Latest Research on Concussions; Rather No Concussions = Changes

Certainly the research is flying in; mostly the investigations are now looking at either ways to detect the injury or objective ways to determine recovery.  There are a bunch of other designs and angles out there but the most important are the above.  Although it would be great if we had an objective way of determining concussion, it is really not the pressing issue (with solid education and conservative approach to injury – sit them out).

As I have stated over and over, the BIGGEST issue we face with concussions is the mismanagement of concussion from the beginning; therefore the need to identify when it is safe to return is more paramount in my opinion.

The newest research is out from the Cleveland Clinic, it looked at 67 college football players, more specifically it looked at their blood, report from WKYC;

In a study of 67 college football players, researchers found that the more hits to the head a player absorbed, the higher the levels of a particular brain protein that’s known to leak into the bloodstream after a head injury.

Even though none of the football players in the study suffered a concussion during the season, four of them showed signs of an autoimmune response that has been associated with brain disorders.

There we go again, telling and showing people that the hits that don’t elicit a concussive response are also a culprit in the brain injury crisis we are facing.  Coaches, particularly in soccer and football, will tell us that we are wrong and that it is either unproven or not a possibility because of how “safe” they practice or the equipment they have.

Back to the research, the group looked for the S100B protein that should only be in the brain;

Typically, S100B is found only in the brain; finding S100B in the blood indicates damage to the blood-brain barrier. While the exact function of S100B is not known, it is used in many countries to diagnose mild traumatic brain injury when other typical signs or symptoms are absent.

Studies in Janigro’s lab revealed that once in the bloodstream, S100B is seen by the immune system as a foreign invader, triggering an autoimmune response that releases auto-antibodies against S100B. Those antibodies then seep back into the brain through the damaged blood-brain barrier, attacking brain tissue and leading to long-term brain damage.

They also did some PET scans to Continue reading

Let’s Clear Something Up Here

On Twitter yesterday I commented on the words Jim Nantz spoke on “Face the Nation” regarding concussions (emphasis mine);

“[r]esearch shows that at the college level, a women’s soccer player is two and half times more likely to suffer a concussion than a college football player. I don’t hear anyone saying right now, ‘should we put our daughter in these soccer programs?'”

Huge props to Jason Lisk of bigleadsports, for doing the work of digging to find the information that Nantz used in the interview.  The long and short of Lisk’s adventure was that he could not find a specific connotation of such claims.  The 2007 article he cited in his wirte-up can be found here, Concussions Among United States High School and Collegiate Athletesvia nih.gov.  You can look and see what Lisk and myself see, football concussions occur more than female soccer concussions – except for an anomaly (very small one less 4%) – in college football and female college soccer.  Lisk also notes this was a 2007 study, although ancient in the realm of concussions, it is very solid and worth citing.

A repeat of the above study could not be found and probably should be done, however there are plenty of “concussion incidence” research in the high school sports.  Those can be found by simply going to ‘Google Scholar’ and defining your terms.  Here is a very good one regarding concussions alone, Marar et Al_ Epidemiology of Concussions, where the football vs. girls soccer numbers are; 6.4/3.4 (that is per 10,000 athlete exposures).  This is a 47% increase as compared between the two sports, almost two-time as likely.  More important is that this information was published a year ago, some of the freshest information out there.

Specifically Nantz was using collegiate soccer as his “trump card” in the case for football.  Not only is collegiate soccer a rare occurrence for those playing soccer, it is not nearly as populated as high school and youth soccer, where the concussion problem is WAY lower than football.

Not only was Nantz – and Limbaugh – spewing information that is both hard to find (no source) and outrageous to this author, it is completely irresponsible to even suggest that female soccer is more “dangerous” than football, in terms of concussions.

Here is my diatribe from twitter last night; Continue reading

Quick Hits on a Cold Thursday

American Medical Society of  Sports Medicine Position Statement…

I had seen this but caught it again in a below article, the AMSSM released its position statement on concussions recently.  Most of those involved in writing this were in Zurich last November and this comes out about two months before the consensus statement is released in the British Journal of Medicine.  (pssssst – it is also going to have a release in Australia, in conjunction with the AFL Concussion Conference and first round of games and I am still looking for a sponsor)

I found one piece of this position statement very encouraging and made me smile for all the hard work others have done;

Return to Class

* Students will require cognitive rest and may require academic accommodations such as reduced workload and extended time for tests while recovering from concussion.

The rest of the statement is not really “Earth shattering” but there are interesting points in there;

* In sports with similar playing rules, the reported incidence of concussion is higher in females than males.

* Certain sports, positions, and individual playing styles have a greater risk of concussion.

* Youth athletes may have a more prolonged recovery and are more susceptible to a concussion accompanied by a catastrophic injury.

* Balance disturbance is a specific indicator of concussion but is not very sensitive. Balance testing on the sideline may be substantially different than baseline tests because of differences in shoe/cleat type or surface, use of ankle tape or braces, or the presence of other lower extremity injury.

* Most concussions can be managed appropriately without the use of neuropsychological testing.

* There is increasing concern that head impact exposure and recurrent concussions contribute to long-term neurological sequelae.

* Some studies have suggested an association between prior concussions and chronic cognitive dysfunction. Large-scale, epidemiological studies are needed to more clearly define risk factors and causation of any long-term neurological impairment.

* Primary prevention of some injuries may be possible with modification and enforcement of the rules and fair play.

* Helmets, both hard (football, lacrosse, and hockey), and soft (soccer, rugby), are best suited to prevent impact injuries (fracture, bleeding, laceration, etc) but have not been shown to reduce the incidence and severity of concussions.

* There is no current evidence that mouth guards can reduce the severity of or prevent concussions.

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X-Games, D on coverage…

Anyone catch the X-Games this past weekend?  Action sports are on the rise and the X-Games Continue reading

CDC, NIOSH and Department of HHS Issue Statement

For many years the “government” has kept its collective mouth shut about happenings in sports.  Occasionally they will make statements regarding the health of players in sports; case in point steroids and PED’s.  The highest football league in the States and world has often had little resistance from “government” while doing business, until now.

The Department of Health and Human Services along with The Center for Disease Control and The National Institute for Occupational Safety and Health have released an NFL Notification about brain and nervous system disorders.  The NFL Notification can be found by clicking on the jump above.  Here are the highlights;

  • In general, brain and nervous system disorders were more than 3 times higher among players; 17 players died with Alzheimer’s, ALS, or Parkinson’s compared to 5 men in the U.S. (see graph).
  • More speed position players died from these disorders compared to the non-speed position players.
  • ALS was 4 times higher among players; 7 players died with ALS compared to fewer than 2 men in the U.S.
  • Alzheimer’s was 4 times higher among players; 7 players died with Alzheimer’s compared to fewer than 2 men in the U.S.
  • Parkinson’s was not increased among players compared to men in the U.S.

This is not “old” news rather, it is confirming what has already been known, but Continue reading

UCLA Tau PET Study

If you paid attention yesterday you saw that a very preliminary study was unveiled about identification of tau proteins in the brain.  This is significant on two fronts

  1. up until now this has been non-existent with current imaging technology
  2. tau is the #1 culprit in chronic traumatic encephalopathy

If, in fact, this PET scan can find and map out the tau in living brains this would be a “watershed” moment in the treatment of CTE.  This would be because we have not been able to treat CTE, the only way to find CTE is via a posthumous examination.

I believe this is very exciting, but remember like all things in life, caution is needed – the study was only five former NFL’ers and to fully confirm the information gathered the researchers could be waiting a long time, hopefully.

A quick side note here, Dr. Bennett Omalu is a co-author on this study, which isn’t ironic as some have suggested, rather a product of his good work in this area.  For those in the “know” surrounding research in concussions and CTE finds this part of the story – Omalu – “interesting”.

What a great start, and I am willing to be scanned if anyone wants to pass that along!  I would even write a blog about my experiences with it.

Matt Chaney – Tireless Worker

SpringGame1984Sideline
If you have been around enough you have seen the stylings of Matt Chaney on this blog, he is someone I call a friend.  In some circles that discounts me as a professional, which is both stupid and dumb.  I don’t always agree with Matt, heck him and I have been known to battle via electronic and phone communications.  However, his opinion is a valuable one – often his work is based in so much fact it makes your head spin as to why some of its missed.  Regardless, Matt has published two recent articles on his blog, for all to consume, here are some excerpts.

Part 1, published January 7th;

Historic football excuses thrive in modern debate over brutality

Lawsuits, criticism explode and officials project blame onto individuals

Old talking points of football apology resonate yet as officials tout anti-concussion measures like trainers along sidelines, new rules for safer play, injury reduction and expert consultation—same type of promises heard from gridiron leaders during the Victorian Era

American football gets lambasted in public for maiming and killing, denounced by an influential movement of critics, and game officials pledge safer play based on their new concepts of prevention, including:

*Qualified trainers and doctors will patrol sidelines.

*State-of-art medical response will treat the rare severe casualties.

*Limits will govern length of practices.

*Injury tracking will cut rates already on decline.

*Coaches will properly train players.

*Every player will undergo medical prescreening.

*Experts will lead safety reform in rulemaking and research.

*Referees and coaches will enforce new rules of experts.

*Players will follow new rules of experts.

Sounds familiar, these steps, a practical recitation of talking points for contemporary “safer football” promoted by the NFL and commissioner Roger Goodell, in face of lawsuit frenzy against the league and sport in general, along with festering disgust in the public.

Except the football rhetoric is 119 years old, from 1894, a packaged response during the game’s initial siege against formidable opposition seeking abolishment. Continue reading

Concussion Symposium March 2nd

I received the following press release about a Concussion Symposium coming up in March.  The faculty is not your “usual suspects” rather some very good and known people in the medical field.  If you get the chance to head down to Texas for that Saturday I believe you will not be wasting your time or resources.  I would love to make it, however I have a prior commitment; that being said someone take good notes for me.

I would also like to add that having athletic trainers on the program list legitimizes this symposium in my mind.  Here is the presser;

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Austin, Texas (PRWEB) January 10, 2013

Concussion Compliance presents “Bridging the Gap on Best-Practices in Concussion Management.” This day-long exchange, sponsored by St. David’s HealthCare, brings together leading medical experts and practitioners to discuss the issues dominating today’s best-practice concussion management and how to incorporate the guidelines as well as the use of several tools into clinical practice.

The national symposium will be held March 2, 2013, at the Norris Conference Center, Austin. Registration is now open

“Communication and education that crosses traditional boundaries are key factors to providing good concussion treatment for our young athletes,” said Theodore Spinks, M.D., chair of the symposium program planning committee. He is a board certified neurosurgeon seeing patients in Austin, Round Rock, and Georgetown, Texas. Dr. Spinks currently serves on the CDC Expert Panel for Pediatric Mild Traumatic Brain Injury. He also served on the Texas Medical Association Committee on Concussions in Athletes during the last session of the Texas Legislature.

The symposium program provides an overview of the current best practices and consensus statements on concussion management, the latest scientific research, an update on tools available to practitioners, and perspectives from experts in concussion management.

  •     Featured Topics – The Physician’s Perspective; An Athletic Trainer’s Perspective; Head to Head: Cognitive Testing; Beyond Cognition: Balance Testing; A Look Into the Future: Vision Testing; Neurosurgical Management of Head Injuries and Concussion; Implementation of Best Practices Into Clinical Practice
  •     Keynote Speaker – Dr. Steven Erickson will present on the latest best practices in concussion management. Dr. Erickson is the medical consultant for Major League Baseball caring for the umpires and serves on the Major League Baseball Medical Advisory Committee and the Major League Baseball Mild Traumatic Brain Injury Committee.
  •     Reading of Proclamation from Governor Perry’s Office – March Concussion Awareness Month in Texas
  •     Exhibit Hall – Featuring the newest in technology, practice services, practice information, and pharmaceuticals

In addition, Governor Perry has Continue reading

Matthew Gfeller Neurotrauma Symposium

Loudermilk_picsIn Zurich I had the chance to speak to many people; I enjoyed my brief time speaking with Jason Mihalik – fellow athletic trainer.  He reminded me of the previous Symposium in North Carolina and the upcoming second version.  I asked him to send along an email and I would put it up on the blog.  Here it is, and he is right, make sure you register NOW, it fills fast.

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It is with great excitement that my colleagues and I will be hosting the Second Matthew Gfeller Neurotrauma Symposium at the University of North Carolina at Chapel Hill on March 8-9, 2013. We have lined up another great list of local, regional, and national speakers. For additional information regarding a schedule of topics, invited faculty, and links to negotiated hotel rates, please visit us at http://tbicenter.unc.edu, and click on “TBI Symposium” in the header. A direct link to register for the symposium is as follows: http://tinyurl.com/c576kdu.

Our first symposium sold out 2 months prior to the scheduled event, so register early! Current Early Bird rates in effect until January 8, 2013 are as follows:   Continue reading

Possible Biomarker? Possible Definitive Imaging?

Biomarkers are the next frontier in the concussion realm, really any specific and reliable objective measure to confirm a concussion.  Currently we can view concussion a “diagnosis in absence”; meaning if you have head trauma and there is no remarkable imaging the default diagnosis would be concussion.  This can be effective if there were enough signs that warranted the exam or the individual was truthful about symptoms; but what about the population that either does not respect/believe concussions or refuses to accept that they are a brain injury?

That is why the race is on to find either a biomarker or imaging technique that someone can say; “look, see these numbers/images, it means you have a concussion.”  This is great if the process of evidence based practices (EBP) was swift and widely accepted; the sub-issue is that there is ALWAYS “more research to be done”.  The first study deals with not a blood drawn biomarker, rather an imaging measured biomarker.

Dr. Michael Lipton of the Albert Einstein College of Medicine in New York presented this information recently;

In a single-center, case-control study, patients with mild traumatic brain injury (TBI) who had more abnormally high fractional anisotropy (FA) had fewer concussive symptoms and better quality of life a year after their injury than those who had less of the biomarker, […]

“If abnormally high FA represents neuroplastic effects, and if that’s how people recover from brain injury, it would be possible to use this in translational studies to identify the underlying mechanisms of pathology and to identify therapies that don’t look at how we fix the damage, but how we enhance the brain’s ability to compensate for that damage,” Lipton said during the briefing.

[…]
Overall, all patients had detectable areas of abnormally high FA: some had more, others had less, Lipton said.

But those who had higher levels of abnormally high FA had fewer post-concussive symptoms and better health-related quality of life a year after their injury, he reported.

Higher levels significantly predicted improvements in concussive symptoms (P=0.01), as well as better outcomes in terms of the quality-of-life outcomes of mobility control (P=0.024) and psychological functioning (P=0.007).

This suggests that the “brain is compensating for its injuries,” Lipton said, and that high FA “may be a manifestation of neuroplasticity.” Because the brain does not form new axons, he said, it could be that the connections between existing axons are changing or strengthening.

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At the same time  a group led by Dr. Yulin Ge found and published in Continue reading

Good Reminder About Rest After Concussion

This blog post was made a while back, from time-to-time I will republish them with associated comments that resulted.  This topic is about “rest” after the injury.  Most if not all medical professionals now prescribe this method, but as we found out in Zurich recently, the research behind exactly what “rest” is and for how long is unknown.  What is known allowing the brain to settle down for a period of time is highly beneficial.

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Although most point to physical rest as the major component of concussion management the truth of the matter is that all activity that affects brain activity needs to be limited after a concussion.  If we use the “snow globe” analogy; all the flakes in the globe must come to rest before exposing it to further activity.  What excites the “flakes” or brain, honestly, just waking up does this.  That is why I have been hammering on the need for COMPLETE rest after a concussive episode.  It is also why I am a firm believer in getting kids out of school while the brain injury heals.

This information is not new to you that read the blog, but it seems that this management technique is just catching on as a principal protocol, rather than using it if there are setbacks;

“There is so little we really know about concussions,” said Dr. Mary Dombovy, vice president of Unity Neurosciences, which includes physical medicine and rehabilitation, neurology and neurosurgery. “We’re learning more as time goes by. What we’re learning is it’s not just physical exertion that is making the brain work harder. School tasks, studying for tests, trying to write a paper, these things are very stressful for people who’ve had a concussion.”

It is not that it is stressful, per se, it is that the brain is FUNCTIONING to do those tasks and like getting on crutches for a broken leg, the only way to get the brain on “crutches” is to not give it any stimulation.  Along with that comes how long and what to do when symptoms have gone, to me it is obvious that this is where you then begin the Zurich RTP protocol (the current concussion management protocol I use).

What I am having a hard time fathoming is Continue reading

Zurich Day 2… And We Are Live

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…

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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

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Dr. Jamie Kissick speaking on “From Consensus to Action”

  • Knowledge is power
  • “There is an app for that”
  • Knowledge Translation (KT) Concepts Continue reading

Zurich Live…. Sort Of… UPDATE End of Day 1

It almost all fell into place…  I just don’t have the battery power as my converter is not converting the electricity to what is needed for my computer…

However, I will post re-caps as time and battery warrant, for the time being you can follow on Twitter as I will do my best, until that battery goes gone as well…
I can say nice conference room and a lot of the “who’s who” in attendance, Steve Broglio and Chris Nowinski amongst the first to say hi to me…

Conference set to begin in 20 minutes…

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1408

wow,  good start…  So much to tell!  Lunch was awesome, met some good people with same frustrations…

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END OF DAY ONE RECAP

It all began with the usual welcomes and introduction as well as the process and thoughts/history behind the Consensus Statements.  As it began in 2001 at Vienna with International Ice Hockey Federation (IIHF), International Olympic Committee (IOC) and FIFA it has since expanded to include everyone on panel today.  There are North American interests from NHL, NFL in attendance, didn’t notice the MLB, NBA or NASCAR overtly.  The theme is that is is much bigger than sports but we are here for the sport aspect and this is an international problem, hence all of us here.

The format is to address 12 questions regarding the previous 2008 statement and how things can be improved/changed.  This is a living statement/guidelines as you will see with the complete action of no same day return to play (RTP) for any sport – if you remember in the 2008 version they excluded some professional and collegiate American Football players (no longer the case).

The next part of the presentation was what were the responses to the 2008 Statement; Continue reading

TBI Symptoms May Not Subside

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

Zurich… It’s Happening

Well I am jacked, a bit nervous, and thankful for this opportunity.

I head out tomorrow and if all goes well – electricity/wi-fi/rules, etc. – I hope to be blogging the conference live back to you here in the States.

There are many people I would like to thank for donations; there was a total of 8 people and one group that chipped in and since some don’t want to be listed on the blog I will just say thanks to all of you.  The donations offset the cost enough along with some handy savings, I was able to bring my wife along for a once-in-a-lifetime European date.  One group can be thanked, that is my high school Athletic Booster Club, as they surprised me with a 50/50 raffle in the last football home game.  I can also thank my parents as well for their kind donation.

This is mainly a “business” trip as I really want to get the information out to as many people as possible, often time we don’t get to hear about such things in a timely manner.  That being said I will do the best I can; there is a 7 hour time difference to central time, meaning on Thursday I should begin at 4am CST (earlier on Friday).  Regardless of the circumstances I do have wi-fi in the hotel so I can at the very least write a wrap up if needed (and it will be at a more convenient time for you).  I will also have Twitter available, so one way or another you will get information!

Here is the Program for the event.

I will also try to be “journalistic” and see if I can get a few of the presenters and those in attendance to answer questions.  The problem is that I don’t have any set questions to ask, feel free to include some in the comments section.

Again, I truly appreciate this opportunity and thank all of you who come to this blog, without the interest and massive amounts of hits a day this would never had happened.

Thank You!

Cantu Interview with SportsLetter

Thanks to a heads up serial emailer I was able to not miss this interview of Dr. Robert Cantu, appearing in the SportsLetter – it appears to be written by David Davis.  There were some very good questions and answers, below is a sampling;

SL: When did you first realize that concussions in youth sports were becoming a major problem?

RC: When I was a sideline physician for a high school football team over 30 years ago.  That’s when it occurred to me that we needed some written guidelines for returning our young athletes to the field of play after they suffered a head injury.  That’s what led me to write the first Return to Play Guidelines back in 1986.

I’m a strong supporter of youth sports, but no head trauma is good head trauma.  You cannot condition the brain to taking blows. If you subject the brain to enough head trauma, permanent brain damage may happen.

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SL: In your practice today, what are the most common myths — the most common misconceptions — about concussions among youth athletes?  Is it that there has to be a contact sport involved?

RC: I think the number-one most serious misconception is that you have to be rendered unconscious to have suffered a concussion.  More than 90 percent of athletic concussions occur without any loss of consciousness.  There are 26 symptoms associated with concussions, and loss of consciousness is only one of those.

Another very common myth is that concussions become exponentially worse as you accumulate them, so that your first one will be more mild than your second, and your third will be worse than your second one.  That’s just not reality.  The concussions happen to be whatever they are based on the forces involved.  I’ve seen many individuals whose first concussion was much more severe than subsequent ones.

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SL: How is a concussion involving a youth athlete different than a concussion involving an adult athlete? Continue reading

Dietary Concerns and Concussions

I was given the name of a person who has some interesting theories on concussions through this blog.  I wanted to see what he had to say so I contacted him and asked that he write, in his own words, what he is thinking.  Not only does the below blog do a good job of that it also can explain why concussions are more of an issue now.  It would answer the comments “back in my day it wasn’t a problem”, this reader and now writer deserves our attention world!

With regard to the susceptibility to concussions occurring and the factors involved in helping the brain heal itself–I am reminded of a famous saying from the past by Galileo Galilei (1564-1642) “In questions of science the authority of a thousand is not worth the humble reasoning of a single individual.” In other words, today many can not see the forest for the trees!

I have spent the last 22 years of my life studying the interaction of essential fatty acid (EFA) metabolism and human physiology and the dietary manipulation of eicosanoids–all thanks to the deceased eminent researcher Dr. David Horrobin and his lovely wife Sherry Clarkson.  I would also like to mention Dr. Mehar Manku (current editor Medical Hypothesis), he was instrumental in the early 90’s in introducing me to essential fatty acids and disease.

To keep this brief — Continue reading

Ever Wondered About the Adolescent Brain?

We have discussed quite often about the adolescent brain and why concussions/brain trauma is much more troublesome for this set of the population.  Trying to explain this part has been difficult for me as I really grasp the concepts of it, rather than the practical application of the information.  Thanks to TED (a nonprofit devoted to Ideas Worth Spreading. It started out (in 1984) as a conference bringing together people from three worlds: Technology, Entertainment, Design. Since then its scope has become ever broader. Along with two annual conferences — the TED Conference in Long Beach and Palm Springs each spring, and the TEDGlobal conference in Edinburgh UK each summer — TED includes the award-winning TEDTalks video site, the Open Translation Project and TED Conversations, the inspiring TED Fellows and TEDx programs, and the annual TED Prize) we can listen to Sarah-Jayne Blakemore perfectly illustrate the adolescent brain.

Sarah-Jayne works  for the Developmental Group at the UCL Institute of Cognitive Neuroscience focuses on the development of social cognition and executive function during adolescence. Our research involves a variety of behavioral (psychophysics, eye-tracking, motion capture) and neuroimaging (MRI, fMRI and MEG) methods. We are based at the UCL Institute of Cognitive Neuroscience in Queen Square, London, UK.

This is one of the most serious brain labs in the world.

Book Review: Concussions and Our Kids – Dr. Robert Cantu

Due out tomorrow, Tuesday, September 18th, is Dr. Robert Cantu’s most recent writing on brain trauma; more specifically the concussion and how it relates to the ‘kids’.  Dr. Cantu is THE expert when it comes to concussions, heck his CV is so expansive it would take up like 7 pages on here.  The man knows his stuff; collaborating with Mark Hyman I believe he has written a book that is worth the read for everyone interested in this topic.  By writing this book they not only address the concussion issue but the “iceberg below the surface” the youth athletes and their care.  Obviously the millions that partake in sport and recreation are not privy to the top of the line medical staffs that the professional and high college athletes have at their disposal.

With Dr. Cantu’s wealth of knowledge there was a chance this book could have been written above the audience – so to speak – but after reading it twice I have found it to be perfectly succinct and to the point.  There is no beating around the bushes and you definitely get the feeling of where Dr. Cantu stands on this pressing issue.  All of that being said there are some points that I disagree with, but remember my favorite Japanese Proverb: “None of us is as smart as all of us.”

The book begins with the most important topic, in my opinion, “what is a concussion?”, delving into the brain and its physiology.  Don’t be scared, it is a well written chapter and explains to the layman how and what we feel determines a concussion.  Highlighting that section is the explanation of linear and rotational acceleration and why one is way more important than the other.  If you have read here enough you will note that the rotational aspect of the traumatic force to the brain bucket is the most troublesome, Cantu agrees.  In this chapter Cantu also discusses the term “rest”, and what we are all trying to convey, especially to the youth.  Rest is both physical AND cognitive, meaning not using your brain.

The next two chapters deal with collision sports Continue reading

New Study; Posting for Reference

This information was not only new, but really took up time on the airwaves with its information.  For some this may be a head scratching, but for most in the know it was really confirmation of what the popular line of thinking has been.  Really, if you think about this in a vacuum, brain trauma is bad, and increased exposure over long periods of time is real bad.

Here is a recap from CTVNews in Canada;

Former NFL players appear to be at an unusually high risk of dying from Alzheimer’s, Parkinson’s or Lou Gehrig’s disease, suggests a new study that once again highlights the dangers of the game of football.

The study, which appears in the journal Neurology, found that the death rate from those three diseases among a group of former NFL players was about three times what one would expect from the general population.

The study looked at 3,439 former players who had at least five playing seasons from 1959-1988 with the NFL. The average age of the study participants was 57 and only 334 players – about 10 per cent of them – have now died.

Researchers compared the players’ deaths to a comparable group of American men and found that in 10 of the former NFL players, either Alzheimer’s, Parkinson’s or Lou Gehrig’s disease (also called ALS) was listed as the cause of death.

That’s about three times the general rate for American men, the researchers reported.

I would also like to take this time to make sure we are not vilifying the NFL or football for that matter.  Sure the sport has plenty of brain injury, but concussions and repetitive blows to the head are not unique to the gridiron.  Soccer for one is a sport that is both understudied and had potential for chronic cases.  In the sport of baseball the catcher position is an area of concern.  Hockey, rugby, rodeo, Aussie Rules all have a place in this discussion.

Mostly, remember that kids are now exposed to sports at a much younger age then this study group, and the group also was playing before the 90’s – before everyone got bigger, faster and stronger.

Jane Leavy’s Article on Ann McKee

In the category of must read, this piece on Grantland by Jane Leavy is one the mouth-breathing, booger-eating, Neanderthal types who thing science is ruining the game, should become acquainted with (if they can even read).  Dr. McKee and people like me are not trying to take away the sports you love.  In fact we are trying to save them, football included.

Dr. McKee is a fan, just like most of us;

Every football Sunday, she parks herself in front of the TV in her authentic Packers foam Cheesehead ($17.95 at packersproshop.com) and Rodgers’s no. 12 jersey and prays that none of the men on the field end up on a dissection table. To date, she has found ravages of CTE, the neurodegenerative brain disease that has become her life’s work, in over 70 athletes, nearly 80 percent of those she has examined. Among them: 18 of the 19 NFL players she has autopsied; three NHL enforcers; and a boy just 17 years old. McKee, who received $1 million in funding from the VA as well as a home for her lab, has also documented evidence of CTE in combat veterans exposed to roadside bombs.1

“The coolest thing about Ann is she spends all day doing autopsies on NFL players and can’t wait for the weekend to put on her Packer sweatshirt and climb into bed with a big bag of popcorn and a beer,” says Gay Culverhouse, former president of the Tampa Bay Buccaneers, who now advocates on behalf of former players.

“Well, I don’t usually do it in my bed,” McKee says.

Dr. McKee relishes her job, no matter how anyone sees it; Continue reading

ATSNJ Sports Safety Summit Update

You have certainly seen me publicizing the Athletic Trainer Society of New Jersey and their 3rd Annual Sports Safety Summit, it is for a good reason.  Eric Nussbaum and his staff do a VERY, VERY good job!  I would travel that way for this event anytime, however I will be a keynote speaker in Iowa the day after (guess UPS and their “Logistics” can’t fix that for me).

But wait, there is some great news for anyone interested is seeing what all the hype is about, Eric emailed me yesterday to tell me that the Summit will be broadcast live, for FREE!  You will not be able to get CEU’s this way, but at the very least you can hear all the great information from the wonderful panel they have assembled.

Here are the deets:

  • All people will need to do is log onto their site, (www.concussiontv.com) and register.
  • On the day of the event (August 1st) you simply log in to view.

Click the link at the top to get the information.  Here is a run down of the presenters: Continue reading

Swedish Boxing Study

In April a Swedish study was released on boxing and biomarkers in the cerebrospinal fluid (CSF); findings were not only somewhat successful for possibly getting a biomarker test, it shed light on the controversial subconcussive blows and cumulative effects as well.

Sanna Neselius, Helena Brisby, Annette Theodorsson, Kaj Blennow, Henrik Zetterberg and Jan Marcusson did perform the largest study of active boxers known, what was less known until this one study is how long and what level the CSF biomarkers are in samples of each boxer.  The most curious part of the study is that only ONE of the boxers ever reported symptoms associated with concussion yet the results show increased levels of certain biomarkers in 80% of the boxers that would be indicative of “acute axonal and neuronal damage.”

The studied biomarkers were; Continue reading

Multiple Concussions Cause Delay Deficits, says new study

The study was done with the mouse model as the human analog, however its results could lead researchers down the path of what most believe about multiple insults to the brain;

We did it in mice. We gave them one mild concussion, so mild that they had no problems with learning or memory afterwards and then did it over and over and over again,” said Meehan, the study’s first author.

The mice were then tested for learning and memory, using what’s called a Morris water maze.

“Under the surface of the water is a hidden platform. And every time the mice find that platform, we reward them,” said Meehan. “The mice that are uninjured, have not been concussed, find that platform within five seconds after they do it several times. But mice that are injured take 20 to 25 seconds.”

And with each concussion, Meehan said it just got worse.

“Once they’ve had three concussions, or five, or 10, they develop profound deficits in their ability to learn and in their memory. And of course, mice don’t use steroids, and they don’t abuse drugs and alcohol,” said Meehan

The study appears in Neurosurgery and highlights not only the compounding effects of multiple traumas but takes out the other “factors” some seem to be grasping at for a reason as to why the brain is suffering.  While we are looking at the text, it seems Continue reading

Bombshell Found in Sports Illustrated Vault

Thanks to @ConcernedMom9 I was sent an article from Sports Illustrated written by Michael Farber.  Before I tell you the year and provide the link I want so share some quotes from it;

“People are missing the boat on brain injuries,” says Dr. James P. Kelly, director of the brain-injury program at the Rehabilitation Institute of Chicago and an assistant professor of neurology at Northwestern University Medical School. “It isn’t just cataclysmic injury or death from brain injuries that should concern people. The core of the person can change from repeated blows to the head.

“I get furious every time I watch a game and hear the announcers say, ‘Wow, he really got his bell rung on that play.’ It’s almost like, ‘Yuk, yuk, yuk,’ as if they’re joking. Concussions are no joke.”

That sounds very similar to what we are discussing now in 2012.

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•Of the 1.5 million high school football players in the U.S., 250,000 suffer a concussion in any given season, according to a survey conducted for The American Journal of Public Health.

•A player who has already suffered a concussion is four times more likely to get one than a player who has been concussion-free. Quarterbacks, running backs, receivers and defensive backs are most vulnerable, […] that special teams players were at the highest risk per minute spent on the field.

•Concussions are underreported at all levels of football. This is partly because of the subtlety of a mild concussion (unless a player is as woozy as a wino, the injury might go undetected by a busy trainer or coach) but primarily because players have bought into football’s rub-dirt-on-it ethos. “If we get knocked in the head, it’s embarrassing to come to the sideline and say, ‘Hey, my head’s feeling funny,’ ” says San Francisco 49er quarterback Steve Young, who has suffered at least a half dozen concussions. “So I’m sure we’re denying it.”

•Football’s guidelines for players returning after concussions are sometimes more lenient than boxing’s. The New Jersey Boxing Commission requires a fighter who is knocked out to wait 60 days and submit to an electroencephalogram (EEG) before being allowed back into the ring.

•According to Ken Kutner, a New Jersey neuropsychologist, postconcussion syndrome is far more widespread than the NFL or even those suffering from the syndrome would lead us to believe. […] Kutner says that the players fear that admitting to postconcussion syndrome might cost them a job after retirement from football.

Hmmm, we all thought this was information new to us – new being 2008.

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That, however, doesn’t console Lawrence and Irene Guitterez of Monte Vista, Colo. “He just thought it was something trivial,” Irene says of her son, Adrian, who was a running back on the Monte Vista High team three years ago. “He had a headache and was sore, but it seemed like cold symptoms. He wasn’t one to complain. He wouldn’t say anything to anybody. He wanted to play in the Alamosa game.”

He did play. At halftime Guitterez, who had suffered a concussion in a game two weeks before and had not yet shaken the symptoms, begged teammates not to tell the coaches how woozy he felt. When he was tackled early in the third quarter, he got up disoriented and then collapsed. Five days later he died.

Years later another Colorado high school football player, Jake Snakenberg, would unfortunately repeat history; leading to the concussion legislation passed in that state.

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Do you have a guess on the year… Continue reading

Comments About Wagner/Deadspin Article

The comments on this blog have been on point but I was able to find some other very informed comments regarding the information provided in the Deadspin article via Football Outsiders;

by MJK :: Thu, 06/21/2012 – 6:46pm

Interesting article, but there’s some things in it that are decidedly wrong, and others that are completely ridiculous. The idea that increasing intracranial pressure through trapped blood accumulation could somehow “cushion” the brain and reduce the impact force of the brain as it “sloshes” in side the skull was obviously dreamed up by someone that has no grounding in biomechanics whatsoever. First, many head “mild” injuries (the ones that don’t involve skull fracture or haematoma) occur because of rotation of the head, not linear impacts, and suppressing brain motion relative to the skull won’t do a thing to help that. Secondly, CSF is essentially water from a physical response standpoint–and if you have an object floating in water, increasing the pressure in the water doesn’t do a single thing cushion the object floating in it.

The other major issue that I can see is, based on the doctors and biologists I’ve talked to, the accumulation of tau protein associated with CTE can take a minimum of many months, and more generally several years, to occur after the head traumas that triggered it. Also, apparently once you hit a critical threshold level of tau buildup, it becomes self propagating, even if you don’t have any additional head trauma. So monitoring the increase in tau protein wouldn’t be a good way to decide when to hang up the cleats…you could quit when you were still at a “healthy” level, it could take a couple of years to accumulate more, hit the threshold, and you could still end up with early onset of dementia or other lasting brain injury.

The article also touches briefly on, but glosses over, an alternative diagnosis technique that does show promise…diffusion tensor imagine MRI. Although poorly understood, there’s some really promising research about using it to track the biomechanical insults that could lead to long term tau protein buildup.

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by akn :: Thu, 06/21/2012 – 7:25pm

This entire article sounds like the author took the researchers’ grant proposal and Continue reading