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This Is Unacceptable, In My Humble Opinion

24 Oct

Yesterday I wrote about concussions and the difference between professionals and adolescents using Jamaal Charles as an example.  What happened last night on the professional field with millions watching was completely unacceptable, professional athlete not withstanding.

Late in the third quarter of the game, last night, San Diego’s defensive back Jahleel Addae (#37) ran into a pile to finish the tackle on the Denver running back.  He was running at full speed and led with his left shoulder, but as he made contact with the RB his head dropped and he also made (incidental) helmet to helmet contact with the runner.  This type of collision is very frequent and looked innocuous…  Until you saw the after math…

Addae was bounced back, still on his feet, and began “short circuiting” for the national audience to see.  He begins to look around, kind of, and stumble, kind of, and lose full control of his extremities, all of them.  As a medical professional and athletic trainer I would have documented this OBJECTIVE finding as “unsteadiness and disorientation”.  It looked like a boxer/MMA fighter catching a fist/kick in the face late in a boxing match; the type of reaction that any referee in those sports would stop a match for and award a TKO to the other guy.

It happens from time to time in this and other sports, that is not the issue here.  The issue is that Addae returned to the game (oh, it gets worse).  Here is the tweet from last night (h/t to Brady Phelps’ Vine);

https://twitter.com/concussionblog/status/525487638481235968

From what I can piece together this play was the last of the 3rd quarter and reports had him taking the field on the first play of the 4th quarter.  HE DIDN’T MISS A SINGLE SNAP!  Even with the long commercial break between quarters there is a maximum of 4 minutes, but if my DVR time was correct it was between 2 and 3 minutes.  This is not nearly enough time for a full concussion evaluation, by anyone.

“Maybe he was screened, like you said yesterday, Fink.”

There was absolutely no reason for a cursory “screen” in this situation, Addae showed a clear and overt sign of neurological impairment, in concussion recognition jargon: a sign.  When any player shows a sign there is no screen it means Continue reading

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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

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.

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

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.

======

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.

======

Do you have a guess on the year… Continue reading

That Light in the Distance Might Just be a Freight Train

5 Mar

It is still very early in the concussion issue – called an epidemic by the CDC – however this has not stopped people seeking damages against schools and institutions for perceived wrong doings.  These suits are based on the proper protection of the individual injured, you can see the multiple former NFL players filing suit for examples.  However, there are some that fly under the radar, well because they are not high paid athletes.

One such case in California was just settled and reading the article brings chills down my spine as an athletic trainer for adolescents; Continue reading

New Doctor, Different Results: Tracey Mayer

21 Feb

Parent Advocate, Tracey Mayer will be offering up her writings to The Concussion Blog as a resource to the readers, especially the parents out there.  As time allows she will be submitting posts for you to read.  I truly hope that everyone gets a chance to read about concussions from yet another perspective.  Thank you Tracey!

My son, Drew, suffered a severe concussion during a freshman high school football game in September, 2008, and has not played football since.   He would have stepped back on the field the next week and would still do so if he was allowed to.   It was not his first concussion, but it was clearly the most severe.  My earlier posts on here explain the details of what he has gone through.  Clearly, he has made tremendous progress, but he still has some cognitive difficulties.  He also suffers from migraines, which are typically provoked by intense focusing or from being hit on the head.  It does not happen often, but there have been a handful of incidents over the past 2 years.  Two weeks ago, he was elbowed in the head very hard during a basketball game, which resulted in a migraine with major fatigue that lasted for 4 days.

Drew saw a leading neuropsychologist out of Loyola who is an expert in concussive injury last week.   I chose to not reveal his name Continue reading

Show Critiques (CNN and ESPN)

30 Jan

Yesterday there were two important shows that aired.  One on ESPN, the Outside the Lines presentation on helmets and the other was a documentary by CNN and Dr. Sanjay Gupta.

CNN and Dr. Sanjay Gupta presented an hour-long look into the concussion issue, mainly at the high school level.  Although the main press is with the professionals, the time spent at the high school was a HUGE KEY to making this documentary a success.  Like we have been posting on this blog for the past 18+ months the real issue with concussions begin at or earlier than high school.  This is not only because there are obviously more participants at the HS level, but it is also where kids are learning and learning how to learn.  In short the high school level is where the brain is functioning the hardest.

The presentation was excellent, it not only provided the current (subjectivity) but exploding (CTE) issues in the concussion discussion, but exposed a real solution to the issue. Continue reading

Lucky To Be Alive

11 Oct

Adrian Padilla is lucky to be back where he wants to be, on September 19th he suffered a major brain injury that required emergency removal of part of his skull.  The fact that it was taken care of in time to save his life is a great thing, but after reading a story about his triumphant return to watching his teammates there was a passage that has me extremely concerned;

Padilla can recall everything that happened leading up to when he collapsed on the sideline at the San Luis Obispo game.

He said he had suffered a minor concussion two weeks before the game, but felt well enough to play. Everything seemed normal until he blitzed the quarterback leading with his helmet.

“After that, I got up and ran to the sideline and told coach what happened. He told me to go sit down, and I tried going to the bench and moving some bags. Then I collapsed,” Padilla said. “The next thing I remember was waking up in the hospital four days later.”

The fact that Padilla recognized Continue reading

Comprehensive Article From LA Weekly

18 Aug

Kids are the reason there is so much buzz about concussions.  The professional player understands the risk and is getting paid to take those risks, kids are not.  The other more important reason is that a younger brain can be more adversely affected by an insult/concussion.  Steve Jansen and Gus Garcia-Roberts wrote an extensive and comprehensive article titled: Concussions Take a Terrible Toll on America’s Young Athletes.

Across the country, people have awakened to the sometimes irreversible damage of concussions, especially in high-impact professional sports. With much of the attention focused on the National Football and National Hockey leagues, Village Voice Media conducted a nationwide investigation into the consequences of concussion on youth athletes.

The article finds that there are some inherent gaps in the former and current systems for concussion recognition and return to play.  A lot of the confusion Continue reading

Great Resource About Concussion Myths

5 Aug

Matt Chaney has been busy this summer with work, but he found some time to forward a bunch of links regarding concussions.  There were a lot dealing with the state laws and the mandates now in place across the sporting landscape, all with very valid opinions.  Some dealt with his area of expertise, steroid and PED detection.  However there was one that I must share with you; a link to a NASP Communique (National Association of School Psychologists)

The link was very resourceful but the gem was the attached .pdf that dealt with the myths we commonly hear with concussions.  Due to the rudeness of ripping off all the information below you will see the myths they took on, and for the actual facts please click on the .pdf link above;

Identifying Concussions

  • Professionals agree on the definition of a concussion.
  • A more accurate term for concussion is a head injury rather than a brain injury. Continue reading

Live From Princeton

17 Jul

Welcome to the continually updated live feed from the Athletic Trainers Society of New Jersey 2nd Annual Concussion Summit.  I would like to thank the ATSNJ in particular; John Furtado, Eric Nussbaum, and Mary Jane Rogers for the help in getting things set up.  We are at the Wyndham Princeton Forrestal Conference Center & Hotel in a stunning amphitheater, attendance is anticipated to be high.  I anticipate updating this post as soon as possible after each speaker.  Follow @concussionblog for updates.

6:25am CST: Crowd flowing in with provided breakfast in hand.

———-

6:33am CST: Jason Mihalik, PhD “Biomechanics of Concussion”;

  • Concussion is a FUNCTIONAL injury not structural injury
  • Brian injury a major public health concern (showing a pyramid with the head injuries on the bottom, unseen or caring on their own)
  • Things that feed into Traumatic Brain Injury:
  • Cognition, Concussion History, Postural Stability, Mechanism of Injury, Physical Exam, Symptomatology, Knowledge/Attitude
  • Injury Prevention (anticipation, infractions, play type, closing distance)
  • Kinds of impacts that cause concussion; research obviously done primarily on animals beginning in the pre 40’s.  The coup-contracoup model was found by using animal models
  • Research moved from animal models to human analogs; wax skulls/gelatinous brains Continue reading
  • Live From Lexington

    24 Jun

    Welcome to the intended live feed from the 2nd Annual Sports Concussion Summit here in Lexington, Kentucky.  We are at Cardinal Hill Rehabilitation Hospital, a beautiful facility.  Attendance looks to be very good, about “60 or so” according to Jonathan Lifshitz, host of the event.  I will be updating this post as we go along with a time, follow @concussionblog on Twitter for updates.

    7:05am CST:  Jonathan Lifshitz, PhD opens up the conference, a big “walk-in” group, I still think I may be the only one not from KY here.

    7:10am CST: Dr. Lifshitz had a great perspective on announcers and how the terminology of the game regarding head injuries has to slowly begun to change.

    ——

    7:50am CST: Dan Han, PsyD “Contemporary Perception on CHI: Multidisciplinary Initiatives

    • 1.7M documented TBI; 52,000 deaths per year, 275,000 Hospitalizations (CDC Numbers)
    • 75% of TBI (1.3M) are concussions/mTBI/mDAI; 300,000 are DOCUMENTED sports concussions
    • 0-4, 15-19 and 65+ y/o’s most likely to sustain a TBI
    • Females have significantly higher odds of poor outcomes
    • Documented TBI (see above) not the real issue; the undocumented TBI is the proverbial iceberg under the water
    • Diffuse Brain Injury
    • Secondary to stretching forces on the axons
    • Moderate DAI = “Classic Concussion” (unconsciousness, possible basal skull fracture)
    • Persistent confusion, retrograde & anterograde amnesia, mood/personality changes
  • Severe DAI = Brainstem Injury (high mortality rate)
  • And TCB Contributor Tracy Yatsko gets some run on a video!!!  Man girl you get around :)!
  • Postconcussional Disorder
    • LOC > 5 min or anterograde amnesia or new onset of seizures within 6 months after CHI
    • Just learned a lot about seizures; many go unnoticed
  • AND attention or memory deficit
  • Plus 3 or more symptoms present for at least 3 months following CHI
  • Significant impairment in social or occupational functioning
  • Academic achievement decline
  • HUGE Multidisciplinary Concussion Program at University of Kentucky, well on the way to being a leader in concussions
  • —–

    8:50am CST: Greg Wheeler, MD “Treatment of Sports-related concussions and return-to-play clearanceContinue reading

    Exciting New Online Education

    9 Jun

    I was recently contacted by Sport Safety International to take a look at and provide feedback to online concussion education courses.  We do get a lot of these type of emails, usually with flattering introductions trying to get publicity.  And to be honest as time warrants I do my best to investigate every single one of them.  You have seen that I have looked at and informed the audience about many products and services for concussions.  So this was somewhat routine for me, to take a look and give honest feedback (sometimes the feedback is not what companies and people want or expected to hear).  However Sport Safety International has something that was not only worth every second of my time, but worth ANYONE’S time.

    I am gladly going to go as far as promoting this service, mainly because it is FREE to coaches, athletes and parents (see general public).  Here is their own words; Continue reading

    Edit: Matthew Gfeller Center Hosting Symposium

    28 Apr

    The National Sports Concussion Cooperative (NSCC) that was launched in March is meeting up as the Matthew Gfeller Cetner is hosting a symposium this upcoming weekend.  The NSCC is championed by;

    These four entities have come together for the goal of reducing the incidence of sports-related concussions with the formation of a cooperative to bring interdisciplinary collaboration to concussion research and testing.

    The National Sports Concussion Cooperative will hold its founding organizational meeting in Chapel Hill, North Carolina on May 2, 2011, to develop an agenda by which it will identify the most pressing concussion objectives in sports and set a course for assessing their significance through research and peer review. After the meeting, additional partners will be engaged to consider joining the collaborative effort and finalize the objectives for each stakeholder group.

    The event this weekend, April 29 and 30, titled “Matthew Gfeller Sport-Related Neurotrauma Symposium”, will bring together “experts” within the field of research, clinical and equipment manufacturing to share their thoughts on the concussion issue.  The chair for the symposium is Jason Mihalik, Ph.D., any media requests for him should be directed to Patric Lane, (919) 962-8596, patric_lane@unc.edu.

    The full press release is as follows; Continue reading

    Knowing Is Half The (UPDATE)

    21 Apr

    UPDATE: Thanks to commenter @SpMedConcepts I should write that one test is just a piece to the puzzle.  And a comprehensive testing procedure that includes all of the available “baselines” and assessments should be used.  It becomes more difficult to cloud the picture with deception when using this approach.

    Knowing about concussions is one thing, but knowing that players may take advantage of the system is another factor.  Like anything else in this world people will look to exploit weaknesses in systems to gain an advantage.  After all isn’t that the crux of competition and sports?  We have seen Irv Muchnick open up the dialogue on Ritalin as a possible way to “cheat the system” and now Alex Marvez of Fox Sports tells us the other, more obvious way to “cheat the system”;

    Dr. Daniel Amen, who has treated current and former players for post-concussion symptoms, said some of his clients have confessed to fudging the initial baseline tests administered by NFL teams. By doing so, Amen said those players are seeking quicker clearance to return from any future head injuries they might suffer.

    If the baseline tests are to be used to compare then why try hard and excel at them, only to have that first test hinder their return?  This is the common question that the professional and adolescent athletes are dealing with.  Even though baseline tests, be it neurocognitive computer based or hand written like the SCAT2 or the new NFL test, are objective Continue reading

    Concussions Bigger than Steroids?

    13 Jan

    Matt Chaney is a journalist, editor, teacher and publisher, and he too has a blog that is just getting up and going.  However, Chaney has published a book titled Spiral of Denial; Muscle Doping in American Football, so he is not new to finding and presenting good information.

    Chaney sent me an email today alerting me to his most recent piece, and it is a good one;

    By Matt Chaney

    As a foremost authority on sport doping, Pennsylvania epidemiologist Charles E. Yesalis identifies a public health problem of longstanding: athletes’ use of anabolic steroids, stimulants and more drugs that permeate amateur and pro ranks.

    But Yesalis, professor emeritus of health policy at Penn State, sees a larger issue rearing now, brain trauma, to threaten all contact sports and particularly American football.

    “This is going to eclipse the drug problem, and it probably already has,” Yesalis said in a recent telephone interview. “I think the whole drug issue is passé, to some extent. You don’t see any protests at moment about drugs in sports. … Steroid fatigue is all over the place, and I think people have just accepted it, deciding to go along.”

    “But I really think that tackle football is in trouble (for concussions),” Yesalis continued. “Football is clearly the No.1 game in American sports, and it does not look good from an epidemiological standpoint.”

    You can read more on this by clicking HERE.

    In the entire post you will see how the Nathan Stiles case was viewed by Dr. Robert Cantu, a renowned neurologist of Boston University and the Sports Legacy Institute.  Cantu does not completely believe the medical examiners report of an undiagnosed or missed subdural hematoma.

    Thank you for the email and story Matt!

    2nd Impact Syndrome Survior

    20 Sep

    This video was produced by StarLedgerNJ.com in 2008.  It has some great messages from MD’s and kids alike…

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