Concussions – Where We Have Been, Where We Are

Some of the most important posts will be re-published from time to time.  This one was published December 16, 2010.

From time to time, I like to reflect and refresh on many things, but this is a good time to look at concussions; where we have been and where we currently are.  Today I will take a very quick look into the management of concussions.

For years as a health care provider we were guided by early work of Dr. Robert Cantu and others for guidance with concussions.  The information that was first published as early as 1986 and endorsed/accepted by the American Academy of Pediatrics and American Academy of Family Physicians in 1999.

TABLE 1
Concussion Grading Scales Continue reading

The Hardest Part Of My Job

As an athletic trainer there are many difficult situations that arise on the job.  Broken bones, overzealous parents, concussions, weather and a myriad of other things get to you.  However, there is nothing more troubling and depressing than what I just had to do.

Back story is a female basketball player who has sustained multiple concussions over her high school years in various sports/activities.  Each one was handled to the best of our ability and under the concussion policy at this school, even had great conversations with the MD on the case.

After her last concussion, last December, we discussed that because of the number (then at 4) for her the resolution would be longer and possibly met with more difficulties.  We also discussed that if all her care takers; parents, coaches and Continue reading

This isn’t about Tebow…but it kinda is

Nick Mercer is a guest author and his original blog can be found at concussiontalk.com.  Nick is a survivor of TBI using his experiences to educate and opine about current issues in the realm of concussions.  Nick has presented on these issues in his native Canada as well.  Enjoy!

On Sunday I watched the Denver Broncos score 10 points in a little over 2 minutes to tie the Chicago Bears and then win in overtime. This is an impressive comeback, but it wouldn’t be so believably unbelievable had it not involved the Broncos and their quarterback Tim Tebow. Last week Chuck Klosterman wrote an excellent article on www.grantland.com  entitled The People Who Hate Tim Tebow and he tries to find out why Tim Tebow is so fascinating to other people and why he’s so polarizing. Klosterman inevitably talks about faith and belief. I think the reason a nice, genuine guy is so polarizing are very similar to explaining concussions and brain injury in sports.

Tim Tebow is the Broncos quarterback and seems to lack most of the apparently ‘essential’ skills of the modern-day NFL QB. Football purists and many former players are quick to note his lack of skill, his inability to make accurate passes and his reliance on running and scrambling. Continue reading

Tuesday Quick Hits

When will people and doctors understand that not only do repeat traumas to the brain while still recovering from an initial injury make the sequelae prolonged and worse, but returning to school will do the same?  As we have said over and over on this blog and in my many public speaking appearances removal from school and other cognitive activities is a MUST;

Drawing is just about all the 14-year-old high school freshman can do right now. He can’t play video games, watch TV, or use his cell phone said his mom, Michelle Hensley-Shelton. He can’t even go to school.

“He can listen to some soft music,” she said.

Michelle said it’s all because Hunter is recovering from concussions.

“Definitely two but the doctors at Baptist say that it could have been three or four,” said Michelle.

Michelle said they happened while Hunter was playing JV football. The first happened in August when Hunter was knocked out for a few seconds in practice.

“It was a pretty hard impact he took. He come down on his shoulder and he kind of went up and messed with his neck,” she said.

Hunter got checked out at the hospital and while he didn’t go back to practice for a few weeks, he did go back to school the next day.

“We learned one of the first things we probably should have done with his first concussion is not only keep him away from athletics for a few weeks, but his brain needed time to heal from schoolwork, as well,” said Michelle.

SOURCE

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Q: What exactly is tau protein and why does it matter in the concussion issue?

A: Normally occurring protein in the brain with a function, but in overabundance it has been implicated in CTE; Continue reading

Coexistence of Concussion and Football: Part IV

I have been asked to write about concussions from time to time.  I attempted a chapter on concussions for a book at some point, over the next few weeks I will post this chapter, as I wrote it, no matter how horrible it is.  After all I am not an author, but at least you can take a look.  This particular chapter deals with concussions in the sport of football.  We all should know this injury can be sustained in any sport.  Because football is the biggest draw of sporting eyes I felt it was best to present it in this way. (Part I, Part II & III) *All sources will be posted after last portion is up.

Detecting a Concussion

Although the injury is “invisible” there are ways to identify and detect a concussion.  In fact this is one of the few injuries where modern technology – x-ray, MRI, CT scan – cannot “see” the injury, rather those diagnostic tools are used to rule out much more severe injuries; such as skull fractures or bleeding on/in the brain.  Medically speaking any blow to the body and/or head that results in signs and symptoms is classically diagnosed by a physician as a concussion[i].

In the field as an athletic trainer trying to root out those concussed conditions are slightly more difficult, weather conditions and things like lighting notwithstanding, the individual and those surrounding him/her make detecting a concussion very difficult at times.

Most athletes are competitive by nature and have a very hard time coming off the field for any reason, let alone an injury; something that would show weakness.  Now try getting that athlete off the field when there is nothing for the general public, coach, or teammates to see.  A lot of what goes on with detection as an athletic trainer has to do with observation of the actual hit/hits, but usually being outnumbered 40-50:1 makes watching every play and every hit nearly impossible.  This makes second-hand information VERY important; Continue reading

Fujita To Lobby Players Association

Not only is Scott Fujita a veteran on the NFLPA Executive Committee but he is a concussion “survivor” as I call them.  Someone who has experienced the injury and managed it correctly.  Scott Fujita plays for the Cleveland Browns the same team that DID NOT perform a concussion evaluation on Colt McCoy last Thursday (in my humble opinion I think the Browns have had a very good track record up until this incident);

“The one thing I know is that when it comes to this issue, players, coaches, and team medical personnel struggle in the heat of the moment,” Fujita said earlier in the day, in an email sent both to King and to PFT.  “This has been an ongoing problem for years.  The game-day sideline is intense, there’s a lot going on, and we can’t always count on everyone to make the most responsible decisions.”

Because of this Fujita has told Peter King and myself that there will be dialogue on the matter of placing someone truly independent on the sidelines to avoid the situation; Continue reading

Misinformation: Hockey

I must admit I am being a bit “Pollyannaish” about using the correct terms and classifications of concussions.  But seriously it needs to stop, for the sake of the kids and general public.  All these terms do is muddy the water about concussions.

Case 1: Chris Pronger – “Concussion-Like Symptoms”;

Pronger has what general manager Paul Holmgren called “concussion-like” symptoms and is out indefinitely.

Braydon Coburn, when asked whether it had been easier to wrap his head around just three more weeks without the captain as opposed to the “indefinite” absence announced on Friday, said: “I don’t know. I don’t even know what day it is.”

Case 2 (my biggest pet peeve): Daniel Paille – “Mild Concussion”; Continue reading

Rugby Concussion Education: Tim O’Connor

The Concussion Blog is excited and privileged to have a guest author post about rugby.  Tim O’Connor is a barrister practicing in Ireland with a specialty in rugby and sports law.  He writes on the topic at www.rugbylaw.blogspot.com.  Tim will be posting from time-to-time from across the pond.  Here is is first entry about the IRB and concussion law (rules).

As a child, one of the very first things you learn playing rugby, is how to fall and protect your head.

And there’s a good reason. Rugby’s a fast-moving collision sport, and a relentless one; there are multiple phases, no rolling substitutions, and all sorts of areas where a misplaced boot, knee, elbow, shoulder or head can come sharply into contact with your head. No-one is taught to use their head in the tackle; but when a 160-pound 5’10” outhalf can find himself facing up to a 6’7” 260-pound lock who’s moving at 100m-in-11-seconds pace, accidents can and will happen when all the protection you have is a gumshield, maybe a scrum-cap, and determination.

So, rugby has known for a while that concussions happen. And the leading rugby nation on earth, New Zealand, have been leading the way on concussion management. Since their RugbySmart program was introduced in 2001, Continue reading

2011 NFL Concussion Report Week 13

With Week 14 upon us four regular season weeks remain on the NFL schedule and the concussions don’t seem to be any lower than last year at this time.  The numbers at this point are almost identical to last year for the regular season however the overall number since the season began is up 23%.  As Will Carroll wrote in his Med Check on SI.com this may primarily be due to awareness and reporting (with the lack of transparency from some teams it’s a w0nder it is higher).  Currently we have 122 regular season concussions listed as opposed to 119 last year through 13 weeks.

And the NFL is tweeting about how a player is “tough” for playing though memory loss and possible brain injury, WTF:

@NFL: Roethlisberger wasn’t the only tough QB last night… though Colt McCoy doesn’t recall the hit he gutted out. http://bit.ly/tAvS6I

With all of our experience we still miss some information on concussions and how they are occurring.  We really wanted to track all the special teams concussions especially the kick off; because of the rule change.  Scouring our sources and the journalists articles we have been short of saying we are successful at pinpointing the numbers.  We have found that 8 of the 122 were on ST and 2 on kick off; with many of the players listed being reserves it seems plausible that those too happened on special teams.

A new source was found this week leading us to update the numbers (hence the sharp increase from last week in overall concussions); Continue reading

Why So Afraid?

After James Harrison of the Steelers basted Colt McCoy of the Browns with a borderline illegal hit everyone (well not everyone but many) were concerned with the immediate effects and a possible concussion.

The Browns were fast to let the world know that McCoy didn’t have a concussion.  This was required speak because they did not even properly evaluate McCoy for a concussion.  I did not see any overt signs at the time, but that means nothing.  What is even more interesting is that McCoy was reported to have some delayed symptoms;

They’re awfully quick to dismiss the possibility considering McCoy showed the after-effects of a player who had been concussed. McCoy told the Elyria Chronicle-Telegram that he didn’t remember the hit, and he was still glassy-eyed 20 minutes after the game. The Browns P.R. staff also asked reporters to turn off their lights during McCoy’s post-game availability session.

Straight from the horse’s mouth we have: memory loss, vision disturbance/fogginess, and sensitivity to light.  When I evaluate for a concussion on the sidelines and after games of high school players 3 reported symptoms are enough to warrant the assessment of concussion.  In fact after a report and clinical evaluation/questions that would end the assessment right there and they would be sent off to a quiet room/home.

So why are NFL teams so afraid to label concussions, concussions?  I have no freaking clue.

NHL Concussion Report 12/8/11

Last month during our concussion report for the NHL we noted an encouraging decrease (23%) in concussions/head injuries over the previous year.  Now that difference is (2%) as 13 more injuries have been exposed over the past month.  One situation we will not be classifying is the current Sidney Crosby issues.

Crosby and the Penguins are making a bold and correct statement by not traveling with the team during the current road trip.  Reportedly Crosby is not quite 100% and the team does not want to take the chance of another concussion occurring after a big hit he sustained in the previous game.

It is worth noting that in the associated article that Sidney “passed” his ImPACT test but still is being held out of action.  We have heard from many entities (including uninformed school boards/districts) that passing a nerocognitive test (ImPACT in almost all cases) would be enough to allow a player to continue.  Continue reading

Tuesday Quick Hits

It has returned, the Quick Hitters…  Let’s begin…

Toradol and concussions, not such a good combination and former NFL players are suing the league for its rampant use;

It’s one of about a half-dozen suits filed against the NFL in recent months by past players who say the league did not do enough to protect them from concussions. As in other complaints against the league, the latest criticizes the NFL’s original committee on brain injuries and says the league concealed risks of concussions.

“The difference with this case is what we’ve learned from our players is that they used to administer a drug called Toradol, which is basically a painkiller … even when players didn’t have symptoms,” Seeger said in a telephone interview. “Our experts say that’s the worst thing you can do for a brain injury or a concussion.”

I have witnessed the pregame ritual of Toradol injections (to clarify not in an NFL locker room), and for some cases it was the only way players could play.  However Toradol is intended for trauma and can mask a lot of issues/pain including symptoms of concussions.  In fact the use of Toradol has been banned in Europe for certain uses.

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An In Depth Look At Boogaard

In case you have missed it the New York Times has been publishing a comprehensive look at Derek Boogaard, in a three-part series.  Not only the circumstances surrounding his death, but the wonderful life he had.  With the revelation that Boogaard was confirmed to have CTE all of this information is relevant to the concussion front.

The Times began the series with a look at Boogaards rise to the NHL, from an awkward skater with little scoring prowess to the massive man on skates that would fight anyone at any time, “A Boy Learns to Brawl“;

Boogaard rarely complained about the toll — the crumpled and broken hands, the aching back and the concussions that nobody cared to count. But those who believe Boogaard loved to fight have it wrong. He loved what it brought: a continuation of an unlikely hockey career. And he loved what it meant: vengeance against a lifetime of perceived doubters and the gratitude of teammates glad that he would do a job they could not imagine.

He did not acknowledge the damage to his brain, the changes in his personality, even the addictions that ultimately killed him in the prime of his career. If he did recognize the toll, he dismissed it as the mere cost of getting everything he ever wanted. Continue reading

Polamalu – I Hear You

Troy Polamalu the recent poster boy for concussion management has spoken for the first time since the  “concussion-like” spell.  He was interviewed via The Republic and had some very salient comments;

“I’m well aware of the research, well aware of the frenzy that’s kind of surrounded this particular injury,” he added. “I also realize that with the amount that I have had that I’m probably under a lot more scrutiny, and we’re under a lot more scrutiny than other organizations.”

I have always thought of Polamalu as someone who is of full capacity and really, an over all a competitor.  There inlays the struggle of athletes, playing hurt.  But are concussions an injury you can play hurt though?  As of now there is ZERO indication that this should even be considered for adolescents.  Professional athletes are adults and as we can see from the above comment aware, but they are making a living. Continue reading

2011 NFL Concusison Report Week 12

The Concussion Blog Original, NFL Concussion Report, is a weekly compiling of the reported head injuries in the National Football League.  Concussions are added to the list each week from multiple sources to give you the reader a picture of what is happening on the field.  Each week we will bring you the information along with relevant statistics.  If we have missed a concussion or put one on here erroneously, let us know (we will also be using Fink’s Rule to classify a concussion/head injury).

A relatively quiet week on the concussion front in the NFL.  Of significance another player was places on IR due to concussions, Sidney Rice.  This is in direct contrast to another player who has his second incident of head injury, Troy Polamalu.  I really have nothing more to say this week so here are the stats (146 total concussions from camp on); Continue reading

Homework Assignment

After some discussion with other football people I thought it would be a good assignment for everyone that has access to the information to breakdown concussions from the past fall.  A simple tweet, email or comment in this thread will be just fine for this “non-scientific” data gathering.

I would like to see the ratio/splits of concussions in high school football between those that played one level exclusively compared to those that played multiple levels.  I am speaking of players that played freshman and junior varsity, or varsity and junior varsity, or freshman and fresh-soph, etc.

For example we had 7 concussions this past football season and all of them were from those that played multiple levels.  There were ZERO concussions from players that were exclusively on one level.  From informal texts and calls from surrounding schools there is a disproportionate amount of concussions from those that play multiple levels.

I would like to see what you have, maybe it is isolated…