2010 Head Trauma & The Athlete

On Friday October 1st, this conference was held with 192 in attendance listening to the 11 speakers about how head trauma is affecting sports/athletes in Boston, MA.  More importantly it was being discussed how the young athlete is most susceptible and preventative steps must be taken.

Chris Nowinski, co-director of the Boston University Center for study of CTE, and advisory board member of www.sportsconcussions.org, was to the point about reducing hits to the head of individual athletes,

“We can have a way to reduce the number of hits in the head from 1,000 to 300, tomorrow.”

But a lot needs to be studied and in order to do that more brains are needed.  Thankfully there are some out there that are willing to donate when the time comes.

Some 350 athletes, from all sports and including amateurs, have agreed to donate their brains to the Boston University center since the program’s inception last year; its goal is 750 donations. Meanwhile, six retired pro athletes are participating in a study in which their brains undergo state-of-the-art imaging tests, and they already have produced evidence of lost brain tissue compared to non-athletes.

Next month, the center directors said, 200 retired NFL players of all ages and years of experience will begin a program of neurological, psychiatric and medical study that will include spinal taps, to track potential brain injury and disease and find other ways that they can be diagnosed.

Read the entire story here.

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Congressional Hearing

Today there was a hearing on the concussions and how they affect the student-athlete on “The Hill”.

Protecting Student Athletes from Concussions Act is what it will be called.  It is suspected that they will use language similar to Lystedt Law in Washington.

All of this is supported by the NFL and other sanctioning bodies.

CNN.com has a story

Hearing On The Hill

ANNOUNCEMENT
Full Committee Hearing 10:00 AM, September 23, 2010 2175 Rayburn H.O.B.
Washington, DC
 
On, Thursday, September 23, the House Education and Labor Committee will discuss legislation to reduce and more safely manage concussions in student athletes.  At the request of several members of the Education and Labor Committee, the Government Accountability Office (GAO) investigated the prevalence of concussions in high school athletics and found that concussions often go unrecognized. Recent research shows that concussions can have serious repercussions for student athletes both on the field and in the classroom. During the 2005-2008 school years, an estimated 400,000 concussions occurred in high school athletics – brain injuries that often go unnoticed and untreated.

The Protecting Student Athletes from Concussions Act would establish minimum standards in K-12 schools on concussion safety and management, including educating students, parents and school personnel about how to recognize and respond to concussions. The Education and Labor Committee held a full committee hearing on the issue in May and hosted a field hearing in Long Island, New York in early September.

 
 

Concussions By Sport

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

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.

Chicago Bear Out For Season

Hunter Hillenmeyer was placed on a season ending Injured Reserve.  According to the Chicago Tribune Hillenmyer believes that he is suffering from the continual effects of a concussion sustained in the preseason.

However there is a unique quality to this particular case, and that is the fact the Hillenmyer is one of the NFL players that have made the decision to donate their brain for NFL research.  This of course will happen after he has a long and wonderful life.  The NFL and others are interested in the long-term effect of multiple concussions and how they may relate to Traumatic encephalopathy.

Hillenmyer is also one of the most active advocates for player safety, where his personal focus has been concussions.

Research

A diagram of the forces on the brain in concussion
Image via Wikipedia

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.

Why the increase in concussions?

Bar graph of the incidence of mild traumatic b...
Image via Wikipedia

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.

Recent WebMD Article