Concussion on XBOX 360?!?

It is pretty scary that simulations of NFL games have players leaving the game from concussions:

"...but Jones absorbed a vicious hit from SS Rodney Harrison and looked rattled. However, it was Harrison who got the worst end of it suffering yet another concussion that will sideline him for the rest of the game."

Gradual onset, gradual recovery

Here is an example of a player who didn't even know he had a concussion for several days:

"I noticed when I got hit that I hit my head and I didn't feel bad the next day -- or the next three or four days..."

"I played two more and it slowly got worse and I felt before the game in Denver [Dec. 23] that something wasn't right."

After sitting out 6 games over 2-3 weeks, gradual return to exertion appears to be the key, with two days of symptom-free biking. However, it doesn't sound like this guy is quite ready:

"It's tough to explain to someone who hasn't had one [concussion]," he said. "It's been a different experience and at times tough days, but I feel better. I've had some good days and you wake up the next morning and feel not as good.

"But I feel optimistic. I still have some slight [headaches] but not as bad as I used to."

Why we need trainers at ALL athletic competitions

Some schools recognize the importance of having trainers on-site during athletic events.

"I had a kid drop out of a drill in practice, he was face down, and I didn't know if it was heat-related, or what," said Nick Collins, the head football coach. "We have kids get hit in practice and we need someone there who is skilled enough to evaluate for a concussion."

I know it is a big jump from college to high school, but imagine if there was no trainer at Washington State, where a college basketball player was struck in the head during a practice, collapsed and appeared to stop breathing.

"...took an elbow to the face during the scrimmage... he went down on all fours, rose to his feet, and walked off the court before falling to his knees, then collapsing on the floor."

the trainer administered mouth-to-mouth resuscitation for one breath before he responded and regained consciousness

Back from a long hiatus

Got wrapped up in life, but hockey season is in full swing. Patrice Bergeron is still experiencing symptoms from a concussion sustained in Oct 2006, Joffrey Lupel is recovering from a concussion and a bruised spinal cord, reporters are listing the the 7 deadly sins associated with hits in the NHL, and even other bloggers are talking about concussions in the NHL.

So much for web dominance!

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.

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...

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.

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."

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!?!

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."

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)

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

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!

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.

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.

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.

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?

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."

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...

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.