#C4CT Concussion Summit: 2014 Edition – Live Blog


And so it begins from the United Nations here in New York City.  Check-in has begun, and everyone is arriving; the Brewer Sports staff is feverishly working to make things go as smooth as possible (looking at you Kristi, Lindsay and PJ).  As evidenced by this being posted you can see that the wi-fi is working (at least here in the reception area) and I am ready to blog away.

Throughout the day this post will be updated by me with a time stamp and pertinent information.  The most recent information will be at the bottom of the post.  So, click on the “Continue Reading” and scroll down, enjoy!

During the event make sure you also follow @BrewerSports as there will be Twitter Q & A’s and we will be using the #C4CT.

—– 08:03 EST—–

It looks as though the network will be spotty at times…  I will do my best and have a few back up plans

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IMG_1654—–09:04—–

Jack Brewer and Gerald Commissiong give opening remarks to the #C4CT Summit.  The overall need is to get people collaborating in the entire concussion space.  I felt listening to them that; although we will be using the professional ranks to get the message out but younger groups need to be addressed and change should be affected there.

I really feel like people need to get behind what Mr. Commissiong is doing in this space; he has unique experience and thoughts.

General Peter Chiarelli talks about his ONE MIND organization.  The guy is good at loosening up a room, great one-liners.  The General, although concerned about concussions in general his interest came from the upwards of 67% of TBI rate soldiers had in 2008.  His story about trying to explain to soldiers that they were hurt even though they could not see it, a lot like what we deal with on the field with the machismo of sport.  He is most proud of breaking down the stigma of TBI and PTS.  “Something’s gotta change.” “No longer allow little science,” no more hoarding of information, “we have to find a way to share information… and connect.”  Amen, General!!!!

NEXT: Long Term Consequences of Repetitive Brain Trauma – Cantu, Bailes, Stern…

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—–09:25—-

Andrew Maas, MD is moderating, here with us today from across the pond.

Up first is Dr. Robert Cantu: shows clips from Friday Night Tykes to show us we’re actually going backwards in this (FNT) case…  If you have seen Dr. Cantu’s presentations on CTE, there is not really a whole lot new to add.  The guy is working hard to figure this all out with the help of many (McKee, Stern, etc.).  Remember that a lot of thoughts about concussion began in 1927…  87 years ago…  EIGHTY-SEVEN…  New slides about historical perspective of CTE…  First helmet in 1894 made for Navy player, presumably to reduce issues with his head…

Side note: Sitting next to Danny Crossman of impakt protective, is both educational and entertaining…

Back to Cantu: the brain slides have begun, beginning with a 77 y/o rugby player.  Dr. Cantu states they are on the “cusp” of breaking through the issue of not being able to diagnose CTE in the living.  Gerald Commissiong eluded to an article presented now by Dr. Cantu; about deaths related and attributed to head issues.  Again Dr. Cantu hammers home TOTAL brain trauma including subconcussive and accumulation of head trauma.  Now moving on to football with CTE, love how Dr. Cantu now pleading for actually calling the rules (leading with head) as it was intended in 1972 (yup, 42 years ago), see spearing.

Side note: its always fun to hear presenters elude to upcoming studies being published.

Dr. Cantu thinks that concussions should be thought of by how severe they are – ONLY AFTER RECOVERY – rather than a number of concussions that may end a career.  Role of subconcussive trauma will be something that we will get very aquainted with over the next few years, Dr. Cantu thinks.  I will be honest, a lot of these studies start to blur, but dang they are so good, wish I was better at transcribing.  Now Dr. Cantu discusses the blood biomarkers including S100B.

Up Next Julian Bailes

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—–09:56—–

Dr. Bailes is going to be discussing the beginnings of CTE, a more historic prospective.  Good estimates have over 100,000 miles of nerves in our brain – um, that’s a lot.  Dr. Bailes bases brain surgery on Six Pillars – White matter mapping, Navigation, Optics, Access, Resection, Therapy.  AWESOME video of brain surgery – it is so advanced.  Transition to brain injury and sport.  Question: “Could there be long term brain consequences of football?”  Gaddes article in 1999.  Showing video of players launching and using head to make contact in tackles, SPEARING.  Bailes touches on Webster and long, acknowledges Omalu and his contribution, and reiterates how “big” the initial discovery articles were, regardless of how controversial.  “Tau is like sludge in the brain cells.”  Remember: Locus Coeruleus of our brains, Bailes thinks this is very important.  Bailes continues time line with Henry and Benoit with video of hits in WWE.

Side note: a lot of guttural reaction to videos, good work guys!

Dr. Bailes also thinks all this information is going to lead us to subconcussive hits/effects.  Promoting the hit count now, exposure limitations make sense….  DUH!

Up Next; Robert Stern

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—–10:22—–

Robert Stern likens himself to Bill Buckner compared to the heavyweights that just presented.  Yeah right Dr. Stern.  “Clinical Presentation of CTE…” (crap slide changed) is what Dr. Stern will be talking about.  He starts off with thanking Nowinski, Omalu and McKee for developing his passion.  Dr. Stern shows clips of “Harry’s Law” and “SVU” and “Good Wife” and “House” and ‘CSI” using CTE as show premise.

What we think we know: CTE is dementia pugiclistica, CTE is unique disease neuropathologically, CTE is NOT Alzheimer’s Disease (lack of beta amyloid), All neuropathological confirmed cases of CTE have had repetitive brain trauma, It is not the history of the “big” stuff (subconcussive) – example was Tom McHale, Cascade of changes begin early in life, Suicide is likely not caused by CTE – its very complex, Seen markers of CTE as early as 18 y/o, Presentation of the disease often comes years/decades after stopping the head trauma business, (using cases like: Thomas, Pelly, Freel, NHL Enforcers, etc to paint this picture), Clinical presentation is very unique to each individuals…  Now what do we need to know next: Is it common? Why does one person get it and another, not? (APOE e4) How can CTE be prevented?  How can it be treated? How does it start (mechanism)?  How to diagnose during life?  (A lot of research going on with this including biomarkers and imaging).

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—–11:07 EST—–

Q & A with Cantu, Bailes, and Stern …  You’re on your own for that, ha!  There are some very smart people here…

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Up Next Session 3: Diagnostics & Standard of Care

  • Brolinson
  • Clugston
  • Mayer
  • Hainline

The Summit is running at least an hour behind, I know we can make it up somewhere, but I think that somewhere may be my section.  I surely hope not, I really want to be heard on this stage.

—–11:15—–

We are going to have the panel first in this section due to time constraints – soooo next update coming after

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—–11:32—–

I am going to start a random thoughts of this event in another post just for posterity and observations.

—–11:35 EST—–

Gunnar Brolinson, DO of Virginia Tech talking about telemetry and data capturing via sensors.  A lot of his work is with the Simbex/Riddell HITs System.  This information is very key to getting to the point of injury, moreover as Brooke De Lynch of MOMSTeam this information can be used to avoid missing any possible injuries.

Impacts per season: NFL – ???, College – roughly 1000, High School – 596, Youth 107 (missed the threshold for this number)

Quick discussion on return to play and the complexity.

Big props to Brolinson for trying to accelerate the session.

Clinical considerations for multiple concussions; have to think about removal from season or career (complexity of recovery and frequency).  Sports have changed and there is a risk, how great needs to be found out, so we should understand those and guide ourselves going forward on it.

Quick discussion on legislation; “none of it is based on science.”  Used the Virginia High School League as an example.

Rule Changes and Techniques being discussed (gratuitous VT Hookie name drops, I like).  Bridging right into Concussion Incidence Management.  Some wonderful technology showed in capturing data.

A very timely conclusion about female athletes, great research angles that could be forthcoming and quick wrap up…  It was quick and very good, thank Dr. Brolinson!

Up Next Jay Clugston

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—–11:55—-

Dr. Clugston talks about diagnosis from a team physician perspective.  It starts with definition (used Muschamp of FL in a press conference defining concussion).  Once definition is understood you have to use context when making a diagnostic decision of concussion (what are we actually looking for – its subjective, can it be prevented, gender, long-term, etc.).  Continuing on context, the when, when are we looking for concussion (practice/games).  How about where (sideline/locker room/home vs. away)?  We need to understand ramifications of actually doing an exam (are the automatically removed for remainder regardless of outcome)?

Moving to clinical evaluation – great Irish Setter comic via Micky Collins.  A highly trained medical person may not need more examinations, it can be very easy if you understand the athletes.   Dr. Clugston calls it a quick assessment, but really it is a screen.  A lot of what he talking about hits home, feelings and clinical observations.  Talks about a “walking evaluation” on the way to the area where you are doing the exam (which is great if you have enough people for this, in the HS setting, really only have halftime for this).

For those that have never conceptualized an evaluation Dr. Clugston did a great job of sharing it.

They use SAC, BESS, King-Devick and Vestib-Occular modules in their exams.  He explained the King-Devick Test for everyone.  Decision is made through: exam, reported symptoms and functional testing.  “A lot of times your decision is made before all testing is complete.”  One of the biggest concerns is lack of objectivity.  Dr. Clugston does a great job bringing forth small things that people don’t think of (competitive disadvantage, resource diversion).  Great shout-out to athletic trainers!

Developing Technologies: imaging, blood tests, eeg, voice recognition, etc.

Very comprehensive and wonderful presentation by Dr. Clugston.

Up Next: Andrew Mayer

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—–12:19EST—–

Andrew Mayer, PhD will be discussing how neuroimaging can help us – or generally that.  A change has come in mTBI research: from psychiatric to neuorlogical it can be explained as a “black box”.  This is where neuroimaging comes in.  Currently no objective diagnosis for concussion or mTBI.

Mayer was asked to move quickly, so some of his presentation will be cut, thank you for your sacrifice.

Talk about animal research and pointing to Glutamate, its peak after injury and resolution.  With imaging techniques we can now look at both structure and function including neurochemistry.  Andrew is now discussion his research, very quickly I might add.  Andrew uses a glass of water and its molecules to explain diffusion tensor imaging.  That was a good example.  Initially DTI was white matter, now its getting into the grey matter of the brain.

DTI findings have found different recoveries based upon actual type of injury, making the imaging angle a good one for further investigation.  On to MR type imaging Andrew gets into multisensory attention marking.  Andrew has to be tired!

Up Next Dr. Brian Hainline of the NCAA

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Dr. Hainline will be talking about Concussion Awareness: The NCAA and Society.  He begins with definition of concussion and notes there are 42 current definitions (TOO MANY).  He states we need to think about brain localization; “we are in our understanding of concussions now as we were with MS 30 years ago.”  Hainline points out there is not education for concussion (structured) for neurologist like him and there needs to be!

Attaboy Dr. Hainline

What would be your dream project for solving this concussion process: unanimous consensus was to study the natural history of concussion.  It takes a lot of help from all 1100 plus member institutions.  He now is talking about a centralized database, which is needed and I have discussed many times on this blog.  It is in the NCAA “game plan”.  Dr. Hainline is proud to being a bridge builder, which fits into this overall theme of this Concussion Summit.

NCAA met in Atlanta to talk about practice considerations in sport, again progress.  Concussion education is a huge part of what they are tying to do, and AGAIN a huge influence of this blog.  But just understanding does not translate in to lower incidences.

His slide on concussion solutions had these: Refine definition, Prospective longitudial studies, Harmonize imaging/biomarkers, Evaluation of concussion education.

Well done, Dr. Hainline.

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Up Next Session 3

—–12:53—–

David Lowe, PhD discussion TBI: A global health challenge.

These presentations are being cut short due to time

David is talking from Amarantus perspective and overviews impact TBI and non-impact TBI.  Our first real mention of emotions as it relates to brain injury.  Discussing how this truly is a global issue and needs collaboration, leadership and commitment.

Estimates of TBI have it at 2-3 per 1000 persons globally.  Some studies have it as high as 5.5.  TBI is leading cause  of death and disability in young adults (graph on leading causes of TBI).  Majority of information was about true TBI (also had to tend to some other needs during talk).  Sorry if this is so brief.  His recommendations were very good and global.

Up Next: Dr. Andrew Maas

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—–13:08—–

Dr. Maas talking about new directions and globalization in TBI research.  Again a topic that deals with TBI over concussion.  They are related, especially with the relation of accumulation of sequale.  Dr. Maas’s EU TBI numbers are shocking even to him.

InTBIR – International Initiative for TBI Research.

In TBI there is a Reductionistic Approach, which could be adapted in concussion, no?  The advances in TBI care has been going well, but a new vision is upon: Make use of the existing heterogeneity and comparative effectiveness.  Always ask “why”.

EGO DESTRUCTION is necessary for true collaboration.  Team is better than individual.  BOOOOOOM, Dr. Maas! #dropthemic

Up Next Dr. Michael Bell

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—–13:25—-

Dr. Bell going to fly through this, I don’t envy his position.  And I missed his title slide.  Talking about Pediatric TBI.  I feel bad for Dr. Bell not getting the coverage of others (this whole session).  Hopefully we can catch up again some time soon…

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LUNCH

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—–14:42 EST—–

Chris Nowinski delivered the Lunch Keynote and it was very good.  He discussed a lot but the overall theme was changing how we protect and expect to protect the youth in sports.  Informed consent, hit counts, proper medical personnel, proper coaching.  It was a very good talk.

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—–15:00—–

It appears there was a schedule change and we will begin with the Public Policy Panel moderator Andrea Kremer.  Panelists are: Dr. John Reppas, Dr. Howard Fillit, Joyce Oberdorf.

Andrea makes a good point about us being at the UN discussion concussions during the Super Bowl; how far this topic and issue has come over the last few years.  This panel is examining public policies and it relates more to the general brain injury, not as specific to concussions.  Dr. Reppas is big on philanthropy and there seems to be a hole in this part of the issue (other than GE recently).  He is also wading into the pharma portion of the issue.

Joyce explaining how the funding is an issue, the cost seems to be a barrier at this point.

Changing public policy is difficult when there is confusion or non-collaborative efforts.  Finding treatments, standardized care is something that a lot of people are interested in.  This is true for all of us involved with concussions.   Joyce uses a great line: “what is measured is improved.”

Emerging Diagnostic Tools

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—–15:28—–

Back to the presentations up first in Adam Simon, PhD.  He is discussing the tools in the concussion space; from accelerometers  to actual medical staff.  Adam is showing something called Cerora’s MindReader Technology.  A mobile EEG if you will.  He is actually wearing it and showing it as he talks.  Simple system that has a multitude of modes to be used for analyzing.

Lehigh Sports Medicine Collaboration leading the way on this technology.

Very interesting technology.

Up Next: Kim Heidenreich, PhD

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—–15:38—-

There is a “theraputic window” for drug intervention of TBI, Kim will be looking at FLAP inhibitors.  Pathology is complex and heterogeneous in terms of TBI, which can be the same for concussion.  Kim’s lab looks at BBB disruption and __________ (crap missed that).  Lab also found that Leukotrienes and potent lipid inflammatory mediators are made with in minutes after a TBI.

This is some heavy physiology.

A FLAP inhibitor after TBI can block production of leukotrienes, blocks edema and BBB disruption.  This is very interesting for a pharma intervention.  Rat models show that learning is effected by not having a FLAP inhibitor on board.  Kim thinks we should look further into FLAP inhibitors as an intervention, she may be right.

Up Next: Donald Dengel, PhD

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—–15:51 EST—–

Sports-Related concussions will be the backdrop of this emerging diagnostic tool.  Donald and the University of Minnesota’s focus is on physiological alterations due to concussions.  They use BOLD signal for MR.  They alter the BOLD signal for repeatable results using PCO2 changes.  This creates cerebovascular reactivity; blood vessels constrict and relax regularly.

Concussed individuals show slow and not as capable vascular response to the changes of PCO2.  Multiple concussed individuals are compromised.

Donald talks about the need to drill down the information and get larger studies.  These are new and preliminary results but it does show a change.

Up Next Gerald Commissiong

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—–16:00—-

Gerald is talking about new detection for Alzheimer’s.  LymPro Test for Alzheimer’s Disease.  I wish I understood pharma and physiology better than I do.  This is very interesting, the whole newness of it all.  Basically this is a blood test that can detect Alzheimer’s and with hope possibly CTE.  LymPro looks at the cell cycle and uses that as a measure.  There are plans for acute phase trials, but now with collaboration with Boston University trying to get at CTE.

Up Next: Future of Contact Sports Panel

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I will not be live blogging this portion, as I will be part of this panel.  The remainder of the panel include: Dr. Nicholas Conti, Sean Sansiveri, Dr. Patricio Reyes, Chris Larcheveque, and Brook De Lench.  Again moderated by Andrea Kremer.

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—-17:30—–

Esteemed panel on athletes, agents and attorneys: Leigh Steinberg, Carl Eller, Christopher Seeger.  Moderator Andrew Brandt.

I have missed much of this due to a restroom break and some stops along the way…  Sorry once again…

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I am going to wrap up the live blog for today, thank you all for following and using #C4CT on twitter.  I am going to be a participant and listen to the remaining panel (current and former players).

I would also like to thank Jack Brewer for the invitation and Brewer Sports International, Amarantus BioScience, One Mind and MDM Worldwide Solutions, Inc.  This was a wonderful experience.

Thank You!

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—–17:50—–

I lied, just thought I would let you know who is on the last panel:

  • Andre Berto – World Champion Boxer
  • Antonio Pierce – ESPN, Former NFL Linebacker
  • Andtrel Rolle – Current NFL Safety
  • Bida Mutebi – Former Collegiate Soccer Player
  • Brian Williams – Former NFL Cornerback
  • Charles Mann – 3x Super Bowl Champion
  • Chimdi Chekwa – NFL Cornerback
  • Clinton Portis – Former NFL Running Back
  • Darrell Reid – NFL Linebacker
  • EJ Henderson – Former NFL Linebacker
  • Fred Robbins – NFL Tight End
  • Hank Basket – Former NFL Wide Receiver
  • Isaiah Kacyvenski – Former NFL Linebacker
  • Jeff Cumberland – NFL Tight End
  • Jeremy Shockey – Former NFL Tight End
  • Jermichael Finley – NFL Tight End
  • Kurt Coleman – Former NFL Linebacker
  • Lance Johnstone – Former NFL Defensive End
  • Ramses Barden – NFL Wide Receiver
  • Robert Griffith – Former NFL Safety
  • Ryan Grant – NFL Running Back
  • Sidney Rice – NFL Wide Reciver
  • Will Allen – NFL Safety

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