Wednesday, October 10, 2007

Just like Grandpa!

Research has show there may be prolonged effects of concussion in youth athletes, and this college freshman is still experiencng effects of concussions sustained in high school:
"Matt... suffered two concussions while playing high-school football. Now a freshman in college, he is still affected by the injuries. "My friends always laugh when I say my memory is not what it used to be... but it's kind of sad because that's the sort of thing my grandpa says, and he's 90 years old."

When you see pro athletes having lower thresholds following their umpteenth concussion, you have to feel for a concussed college athlete trying to make the pros.

Tuesday, October 9, 2007

Scrambled eggs...

It is sad to see a photo like this and read the accompanying article about Trent Green after sustaining what appears to be his 7th concussion.
"Last summer, Miami Dolphins defensive end Jason Taylor offered an indelicate but eerily prescient prognosis for quarterback Trent Green. One more hit, Taylor told Sports Illustrated, and Green would be “scrambled eggs.”

On Sunday, when Green sustained a serious concussion against the Houston Texans after he took a knee to the side of the head while attempting a block, something else got scrambled: his football future.
As we know the effects of concussions are cumulative, let's hope Green makes a sensible decision, after he fully recovers...

Monday, October 8, 2007

More on Mouthguards and the NFL

Mouthguards have been receiving a lot of press as of late, and rightfully so. It is good to see potential solutions being discussed:
"Players who use (the) device swear by it. Any kind of mouthguard would probably help, for that matter. The NCAA requires them. The NFL doesn't, and 40 percent of players don't bother.

You'd think the NFL would want to protect its investment. Apparently you've got to look out for yourself."
It is good to see that Pellman is no longer running things, and if he was wrong about when to return players to action after a concussion:
"...what really sunk Pellman's argument was his response to reports that 15 percent of NFL players return to play immediately after a concussion and 34 percent come back later.

"If a player feels good, what's the contraindication to letting him play again?" Pellman asked the magazine. "There is none."
... he may have been wrong about mouthguards.
"Pellman told the magazine he doesn't believe the mouthguards are viable.... a debatable point..."

I would love to see a longitudinal or retrospective study by the NFL on the efficacy of mouthguards. They cost very little, and should be considered in the same category as helmets - mandatory.

Friday, October 5, 2007

You don’t get another brain.

Follow-up commentary on yesterday's post reveals that the beat writer "gets it":
"No one at UT will actually admit McCoy suffered a concussion, which I find troubling.... the medical staff issued a statement that said the quarterback had “symptoms” of a mild concussion.

-------------

It’s simplistic but true. A concussion — even a mild one — results in an injury to the brain. It’s one thing to let Jon Kitna of the Detroit Lions talk his way back onto the field after a concussion because he’s a professional earning millions of dollars. The same goes for Julius Jones, who said he suffered concussions in two of the Cowboys’ first three games.

But McCoy won’t earn a nickel for Saturday’s game.

Just about every piece of medical evidence available suggests once a person has a concussion, he’s susceptible to having another — and usually more severe.

Beating OU simply isn’t worth the chance."

Thursday, October 4, 2007

One step forward, two steps back...

Truly scary, given the knowledge out there, that the following passage could appear in print:
"McCoy threw four picks, one of which was returned for a touchdown, and left the game twice after getting driven into the turf by a defensive lineman.

Team doctors said he showed symptoms of a concussion -- vomiting and dizziness late in the game -- but nobody at Texas will say outright whether he suffered a concussion.

"I don't want to talk about it much," McCoy said. "I'll be fine. I've been with the doctors and trainers. We'll be OK."

Hmmm... let's see... driven to the turf, vomiting and dizziness, can't say he experienced a concussion.

Are you sure you want your kids playing football!?!

Wednesday, October 3, 2007

Is it as simple as it seems?

If blows to the jaw transfer force to the skull, or if having a chinstrap on a helmet helps transfer energy to the skull in a collision, what could be the resistance to wearing custom mouthguards?
"It’s a device, Maher said, that’s simple and effective—two small pieces of acrylic that fit over the back four teeth of each side of the lower jaw, linked by a thin ‘‘lingual bar’’ that rests behind the front teeth and allows better breathing and communication than the conventional wraparound mouth guard.

Maher’s mouth guard brings the lower jaw slightly forward, moving the condyle (the nobby tip of the jaw) to rest against a slightly thicker portion of the skull, thereby providing more cushioning. The mouth guard also ensures that the condyle does not slip off the thin disk of cartilage that is supposed to sit on top of it and act as a ‘‘shock absorber.’’

The point is to make the jaw absorb and dissipate the force of a blow that otherwise would radiate upward into the skull, where it could rattle the brain."

Tuesday, October 2, 2007

Don't you know that it's different for girls?

The NY Times has a great article on gender differences in concussion rates. While we do not quite know why, girls get concussions at a higher rate than boys: (free subscription required)
"Doctors are also uncertain as to why documented rates of concussion among high school girls are consistently higher than among boys in the same sports. The primary theory is that girls might be more honest in reporting injuries — though experts are confident that many girls, just like boys, hide injuries either because they are not aware of the risks or because they simply do not want to miss playing time. Other rationales include the fact that girls’ neck muscles are less developed than boys’, providing less shock absorption during impact."

Regardless, parents, be aware with girls playing sports that are not considered "contact" sports (soccer, lacrosse, field hockey, etc)

Thursday, September 20, 2007

In the National News

While it is not a major revelation, it is good to see that concussion management is the focus of a series this week on NBC News

Wednesday, August 22, 2007

Good to see High Schools getting involved

A recent article in the Philadelphia Bulletin shows concussion testing making its way into area high schools. This can only be a good thing, but more needs to happen:
As of now, no high school league in the Philly area mandates that concussion testing be a part of every sports season. And the Pennsylvania Interscholastic Athletic Association, the organization that oversees the majority of high school athletics in the state, has not fully discussed implementing the testing either, although it may be on the docket the next time its Sports Medicine Advisory Committee meets, according to PIAA Assistant Executive Director Melissa Mertz.

If your kids/friends/etc are involved in High School athletics, talk to the Coach, Nurse, Principal, etc... have them e-mail me if you need some help!

Tuesday, August 14, 2007

Back from hiatus, NFL is getting serious

Took some time this summer to regroup.

Recent news suggests that the NFL is getting serious about concussion management:
The NFL's new guidelines on concussion management include a telephone hotline that will make it easier to report to the league when a player with a head injury is being forced to practice or play against medical advice.

The league's new concussion guidelines... include whistleblower provisions for individuals to report concussions with the telephone hotline and a booklet that will allow players and their families to identify symptoms.

Sunday, July 1, 2007

Concussion and Dementia, continued...

You have likely heard of Chris benoit, the wrestler who killed himself and his family. I was wondering how long it would take to make the "concussion->dementia->depression->suicide" claim, but it appears to have happened. It seems that despite a lack of concussion history, Benoit's "signature move" was to dive off the top ropes of the wrestling ring and land head-first on his opponent:
Benoit's signature move was an aerial leap off the top of the ring post, which sent him airborne toward his opponent, who invariably was lying on the mat. It was designed to look as if he were spearing his rival. But Benoit pulled up just before impact, absorbing most of the stress himself. That caused his neck to become so fragile that he underwent surgery in 2001 to fuse his vertebrae. It kept him out of wrestling for nearly a year.
According to this article:
Researchers involved with the study of brain trauma in deceased NFL players are seeking permission to look at Benoit's brain to try to learn whether head trauma might have played a role in Benoit's condition.

Thursday, June 21, 2007

Is portable imaging the answer?

A company producing portable CT scanners, NeuroLogica, supports the NFL summit to review concussion policies. Evidently, their CereTom scanner was adopted as the "Official Scanner of the De La Hoya/Mayweather fight", and
NeuroLogica recently received accolades from medical staff ringside at the Oscar De La Hoya - Floyd Mayweather fight on May 5, as the company provided its mobile, cordless CT scanner, the CereTom, to scan boxers post-fight. The company scanned eight boxers following fights throughout the weekend, and potentially saved one man's life by identifying a brain bleed that otherwise may have gone undiagnosed had he not been scanned.
The problem is that concussions rarely involve positive finding on neuroimaging... other than the extremely rare moderate-to-severe closed head injury with intra-cranial bleeding, a CT-scanner will likely show nothing following an concussion.

Monday, June 18, 2007

Roethlisberger on helmet use

One-year after his motorcycle crash, Ben Rothlisberger was interviewed about his accident and its aftermath:
The 25-year-old Roethlisberger was asked to do public service ads advocating the use of a helmet while riding a motorcycle in Pennsylvania, but declined to do so.

"I think it's every person's decision, whatever they want to do," he said.
Pennsylvania's Motorcycle Helmet law is ridiculous, as is any law that decreases use of death-preventing safety devices, but this guy is lucky to be alive... maybe he still has lingering effects of that concussion?

Tuesday, June 12, 2007

When in doubt...

sit them out.

A well-known phrase championed by Dr. Robert Cantu, and reaffirmed in this news article:
...high-schoolers are more vulnerable to concussion than younger athletes. "Their brains seem to be in a second window of development," Rieger explains. "Because of what's going on metabolically, the brain seems to be more vulnerable to injury and takes longer to recover." And, someone who has suffered one concussion is more at risk if they suffer another. The symptoms can last longer, and recovery can take longer.

If you are a parent or coach, and you're unsure how seriously a player was hurt, Rieger says pull them from the game. "When it doubt, sit them out."

Monday, June 11, 2007

NFL needs to get things corrected

So, the authors of a controversial article in Neurosurgery claim that the actually disputed the findings that it is safe to return players to the same game in which they were concussed:
Two of the five authors of the paper published in the journal Neurosurgery, Dr. Henry Feuer of the Indiana University Medical Center and Dr. Cynthia Arfken of Wayne State University, said in telephone interviews last week that the paper’s conclusion was inappropriate, and that the research should not be applied to high school and college players.

The NYTimes article goes on to state:
Arfken and Feuer thereby joined critics who had long claimed that such a suggestion was dangerous for younger players. Their less-developed brain tissue is believed to be more susceptible to short- and long-term damage than adults’. They also receive considerably less medical attention than players in the N.F.L.

The NFL has boldly stated:
On behalf of the N.F.L., the league spokesman Greg Aiello said in a statement, “We do not believe, and have never suggested, that the experience of N.F.L. players, or the return-to-play decisions of team physicians, should guide the management of concussions in high school or college players.”

Sounds like this upcoming summit on Mild TBI is a good idea...

Tuesday, June 5, 2007

Word is getting out

Concussion appears to be the hot topic in the news lately. NFL coaches and players are talking about the importance of concussion management, NFL Coaches and Owners are trying to stop head-shots, and we have stories popping up on MLB players, Professional Wrestlers, and even on fantasy baseball sites.

Now, if only there were "concussion centers" for concussed kids, like the one this 11-year-old went to.

Thursday, May 31, 2007

As the NFL Turns...

Interesting that a new study on retired NFL players with a history of 3+ concussions, conducted independent of the NFL, found different results than the NFL found in their studies.

Guskiewicz and colleagues found that
retired NFL players who had at least three concussions during their careers had triple the risk of clinical depression as those who had no concussions... Those who recalled one or two concussions were 1 1/2 times more likely to be diagnosed with depression


On the other hand, the NFL found that concussed players returning to play in the same game showed :
Fewer initial signs and symptoms than those removed from play. Return to play does not involve a significant risk of a second injury either in the same game or during the season. The current decision-making of NFL team physicians seems appropriate for return to the game after a concussion, when the player has become asymptomatic and does not have memory or cognitive problems.
...but for players sustaining concussions requiring more than 1-week removal from the game:
only 1.6% involved a prolonged postconcussion syndrome. They recovered from symptoms and had a consistent return to play in the NFL.
It doesn't take a neuropsychologist to realize that something is wrong here....

Tuesday, May 29, 2007

On the right track

Hopefully, the NFL will get it right with their new concussion management rules:
Neuropsychological baseline testing will be required for all NFL players beginning this season, using a standardized test to establish an individual functional baseline. Neuropsychological testing is one tool a physician can use to assist in the management of MTBI. It cannot be used by itself to make clinical decisions. For players removed from games due to concussions, repeat testing will be done during the season to track recovery and to help decide when they can return to play. These players also will be re-tested against their baseline performance the following season at training camp.
Maybe they can follow the guidelines of Australian Rugby:
..."He has a concussion that is being monitored and will return to training dependent on when his headaches go away. You have to wait until your headaches go away, you have got normal concentration and your appetite returns and all of those symptoms go away."

Tuesday, May 22, 2007

New worry for parents?

It seems that "helmet boxing" has become a popular backyard sport (see YouTube), but it is anything but "safe" simply because helmets are in use:
To play, each individual dons a helmet with a face mask, along with a pair of gloves, and then each hits each other in the head until someone passes out, a helmet gets knocked off, or someone simply throws in the towel.
The linked article points out that while the American Academy of Pediatrics has no "official stance" on helmet boxing, they do
consider it to be on the "same playing field as regular boxing," which has been deemed unsafe for "young children with developing brains."
Concussions during childhood are now being recognized as mor ethan one-time benign incidents, as seen by this blogger's recent post:
...because it’s not yet known how such head injuries will manifest themselves in today’s athletes 15 to 20 years from now.

Monday, May 21, 2007

Every now and then...

we get some good press on concussion. A recent article in the Baltimore Sun talks about the "hidden" nature of concussion, and how not enough information is know where it is needed most:
"When someone gets injured and goes to a pediatrician or the emergency room, the information they get is wildly variable and the symptoms may not be recognized as a concussion."
As for why concussions go unreported:
"It goes back to [the fact] we don't have a certified athletic trainer in every school, at every game and practice. It's fallen into the hands of the coach, and it's not their expertise."

Saturday, May 19, 2007

Global Retrograde Amnesia

Here is a strange case of a high school girl who fell and hit her head playing soccer in a non-contact situation. After what sounds more like a moderate-to-severe TBI, neuroimaging was negative but she experienced complete retrograde amnesia for all information prior to her injury.

She returned to school and soccer, with headaches and some academic difficulties, but is going on a 4-year college soccer sholarship next year that she earned "before coaches knew about her accident."

Friday, May 18, 2007

Who is making the decisions here?

A high school lacrosse player is ok'd to return to play 3 days after sustaining a concussion, and just 10 minutes before the game. After playing, he says:
"I didn't feel it during the game but now I'm starting to feel it..."
The player said he wasn't concerned about the concussion during the game.
"You can't put that stuff into your head before a game, I was just zoning it out and just played."
Perfect... just ignore the symptoms and focus on the game. Great example for the need to educate players, coaches, and parents, especially when there are limited sports medicine personnel involved.

Thursday, May 17, 2007

Excellent diagnostics

Amazing... a catcher takes a direct hit from a baseball in the forehead, is "dazed and stunned", is later suffering from headaches, and this is a repeat of a similar incident from last year in which he did suffer a concussion, yet the coach states:
"He’s hurting right now. He took quite a shot. He’s fortunate he didn’t get a concussion. He has swollen eyes and some severe headaches."

This high-school baseball coach is clearly unable to accurately identify symptoms and severity of concussion, as headache clearly means something.

Wednesday, May 16, 2007

Very real dangers

Youth athletes are even more vulnerable after concussion than adults, as seen in this unfortunate case of a teen rugby player who returned to play too soon after a concussion.

Tuesday, May 15, 2007

Getting started

Back in October 2006, ESPN aired an episode of Outside the Lines on the controversy regarding how the NFL is managing concussions in their players. Other concussion-related press included the link between Andre Waters' suicide and depression and concussion.

HBO aired a segment on the long term effects of concussion last night (May 14th) on Real Sports, and interviewed Chris Nowinski, author of Head Games.

Hopefully, there will be some positive outcome from an upcoming NFL summit on concussion headed by the new Comissioner, but only time will tell.

I've been e-mailing students from a class on TBI and Concussion since the semester ended, and thought this would be a better way to communicate updates to them and anyone else interested. Keep posted...