing, while the other freshman and juniors along with seniors were up for the “beta test” on the C3 Logix platform.  With the split we had 30 kids Continue reading

What About Return-to-Learn?

4 Nov

Two important groups released information about concussions and youth recently.  The Institute of Medicine recently released its Sports-Related Concussions in Youth: Improving the Science, Changing the Culture, addressing concussions for the youth (obviously by the title).  This was on the heels of the American Academy of Pediatrics release of their second report on concussions, addressing the return-to-learn aspect.  I offered some opinions on both of the reports via Twitter, but was really underwhelmed by the information in both documents.  It seems to me that even though the car is pointed in the right direction the gas pedal is being confused with the brake pedal.  At best I feel the community is driving though the rear-view mirror.

A loyal follower and some time contributor, Dorothy Bedford, a self-described “parent activist in concussion education, awareness and advocacy, and newly retired school board member in Princeton NJ,” has penned the following post regarding return-to-learn and the AAP paper.  This is not your typical parent; “I come by the interest in return-to-learn honestly, both from my daughters’ concussion and from the point of view of a school board member – with the opportunity to help protect the brains of all students.”

With all of that said, below is her post.  Thank you, Dorothy.  As a reminder, the inbox is always open to contributors.

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The Pediatricians Weigh In on Returning-to-Learning – A Mixed Review

The American Academy of Pediatrics has released its second major clinical report on concussions. It’s a good first step which will help many pediatricians begin to address the second most important issue in concussion management (after “remove from play,” and before “return to play”).  On the other hand, ten pages limits the territory it can cover; there’s little new for the ATC who takes a broad view of concussion recovery; the report wildly underplays the complementary role of the neuropsych, and omits any discussion of some important symptoms. I think the most important contribution this report makes will be nudging school administrators to action, especially those who have been inattentive or resistant to dealing with concussions in the classroom and gradual return to learn. It’s hard to ignore the AAP.  I will confess, since its release my reaction has swung up and down with each re-reading. Five days later, I hope this will be a balanced review. I like to keep the conversation open.

“Returning to Learning Following a Concussion” was published on October 27 (full report here: http://pediatrics.aappublications.org/content/early/2013/10/23/peds.2013-2867.full.pdf+html)  complementing AAP’s 2010 clinical report on “Sport-Related Concussions in Children and Adolescents”. The lead author on both reports is Dr. Mark Halstead, a specialist in non-operative sports medicine at Washington University in St. Louis. Neuropsychologist Dr. Gerald Gioia of National Children’s Medical Center was a consultant. Dr Gioia is a co-author of the CDC’s Physician’s ACE Return to School form, which should be in the hands of every student athlete and their parents for any concussion-related visit to a doctor (http://www.cdc.gov/concussion/headsup/pdf/ACE_care_plan_school_version_a.pdf ). Six other professional societies have endorsed this report.

The Good:

For pediatricians in areas with thin or no sports medicine/neuropsych coverage, this report is going to be very important,  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.

“League of Denial” (Part 2)

8 Oct

Coming to a bookstore and TV near you today is “League of Denial” a book and documentary about one of the dirty little secrets the NFL has been avoiding for some time.  Fortunately, I have been provided with advance copies of both; the Frontline film was easy to digest, as for reading a book, well we can just say I am trying to read as fast as possible.

I was reminded quickly, yesterday via Twitter, that I may lack valuable perspective when it comes to concussion information (and that I am not normal – this is not breaking news).  Will Carroll of Bleacher Report let me know that this information will be new to a lot of people out there.  He is exactly right, not only that, this documentary will be easily digestible for the fan of football.  For any person just wading into this, when you tune into PBS tonight to view “League of Denial” you will be absolutely hooked from the start.

The sounds of the crowd, visuals of big hits grab your football part of the brain IMMEDIATELY, over those sounds you will quickly discover the problem NFL players have faced with brain injuries playing their sport.  Harry Carson saying “and then they are gone” when talking about former players.  A bold statement that the level of denial was “just profound.”  An NFL lawyer saying “we strongly deny those allegations that we withheld information or misled the players.”  And more video and sound of punishing hits that used to fill the highlight reel bring the opening curtain of this very important documentary.

This problem is real – it’s not just real for the professionals – and from the get go Frontline makes you understand, vividly and personally, why this is.  After listening to old radio calls of the Steel Curtain it all begins with the story of Mike Webster and the forensic pathologist who studied his brain, Bennet Omalu.

The discovery of a possible reason one of the most respected and lauded players in Pittsburgh sports pantheon fell from grace and eventually found and early demise.  If the football portion of your brain does not connect to what is being presented then I would haphazardly guess that you are not ingrained within the fabric of football.

As Harry Carson explains how the game was played and to some extent how it’s still played you can begin to understand the issue at hand.  This is hammered home when Robert Stern, PhD tells the audience blows to the brain are at forces 20 times greater than the force of gravity (20 G’s); or as he so eloquently put it “driving into a brick wall at 35mph”, 1,000 times or more in a season.

In the first 11 minutes of this 2 hour presentation you are at full attention and want to understand the “whats”, “whys” and “whos”.  If you are not engaged and ready for further explanation I can only say that you don’t care or want to bury your head in the sand.

Contributions in the film include Continue reading

Delaware Youth Concussion Summit – Wrap Up

27 Sep

A regular reader and a very good friend to The Concussion Blog was fortunate enough to attend the Delaware Youth Concussion Summit the past week.  I had asked her to write-up a report and she kindly and succinctly did that for TCB.  Because of Dorothy Bedford I can bring you this information, thank you.  This is also a reminder that if you attend a conference, symposium or summit and feel the information would good for the readers you are more than welcome to submit it so us in a .doc or .docx form and we will publish.  Without further ado here is Dorothy’s contribution;

The Delaware Youth Concussion Summit, an initiative organized by the State Council for Persons with Disabilities Brain Injury Committee, Nemours/Alfred I. DuPont Hospital for Children, and the Brain Injury Association of Delaware, yesterday released its three-point Action Plan regarding the diagnosis, management, and return to activity for the rising number of young people sustaining concussions in sports activities. Participants in the summit and action work groups include leaders and experts in medicine, neuro-psychology, education, sports, advocacy, state agencies, and elected officials.

The Summit aims to further the aims of Delaware’s concussion legislation, signed in August 2011, which mandated both concussion training for all DIAA coaches and awareness training for parents and athletes, and set some rules around written medical clearances before returning to play.

After convening in May 2013, the Summit divided itself into working groups and today announced three focus areas for further action:  Continue reading

Possibly the Most Comprehensive mTBI Guidelines

26 Sep

The Ontario Neurotrauma Foundation has released their updated Guidelines for Concussion/mTBI & Persistent Symptoms: Second Edition, and it may be the most comprehensive/complete to this point.

The guidelines stretch from diagnosis through return with emphasis on “hang-ups” that can come along with recovery, here are the modules;

  • Diagnosis
  • Management
  • Sports Related
  • General Recommendations for Diagnosis/Assessment of Persistent Symptoms
  • General Recommendations for Management of Persistent Symptoms
  • Post-Traumatic Headache
  • Persistent Sleep/Wake Disturbances
  • Persistent Mental Health Disorders
  • Persistent Cognitive Disorders
  • Persistent Vestibular and Visual Disturbances
  • Persistent Fatigue
  • Return to Activity/Work/School

Of special note and to reference is all of these recommendations are for adults.  That being said some of this can be “creatively adapted” for those in high school.

Here is the .pdf for the Sports Related Concussions/mTBI.  All of it is worthy looking over; not only for athletic trainers but doctors as well.

Launching National Study of Female Athletes and Concussions

18 Sep

Here is a press release from Kathrine Price Snedaker and Pinkconcussions.com

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Press Release

For Release: Wednesday, September 18, 2013 
Launch of National Study of Female Athletes and Concussions
Study begins October 1, to explore Female Athletes’ Experiences with Concussions
Contact:
Katherine Snedaker, MSW, PinkConcussions.com / 203-984-0860 PinkConcussions@gmail.com
Dr. Jimmy Sanderson, Clemson University / 864-656-3996 jsande6@clemson.edu

Norwalk, CT – Men’s football concussions are in the news daily from former and current players, but there’s rarely news about female athletes’ experiences with concussions. Female athletes experience a significant number of concussions, yet they seem too often overlooked when concussions are discussed in mainstream media. Mentioned in the report American Medical Society for Sports Medicine Position Statement: Concussion in Sport 2012data suggest that in sports with similar rules female athletes sustain more concussions than their male counterparts. In addition, female athletes experience or report a higher number and severity of symptoms as well as a longer duration of recovery than male athletes in several studies.

This new study will be focused on female athletes from all sports, and their past and present experiences with concussions. Current and former athletes are eligible for this study conducted by researchers from Clemson University with the advocacy group, Pink Concussions. For this study, female athletes, age 18 and over, who are willing to participate can sign up now at PinkConcussions.com. On October 1, participants will be emailed a link to a twenty-minute online survey about their experiences with sports and non-sport concussions and reporting concussions.

This research study will also explore female athletes’ experiences with reporting concussions, another salient avenue in the concussions dialogue, as many athletes do not report concussions willingly or are mis-diagnosed.

The research also will investigate female athletes’ willingness to have genetic testing that may show links to the repair and recovery of brain cells after concussion. After finishing the survey, participants in the study can opt for an additional study and consider submitting DNA collected by a cheek swab to be tested for variants at the Apolipoprotein E (APOE) gene.  Testing for certain genes has previously documented an association between specific genetic factors and outcomes from injuries such as concussion.

Apolipoprotein E is a protein that is important in the repair and recovery of brain cells that have been damaged due to concussion. The clinical studies point to a relationship between certain genetic signatures and poorer overall concussion response. While additional evidence is needed to better understand the relationship between APOE status and concussion outcomes, the American Academy of Neurology introduced APOE testing into concussion management guidelines this year.  EDIT FROM AAN: The American Academy of Neurology did not “introduce APOE testing into concussion management guidelines this year.”  The AAN stated that apoE4 was a risk factor for cognitive impairment in professionals; but no recommendation was made to conduct apoE testing, and there was no evidence reviewed regarding apoE4 in amateurs. 

The results of this research will help further concussion research by focusing on the communicative element present in this issue, and the results of the study will be helpful for athletes, parents, administrators, physicians, and advocates. This research will be beneficial in shedding light on female athletes’ experiences with concussions and reporting concussions. Often female athletes are omitted from the public discourse surrounding concussions and the results of this research will assist concussion advocates in raising more awareness about concussion issues in sports.

Co-Researchers in this study are Dr. Jimmy Sanderson and Dr. Melinda Weathers in the Department of Communication Studies at Clemson University, along with Ms. Katherine Snedaker, MSW, of PinkConcussions.com.

# # #
For more information about this study, help in recruiting athletes or to participate in the study, please fill the contact form at PinkConcussions.com or contact:

Dr. Jimmy Sanderson
Clemson University
864-656-3996
Katherine Snedaker
203-984-0860

Next Level… In Concussion Care

14 Aug

As an athletic trainer – an opinionated one at that – I struggle with all the “bells-and-whistles” in this conundrum that is the concussion issue.  If you have visited here or heard me speak you undoubtedly know that mismanagement of concussions is the true issue of this complex paradigm.  Yes, we need to know when a concussion occurs to begin the process in the right direction; however, this can be accomplished by simply making sure you have a trained medical professional on hand when the need arises.  Getting an athletic trainer to cover the most at risk sports at the most at risk times is a great start (and in the authors opinion is the only choice if you want to have collision sports).  Short of that, education over-education is necessary for everyone: players, coaches, parents, officials, teacher etc. to properly identify and accept the nature of concussion in sport – it is a risk.

Even having an allied medical professional, like an athletic trainer (AT) at practices and games does not stop the injury from occurring.  In fact, many products that may claim reduction in concussions or “possible concussions” are toying with fraud; at the very least they are practicing deceptive marketing.  The point being, once we identify a concussion how do we and who do we send the injury to, to avoid the rest of the iceberg lurking under the surface of the water?  Moreover, what tools do we have that can help get the right prognosis, treatment and recovery for the injured (and there are many out there)?

I feel there is a new product (I am not a paid endorser, nor have I been given compensation for this article/opinion) now hitting the market that may get us closer to the panacea that we are all hoping for (note I said “closer”).  Although it may have been presented as some big secret; the C3 Logix: Comprehensive Concussion Care system is not a secret rather it is something I feel is a “game changer” for concussion care.  It is Continue reading

Rugby Being Put Through Wringer in Scotland

6 Aug

Scottish rugby has become somewhat of a surrogate for the problems in rugby when dealing with the current concussion issue.  Scotland certainly is not the only place this has become and issue (even though the IRB would like to tell you so); and this issue of concussions and sport seem similar in nature to what we have seen here in the States with American Football.

The uproar all began when a former player, Roy Lamont, made it known that he thinks/knows that players were both “sandbagging” and deliberately deceiving concussion test in order to remain playing;

Players regularly pass the tests. In many cases that is because they cheat,” revealed Lamont. “Players all talk about it. A test is done at the start of the season as a baseline test, and players who suffer from concussion have to return to that level to be passed fit to play.

“But some players will deliberately do stuff in the baseline test so that their results are low, making it easier to pass after concussion. And I’ve seen players carrying concussion into games. They’d come off a fairly straightforward tackle, but be sitting on the ground, starting into space for a few seconds.”

Interestingly Lamont’s comments were in response to an incident where a player was not sent off for concussion even though he exhibited overt signs;  Continue reading

HITs Takes a Hit… Maybe

1 Aug

Solid research is produced over a long period of time with validation and verification of standards.  When using tools there must be a set of numbers that validate what data is being collected – in short to make sure the data is “good”.  This has been a problem with many things in the concussion realm, most notably with computerized concussion testing.  However last night I received an email with an abstract regarding the Head Impact Telemetry system or HITs.

Before we go further you will need to familiarize yourself with a couple of statistical terms: absolute error and root-mean square error.

Absolute Error is the amount of physical error in a measurement, period.  The example I found was when using a ruler on the metric side the absolute error of that device is +/- 1mm.

Root-Mean Square Error is a frequently used measure of the differences between values predicted by a model or an estimator and the values actually observed.  This measure is used to compile the deflection of errors in predictions and is good summation of accuracy, which only holds true for a particular variable not between variables.  In other words RMSE shows us how accurate the data is compared to its model/validation.  If this number is high it can show that either the model was incorrect or that the data was compiled incorrectly.

Appearing in the online version of the Journal of Biomechanics researchers from Wayne State (one of the notable places for head impact testing) found that a difference in helmet size on the Hybrid III head model has called into question the validity of the HIT system (abstract);

On-field measurement of head impacts has relied on the Head Impact Telemetry (HIT) System, which uses helmet mounted accelerometers to determine linear and angular head accelerations. HIT is used in youth and collegiate football to assess the frequency and severity of helmet impacts. This paper evaluates the accuracy of HIT for individual head impacts. Most HIT validations used a medium helmet on a Hybrid III head. However, the appropriate helmet is large based on the Hybrid III head circumference (58 cm) and manufacturer’s fitting instructions. An instrumented skull cap was used to measure the pressure between the head of football players (n=63) and their helmet. The average pressure with a large helmet on the Hybrid III was comparable to the average pressure from helmets used by players. A medium helmet on Continue reading

Kutcher Concussion Talk 2011

25 Jul

Here is a video from YouTube of Dr. Jeffrey Kutcher titled “How to Minimize Concussion Damage”

Dr. Kutcher, M.D., is director of the Michigan NeuroSport Program. He spoke at Play Smart: Injury Prevention on and off the Field, a 2011 National Public Health Week “Live Injury Free” event at University of Michigan School of Public Health. His topic was TBIs–Traumatic Brain Injuries (concussions) among young athletes.

Helmets Aren’t the Answer

17 Jul

So says a group of researchers from Wisconsin.  After gathering data on over 1300 football players the overall theme was that there was no correlation between expensive helmets and reduction of concussion incidence.  On first inspection the design of the study looks sound, especially since high school athletic trainers were involved, and the results appeared to be sound according to Timothy McGuine;

“We found the actual incidence of concussion was not more for players wearing the newest helmets versus wearing helmets 3, 4 or 5 years old,” McGuine said. “We also looked at [concussion] severity by helmet model. No difference there, either.”

This finding is absolutely logical based upon today’s helmet technology.  McGuine is correct the exterior shell has achieved its goal to a tune of 99.9999% – prevention of skull fractures – however, the issue of concussions is really something a helmet was/is not designed to combat.

Think about this; the brain rests within fluid inside your skull, the primary protection for our brain, thus allowing our “noodle” to move “freely” for everyday tasks like walking, running, jumping.  In fact, it is an amazing process 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

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