Information and Reserach about HBOT

If you recall we have posted about hyperbaric oxygen therapy for TBI and concussions; mainly about how there seems to be promise shown but little research that is accepted/supported for that.  Now the Navy League of the United States is giving a presentation on HBOT for treating Veterans.

The event is November 9th in Arlington, Virginia; granted a lot of you reading will not be able to go, but perhaps you know someone (that knows someone) that would be interested in the DC area.  Here is the press release I challenge people to find someone to attend (I called my uncle);

IEDs cause over 70% of U. S. Casualties in Afghanistan. TBI and PTSD have become the “Signature Injuries” of that conflict.  There are between 200,000 and 600,000 combatants who have been diagnosed with TBI/PTSD.

Untreated TBI/PTSD can bring with it disabling symptoms, including loss of short-term memory and executive functioning , migraines, sleep disruption, loss of impulse control, depression, rapid mood changes, photophobia and hyper-vigilance.  Left untreated, the disabled individual Continue reading

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Suggestions For Return To _________

In light of Tracey Meyer’s post about her son and his plight with a concussion, in particular the academic setting, I feel it is a good time to highlight the work of Don and Flo Brady.  Don is part of the National Association of School Psychologists, and with is wife wrote an article about Sport-Related Concussions.

Below is the excerpt about the return to Play from the NASP Communique, Home, School and Social Settings;

Suggestions for Returning to Play, School, Home, and Socializing

The complex, varying, and individual central nervous system response to a brain insult and resultant concussion injury not only justifies but also requires a comprehensive assessment from a readily available and qualified multidisciplinary team of healthcare providers (McKeag, 2003). The utilization of a multidisciplinary team is particularly essential since consequences of a concussion include both neurological and nonneurological effects. Suggested members of this healthcare team may include the following: physician, neurologist, neurosurgeon, psychologist, neuropsychologist, school psychologist, teachers, school administrators, optometrist, ophthalmologist, coaches, athletic trainer, speech pathologist, occupational therapist, and physical therapist. Equally important is the Continue reading

Hypothermia For Concussions + A Possible Delivery Device

The old adage of the profession of athletic training is “ice er’ down”.  This comment is both simple and can seem to the patients/parents/coaches that you are not doing enough.  However I am here to tell you that hypothermic treatment (ice) is EXTREMELY beneficial for just about every* injury we see for the basic principle of; slowing the metabolic response to injury.

When there is an insult to the body the immediate response is a metabolic reaction – in other terms the body uses chemical and mechanical pathways to repair/fix itself.  Although the reason for the metabolic response is thought to be for “repair” the body response is usually not limited to what is needed – the more is better philosophy.  I can bore you and make you click away real fast by giving you all the physiology of a metabolic response, so I won’t, but if you would like to read about it T.S. Walsh wrote a chapter in a book called “Principals of Surgical Care”.

Subsequent medical research has shown that attenuating the metabolic response has; decreased pain, shunted swelling, and improved outcomes, especially in a very narrow window after injury.  The least invasive and easiest way to accomplish this is via hypothermia (see heat related illness).  Cooling the body, even locally, can Continue reading

HBOT

That is not an off-shoot of the cable channel, it is a therapy that can be used for brain injury.  Hyperbaric Oxygen Therapy has been in the distance as a treatment for head injury, specifically concussion for a few years.  The main reason is the lack of support from the insurance companies as pharmaceuticals seem to be the main concern.

What we do know is there is not a “pill” that can solve the mysteries of concussion/mTBI, but we are now starting to see results from therapeutic modalities that can help: vestibular rehabilitation, balance training, cognitive training, dual-task therapy.  However HBOT seems Continue reading

Comprehensive Article From LA Weekly

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

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

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
  • New Jersey Concussion Summit

    The Athletic Trainers’ Society of New Jersey is hosting its second annual Concussion Summit on July 17th.  It is after the “early registration” however the line-up is certainly worth a look.  This is the same organization that produced the very well put together tutorials on concussions, SEE HERE.

    • Steve Broglio, PhD, ATC – Assessing Balance in Concussion
    • Robert Cantu, MD – Long-term Effects of Concussions
    • Annegret Detwiler-Danspeckgruber, EdD – Imaging Concussions: DTI and fMRI
    • Ruben Echemendina, PhD, PSY – The Role of Neurocognitive Testing
    • Jason Mihalik, PhD, CAT(C), ATC – Biomechanics of Concussions Continue reading

    Return-to-Play Test?

    Perhaps.  University of Buffalo doctors and researchers believe that they may have a tool that can provide definitive answers and take the “chance” out of the impending second injury.  John J. Leddy, MD, Karl Kozlowski, PhD and Barry Willer, PhD are authors of a study aimed at just doing that;

    University at Buffalo researchers have developed a test to determine when it’s safe for athletes to return to play after a concussion.

    Currently no standardized method exists to assess when the time is right. It is usually a judgment call made by team physicians.

    “We believe this new approach could change the way professional and amateur sports team physicians make decisions about concussion recovery.”
    Barry Willer, PhD
    professor of psychiatry and rehabilitation medicine and senior author on the paper

    The treadmill test devised by UB concussion specialists in the Department of Orthopedics could change that by providing a systematic approach to evaluate readiness.

    “In the past, how a team physician and trainer made this decision was left to chance,” says Barry Willer, PhD, professor of psychiatry and rehabilitation medicine.

    Willer is senior author of a paper titled Reliability of a Graded Exercise Test for Assessing Recovery from Concussion, published in the Clinical Journal of Sport Medicine.

    Using the Balke standardized treadmill test the subjects were taken to either symptom exacerbation or perceived exhaustion.  Starting Continue reading

    Live From Lexington

    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

    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

    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

    Getting It Across

    (Project Brain Wave) In June, the Newfoundland and Labrador Brain Injury Association, of which I am on the Board, is holding a symposium-type event to discuss brain injury, who it affects and how we think we can help people in the province. I have been asked to talk about my experiences, so now, I am writing and gathering ideas – from previous posts on this blog and from my mind – so that I can talk about my brain injury, my recovery and the struggles and opportunities that have come out of my experiences. I have named my talk: (Brain injury) Recovery experiences, challenges and new opportunities. Now it’s just a matter of putting this all together.

    Before my brain injury I wasn’t a very confident speaker, but once I got going, my nervousness would disguise itself as confidence and I could ramble and bullshit my way through a lot. I have almost the opposite problem now; Now, my speech belies my confidence (this is unfortunately true in more situations than public speaking) and there’s a lot for me to talk about on this subject.

    I am very excited about talking about this and I’ve got to make some decisions to keep the audience interested. Here’s the way I see it:
    1. Most people reading this blog are my friends and you may be interested to hear my thoughts because most of you knew me before I was injured and want to know how I feel now and what’s changed for me personally. I can’t thank you enough for your support during and since. Thanks so much everyone!
    2. You’re the audience for this blog, not for my talk in June. That talk is for people who — Continue reading

    Chicagoland Concussion Meeting

    Yesterday I had the opportunity to attend the Association of Chicagoland Sports Physicians Concussion Update presented by AthletiCo, in Oakbrook Terrace, Illinois. I was invited by my medical director, along with our sports medicine physical therapist; the three of us went north to listen to three very good presentations, network and get ideas for our hospital (the food was also great).

    Heading in I knew the primary audience for this meeting was physicians MD and DO, in fact I believe that of the 70 or so people I think there were only 5 athletic trainers and 3 physical therapists. It seemed the room was evenly split between practicing physicians and residents, with some very knowledgeable and exceptional physicians in attendance. I was extremely encouraged to see all the “young” physicians willing to learn about concussions, some of whom didn’t even focus on Sports Medicine, but they wanted information.

    There were three presentations on the night; Chicago and Illinois legislation regarding concussions, Vestibular Rehabilitation for treatment of concussions and Point-Counterpoint of Neurcognitive Testing; possibly the three most poignant topics in the area.

    Continue reading

    Wrestling Concussion Aftermath

     

    EXPRESS TIMES PHOTO - Bill Adams

    Concussions in wrestling are a concern, they happen less often as other sports, but when they do there is a small window for the athletic trainer to determine if the injury warrants removal.  In the amateur sport of wrestling the head is both exposed and sustains frequent contact, why we don’t see more is amazing (there has to be a reason).  That is not the point of this post, rather an instance of a concussion and its uncertain aftermath.

     

    Demond Davis, a high school wrestler in Georgia was continuing his exceptional career and closing out his home meets with a senior night match, when it happened;

    The day of the wrestling match, Demond had been texting his mother to see if she was able to leave work early and make it to his match.

    Davis is a single mom who works hard to support Demond and his 13-year-old brother. But that night, the seniors on the wrestling team were going to be recognized in a special half-time ceremony and Demond really wanted her to be there.

    Her phone rang at 6 p.m., but this time it wasn’t Demond.

    It was the frightened athletic trainer.

    Demond had been hit hard. His opponent from McIntosh County Academy had reportedly grabbed his left hand and thrown Demond’s left shoulder hard into the mat. He was rattled by the illegal move, but after being checked by the athletic trainer, Demond went back in for the win.

    He got into position, and for the second time Demond was thrown hard into the mat. But this time he took direct blows to his head and left shoulder.

    Something was really wrong. An ambulance was called. Demond’s season was over.

    His mother rushed to the school where all he could do was communicate Continue reading

    SCoBIRC

    The Concussion Blog likes to highlight people, places and things that are helping with the awareness, prevention, identification, management, and rehabilitation of concussions.  I recently had a good Twitter conversation with @ganglion11, known as Jonathan Lifshitz, PhD, whose research and group was responsible for our most popular video, Fencing Response.  I asked him to give me an idea of what he and his group is doing, he wrote below;

    The University of Kentucky’s Spinal Cord and Brain Injury Research Center: A Homegrown, Basic Science and Translational Center Dedicated to Developing Novel Treatments for Traumatic Brain and Spinal Cord Injury

    In 1999, the Spinal Cord and Brain Injury Research Center (SCoBIRC; http://www.mc.uky.edu/scobirc/) was established at the University of Kentucky College of Medicine to promote individual and collaborative research on injuries to the spinal cord and brain that result in paralysis or other loss of neurologic function. The long-term goal of SCoBIRC is to find treatments for spinal cord and brain injury that are more effective in achieving functional repair of the injured central nervous system. The combination of brain and spinal cord injury investigation sets SCoBIRC apart from its contemporaries.

    The creation of SCoBIRC was a direct result of the 1994 state legislation, which established the Kentucky Spinal Cord and Brain Injury Research Trust (KSCHIRT). KSCHIRT is funded annually by the surcharges on moving violations, violating the mandatory seat belt law and driving under the influence. Competitive research grants from KSCHIRT compensate for the disproportionate allocation of federal research funds towards other less prevalent major diseases. Continue reading

    Bust Out The Fish Oil

    After posting about the “7 Ways To Help With Concussion Management” I realized that I had not posted about the possible benefits of Omega-3 fatty acids/DHA supplements for concussion management.

    In a July publication of The Journal of Neurosurgery, Dr. Julian Bailes (BIRI) and Dr. Barry Sears (leading authority on anti-inflammatory nutrition, creator of Zone-Diet) found that supplementing rats with O3/DHA after head injuries reduced the observed issues with a concussion; (SOURCE via weightlosingideas.com)

    “Animals receiving the daily fish oil supplement for 30 days post concussion had a greater than 98 percent reduction in brain damage compared with the animals that did not receive the supplement,” Dr. Sears said. “It is hypothesized that the omega-3 fatty acids in the fish oil reduced the neural inflammation induced by the concussion injury.”

    O3/DHA has been documented to help with the inflammatory response of the body, many people use this SAFE and AVAILABLE supplement when training to temper swelling.  It is also has shown great promise for the cardiovascular system, mainly heart health.  Further investigation is underway Continue reading

    Sleeping is Good

    It used to be that doctors would tell you to keep people awake with head injuries.  That has changed, quite a bit.  Keeping someone awake might be indicated for a possible brain bleed, but concussions need the sleep and recovery time.

    Sleeping is first. If you’re not sleeping, forget it,” said Cara Camiolo Reddy, the co-director of the UPMC Rehabilitation Institute brain program and the medical adviser to the Sports Medicine concussion program. Sleep is vital in the recovery process because the injured brain needs rest to begin to heal itself. The concussion program and Camiolo prescribe medications, however, only to post-concussion syndrome sufferers who are three weeks or longer into their injury.

    This quote was from and article by Chuck Finder of Scrips Howard News Services and appeared on NewsChief.com today.

    In the article you will find that this prescription is not widely accepted by the community that deals with concussion management.  However in my experience it is vital to let the brain rest.  When I am debriefing with the athlete and their parents, the most often question I get is “can you sleep too much?”.  My answer is no.  To make the parents feel better I have them arouse the concussed individual at infrequent rates to observe their arousal response.  I also have the parents ask the three words that we asked the person to remember right after the concussion episode.

    With our experience at our school, the kids and parents that abided by the recommendations of sleep and complete brain rest have recovered at a much quicker rate.  The kids and parents that did not listen are still dealing with symptoms and have yet to be cleared.

    I know that is not a research study in its most proper form, but the observational evidence tells us, and those in the above article that sleep is indeed needed.

    REAP

    • Reduce
    • Educate
    • Accommodate
    • Pace

    R.E.A.P is a concussion program that has been put in place in Colorado.  Written by Dr. Karen McAvoy the protocol is about education, making sure all aspects and people are covered/addressed in the recovery from the concussion.  The information can be found at the Youth Sports Medicine Institute’s Center for Concussion.

    Vestibular Rehab For Concussions

    We all know, or should know, that balance issues are a primary concern with concussions and post-concussion syndrome.  Along with memory problems, balance disturbance is high on the predictor list for duration of symptoms ergo severity.

    As an athletic trainer one of our primary tests, and “go-to” is the Rhomberg Test, or sobriety test as most may know it as.  What is tested there is the gross balance and fine motor movements controlled by the brain and vestibular system of our ears.  During a concussive episode the synapses (or messages being sent) between the neurons in the brain get disrupted, each individual will experience different durations.  Using the knowledge that balance is commonly and most immediately affected by a concussion the Rhomberg provides great feedback.

    During the Rhomberg the athlete is challenged with single leg balance, tandem walking, spatial awareness and other concentration efforts that would otherwise be very simple.  These menial tasks become very difficult when you are concussed.  Now imagine those small but difficult tasks and dizziness plaguing you on a daily basis days, weeks or even months after you have sustained a concussion.

    Alsalaheen, Mucha, et al. provided a research study in which they Continue reading

    7 East

    7 East is a floor at the National Hospital in Bethesda, MD where our service men and women come home after being injured on the battle field.  7 East houses many concussions or traumatic brain injuries (TBI) from abroad.  Christian Davenport of the Washington Post wrote a story that appeared on The News Tribune’s Military page.

    The military brass are discovering that what used to be shrugged off as “getting your bell rung” can lead to serious consequences. In some cases, even apparently mild brain injuries can leave a soldier disqualified for service or require lifelong care that critics say the Department of Veterans Affairs isn’t equipped to handle.

    Since 2000, traumatic brain injury, or TBI, has been diagnosed in about 180,000 service members, the Pentagon says. But, a Rand study in 2008 estimated the total number of service members with TBI to be about 320,000.

    This “hidden” danger is not hidden.  It is a problem that the military REFUSED to believe in and spend resources toward.  More and more pieces like the one written by Davenport need to be put out there.  Many lives, not only the soldiers, but their families are affected by this.

    Recommendations

    Recently I have had a few more concussions than usual.  Along with that I have had parents really struggling to understand the recommendations I have given them.  The restrictions seem very harsh, they tell me, or they are confused because their doctor did not recommend the same.

    Here are some guidelines from St. Vincent Sports Performance of Indianapolis

    For someone diagnosed with a concussion, increasing the blood flow to the brain through physical or mental exercise can destroy vulnerable and damaged brain cells, slowing down recovery. The following guidelines help an athlete recover faster from the injury:

    » Do not attend school.

    » No extended reading.

    » No video games.

    » No MP3 or iPod use.

    » No walking the dog.

    » No movies.

    » No PSAT or SAT tests.

    » No computer use.

    » No text messaging.

    » No socializing with friends.

    » No school functions.

    » Use sunglasses in bright environments.

    » When the athlete no longer has a headache, he or she can return to school gradually, attending class until symptoms return. After 48 hours pass without any symptoms, a doctor will begin a treatment that allows an athlete to return to the field.

    Wii & Concussions

    Ohio State University and University of Maryland are using the Wii Fit on a trial basis for assessing concussions.

    The Colonial Serf Log, bloged about it recently.

    Even though the gaming system and game were not designed for the purpose of medicine/rehabilitation the Wii is getting attention in this area.  The balance you must exhibit on some of the game interfaces, as well as the memory and reaction time needed for others can indeed help make assessment decisions. Continue reading