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Jack Sisson's TBI Blog

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Concussions confer tremendous brain damage," reports CNN. That's the latest finding from the Center for the Study of Traumatic Encephalopathy (CSTE), at the Boston University School of Medicine. From a Boston University press release:
Leading medical experts at the Center for the Study of Traumatic Encephalopathy (CSTE) at Boston University School of Medicine (BUSM) reported today that nine-year NFL veteran, former Tampa Bay Buccaneer Tom McHale was suffering from chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by head trauma, when he died in 2008 at the age of 45. In addition, the CSTE has discovered early evidence of CTE in the youngest case to date, a recently deceased 18-year-old boy who suffered multiple concussions in high school football.
Jack has argued for many years that concussions were more serious than popular opinion made them out to be. In fact, he was concerned enough to found a study at his prep school alma mater that administers neuropsychiatric tests to every incoming athlete. This serves as the baseline for future tests. Then, if a student athlete suffers a head injury, a subsequent test could presumably measure the extent, if any, of brain damage.
The discovery of the initial stages of CTE in an 18-year-old should move the discussion of football's concussion crisis toward youth football. The identity of the 18-year-old will not be revealed at the family's request. According to Cantu who wrote the first return-to-play guidelines, "Our efforts to educate athletes, coaches, and parents on the need to identify and rest concussions have only been moderately successful because people have been willing to look the other way when a child suffers a concussion. I hope the discovery of CTE in a child creates the urgency this issue needs. It is morally and ethically wrong to allow our children to voluntarily suffer this kind of brain trauma without taking the simple educational steps needed to protect them."
By the way, Jack doesn't limit his concerns to athletes. He thinks everyone should be tested as part of routine medical care.

According to the results of the study:
McHale, a Cornell University graduate, former restaurateur, husband and father of three boys, is the sixth former NFL player to be diagnosed post-mortem with CTE since 2002. CTE, a progressive neurodegenerative disease caused by repetitive trauma to the brain, is characterized by the build-up of a toxic protein called tau in the form of neurofibrillary tangles (NFTs) and neuropil threads (NTs) throughout the brain. The abnormal protein initially impairs the normal functioning of the brain and eventually kills brain cells. Early on, CTE sufferers may display clinical symptoms such as memory impairment, emotional instability, erratic behavior, depression and problems with impulse control. However, CTE eventually progresses to full-blown dementia. McHale died due to a drug overdose after a multi-year battle with addiction. Expert consensus is that drug abuse of any kind would never cause the neuropathological findings of CTE seen in McHale.
We encourage you to read the entire press release.

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From Injuryboard.com:

Researchers studying brain injury believe that people with unrelated social or cognitive problems may have something in common: a long-forgotten blow to the head. It is widely accepted that severe head injuries can lead to cognitive and behavioral problems. What is new, according to brain researchers Wayne A. Gordan, M.D. and Mary Hibbard, Ph.D., is the contention that there are many other cases where a past blow to the head resulting in unconsciousness or confusion is the unrecognized source of such problems. These problems include learning disabilities, alcoholism, drug abuse, and depression.
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Dr Gordon, director of Brain Injury Research Center at Mount Sinaii School of Medicine in New York, says, "[unidentified traumatic brain injury is an unrecognized major source of social and vocational failure." According to one researcher, "[when you look at children with learning disabilities or behavior problems, there's often an underlying high percentage of children with traumatic brain injury. We're looking at about 20%."

Continue reading.

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From the ImPACT Web site:
In the United States, the annual incidence of sports-related concussion is estimated at 300,000. Estimates regarding the likelihood of an athlete in a contact sport experiencing a concussion may be as high as 19% per season. Although the majority of athletes who experience a concussion are likely to recover, an as yet unknown number of these individuals may experience chronic cognitive and neurobehavioral difficulties related to recurrent injury. Such symptoms may include chronic headaches, fatigue, sleep difficulties, personality change (e.g. increased irritability, emotionality), sensitivity to light/noise, dizziness when standing quickly, and deficits in short-term memory, problem solving and general academic functioning. This constellation of symptoms is referred to "Post-Concussion Syndrome" and can be quite disabling for an athlete. In some cases, such difficulties can be permanent and disabling. In addition to Post-Concussion Syndrome, suffering a second blow to the head while recovering from an initial concussion can have catastrophic consequences as in the case of "Second Impact Syndrome," which has led to approximately 30-40 deaths over the past decade.Photo credit: Medline Plus

In summary, athletes that are not fully recovered from an initial concussion are significantly vulnerable for recurrent, cumulative, and even catastrophic consequences of a second concussive injury. Such difficulties are prevented if the athlete is allowed time to recover from concussion and return to play decisions are carefully made. No athlete should return to sport or other at-risk participation when symptoms of concussion are present and recovery is ongoing. In summary, the best way to prevent difficulties with concussion is to manage the injury properly when it does occur.

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ImPACT 2005 is a user-friendly, Windows-based computer program that can be administered by a team coach, athletic trainer or physician with minimal training. Reaction time is reliably measured to one hundredth of a second across individual test modules (10 modules total) and allows for an assessment of processing speed as the player fatigues. The test battery consists of a near infinite number of alternate forms by randomly varying the stimulus array for each administration. This feature was built in to the program to minimize the "practice effects" that have limited the usefulness of more traditional neurocognitive tests. ImPACT takes approximately 20 minutes to complete. The program measures multiple aspects of cognitive functioning in athletes, including:

  • Test Section 1: Subject Profile and Health History Questionnaire
  • Test Section 2: Current Symptoms and Conditions
  • Test Section 3: Neuropsychological Tests (Baseline and Post-Concussion)
    • Module 1 (Word Discrimination)
    • Module 2 (Design Memory)
    • Module 3 (X's and O's)
    • Module 4x (Visual Attention Span)
      ImPACT 1.0 only-This module has been removed for version 2.0.
    • Module 4 (Symbol Matching)
    • Module 5 (Color Match)
    • Module 6 (Three letters)
  • IV. Injury Description
  • V. Graphic Display of Data
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For more information on this exciting diagnostic tool, visit ImPACT's comprehensive Web site.


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N.Y. Times, June 10, 2007 --
For several years, many medical experts have maintained that high school football players who sustain concussions should not return to the games in which they are injured. So when doctors commissioned by the National Football League published a study two years ago concluding “it might be safe” for such players to do so, the assertion sparked widespread criticism. Now the criticism is coming from authors of the paper itself.

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.

Arfken also said the passage had been added without her knowledge.

The two principal authors, Dr. David Viano of Wayne State and Dr. Ira Casson of Long Island Jewish Medical Center, acknowledged that they had altered the conclusion but said that all authors had received proof copies before publication. They said the section in question was added to appease peer reviewers who asked for a discussion of high school and college players, and they continued to stand by what was written.

Arfken and Feuer disavowed the paper’s recommendation that high school and college medical personnel “keep an open mind” about the paper’s analysis of concussions, which deemed safe the league’s record of allowing half of the players with concussions to return to the same game. 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.

Feuer said that he “would change that sentence; I’d eliminate it.” Regarding high school players, he added: “It’s been shown that they don’t seem to recover as fast. Period.”
Continuing reading the article.

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New York Times, May 31, 2007 --
The rate of diagnosed clinical depression among retired National Football League players is strongly correlated with the number of concussions they sustained, according to a study to be published today.

The study was conducted by the University of North Carolina’s Center for the Study of Retired Athletes and based on a general health survey of 2,552 retired N.F.L. players. It corroborates other findings regarding brain trauma and later-life depression in other subsets of the general population, but runs counter to longtime assertions by the N.F.L. that concussions in football have no long-term effects.

Later in the article:
While consistently defending its teams’ treatment of concussions and denying any relationship between players’ brain trauma and later neurocognitive decline, the N.F.L. has subsequently announced several related initiatives. The league and its players union recently created a fund to help pay the medical expenses of players suffering from Alzheimer’s disease or similar dementia. Last week, N.F.L. Commissioner Roger Goodell announced wide-ranging league guidelines regarding concussions, from obligatory neuropsychological testing for all players to what he called a “whistle-blower system” where players and doctors can anonymously report any coach’s attempt to override the wishes of concussed players or medical personnel.

Mr. Goodell said last week that the league’s concussion committee had just begun its own study “to determine if there are any long-term effects of concussions on retired N.F.L. players.”

Dr. Casson, the committee’s co-chair, said that players who retired from 1986 through 1996 would be randomly approached to undergo “a comprehensive neurological examination, and a comprehensive neurologic history, including a detailed concussion history,” using player recollection cross-referenced with old team injury reports. He said that the study would take two to three years to be completed and another year to be published.
Read the complete article here.

Also, don't miss this site for more information about head injuries and football (from youth ball to the NFL).

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The NFL's Committee on Mild Traumatic Brain Injury (TBI) has come under fire from several sources reports the Baltimore Sun. The flack started last fall when ESPN The Magazine published an article critical of the committee's report and said "the committee skewed its data to minimize the effect and nature of concussions," a charge rejected as "totally false" by Dr. Andrew Tucker, a member of the committee since 1994 and a Ravens team physician.

Among its criticisms, the magazine said Dr. Elliot Pellman, who recently resigned as committee chair, "omitted large numbers of baseline reports from neuropsychological testing in a six-year study to arrive at figures more favorable to the league."
"People on the outside see it as industry-funded research and research that is not as accurate or sound as it should be," said Dr. Kevin Guskiewicz, the research director of the Center for the Study of Retired Athletes at the University of North Carolina, which has been criticized by Pellman's group for some of its work.

"That was basically done to protect the image of the game, of the league. It's troubling to me and many others that there is all this work out on retired NFL players and they have chosen to ignore the findings."
Read the entire article here and then tell us what you think. Is the NFL doing enough to protect its players and provide for them long term?

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