I was just minding my business reading the news and getting lost in my Sunday mindless exercise, when I came upon a news story that shook me – on many levels. This story is about Captain Peter Linnerooth; a story worth noting and sharing. Does it have to do with concussions, I don’t know and I don’t care, it has to do with the well-being of humans – a plight that is part of the concussion story.
He had a knack for soothing soldiers who’d just seen their buddies killed by bombs. He knew how to comfort medics sickened by the smell of blood and troops haunted by the screams of horribly burned Iraqi children.
Capt. Peter Linnerooth was an Army psychologist. He counseled soldiers during some of the fiercest fighting in Iraq. Hundreds upon hundreds sought his help. For nightmares and insomnia. For shock and grief. And for reaching that point where they just wanted to end it all.
Linnerooth did such a good job his Army comrades dubbed him The Wizard. His “magic” was deceptively simple: an instant rapport with soldiers, an empathetic manner, a big heart.
The man knew how to handle others and create an atmosphere for helping on a battlefield and beyond;
He was, as one buddy says, the guy who could help everybody – everybody but himself. […]
“There’s no cavalry to save the day,” McNabb explains. “You ARE the cavalry. There was no relief.” […]
For about half his tour, Linnerooth’s office was a 12-by-12 trailer. His heavy-metal soundtrack – he banned the Beatles and Pink Floyd, deeming them too sad – provided a sound buffer. A thermal blanket serving as a makeshift room divider also provided a modicum of privacy.
Linnerooth brought hope to those gripped by hopelessness. In a desert, he could always find the glass half full.
He turned tragedies into cathartic moments: When a platoon lost a member, he’d encourage the survivors to deal with their grief by writing letters to the children of the fallen soldier, recounting the great things about their father.
Here are a couple of videos to tide you over until some time next week!
In the first one we can hear how the military began their concussion management protocol. Although not enough it was way ahead of the curve on concussion management.
Here is one that shows a compilation of big hits found on YouTube. Watch all the football ones and the vast majority are “clean” hits. Then take into account all the other sports and think back to my mantra here: “The injury of concussion is not the elephant in the room, rather, it is the mismanagement of the concussion that is problem.” Then tell me you didn’t throw up in your mouth at the last clip…
I have figured out the power situation so I will be trying to update the blog ASAP after each session… For the time being make sure to follow on Twitter…
1030 CST: Session 7, final session: The Sharp End
First debate between Dr. Cantu (yes) and Dr. Herring (no): is no RTP same day the best management paradigm? Is keeping a player out one week long enough and is the graduated RTP protocol sufficient…
THERE WILL BE NO RTP on same day in the new statement!!!
Change of direction on Session 7, questions with panel answers, pro-con (if available)
Do 3 concussions end your career?
its comedy hour
Aubrey – treat each athlete individually
Dvorak – it has to be based on timing and complexity of each recovery – case-by-case basis
Putukian – if we can’t agree on dx how can we agree on a number
Overall theme is it is individualized, not all concussions are the same (Cantu)
Who is best qualified to make the sideline decision?
Cantu – multiple members working under a physician can make the call
Herring – concerning to him that some information is intrinsic to doctors so need to be careful
better question is who best qualified – person with most experience
Dvorak – looking at spectrum of games played, doctors are best qualified in most instances, but are they there in all matches? We should aim all this to the “grass roots” as the professional level there is more than adequate coverage.
comedy about football versus american football
Ellenbogen – those that know the athletes should be making the decision, maybe a parent in youth sports, or athletic trainers, understanding the patients baseline is important
Putukian – balancing act, in a perfect world its a team approach (Athletic Trainer mention), and she says in the US the athletic trainer should be making the decisions on the sidelines…
Aubrey – Hockey Canada has a safety person (volunteer) in lieu of an athletic trainer
Cantu – brings up possibly training school teachers in concussion
Herring – if you are team physician do you need someone else to make the decision if you are on the sideline? Panel – no
Is there a role for grading concussions?
Cantu – not perfect, but informing patient is important about severity and duration of recovery, after the fact
McCrory – we have moved from grading, look at the recovery – perhaps look at the SCAT/serial testing
Putukian – looking at history is more important than arbitrary “grade”
Herring – may help with continual care from one place to another, but again important to understand history
Should we be returning on the same day of concussion?
Aubrey – what about the NHL player in the playoffs (rhetorical question)
Cantu – no once recognized
McCrory – what about the players that clear the SCAT, so no concussion, but you know something is amiss?
Putukian – example of hockey player with delayed symptoms
McCrory – concussion is often an evolving injury
Ellenbogen – it is a traumatic brain injury, is the game worth it? No.
Panel – consensus is NO RTP same day
McCrory to Aubrey about playoff example – what about a regular season, and Aubrey is being very honest, and he feels the player push back is greater
Ken Dryden from the audience – why are we treating professional athletes different from the youth or non-elite athlete
We are starting to move away from that, all athletes should be treated the same
Should there be helmets in woman’s lacrosse and field hockey?
Cantu – yes, because of stick and ball causation of concussion
Putukian – no, change nature of the game, no reports of intercranial bleeds in women’s lacrosse, weary of unintended consequences (BTW, probably has the most experience with this)
Cantu and Putukian discussing this topic
Change gears – what about football?
Dvorak not in FIFA’s plans to recommend, many reasons including the false security of wearing head gear
Audience Q: should we discourage the use of the head bands/head gear
Dvorak – your own prerogative but data does not support the use of them as recommendation (Czech goalie wears one)
McIntosh – Rules are more important at this time
Should there be age restriction on tackling in American football, heading in soccer and checking in ice hockey?
Cantu – his words speak for themselves, youth sports needs to look at how the game is played because of the differences between older
McCrory – in Australia you cannot get to the gladiatorial aspect of Aussie Rules until they are “of age” (13 if I heard correctly)
Ellenbogen – risk of activity, most concussions via CDC information is from wheeled sports and recreation, does not make sense at this time to him, advise accordingly
Cantu – youth sports don’t have the good data, personally he does not believe learning a sport at age 5 will make you elite, it is a genetic disposition in his opinion
Putukian – it makes sense to decrease exposure, US Lacrosse has put age 13 on checking, her take on soccer is that there is no data to support this when using proper sized ball and equipment
Dvorak – young soccer players learn sport first, and fundamentals of “football” its not “headball”, studies done on heading ball and with study there was no increase in biomarkers they were looking at it. They don’t force kids to head ball until skills are sufficient.
Herring – false warranty? Arbitrary age is concerning, take head out of the game rather then taking the game away from youth athletes. The limit to exposure is accurate, but complete removal of the sport may not be necessary.
Cantu – sport needs to be safer for younger athletes
Aubrey – ice hockey has set limits on age for body checking, research is very important, it will help make decisions
Dr. Jamie Kissick speaking on “From Consensus to Action”
In a press release (found on Digital Journal with a lawyers op-ed at the end, forget the source understand the implications) research is showing that war veterans from Iraq and Afghanistan are not showing improvement of traumatic brain injury (TBI) symptoms;
A brain health organization recently announced the results of a study of traumatic brain injuries. By looking at 500 veterans of the Iraq and Afghanistan wars, the research concluded that brain injury symptoms did not subside over the course of eight years. Instead, the veterans reported slightly worse conditions over the course of time. This research draws more attention to traumatic brain injuries as “invisible wounds.” Even though veterans with brain injuries may look completely whole and healthy on the outside, painful and frustrating consequences can continue to make post-service life extremely difficult.
Brain injury symptoms include severe headaches, memory problems, impulsivity or impaired judgment, and even depression. Taken as a group, these symptoms are often called post-concussive syndrome. At least 253,000 American servicemen and women were diagnosed with brain injuries in the last twelve years.
Study’s Results Show Bad News For Brain Injury Victims The new study looked at symptoms of post-concussive syndrome over a period of time. Researchers evaluated veterans with brain injuries during the first four years after a brain injury and then again in the next four years after that. Over the course of eight years, the researchers found that symptoms still had not diminished. Almost 50 percent of the surveyed veterans reported continuing headaches. Forty-six percent said Continue reading →
Cleveland Browns’ team physician spoke at the rookie symposium to warn the incoming players not to hide symptoms of concussions;
At the rookie symposium, Shickendantz said the league cares about the players’ well-being.
“Our only agenda is your health and safety,” he said. “It’s about you, not about us.”
The reality is it’s about everyone. It’s true that players sometimes avoid getting checked out by team doctors because they don’t want to be removed from games, and it’s true that’s a very bad idea. But it’s also true that sometimes players are mistakenly cleared to return to games even when they have been checked out by team doctors, and that’s a bad mistake.
Check out Michael David Smith’s quick take on Shickendantz being the selected speaker. It will be very difficult to change the culture at the professional level (see money), it needs to begin at the youth level.
He may have took the time to address the concussion issue, however Steve Young really said nothing about concussions. Even downplaying his own concussions during his career. However he does feel the NFL is on the right path;
“I saw a quote from one of the players who suspected that in 20 years it wouldn’t be football any more,” Young said. “I think that scared everybody.”
However Young believes the NFL is taking proper steps to make sure today’s players won’t be as affected in the future by concussions.
“The league is getting serious about it and they know that it is important,” he said. “Now they have a whole way of dealing with it and there’s a protocol for how it’s handled. I talked to Aaron Rodgers and Tom Brady about this recently and both felt very strongly that they’re getting the best care. Once you have a concussion, it is very hard to get back on the field.”
For some time the thought was that the mTBI, TBI and concussions suffered on a playing field were different from what was being experienced on the battle field. The mechanisms may be different (collisions versus blast injuries) in nature but the resulting devastation may be similar. Again we can look to the northeast to Boston University’s brain bank and researchers for this new finding;
Scientists who have studied a degenerative brain disease in athletes have found the same condition in combat veterans exposed to roadside bombs in Iraq and Afghanistan, concluding that such explosions injure the brain in ways strikingly similar to tackles and punches. […]
“Our paper points out in a profound and definitive way that there is an organic, structural problem in the brain associated with blast exposure,” said Dr. Lee E. Goldstein of Boston University’s School of Medicine and a lead author of the paper, which was published online Wednesday by the peer-reviewed journal Science Translational Medicine.
The paper provides the strongest evidence yet that some and perhaps many combat veterans with invisible brain injuries caused by explosions are at risk of developing long-term neurological disease — a finding that, if confirmed, would have profound implications for military policy, veterans programs and future research.
As I have stated before I feel the military has been on the cutting edge Continue reading →
I have said it many times on the blog, the US Military has been ahead of the game on concussions. Not only their research but their sudden and correct actions of taking soldiers out of action after sustaining a concussion. In fact all military personnel who sustain a concussion are not only prescribed rest there is a mandatory 72 hour observation.
Researchers at Saint Louis University have teamed up with the Department of Defense as they conduct research on traumatic brain injury. Dr. Richard Bucholz, director of the Saint Louis University Advanced Neurosurgical Innovation Center (SANIC) and his colleagues have received a grant from the DOD to study the brains of service members coming back from the recent wars in Iraq and Afghanistan. Continue reading →
Not only is the month of March devoted to honor and make people aware of the wonderful profession of Athletic Training it also coincides with Brain Injury Awareness Month. Could there be a better combination? I would think not!
The Marine Corps wants to make sure Marines and sailors who suffer concussions and other head injuries are tagged and tracked in a medical database, which officials hope will lead to better health care and treatment.
Starting Jan. 1, every unit will be required to record its Marines and sailors who suffer, or previously had suffered, a traumatic brain injury at any time.
This is a great bit of news for the men and women in uniform, as head injuries compromise the majority of all injuries in the Afgan and Iraq theaters. Here is how Gidget Fuentes wrote how it will work; Continue reading →
A military study done at Washington University in St. Louis, Missouri and abroad looking that the brains of blast injured servicemen from Iraq and Afghanistan shows a ‘early first step’ toward possibly having the imaging technology to discover concussions;
Using a highly sensitive type of magnetic resonance imaging, researchers studied 63 servicemen wounded by explosions in Iraq or Afghanistan and found evidence of brain injuries in some that were too subtle to be detected by standard scans. All the men already had a diagnosis of mild traumatic brain injury (synonymous with concussion), based on symptoms like having lost consciousness in the blast, having no memory of it or feeling dazed immediately afterward.
The Vancouver Sun has this information regarding the previous press release. A lot of the information is not “ground breaking” per se, rather just a confirmation of what most have been saying for a very long time;
Although symptoms of a concussion may not be immediate, researchers at St. Michael’s Hospital in Toronto have been able to show in rats that the affected portions of the brain continue to worsen as time passes during a “vulnerability phase.”
“We can see the actual neurons deteriorating for days and days afterwards,” Dr. Andrew Baker, the study’s head researcher said Wednesday. “It’s an ongoing problem and opens up the possibility that doctors can jump in there to stop it. This first step is to show we can show that it takes several days for the effects of a concussion to be visible.”
The “vulnerability phase” may just be the period during which the concussion has not recovered; if you remember back to our example of a concussion via a snow globe, the brain would be vulnerable during the time the flakes were excited. As the brain has the “cascade” of events including the decrease in blood flow to the brain then the neurons would deteriorate due to lack of nutrients. The physical effects of a concussion through imaging is very important, however if it takes “several days” to do this then what can we do in the meantime?
In a finding that may be more important to the military than sports was this; Continue reading →
During a concussion not only is the brain experiencing a cascade of events causing the injury, but also a metabolic crisis. Not only does blood flow become compromised but the influx of calcium and quick “ejection” of potassium makes the blood energy system chaotic. There has always been the question; can we “feed” the injury to help with this issues occurring? Previous research has mentioned the use of Omega-3’s, DHA, and EPA to help with inflammation. We have even had a commenter suggest the use of creatine to help with (see comment section of the previous link), and because I had not really done research, other than his post, I was unsure. Perhaps we are now becoming less unsure of creatine and the role nutrition plays with management of concussions.
A team of U.S. scientists has found that food can play a vital role in mitigating the damage done by traumatic brain injury – and that a speedy supply of specific nutrients can give hurting brain cells the energy and chemical cues they need to heal while preventing inflammation.
Of all the specific examples that were given in the article; creatine, protein, resveratrol (red grapes) and curcumin (turmeric), research into prophylactic use of them has yet to be studied. What was known is that use of these nutrients very soon after Continue reading →
The United States Army and the Joint IED Defeat Organization funded a study looking into various military and football helmet pads and their attenuation of concussive forces. Posted on R&D Magazine online the results were summed up this way;
Researchers at Lawrence Livermore National Laboratory (LLNL) have found that soldiers using military helmets one size larger and with thicker pads could reduce the severity of traumatic brain injury (TBI) from blunt and ballistic impacts.
This would be a low-cost solution/improvement on current technology. The study did indicate that no material tested outperformed the current padding in the Advanced Combat Helmet (ACH); they looked at old military padding, two types of padding in NFL helmets and “padding used in other protective equipment”.
The researchers Willy Moss and Mike King say that these results can be used in current sports too; Continue reading →
And it is about DANG time the military came around on this. I say military but really the Army is taking the lead as they have recently reviewed their designations for the Purple Heart, and concussions will now be considered for the honor. There is hope that the other branches will follow suit and make concussions worthy of a Purple Heart.
It wasn’t like the Army did this on their own, it took pressure from the civilian sector, namely the NPR;
In response to the ProPublica/NPR reporting, which showed that Army commanders denied some soldiers the Purple Heart even after they suffered documented concussions, the Army’s Chiarelli called for a review of the guidelines. On Wednesday, he announced clarified rules, including a checklist of valid treatments (bed rest and Tylenol among them), that will make it easier for war veterans to receive the Purple Heart after sustaining concussions.
I must say this is great news, because by making this distinction more awareness will be given to “closed head trauma” and making the ‘invisible’ injury more visible to everyone. And I echo the sentiments Continue reading →
Dr. Ann McKee, of the Boston University “brain bank” associated with the Sports Legacy Institute, recently spoke to the U.S. Army during a conference on how to protect soldiers’ brains. Her specialty is chronic traumatic encephalopathy (CTE) and finding this disease in brains sent for sampling.
The bulk of the 66 brains in her team’s “brain bank” are boxers and football players who had experienced repeated blows to the head during their careers. But she did have in her collection the brains of five former Soldiers. The disease, CTE, is the result of repeated trauma to the head.
“This disease does develop in military veterans — it really has been described in many different types of mild traumatic injury,” McKee said. “It’s less important how you get the injury, what’s important is that you had repetitive injury.
Dr. McKee, along with Dr. Benett Omalu, are pioneers in this field and a lot of what they have to say is unfiltered/censored by “bigger” entities.
It was recently published in the Archives of General Psychiatry that concussion/mild traumatic brain injury (mTBI) seems to have little impact on these outcomes after PTSD is accounted for. Melissa A. Poulsny, PhD was the lead investigator on this seemingly well-thought-out research.
Using 953 National Guard soldiers, each was given a survey one month prior to being sent home (time 1) and another survey one year after return (time 2). The results in the ABSTRACT are as follows;
The rate of self-reported concussion/MTBI duringdeployment was 9.2% at time 1 and 22.0% at time 2. Soldierswith a history of concussion/MTBI were more likely than thosewithout to report postdeployment postconcussive symptoms andpoorer psychosocial outcomes. However, after adjusting for PTSDsymptoms, concussion/MTBI was not associated with postdeploymentsymptoms or outcomes. Time 1 PTSD symptoms more strongly predictedpostdeployment symptoms and outcomes than did concussion/MTBIhistory.
I may be looking at this from an obtuse angle, but to me this seems difficult to separate PTSD from post-concussion syndrome. Granted, there are different symptoms and clinical definitions of each, but as we have learned through recent concussion research the two conditions “intermingle”.
I do not believe (and please send me information to clarify) PTSD and PCS are treated the same. If that is the case, then a further study is need to see if those that had been changed to PTSD from PCS are recovering/adapting at a quicker rate than those with just PTSD or just PCS. The thought process is simple in my mind…what if concussions created PTSD? If that is the case then are there things that can be done at the point of injury to offset the development of PTSD? Or is the military medical community switching the classification of these individuals to something they know better?
P. Tyler Roskos of St. Louis University is concerned with the “invisible injury” of traumatic brain injury or concussions that our service men and women suffer while in action.
Each year, 1.5 million Americans suffer non-fatal brain injuries, and three-quarters of those injuries are mild traumatic brain injury, or concussion. A RAND Corporation survey of 1,965 service members who had been deployed to Iraq or Afghanistan found that 19 percent reported probable traumatic brain injury.
The problem is that this is not an injury that everyone can see. Heck, even those that have the ailment don’t realize the problems. Things such as sleep disturbance, depression, and altered state of being are signs of this horrible issue. Dr. Roskos provides help in this area and suggests the following broad steps (detailed further in the full article at Health Canal);
Talk With Other Vets
Enlist Help Reentering Workforce
This is a project funded by the United States Department of Defense, and in a week where we honor those serving our country, this needs to be a high priority.
Today is the 235th year of the United States Marine Corps, and we could not be where we are without them or the other branches.
I have known/know many Marines but there is one Marine that has shaped the way my life is and will continue to be. His name is David Joseph Fink, and served this fine country during Vietnam. Nothing haunts this man more than people who told him and continue to tell him that what he did was wrong, the crux of which was being spit on and told he was a “baby killer” when he returned to this fine country. Well Dad, you did what was asked of you and you lost a lot of good friends, you protected this country and in turn you have instilled every virtue from the USMC that is necessary to have a successful life. If more people had the “guts” and “drive” to do what you did and continue to do then maybe this country would be a better place.
Take pride in what you have done, learned and passed along, without you none of this is possible, thank you Dad.
Now let’s make sure our service men and women can return to their lives with as much support and help as possible, especially with the concussion issue.
Military doctors are diagnosing hundreds of concussions among combat troops because of an unprecedented order requiring them to leave the battlefield for 24 hours after being exposed to a blast.
Writes Gregg Zoroya of USAToday:
From July through September, more than 1,000 soldiers, Marines and other U.S. servicemembers were identified with concussions, more than twice the number diagnosed during the previous four months, Central Command says.
This has been a complete turn around from how the military was doing things even in June of this year. The new guideline went into effect July under the direction of the chairman of the Joint Chiefs of Staff, Adm. Michael Mullen.
Under the new policy, troops caught within 165 feet of a blast (about half the length of a football field) must be pulled from the battlefield for at least 24 hours and examined for evidence of a concussion. The same goes for troops in a vehicle or building struck by a bomb.
Concussions can hit anyone at any time. Sure, those that play high-impact sports, like football and hockey, are more susceptible. But this problem is one that will effect all of us. This cannot be more true than on the battlefield (see The Concussion Blog Archives on this).
“It’s an enormous issue,” she said. “Concussion and TBI have been called the signature medical issues of the wars in the Middle East because of IEDs (improvised explosive devices), the weapon of choice for the insurgents, and rocket-propelled grenades, which can cause blast injuries that we’re just learning about.
“An explosion can cause different kinds of injuries because of the heat and noise, the shock waves and electromagnetic pulse,” she said. “And troops can be exposed to several blasts even in the same day. We take athletes out of a game after one concussion, but troops often go right back into action.”
That is a quote from Dr. Susan Thompson, a clinical neuropsychologist in Grand Forks, North Dakota.
You can read the entire story written by Chuck Haga HERE.
The US Army along with Banyan Biomarkers have been working on a simple blood test to administer to patients (in this case soldiers) that can identify even the most minor of concussions. The USAToday has the full story on this. This is possibly one of the biggest breakthroughs in concussion research, on the diagnosing side of things. Traditional imaging techniques, MR/CT, do not show a concussion and are really only used to rule out brain bleeds. The blood is being tested for certain proteins that are released upon a concussion. If this trial is conclusive and gets approval this will be another weapon in the arsenal to identify the issue. Coupled with the research and development in recovery this could mean safer and quicker return to action, whether it be battle or sports.
We have blasted the US Military on this blog for the way they have not prioritized head trauma on the battlefield. And how making soldiers go back to “war” before their brain was ready may have caused deep and permanent damage upon return to civilian life.
Jon Hamilton of NPR has written a story about how the US Military has “called and audible” of sorts. Using the information and model from the NFL the military is now taking soldiers out of action until they have recovered.
The blast can produce “a concussive wave, or a blast wave, that actually moves the head and body very violently and that can, in fact, cause a concussion,” Hovda says.
Brain scans show that for days or even weeks after an injury like this, the brain’s metabolism slows down, which leaves some cells starved for energy, he says.
“During the time when this metabolism is altered,” Hovda says, “the brain not only is dysfunctional, but it’s also extremely vulnerable, so that if it’s exposed to another mild injury, which normally you’d be able to tolerate really well, now there can be long-term devastating consequences.”
Follow the link for the full story and some very good multimedia teaching tools.