Head injury

7 East

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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.

Concussions By Sport

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Concussions are not exclusive to American football, although it is the most covered sport as it relates to concussions.  This is a good time to note that in the United States the next most concussive sport, is soccer, the number one sport in the world.

A reasearch project by University of North Carolina reported concussion rates by 100,000 athlete-exposures Continue reading →

Sobering Research from the Past

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First appearing in the Journal of Athletic Training in 2001, Frederick O. Mueller found that;

A football-related fatality has occurred every year from 1945 through 1999, except for 1990. Head-related deaths accounted for 69% of football fatalities, cervical spinal injuries for 16.3%, and other injuries for 14.7%. High school football produced the greatest number of football head-related deaths. From 1984 through 1999, 69 football head-related injuries resulted in permanent disability. Sixty-three of the injuries were associated with high school football and 6 with college football. Although football has received the most attention, other sports have also been associated with head-related deaths and permanent disability injuries. From 1982 through 1999, 20 deaths and 19 permanent disability injuries occurred in a variety of sports. Track and field, baseball, and cheerleading had the highest incidence of these catastrophic injuries. Three deaths and 3 injuries resulting in permanent disability have occurred in female participants.
 
 
I would be interested to see this study reproduced in 2010 or 2011.  There have been some deaths recently associated and blamed on high school football the most recent was Andrew “Drew” Fremont Swank, of Spokane, Washington.

Research

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A diagram of the forces on the brain in concussion
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This JAMA article is from 2003, but it does well to expose what we are currently seen with the concussion.  It is good to note that this study was with college aged individuals with a developed brain.  This study did not deal with the developing brain of adolescents.

Conclusions  Collegiate football players may require several days for recovery of symptoms, cognitive dysfunction, and postural instability after concussion. Further research is required to determine factors that predict variability in recovery time after concussion. Standardized measurement of postconcussive symptoms, cognitive functioning, and postural stability may enhance clinical management of athletes recovering from concussion.

Philadelphia Eagles Medical Staff Under Fire

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The Eagles’ team doctors and medical staff was cleared of wrong-doing when dealing with on the field concussions.  NFLPA Medical Director Dr. Thom Mayer determined that the medical staff followed proper procedures.  The return-to-play guidelines for the NFL are not un-similar to general guidelines for all athletes.

The issue arose when Stewart Bradley took a hit and struggled to get to his feet, and when he did, he did his best interpretation of a “punch-drunk” boxer.  That was an OBVIOUS sign of a mTBI/Concussion and should have been disqualified from further activity.  However, the medical staff did not see any of this as they were tending to a previous head injury sustained by Kevin Kolb.  Both players returned to play in the 2nd quarter and did not play again after the half.

According to the linked article, courtesy of ESPN and Sal Paolantonio, both players regressed in their initial on the field evaluation during half time, and were sidelined.

Andy Reid, the Eagles head coach, was also supportive of the initial decision for them to return-to-play.  Now the team will not practice either player until Friday at the earliest and continue to monitor their injuries.

As one can see there are issues with the RTP of concussions, at all levels.  But more importantly we can see that the injury known as a concussion is very different in presentation and resolving.  The great thing is that more and more people are aware, the next step is getting a policy in place that everyone can agree on.

Greater Awareness Leads to Increase in Hospital Visits

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Some North County hospitals, like those in the rest of the country, are seeing a spike in emergency room visits by young athletes who may have concussions, a sign that parents and students are taking head injuries more seriously than ever before.

North County Times, out of San Diego, CA ran this story about the increase in visits to the hospital for possible concussions.

They also cited a Pediatrics study, recently found in the journal, saying that hospital visits for possible concussion has doubled-tripled in the ten-year span of the study (1997-2007).

Awareness is getting better!

Related Articles

NFL Concussions Week 1

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To begin the season we have three players on IR with concussions;

  • Jay Thomas, CB, OAK
  • Mike Furrey, WR, WAS
  • Freddy Keiaho, LB, JAX

 

Preseason concussions listed as doubtful or lower on injury report;

  • Nick Sorensen, S, CLE
  • Brandon Ghee, CB, CIN
  • Jacob Lacey, CB, IND

 

And the reported concussions from Week One;

  • Kevin Kolb, QB, PHI
  • Stewart Bradley, LB, PHI
  • Kevin Boss, TE, NYG
  • Matt Moore, QB, CAR

 

Related Link…  NFL Doctor: Four concussions not a trend

More will be reported as the injury reports come out on Tuesday and this should be updated.  The next post on this subject will be the next injury report and we will list all the reported “head” and “concussion” injuries.

Why the increase in concussions?

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Bar graph of the incidence of mild traumatic b...
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Back when I played if you had a headache you were almost expected to return to play, no questions asked, in all sports.  This did not just go for the boys, the girls had to be tough too.  There was very little in the way of concussion prevention/education for sports, particularly at the high school setting.  Very few schools in the early to mid 90’s had athletic trainers or medical professionals dedicated to the high school, and even fewer that had AT’s that were progressive in head injury management.

Have have you seen the specimens we call kids these days on the playing fields/courts?  Sure when you were in school you had the “fast” or “big” friend that played sports, how many of us had the “huge-fast” or the “monster” friend?  How bout the style of play in sports?  I am positive that we were aggressive in sports, but not to the level we see it today.  The graph is from Langlois JA, Rutland-Brown W, Wald MM (2006). “The epidemiology and impact of traumatic brain injury: A brief overview”. Journal of Head Trauma Rehabilitation 21 (5): 375–8, and indicates that concussions are by far a bigger problem for the developing brain than adults.

There are a variety of reasons why we have seen an increase, but I do not believe we are seeing all of the brain injuries.  It is a great start and a wonderful job being done all over the place in terms of education.  The research of the brain, the concussion, and the long lasting effects of this injury and concurrent injuries is  getting better each year.  Along with that the recommendations from the medical professional and concussion societies are getting more and more protective of the individual.

One thing is for certain, we will continue to see the increase until we as professionals have attained a firm grasp on the mechanism and lasting effects on the growing brain.

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