While I am away catching some sun and hanging my feet in the ocean the least I can do is provide you with a video a day. Today is from Seattle’s Children’s Hospital providing advice for teens dealing with concussions;
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The Concussion Blog 
Hope you’re enjoying your vacation! We just got back from ours.
Rosemarie Moser was a lead author of a study on an intense period of rest on concussion symptoms – there was no control group, but it’s good to see some studies to support the current perscription for rest (perhaps this type of evidence can be used to convince any skeptical school personnel that cognitive rest truly is important).
http://www.msnbc.msn.com/id/47760071
“Taking a week off from nearly all mental and physical activity – including television, talking on the phone and visiting with friends – was linked with improved mental performance and fewer symptoms in people who had suffered a concussion, a study said.”
In case Dustin doesn’t catch this while on vacation, I’ve linked SLI’s press release calling the NCAA to warn athletes about the risks of CTE.
Click to access SLI-NCAA-CTE-Press-Release.pdf
“SPORTS LEGACY INSTITUTE TO NCAA: BEGIN WARNING ATHLETES ABOUT RISK OF CHRONIC TRAUMATIC ENCEPHALOPATHY
AS PART OF CONCUSSION EDUCATION CURRICULUM”
““NCAA athletes are not financially compensated for the health risks to which they are exposed. We need to appreciate the irony of asking scholarship athletes to trade a free education for the risk of a degenerative brain disease that may minimize the benefit of that education. Athletes deserve to have informed consent and the opportunity to modify their behavior based on established science,” said Chris Nowinski, a former All-Ivy defensive lineman for Harvard University.”
http://www.thesunchronicle.com/news/local_news/head-games/article_32f3ab0c-75cb-517e-aac3-77872bd8cdf1.html
“I didn’t report my concussion because I didn’t realize the severity of my injury. I thought I’d be fine if I just took it easy for a few days.
The NCAA has recently implemented strict return to play guidelines for athletes who have suffered a concussion. I knew if I reported what had happened, I’d be unable to play for at least a week. With two important games coming up the following weekend, I wasn’t willing to play it safe.”
“Just before halftime in a close game against Worcester Polytechnic Institute the following weekend, I dove forward to collect a bouncing ball in the goal box when a forward from the other team kneed me straight on the side of the head.
I instantly saw a flurry of stars and lay on the field trying to collect myself as my teammates and the athletic trainer came out onto the field.
As I got to my feet, I felt OK – I didn’t feel very confused or dizzy. With 10 minutes left until halftime, I stayed in the game. But it didn’t take long for me to realize that something wasn’t quite right.
An overwhelming feeling of panic and a crushing, foggy headache swept over me as I stood in the net. Halftime finally came and I took a seat on the bench while asking the assistant coach to get the trainer.
There weren’t words to properly describe the way I felt. I told the athletic trainer that I just “didn’t feel right.” Little did I know at the time that my return to competitive athletics would be a painfully long and frustrating process.”
Dave Pear’s blog includes material from Daniel Amen on rehabilitating damaged brains (wonder what those with medical/research backgrounds think of the suggested “fixes”). The weekend reading post also includes an approx. 30 min. interview with Sean Pamphilon.
http://davepear.com/blog/2012/06/your-weekend-reading-concussions-lawsuits/
First, Nowinski is not scientist and making pronouncements without supporting data is little more than scare mongering and self-promotion. He points to two cases of CTE out of millions who played. Should players be informed getting hit in the head is bad for you, certainly. On the other hand, if this is not about boosting funding opportunities then he should advocate cancelling all collision sports in high school as this makes it appear that collision sports are the equivalent of smoking. Children can’t buy cigs so by the same logic should not play collision sports.
Nonetheless, BU/SLI has been making statements based on limited data that no one could draw a reasoned conclusion. The concussion issue was born for idiotic research produced by political clowns. Now we have research being spun to promote other agendas.
Amen, Harch, Maroon, Bailes et al. have never produced anything that illustrates any of their so-called interventions work in a controlled double blind study. Until they do be very cautious about claimsabout supplements, HBOT, cranial adjustments etc.
It’s always good to get feedback from someone who can cut through the spin (although, personally I view SLI’s press release as a really positive step towards full disclosure for athletes).
I wish we had better data, but until we do, based on what we do know (getting hit in the head is bad for you), perhaps we should view collision sports as the equivalent of smoking, and perhaps children under a certain age shouldn’t be allowed to play (there’s no oversight or accountability for youth programs, school and volunteer immunity laws may have resulted in some unintended consequences, and a number of youth programs may be operated in ways which increase the chance of head injuries).
There are limited documented cases of CTE in college players, but it seems as though there are a number of high school and college athletes who struggle with various impairments after sustaining too many head injuries. I run into those types of stories frequently:
http://www.thehour.com/news/westport/concussion-awareness-night-to-be-held-june-at-saugatuck-elementary/article_91a1758b-e79e-54f5-bdc6-80da43f40bec.html
“Take the story of Staples High graduate and Yale University student Chris Coyne. Having suffered five concussions playing football at Staples, Coyne said he brushed off each injury and forged on in fear of being picked on by his coach and teammates. After graduation, Coyne joined the football team at Yale in the fall of 2011 but soon after suffered another concussion during the pre-season. That injury essentially ended his football career.”
I came across an article containing youth football videos which seem to illustrate that as a society we really need to think about what we’re encouraging kids to do … kids who are too young to understand the potential long term consequences …
http://www.elevenwarriors.com/2012/06/11691/unsafe-at-any-age
” … today I have another series of videos, and I want you to watch them and then try and tell me that kids, even kids as young as 5 or 6, can’t inflict major head trauma on each other and that some coaches, fans, and even parents aren’t encouraging it.
There are, of course, dozens of more examples to be found on Youtube, just search for “Pop Warner hit” and you’ll have hours of fun watching children concuss each other.”
Seems like we already know enough to know that youth football needs a major overhaul …
Another example calling for the use of brain rest (hopefully a step-wise graduated return to school/cognitive exertion protocol will become a common standard practice, and no longer considered an “aggressive step”):
http://www.saukvalley.com/2012/06/08/the-hidden-injury-meet-ethan-hafner/aph7hh3/?__xsl=/print.xsl
“The Hafners quickly got Ethan in to see their family doctor, Joseph Welty, at KSB Hospital. Ethan’s CT scan came back negative, but a neurological exam confirmed he’d suffered a concussion.
But Welty took a much more aggressive step with Ethan – forbidding him from doing anything that could put a strain on his brain. That included watching TV … and attending school.
“This is something I feel is relatively new – the brain rest,” Welty said. “You think about an injured arm or an injured leg. What do you do with it? You rest it.”
Welty put Ethan on a graded return to classes. He began with half days and slowly graduated to full days.
Unfortunately, Ethan suffered setbacks and had to return to quiet rest at home a few times. All being told, it took him 6 weeks to return to school full-time.”
Access to the internet is revealing numerous sport-related concussion stories of youngsters becoming brain injured. These anecdotal injury stories are apparently not sufficiently reported within ‘professional’ journals nor by some ‘professionals’ who claim to have accurate and existing knowledge of sport-related concussion stats within the United States. …
Sadly…these concussion occurrences are also seen as ‘flukes’ or ‘accidents’ rather than as statistically predictable damaging brain injury.
Although the CTE link should not be ignored…
from my view… it is extremely important not to fervently focus on CTE and lose/minimize the important perspective that many youngsters continue to suffer debilitating sport-related concussions that adversely impact school, family and social relationships, self esteem, their emotional status and engagement in noncontact / noncollision / nonstrenuous physical activity.
Furthermore, Cognitive and Physical rest are insufficient for the injured brain. As the brain IS damaged, COMPLETE BRAIN REST should be advocated for the necessary convalescing period. This convalescing period needs to be individually determined by knowledgeable professionals who are attempting to protect the injured brain from further damage.
…thus Emotional rest should also be incorporated into the post, or perhaps more accurately, ongoing brain injury plan. I will not say recovery plan…as there is ample and long existing evidence to support the notion that the brain is permanently injured.
Below is an Abstract of a 1984 article published almost 30 years ago and is entitled:
Post-Concussion Symptoms: Cognitive, Emotional, and Environmental Aspects
that appeared in the International Journal of Psychiatry in Medicine
Volume 14, Number 4 / 1984 … Pages 277 -283
=============================================================
Abstract:
Two head injury [brain injury] patients who experienced the onset and/or exacerbation of post-concussion symptoms (i.e., headache, confusion, and memory difficulty) associated with increased environmental stress are presented. The cases provide insight into the complex interaction between neurological and psychological factors following head injury [brain injury].
Patients should be made aware of cognitive limitations during the recovery period so as to better determine acceptable levels of environmental stress. The development or exacerbation of post-concussion symptoms during convalescence signals the physician that a discrepancy exists between the patient’s cognitive capacities and environmental demands. Timely intervention to modify environmental stress would help alleviate problems with post-concussion symptoms.
Dr. Brady,
Children involved in sports need advocates to speak for their needs for (1) protection from injury/reinjury on the field/court/rink, (2) adequate academic accomodations, and (3) adequate medical treatment. Each story I read seems to contain a repetitive pattern where often the unsuspecting/uneducated (about mtbi/tbi … I’m not insulting their intelligence) parents struggle to get appropriate care for their child (not sure if you read the entire article, but that was most likely not the child’s first concussion). In some cases schools are cooperative, but unfortunately, in many others they make the situation worse for the recovering child/teen.
Just in our small community back in 2009 a football player needed to be removed from the field via helecopter (rumor has it that it was his second or third concussion within a week, and that the emergency responders almost lost him on the field, yet he “fully” recovered and an opportunity to increase concussion awareness and recognition from top to bottom was lost), it was reported that the mom who attempted to increase concussion awareness at our school had two sons who had both sustained concussions in wrestling, we have a baseball player who may have sustained permanent damage to his eye by being hit with a ball in the pitching barn, a young softball player we know was struck by a ball and had convulsions (she also sustained a broken ankle in another incident), another softball player we know had to miss school for her concussion, and my daughter mentioned that one of the middle school football players was having difficulties playing his instrument in band due to his concussion (rumor was that blood had come out of his ears after he was hit, so he was sent to the hospital for evaluation … yet, was back at school and practice shortly after the incident).
I was hoping that one of the benefits of the players’ lawsuits against the NFL would be that parents would become aware of the serious danger of permanent injury from high contact/collision sports as currently played. Unfortunately, that doesn’t seem to be the the case as of yet, and if the suits are dismissed due to labor and other laws, then a huge opportunity may be missed.
Based on the attitudes and responses that I encountered after my son was injured, it seemed like the school and the bantam program were not taking all necessary steps to keep children safe, in part due to a lack of knowledge, but also due to what I perceived as a lack of motivation stemming from the protections afforded by various school and volunteer immunity laws. I recently read that Ohio is closer to approving a youth concussion law and that they specifically included immunity provisions to protect volunteer coaches. I don’t want to see volunteers get sued, yet unfortunately I believe that when all fear of lawsuits is removed, there’s little incentive for youth leagues and schools to clean up their acts.
As far as I’m concerned, it’s past time to re-evaluate how youth sports are played, and at the very least parents have to be made aware of the risks their children are being exposed to (the inherent risks of various sports as well as the risks associated with the resource limitations for youth sports … parents need to know that playing high contact/collision sports under the supervision of unaccountable volunteers/school employees, with questionable training, safety procedures and equipment, and no athletic trainer is exposing their child to additional risks).
Don,
Thanks for pointing out the bear in the room. Second Impact was the bugaboo a decade ago and now CTE has taken its mantle. SIS does occur and can usually be avoided. It does not happen with great frequency. CTE does occur but does not appear (insufficient reports of data) in enormous numbers in athletes in collision sports. What you rightly point out does occur is a large numbers of brain injuries and correct steps must be taken to deal with them.
Hopefully the CTE can be put in its rightful place as a serious injury most likely to be associated with predisposition or extreme exposure to repeated head injury.
Joe Bloggs,
I agree that some of the focus on the rare conditions is taking away from the need to prevent more common injuries. Yes, second impact syndrome needs to be avoided, but I would like to see the first concussion avoided as well … and in some cases the 2nd, 3rd, 4th and up that seem to be allowed before some young athletes are prohibited from participating in sports … aka children and teens with developing brains (the term “athletes” really seems to take away from the fact that we’re often talking about children and young teens).
However, I will say that based on our family history, with MS and other autoimmune diseases on one side, and Parkinson’s on the other side, I believe I needed to be more fully informed about the risks of repetitive head trauma before signing my son up for youth football (we weren’t provided with any information, but as far as I’m concerned some of the basic CDC flyers don’t go far enough). If I knew even half of what I now know last summer, I would have never signed my son up for bantam football. I certainly would have pulled him from the program well before he was injured if I understood how serious concussions truly are.
I suspect SLI has been made aware of a number of anecdotal stories (suicides following concussions, ALS in former youth players, former youth/college players who’ve struggled with headaches and cognitive/emotional issues, etc.) which may be impacting their decisions.
Another anecdote:
http://www.chicagotribune.com/news/local/ct-met-pop-warner-concussion-20120614,0,5352241.story
“Then a freshman, Hoffmann was playing offensive tackle for Fremd High School when he wobbled back to the huddle in a daze.
“I was kind of confused,” said Hoffmann, now 16, who doesn’t remember the hit that left him woozy. “I really wasn’t following the plays.”
His coach pulled him out, but neither Hoffmann nor the coach thought to consult a trainer because his head didn’t hurt. When the second half started, the 14-year-old went back in.
After the game, though, Hoffmann’s mother, Roberta DelGiudice, knew there was a problem when her son came up to her bawling and saying he had the worst headache of his life. A trip to the hospital revealed a mild concussion, the symptoms of which kept Hoffmann out of competition for the remainder of the season.”
In spite of all the media attention, I believe it’s still possible that there are parents, medical professionals, and school personnel who are still in the dark when it comes to concussions. There’s more to Ethan’s story (previously linked above) that illustrates this lack of knowledge:
http://www.saukvalley.com/2012/06/08/the-hidden-injury-all-parties-involved-can-benefit-from-education/aerj3so/?page=2
“Both of Ethan’s parents are teachers – Beth at Clinton Community College, Craig at Fulton Elementary School. Despite the recent explosion of news coverage after the unfortunate deaths of such NFL alumni as Junior Seau and former Bear Dave Duerson, the Hafners were in the dark about concussions.
Not surprising. After all, not all of us watch ESPN’s “Outside the Lines” every day. And, without impetus, who sits at their computer and Googles “concussion symptoms” during their free time?”
“Ethan was diagnosed at Morrison Family Clinic with a mild concussion and advised to take it easy the rest of the day and to not play sports for 1 week. They were told if any other symptoms arose, or existing ones got worse, to call their family physician.
The Hafners say they received no other information or restrictive advice.”
After touching base with their family doctor and doing some research online, Beth contacted the clinic and had the following exchange:
““I said if they use the term brain injury, parents would take it more seriously,” Beth said. “[The caller] said, it’s not a brain injury, it’s a mild concussion.””