Saturday, April 5, 2008

Hidden Wounds of War

I guess I am in a political mood as of late, as this article caught my eye this morning:
Some 1.6 million Americans have served in Iraq and Afghanistan, more than 31,000 have been wounded in action and many more have sustained non-combat injuries or illness. TBI has been called the "signature injury" of this war, and the improvised explosive device (IED) is the leading cause of fatalities and brain injuries..

These powerful devices inflict severe damage and blast shock waves through the body, including sudden and violent impact to the skull causing damage to brain tissue. The resulting TBI can be fatal, or require immediate hospitalization. But more often the result of exposure is a less obvious concussion.

Despite the high incidence, there is little by way of diagnosis, let alone treatment:
Current estimates are that 10 percent to 20 percent of all U.S. military personnel in Iraq suffer concussion. Army studies show less than half of those exposed to IED blasts receive any evaluation.

In the environment of war, such symptoms can go unnoticed and unreported. Experience from sports and other noncombat injuries has shown that if an injured individual sustains a second concussion before resolving symptoms from a previous injury, a "second impact syndrome" can occur with dire, even life-threatening consequences. Repeated concussions cause cumulative damage and slow recovery.

Monday, March 24, 2008

It's a concussion; take it seriously.

Two articles showed up recently, both related to concussions and kids.

Dr. Michael Stuart writes an excellent primer for parents, and Dr. Gerard Gioia is mentioned in a press release about his "SCORE Program:
The program is one of the first of its kind. Currently, most concussion management programs for youth sports lag behind collegiate and professional sports, despite the serious consequences of brain injury on a developing brain.

"Implementing an effective sports concussion management program is essential to safeguard young participants and reduce long term risks,” writes Dr. Gioia. “Management of this serious injury must consider the various effects in the home, school, social and sports environments.”
Consider these "must-read" resources for someone new to concussions.

Thursday, March 20, 2008

Interesting Logic

Pardon the brief political slant, but it appears that returning Vets from Iraq did not receive evaluations to diagnose Mild TBI:
"The fear of discovering a massive war syndrome among American troops returning from Iraq was the cause of Pentagon's postponement of routine brain screening among American soldiers for mild brain injuries.

Col. Kenneth Cox, head of Pentagon's medical assessment division, explained the Department of Defense delayed the conduct of brain screenings to steer clear of another potential Gulf War syndrome discovered among American soldiers in the 1990s."

On the bright side, the DOD has granted significant funds to researchers studying Mild TBI:
The Department of Defense has awarded a consortium of Houston institutions a $33 million grant to investigate mild traumatic brain injury, or concussion, the potential severity of which has long been underappreciated.

The grant, an unusually large amount for the government, targets better understanding and treatment of the injury that afflicts about 1.5 million Americans a year and is considered one of the Iraq war's signature wounds.

Valadka said one emphasis of the research will be to determine if the mild traumatic brain injury suffered in blast explosions is similar to such civilian injuries. If so, the research will have great applicability, he said.

However, the project will not end until 2013, so it willbe a long while before these efforts translate into results.

If you are not registered, please register and vote.

Monday, March 17, 2008

Research reveals brain changes from concussion

Dr. Erin Bigler, from BYU, has identified "subtle but significant" brain changes that normally go undetected using traditional imaging techniques. In this article they explain the benefits of using diffusion tensor imaging (DTI to look at what he calls "the microenvironment" of the brain, an analysis not provided by traditional MRIs:
The researchers found differences in the appearance of the corpus callosum, which separates the right and left sides of the brain, in 10 teenagers who had sustained concussions one to six days previously and who suffered symptoms such as headaches. The study compared these to the brain images of 10 uninjured teens.

The study found that the concussion patients with the worst symptoms had the most substantial changes on the DTI images. Because the DTI imaging is still "several steps removed" from looking at actual brain tissue, Bigler explains, it's hard to tell if those changes represent swelling.
This story will likely hit the AP and Reuters in the next few days, and should span a tremendous amount of new research.

Thursday, March 13, 2008

What is a Concussion Worth?

On Wednesday (March 12th) Buffalo defenseman Nathan Paetsch was knocked unconscious by a "cheap shot" elbow (see the video here). The offending player, Georges Laraque, was suspended for 3 games, while Paetsch remains out "indefinitely".

Interestingly, if you watch a hit Paetsch took only two days ago in a game against the Rangers, you can see that he was clearly concussed as he lay motionless on the ice. In fact, in this ESPN article referring to his condition in the Pittsburgh game, they say:
"Paetsch was already sore, playing with a stiff neck after he was checked heavily into the boards by New York Rangers' Sean Avery during Buffalo's 3-2 shootout loss on Monday."
Not to suggest that Paetsch could have avoided the elbow, but it is possible that he not only shouldn't have been on the ice, but the fact that it appears to have been his 2nd concussion in 3 days may have contributed to the severity.

Friday, March 7, 2008

Recovery times

Conventional wisdom states that athletes tend to recover in 7-10 days, with some requiring up to 30 days, and only a select few experience lingering symptoms akin to "post concussion syndrome".

Let's see how concussed athletes in the recent limelight fared:

Some players are out for their season:
Tiffany Roulhac (NCAA-W-Basketball) - out for the season following 2nd concussion.

Mark MacDonald (NCAA-M-Basketball) - Missed 10 games so far (2 months+)

Simon Gagne (Professional Ice Hockey) - Out for the season after suffering 3rd concussion.

Some players miss extended playing time:
Taylor Procyshen (Minor League Ice Hockey) - Missed 21 games (approx. 2 months)

Tracey Kelusky (National Lacrosse League) - Missed 8 games (Approx 2 months).

Other Players miss only a few games:
Tyler Morris (NCAA-M-Basketball) - Misses 2 games (approx 1 week), now practicing.

Chris Higgins (NCAA-M-Ice Hockey) - Missed one game

And some players don't even leave the game in which they sustained the concussion:
Kate Lance (High School Girl's Basketball) - Returned to the same game after falling face-first during overtime, but returned to hit the game-winning shot, then was examined by doctors to determine if she suffered a concussion and, possibly, a broken nose.

Tuesday, March 4, 2008

Concussions and then some!

Looking at concussion-related news articles for months and months has revealed that concussions do not always happen in isolation, often with other secondary injuries, some of which could be expected:

Concussion and shoulder separation (Hockey):
"Smyth suffered a concussion and a minor shoulder separation after Kings defenseman Jack Johnson checked him into the padded glass partition near the Colorado bench. The Avalanche said Smyth won't return to the ice until he shows no lingering signs of the concussion.

Concussion and spinal contusion (Hockey):
"Lupul returned to the lineup Feb. 9 after missing 14 games with a concussion and spinal contusion."

Concussion and broken nose (Hockey):
"Bergeron was leveled from behind by Flyers' defenseman Randy Jones and went head first into the boards. He suffered a serious concussion and broken nose and has been absent from the Bruins lineup since late October."

Concussion and brain tumor? (Rugby):
"Wallaby fullback Julian Huxley discovered he had a brain tumor after undergoing medical scans following a concussion in a weekend Super 14 match. Huxley was cleared in preliminary scans after he was carried from the field after having convulsions following a head knock in win over Queensland on Saturday night."
It's not very often that neuroradiological studies are positive, so this would definitely be a case of a concussion being a good thing!

Thursday, February 28, 2008

Athletic Trainers vs. Trainers

Athletic trainers affiliated with the National Athletic Training Association (NATA) are distancing themselves from Brian McNamee, who has admitted to injecting Roger Clemens with HGH:
The guy who works with boxers is referred to as a trainer, and though he trains boxers, per se, he's a far cry from an athletic trainer who is focused on injury management and injury prevention. We have medical backgrounds and training. And we know the limits of what we can do. We can evaluate and treat an injury, but we never give injections, and we do not prescribe medicine."

Sheridan, 38, first heard the word trainer while watching the 1976 movie Rocky as a youngster. "Did Mick know how to prepare Rocky for the fight? Yes," Sheridan said. "But did Mick know if Rocky had a concussion? Did he know how to evaluate it and treat it? No. But that wasn't his concern. His concern was to prepare Rocky to fight, not medically manage him."
I can imagine a scene in the politically correct version of Rocky 2012:
INT: BOXING RING: CORNER: ROCKY JR. SLUMPS IN THE CORNER

Rocky Jr.: "I can't think out there Mick, I see double, the lights bother me, I have a headache"

Mick Jr.: "What month is it? Snap out of it Rock! What's the date, the day, the year? Tell me the damned months in reverse order Rock!

How to recover from concussion

Some folks require "peace and quiet to recover from a severe concussion", others are able to "shake off a mild concussion", while others simply "brave a concussion".

Tuesday, February 26, 2008

Cumulative Effects=Get it Right the First Time

So, Flyers' forward Simon Gagne is out for the season after returning too early following a concussion this season:
"James Kelly, a concussion specialist at the University of Colorado department of neurosurgery, told Gagne on Wednesday that his initial brain injury had never healed. Consequently, it got progressively worse with subsequent blows to the head.

"It's one concussion," Gagne said Kelly told him. "It got worse and worse. Every time I was getting hit to the head, the symptoms were coming back."

This does not bode well for players like Gerald Wallace, who suffered his 4th concussion in four years:
"Wallace visited a neurologist Tuesday, four days after the forward was knocked unconscious when he was hit in the face with an inadvertent elbow from Sacramento's Mikki Moore. It was Wallace's fourth concussion in four years, an all-too-familiar statistic for football players, but almost unheard of in basketball.

While Wallace is out indefinitely, there are concerns about his long-term health and questions about what can be done to protect him when he returns.

Let's hope that Wallace takes his time coming back. Concussion testing guidelines can only take you so far, but if the players are going to deny symptoms, there isn't much to protect them.

Tuesday, February 19, 2008

Concussion becoming an common adjective?

Concussions have become so commonplace, the term is being used as an analogy outside of the sports pages. From food descriptions:
"The cucumber was crisp and juicy. Above the sweet, fresh, salty, marine taste of the geoduck, other flavours spun around like the stars of a cartoon concussion"
...to veterinary diagnoses:
"...the owl had been hit by a car about three weeks ago and was sitting on the side of the road with a concussion and an eye injury.
Even in the sports pages, the term needs creative modifiers, as in this minor league re-cap:
"Bell was later taken from the arena on a stretcher, and was hospitalized overnight with what Phoenix coach Brad Church called "an extreme concussion."
Extreme concussion?

Monday, February 18, 2008

Off the Beaten Path

Concussions come from a variety of sources:

Ice-dancing:
"That performance came first despite Chris dropping Frankie on her head while attempting a difficult manoeuvre during training on Friday. "I was really embarrassed. She said it wasn't my fault but she has mild concussion and her neck's been hurting ever since so I still feel like an idiot.:
Acting like a Jackass (link warning: TMI):
"This is not the first time father-of-one Johnny has been taken to hospital following a botched stunt.... while filming Jackass: The Movie in 2002, he was knocked out by one of his castmates and had to be treated for concussion.
Snowmobiling:
"A 13-year-old Mount Vernon boy who was unconscious for nearly 20 minutes after driving a snowmobile off a 20-foot waterfall Sunday was treated and released from St. Joseph Hospital the same day...Family members reported they could not awaken Janicki for nearly 20 minutes after the fall.... he was treated for facial injuries and a concussion
And just getting a cup of coffee:
"A visiting student from Rochester Institute of Technology slipped and fell on the sidewalk in front of the Starbucks Coffee on Saturday. The student hit her head and blood was seen in the snow where she fell... the report said she appeared to be visibly drunk, as were the other people with her, who were said to be extremely intoxicated and less than cooperative. The emergency medical technicians at the scene of the incident said she appeared to have a possible concussion and a small laceration on her head."
Be careful out there!

Sunday, February 17, 2008

The "grim reality"

Being a Philly guy, I suppose I am partial to home-spun news.It may only be two sentences in an article, but Phil Sheriden doesn't waste a word:
"The concussion epidemic in professional ice hockey is another issue that forces us to question just how much we're willing to ignore to enjoy these sports. Watching Simon Gagne follow the path blazed by Eric Lindros and Keith Primeau is slow torture, if you're a fan. Imagine what it must be like for the players.

Sunday, February 10, 2008

Getting the NHL On-board

There is an article on ESPN's web site (also referring to a really interesting video from CBC's Fifth Estate on Chris Benoit), calling on the NHL to "embrace concussion research":
"If the NHL proposed a study or investigation for such an effect, I'd be first in line," Keith Primeau, a 15-year NHL veteran who retired in 2006 because of post-concussion symptoms that still pop up from time to time in his life... "For me, for the day-to-day [post-concussion effects], I think I'm over the worst of it. I've been feeling really good in the last four months. It's been the most comfortable I've been in some time."
Referring to the possible long-term implications of his concussions, Primeau says:
"I've resigned myself to the fact I'm always going to have [symptoms] to deal with, and I hope that they'll be very intermittent, as they've started to become. But I know I'll always have these setbacks. They are a reminder of exactly the price I've paid."

"[Non-concussed players] can't possibly comprehend the severity and long-term ramifications of head injuries... as a sufferer, even I don't know what the ramifications are. I believe at some point in my life there's going to be a consequence; I just hope it's later rather than sooner."
While the NHL has a mandatory concussion testing program, there has never been any data released or published, although it is not known if the blame lies with the NHL or the NHL Players Association.

Friday, February 8, 2008

An Academic Injury

It is great to see a discussion of the social and academic changes following concussion, as found in Brown's newspaper:
Much as they would like to, they cannot treat concussions - the most common prescription is a healthy dose of rest. In time, patients recover on their own. But the meantime can be stressful for collegiate athletes in ways that have no relation to school or sport.

(One student) recalls his injury changing all aspects of his lifestyle - athletic, academic and social.

"I didn't watch TV without my sunglasses on for a month," he says. "You wouldn't believe how it affects your social life."

...one of the harshest symptoms of his concussion was a social awkwardness that accompanied him wherever he went. "It's something that not too many people around you understand," he says. "You don't walk around with a sign up saying, 'I'm concussed.'"

...an injury - especially one as private as a concussion - could intensify the already-demanding pressures of Brown's academic and social environment.

"I think they affect academics not only in terms of material retained, but there is a very real concern that any injury makes you feel very self-conscious, especially within the academic milieu of Brown. You worry you're going to appear dumber than everyone else," she says. "Many injuries are visual - someone's got a cast, someone's got an ice pack - and we have a certain amount of sympathy. But when you have an injury like a concussion, and it isn't necessarily explained to everyone, I think that itself becomes an embarrassment and a frustration."

Wednesday, February 6, 2008

Concussion Treatment?

Folks at the University of Buffalo have come up with a concussion treatment program:
"...the program entails controlled exercise at a level of stress that does not trigger the symptoms. Its effect is to correct imbalances in brain mechanism brought on by the initial blow, which cause the illness and headaches."
It isn't clear how exercise can alter the metabolic cascade following concussion, so it will be interesting to see if this paradoxical "treatment" is helpful.

Friday, February 1, 2008

New ION 4D Helmets in Super Bowl

A few players on the Giants will be wearing the new ION 4D Helmet this Sunday:
"According to the company that makes it, the helmet features a unique design that reduces the risk of concussions... if you look closely at the helmets of the four players on the Giants, offensive linemen David Diehl, Grey Ruegamer and Guy Whimper and long snapper Jay Alford, you'll notice that their helmet looks different than those of their teammates."
Perhaps more interesting is the Riddell Revolution IQ HITS, with:
"Head Impact Telemetry System (HITS™): On-board electronics record every impact, allowing players to upload and evaluate each occurrence on their home computers.... also provides the guidance necessary to understand and address a suspect impact if it is detected."
Researchers are using this helmet to relate the physics of the collision and incidence of concussion:
"Players who look like they have been hit really hard aren't necessarily the ones who will sustain the most brain damage, said Kevin Guskiewicz, professor of exercise and sport science and director of the Sports Medicine Research Laboratory at the University of North Carolina, Chapel Hill. "There's no relationship between the magnitude of the impact and the clinical outcome"

Other findings showed that a single knock to the head at an impact greater than 90g doesn't always result in immediate concussion symptoms, such as headache, nausea, blurred vision or ringing in the ears. In fact, location, not necessarily force, seemed to play a significant role in brain injury. Six out of 13 players that sustained a concussion had experienced impacts at the top of the their head, as opposed to the side."

Wednesday, January 30, 2008

Everything you need to know about concussion, from the Wakeboarding community

Who would've thought that a comprehensive and informative article about the pathophysiology and effect of concussion would show up in a Wakeboarding website. Some snippets:
"Let's start with a little lesson about the brain...

What actually happens when somebody gets a concussion...

After sustaining a concussion, the symptoms may last anywhere from a few minutes to several days or even longer. It is important to recognize when the symptoms completely fade away and know that until they are gone, you should avoid anything that may cause the brain to be rattled around even a little bit...

Basically, what really matters when returning to a sport is making sure you wait for all of your symptoms to disappear...

Whether you're a rider, driver or passenger out on the boat, knowing what a concussion is and what symptoms to look for can make a big difference when you or someone you know suffers a blow to the head....

Monday, January 28, 2008

Time and Rest

It is good to see an article get it right from the start:
A healthy brain will dictate Macartney's return to racing

...the injury Macartney sustained in a scary crash during the Hahnenkamm downhill Jan. 19 at Kitzbühel was a severe concussion — and the only thing that can fully heal a bruised brain is time and rest. A lot of rest. Doctors have instructed the 30-year-old U.S. Ski Team veteran downhiller to rest and let his brain heal.

Nine days post-injury, and he still has symptoms:
"The medical team at USSA will measure Macartney’s brain function and alertness with impact tests built around the baseline test Macartney took when he was 100 percent healthy. Six days after the accident, in which Macartney crashed off the final jump of the Streif course and banged his head multiple times on the icy track and losing consciousness, he was battling a slight headache and a general feeling of cloudiness.

“It’s an overall feeling of cloudiness, not as sharp on the recollection of certain people’s names,” Macartney said. “[I’m] going through things and saying, ‘oh yeah, what was that thing I was just talking about half an hour ago.’ A lot of that stuff is still not 100 percent.”

Sunday, January 27, 2008

Concussion Stories

It seems like there are more and more news articles mentioning concussion every day. Many of these articles appear to be reporting old news or how concussion testing is becoming more common, such as this story, though:
"...says the Panthers also took extra precaution when it came to a concussion. Every player with Carolina would have to take a computer test that measured your memorization and reaction time to a series of questions, and they'd write down your score... after you had a concussion, you had to take that test again. Until your score was back up to your original score, you didn't play."
Or this story about a baseball player with post-concussion syndrome 2 years after hitting his head:
"Koskie has suffered from postconcussion syndrome since he was hurt on July 5, 2006, while backpedaling to catch a popup... the symptoms lasted for months, and the Milwaukee medical staff thought he was experiencing anxiety or that the problem was in part mental... Koskie, who estimates he'd had anywhere from 8-15 mild concussions in his professional career, remembers feeling so tired for so long.

"I look back and say to myself, 'I decided to do that?' " he said. "I wasn't thinking properly. You think at the time you're OK, but then when you get tested and your cognitive skills are so poor, you realize in what kind of shape you're in.
And this article about the process a high school football player experienced recovering from a concussion last season:
"As he walked off the field with his teammates for halftime, he said, he knew things weren't right.

"I felt like I was in a cartoon," the senior receiver said. "I couldn't remember where I put my helmet. I put down my helmet and couldn't find it"... during the game he "felt silly" and was "cracking jokes." Everything was humorous, he said. Afterward, things weren't so funny. Hopkins suffered headaches and nausea after the game and went to the emergency room.

To compound his head injury, Hopkins was involved in a car accident in which his head hit a window. His concussion worsened. He had taken the ImPACT test once after his concussion on the football field. A week later he took it again.

"I did really bad" ... he did finally return to the field for the final two games. "It was another piece of reference I could bring to my neurologist. It gave me an idea how bad the injury really was. It really gave me an idea where I stood."