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Running for Brain Injury

posted by SK Brain Injury    |   October 16, 2011 18:02

The journey of a thousand miles began with a man on a mission and one foot in front of the other.   

David McGuire has hit the ground running in the Run to Remember fundraising campaign. The B.C. native has joined forces with non-profit organization BrainTrust Canada to raise money and awareness for prevention strategies and to develop supports for Canadians living with brain injury.

“This is probably our biggest awareness and fundraising campaign that we’ve taken on, in a national sense,” said Melissa Wild, run manager with BrainTrust Canada. “Brain injury needs to be more in the public eye and there needs to be better funding.”

While donations are being pledged daily, Wild said proceeds raised are upwards of $60,000.

“The public awareness and public response has been really great. They’re really picking up on it.”

According to BrainTrust Canada 483 people per day suffer a brain injury. It is the leading cause of death and disability in those under 45.

McGuire says inspiration for the cross-country run came from his own brain injury sustained in 2005.

Brain injury survivor David McGuire is running across Canada to raise awareness and funds for brain injury prevention and support. McGuire, 38, departed St. John’s, Newfoundland on April 1 and hopes to reach his destination, Victoria, B.C., by December. Photo by Andrea Nicholl

“I went to our local brain association and they had closed down. I walked home literally crying because there were a lot of people who were much more disabled than I was and I just wanted to do anything I could to help.”

It is unclear whether McGuire suffered a stroke, brain bleed or hit to the head, but after seven days of unconsciousness he awoke to a hospital room, a body full of tubes and the absence of memory.

McGuire was told by medical professionals that he may never be able to walk again, but soon after began running to speed his recovery. In 2006, one year after his brain injury, McGuire completed his first marathon.

While the 38-year-old has been rehabilitated, his short term memory has never been restored. The Run to Remember campaign name holds special significance and reflects the memory problems and challenges that affect those faced with brain injury. 

McGuire struggles with remembering simple tasks such as putting on his shoes, setting his training watch or finding his way home.

“If I don’t shave my head, you don’t see the scar down the side of my head and you just think I’m a weird guy that walked into your store and can’t remember what he’s there for.”

McGuire began his Trans-Canada journey in St. John’s, Newfoundland on April 1. Seven months into the run, he says he hopes to reach his final destination, Victoria, B.C., by the end of December. With cooperative weather and flat lands, McGuire says the Saskatchewan leg of his journey has been an “extraordinary” one. 

“I totally love it. Being out here- it’s stunning. I’ve never been here before and I’m blown away. It’s really beautiful out here.”

For more information, or to make a donation, visit or text “brain” to 45678 to contribute $5 to the campaign.


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News | Support the Cause

Saskatchewan Election - Get Your Voice Heard

posted by SK Brain Injury    |   October 16, 2011 18:00

With the Provincial election coming up we urge you to ask the candidates about what they will do for those with brain injuries and other disabilities if they are elected to power. Please listen to this ad by Sask DISC and spread the word!

Click Here for the Sound Clip

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Support the Cause

Aviva Community Fund - Please Vote!

posted by SK Brain Injury    |   October 16, 2011 17:57

As you may have seen, the BIAC along with HEAD STRONG are currently competing in the Aviva Community Fund; its a competition where you submit an idea that promotes change within your community and the way to support the idea is to vote.
HEAD STRONG is a charity associated with the Canadian Brain Injury Association and was started by Ben Fanelli of the Kitchener Rangers.
The idea submitted to the Aviva Community Fund is an education bursary, intended to support those who have been affected by a brain injury gain access to education.
What I am asking you to do is vote everyday until October 19th; it may sound like alot to ask but it only takes a moment to register and voting is easy! If there are enough votes, the cause will go to final round in December and voting starts again until the final round!
Please check out this link:

You must first register and then you may vote for HEADSTRONG. You can vote from multiple email addresses once a day!

Thank you for supporting this cause!!

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Support the Cause

NHL Great, Rick Martin, Diagnosed with Degenerative Disease

posted by SK Brain Injury    |   October 10, 2011 21:05

Boston University researchers have found a degenerative disease linked to head trauma in the brain tissue of the late NHL great Rick Martin, the first 50-goal scorer for the Buffalo Sabres and a member of their famed French Connection line.

Martin, who died in March of hypertensive heart disease at age 59, becomes the third former NHL player found by researchers to have had chronic traumatic encephalopathy (CTE) — a disease that causes cognitive decline, behavioural abnormalities and ultimately dementia.

After his death, Martin's family donated his brain to the Centre for the Study of Traumatic Encephalopathy, a collaboration between Boston University Medical School and the Sports Legacy Institute.

All three former NHL players who agreed to have their brains studied post-mortem at the centre — Martin, Bob Probert and Reggie Fleming — have now been shown to have had CTE, but Martin is the first who did not play an enforcer role and regularly participate in on-ice fights, the centre says.

Neurosurgeon Robert Cantu, who co-founded the institute and is co-director of the CTE centre, told CBC News the findings in Martin's case are alarming because he only suffered perhaps one concussion in his career, unrelated to fighting.

"What I can tell you bothers me: The first two cases in the National Hockey League, Reggie Fleming and Bob Probert [were] renowned fighters, 400 recognized fights during their ice hockey career, God knows how many in bars," Cantu told CBC's Stephanie Jenzer in an documentary airing Wednesday on The National, in which CBC News was granted rare access to the brain centre's lab.

"And so the amount of brain trauma they took from fighting was horrendous. And it could be thought logically that their CTE is related to their fighting. And indeed it possibly is.

"But when we look at this most recent case of Mr. Martin, that's a problem because he wasn't a fighter, he'd only had perhaps one concussion. And so we've got to be concerned that the jostling of the brain just from the skills of the sport of playing in the National Hockey League led to him having chronic traumatic encephalopathy when he died."

Star's head struck ice

Born in Verdun, Que., Martin was an NHL star in the 1970s with 384 goals and 317 assists for 701 points in 685 games, all but a handful with the Sabres.

During his time in Buffalo, Martin combined with fellow French Canadians Gilbert Perreault and René Robert to give Buffalo the top line in the league for a time, and they helped lead the Sabres to the 1975 Stanley Cup final in just the franchise's fifth year of existence.  

Martin was remembered as much for his goal-scoring abilities as a frightening incident in 1978, when he was hooked from behind and his helmet-less head struck the ice. He was knocked unconscious and went into convulsions on the ice before being carried off on a stretcher.

Martin was back the next season with a helmet, as were many other players on his team.

Over the years, Martin adopted Buffalo as his home, and died there in March when his heart failed while he was driving.

Chris Nowinski, a co-founder and president of the Sports Legacy Institute, tracked down Martin's widow after his death, not long after the brain lab made the results of former NHLer Bob Probert's CTE case public.

"Mrs. Martin said Rick would have wanted people to learn from him," Nowinski, the only Harvard graduate to wrestle at the WWE, is widely credited with putting the concussion issue on the map, told CBC News. "If other hockey players could be safer by studying his brain then he would have been all for it."

The centre's researchers said Martin's disease was relatively mild and suggested he was resilient to the disorder and less susceptible to its severity than some of the other athletes whose brains they've studied.

'No question' Martin would have developed dementia

Martin only had stage 2 disease at 59 years old, and by that age most cases in the centre's brain bank have advanced to stage 3 or 4.

But Nowinski said had Martin lived longer, the disease would have progressed.

"Who knows how quickly and who knows how badly, but he would have eventually developed dementia had he lived long enough," Nowinski said. "No question."

 Dr. Ann McKee, the brain centre's co-director who diagnosed the two previous former NHLers Probert and Fleming with CTE after their deaths, said it is unlikely that Martin's disease was triggered by just the 1978 on-ice incident.

"I'm going to imagine that there were many other more trivial blows to the head," she told CBC News chief correspondent Peter Mansbridge in an interview.

"He didn’t play with a helmet for most of his years. So any blow to the head may have been a contributing factor."

Ex-players hope brain study gives answers

There is growing concern about players suffering head trauma and struggling with physical and mental health issues later, especially amid this summer's tragic off-season for the NHL, which saw the deaths of three NHL enforcers: Derek Boogaard, Rick Rypien and Wade Belak.

Cantu and his team have examined Boogaard's brain but the results are not yet public.

Keith Primeau and Ryan VandenBussche, two former players forced out of the game because of traumatic brain injury, have agreed to have their brains donated to the centre for study after their deaths.

Both skilled and physical on the ice, Primeau never shied from aggressive play, even as the concussion tally mounted.

Six years on from his last concussion, Primeau still only counts the number of days he doesn't suffer from the effects of the brain injury — dizziness, headaches and torment that can come with depression — in days and weeks.

 "I have periods where I feel much better and I enjoy them while they last, but I have the ability to regress and show symptoms again," Primeau said at a hockey tournament, where he was coaching one of his kids.

"You become very emotionally volatile. People around you take the brunt of it, so that is sad. So it is almost a domino effect of emotions, and nothing you can really do or are capable of stemming it other than ride it out."

Looking back on his career, Primeau said it was one of his four documented concussions — he believes he suffered "north of 10" in his career — which should have been the wakeup call. On May 2000, a devastating hit at centre ice sent him to the hospital. But 48 hours later, Primeau was back for another game.

"For me, probably, I would reflect that as being the beginning of the demise," he said. "I grew up with the mentality that you get out there at all costs. You play through injury and you play through pain, and I was no different."

VandenBussche told CBC News he first brought up the idea of donating his brain to the centre with Probert, his former roommate.

"I remember chatting to him that I was going to donate my brain and we both agreed that's what we were going to do," he said. "Why wouldn't you?"

A fellow tough guy of the league who famously ended the career of Nick Kypreos with a knockout punch, VandenBussche said he tried to conceal several of the more than a dozen concussions he suffered during his playing days, first to avoid being considered concussion-prone, then later just to stay in the NHL.

"I hid every one of them that I possibly could hide," he said.

Concussions and other injuries ended his career in 2007. His body battered, today he's almost constantly in pain. But VandenBussche never imagined that a few years later, his friend would be dead and his brain might be used to help solve the concussion riddle.

"I believe I don't know the facts," he said. "I wanna be able to see it. I mean I hear a lot of stuff but whether or not you believe it, you have to go figure it out yourself. I am sure it has got some sort of correlation to that. There is no doubt about it if you take repeated blows to the head, there is going to be some sort of effects later on down the road. So I just don't know to what degree."



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Brain Injuries - General Information

posted by SK Brain Injury    |   October 10, 2011 21:03

In the course of everyday life, most of us have suffered the pain of a solid bump on the head. Whether from a fall, a door or a low-hanging branch, that sharp shock is familiar. We can usually sit for a minute or put on some ice, and carry on. But from March 2003 to March 2004, more than 16,000 people were admitted to hospital in Canada with a head injury. Most of those injuries came from falls. The tally doesn't include people who were treated and released at doctors' offices or emergency departments

As well, an estimated 2,000 children a year suffer head injuries in tobogganing accidents. Health Canada has recommended that all children use a helmet when sledding. But no province has passed legislation requiring the use of a helmet while sliding down a snow-covered hill — although most have some kind of bicycle helmet law in place.

While helmets for hockey and lacrosse are regulated, others are not. A private member's bill introduced in the House of Commons would require all recreational snow sport helmets not approved by the Canadian Standards Association to be prohibited under the Hazardous Products Act.

When does a knock to the bean become a cause for concern and medical attention? Here are a few answers to common questions about head injuries.

What are the common causes of head injury?

Car accidents are a major cause of serious head injury. Other causes are falls, sports and assaults. You don't have to be hit on the top of the head — a blow to the jaw or side of the head can also cause a brain injury. People who have had previous head injuries are believed to suffer more serious repercussions when they have another. Another injury to the head before a person has fully recovered can lead to brain swelling.

What types of head injuries are there?

The four main types of head injuries are:

  • Concussion: a mild brain injury that is usually temporary.
  • Contusion: a bruise on the brain.
  • Fracture: broken skull bones.
  • Hematoma: a blood clot caused by a blow to the brain.

The head and brain can be injured whether or not the skull is actually damaged. A hard knock or jolt, even with no external sign of injury, is enough to cause a brain injury.

What are the symptoms?

Symptoms can range from none to mild pain at the site of the injury, bleeding or lack of consciousness. Indications that the injury needs medical attention include:

  • Loss of consciousness.
  • Continued headaches, and headaches that get worse.
  • Nausea and vomiting, particularly in adults.
  • Seizures.
  • Confusion.
  • Loss of memory of events surrounding injury.
  • Drowsiness or lack of responsiveness.
  • Blood or clear liquid from the ears, nose or mouth.
  • Unusually large pupils, or pupils of different sizes.
  • In infants, an inability to stop crying.

How should it be treated?

Many mild concussions don't require more than rest and monitoring. Someone else should watch for signs of more serious injury, though. Sometimes the symptoms of a serious concussion, a contusion or hematoma may not show up for days.

Monitor when the patient does not appear to have any signs of serious injury. Make sure the person with the injury is not confused or having trouble walking. Watch for symptoms listed above.

Call the doctor if the patient later experiences dizziness, repeated vomiting, difficulty concentrating, or changes in personality.

Call an ambulance if the patient has lost consciousness, or is having seizures, paralysis, or problems walking or talking. If it is a small child, call the doctor if you think the child is not behaving as usual.

If the person has a skull fracture, put a bandage on the wound but do not try to clean it out or disturb it in any way. If the injury is serious, call an ambulance and do not try to move the patient.

Someone with a serious head injury is likely to be admitted to the hospital for treatment and observation. Symptoms can take days to show themselves. Surgery may be required to relieve pressure on the brain, if there is swelling or bleeding.

When can normal activity resume?

This will depend on the seriousness of the injury. Be sure to wait until all symptoms are gone. After a mild concussion, some people can resume normal activity almost immediately. Ask a doctor how long to wait after symptoms are gone.

Can they be prevented?

Most injuries can be prevented by sitting quietly at home — but people don't want to live their lives that way. But a few simple steps can drastically reduce the risk:

  • Don't drink and drive.
  • Wear a helmet when biking, inline skating or snowboarding.
  • Wear a seatbelt in the car and make sure children are in safety seats.
  • Slip-proof your home, especially the bathroom.
  • Play sports responsibly, using the proper equipment.

Children and helmets

One of the challenges parents face in protecting their children from head injuries is persuading them to wear a helmet, even when an adult isn't watching over them.

Ellie Wannamaker, a member of the Canadian Physiotherapy Association who treats children with head injuries at Bloorview Kids Rehab in Toronto, has some tips.

  • Convince them that wearing a helmet is "cool" by pointing to people like cyclist Lance Armstrong or other popular athletes.
  • Have children participate in the selection of the helmet, If they like Spiderman and he's on the helmet, they're more likely to wear it.
  • Get the whole family to wear helmets. If parents don't wear them, children are less likely to stick with them through their teens and into adulthood.

Wannamaker says a general guideline is that children should wear a helmet whenever they are going faster than they can run — using roller skates, inline skates, bikes, skateboards, scooters, skis, snowboards, toboggans, etc.



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Q&A with Neurosurgeon who Studies the Brains of Dead Athletes

posted by SK Brain Injury    |   October 10, 2011 20:57

Neurosurgeon Robert Cantu and his team at Boston University study the brains of deceased athletes. They have already examined the brains of Reggie Fleming, an enforcer in the '60s, and Bob Probert, an enforcer who retired in 2002 after 16 NHL seasons and died in July 2010 of a heart attack.

Cantu and his research team Ann McKee, Robert Stern and Chris Nowinski found that both Fleming and Probert had chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by blunt impact to the head.The researchers also examined the brain of Dave Duerson, a former National Football League player who committed suicide in February. Duerson also had CTE.

(CTE was known as dementia pugilistica before doctors figured out that not only boxers developed the condition.)

The brains were studied at the Centre for the Study of Traumatic Encephalopathy, a collaboration between Boston University Medical School and the Sports Legacy Institute, which was co-founded by Cantu.

In the interview, Cantu explains that addiction, depression and anxiety may result from CTE.

In the last four months, three National Hockey League enforcers have died tragically. In May, Derek Boogaard died from a combination of too many painkillers and alcohol. Rick Rypien, was found dead in his home in Alberta on Aug.15, an apparent suicide, and, most recently, Wade Belak was found dead in a Toronto hotel on Aug. 31.

On Friday Lorraine Belak, Wade's mother, confirmed to CBC that her son suffered from depression. Rypien also dealt with depression.

Cantu and his team have examined Derek Boogaard's brain but the results are not yet public.

CBC News: What is it about NHL enforcers that could possibly explain the recent deaths of Derek Boogaard, Rick Rypien and Wade Belak?

Robert Cantu: We've studied several deceased NHL players who were enforcers and the two that we brought public so far — Reggie Fleming and Bob Probert — both died with chronic traumatic encephalopathy.

So anytime I hear of an athlete who has had a lot of head trauma who commits suicide, I am immediately concerned that chronic traumatic encephalopathy may have played a role. And I would like to study their brain to see whether the presence of chronic traumatic encephalopathy is there.

What is it that happens to a brain that suffers, perhaps repeated, damage from concussion or hard blows?

The ultimate hallmark of CTE is the abnormal hyper-phosphorylated tau protein deposit that can be stained for and identified. Tau is throughout the brain, though it is in particular locations in greater concentrations.

The medial temporal lobe is the area of highest concentration. That medial temporal lobe has functions of:

  • memory,
  • impulse control,
  • addiction,
  • emotions,
  • depression
  • and anxiety.

So when that area of the brain is damaged, you have problems in those areas and that's what we see with CTE.

Looking at the brains you've examined, of athletes that have died, why would CTE be a factor in a suicide?

Because the difficulty handling impulses and the difficulty with emotions, especially depressive emotions, are impaired with CTE. That's why depression is very common with CTE.

Georges Laraque, the Montreal Canadiens tough guy, spoke about the enforcer role in a CBC interview Thursday. He said that a lot of enforcers find the pressure tough to deal with and so use drugs and alcohol to cope, and develop problems as a result. What are your thoughts on that?

The medial temporal lobe, as I said, is associated with addictive behaviours and alcohol and drug abuse are addictions. So it is very consistent. And we find that addictions are very common in people with CTE and we find that some of the brains that come our way, came our way not because of a conscious suicide but because somebody was involved with drugs and/or alcohol and the combination became lethal.

So it could be an accidental combination, or driving while impaired, that sort of thing?


What about the pattern, are enforcers more or less likely to suffer from concussions?

And they tell me they go to the penalty box and they never tell the training staff they've had a concussion. And they don't complain of their symptoms because they are afraid if they do they will be replaced, their job will be lost.

Derek Boogaard's death on May 13 was ruled accidental, the result of a toxic mix of alcohol and the powerful pain killer oxycodone. Boogaard, right, fights Jody Shelley at a Nov. 4, 2010 hockey game in Philadelphia.
How common are athlete suicides?

I do n't think we have a real good handle on that. There is evidence to suggest that it is less common than it is in non-athletes at the high-school level, that playing sports improves one's self esteem and gives a better chance not to have depression overtake them. Some high school athletes commit suicide, so it's not an absolute protection. We don't have a good handle.


Do you have a better handle with professional athletes?

We've not had a good data system for recording athletic suicides. It's something that really is needed.

In addition to the data set on athlete suicides, what else should be done to reduce the number of athlete suicides?

Just like there's concussion education mandated by the new legislation in many U.S. states, that education should include a bit about, if you have depression or overwhelming sadness, that you seek help. There are suicide hotlines and crisis control situations available to people.

In other words, we don't ever want to study another brain that came to us by way of suicide.

Will we study them? Of course, but we do not want them to come to us because of that.


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Sidney Crosby's Road to Recovery

posted by SK Brain Injury    |   October 5, 2011 12:06

Look at your right hand. Close your eyes. Do you know where it is? Are you certain?

For months, Sidney Crosby was not.

While the rest of his Pittsburgh Penguins teammates spent the summer resting, working on their golf game and trying to get over a seven-game loss to Tampa Bay in the opening round of the playoffs, the game's greatest player spent it searching for a way back to normalcy.

Two head shots within a week of each other last January ended the former MVP's season, put his career in jeopardy and may have started a culture change in a sport where toughness, grit and “playing through it” are among the most prized commodities.

Crosby didn't set out to be the most public case study on the mysterious lingering effects of concussions. He simply wanted to feel better and get back to doing what he loved.

The road back has been more arduous than he ever possibly imagined when he was scratched out of the lineup following a game against Tampa Bay on Jan. 5 after experiencing what he's since described as “fogginess.”

Months of rest, of tests, of travel, of quietly — and not so quietly — refuting what his camp has deemed as misinformation about his condition, his health, his future have followed.

The organization did its best to give Crosby space. Coach Dan Bylsma and general manager Ray Shero checked in occasionally. Teammates, both old and new, would text or call to talk about anything and everything but the state of Crosby's head.

Penguins forward Jordan Staal says they texted about fishing. The words “vestibular system” — which focuses on a person's ability to balance and work within a given space, the system most affected by Crosby's concussions — never came up.

“I figured he was getting enough of it from everywhere else,” Staal said. “All that matters to us really is that he's healthy. All that stuff you thought you heard, I didn't pay any attention to it.”

Private by nature, the combination of Crosby's injury and his urge to get away from things back home in Canada during the off-season only seemed to feed the frenzy.

He was retiring. He wasn't retiring. He suffered a setback. He was skating at full speed. Each week seemed to bring a new rumour or theory.

Crosby remains polite but reserved when talking about the process, though he did spend more than 40 minutes last month addressing reporters while sitting alongside the two doctors who have overseen his rehabilitation.

Dr. Mickey Collins, a neuropsychologist at the University of Pittsburgh Medical Center, likened Crosby to a Ferrari. Dr. Ted Carrick, who practises clinical neurology and whom Crosby turned to when things seemed to stall in midsummer, has seen so much progress that he likened it to Christmas.

How exactly did Crosby get to this point in his recovery? Well, that's tricky. Unlike a muscle or a bone, there is no obvious physical evidence when you're healed. The science of how to handle and treat the vestibular system is evolving.

“It generally kind of boils down to retraining the brain to know where everything is in space and the awareness of where your body is in space,” said Mark Lovell, the founding director of the UPMC Sports Medicine concussion program and CEO of ImPACT, a computerized concussion evaluation system. “When you have an injury that can be thrown off.”

Getting it back in a normal person takes time, and lots of it. Throw in the unique demands of Crosby's job — namely making sudden movements and constantly recalibrating your balance to adjust to an ever-changing environment — and getting to the point where Crosby feels “normal” is an uncertain proposition.

A thriving vestibular system allows a person to trust their senses. Lovell likened it looking at your hand then closing your eyes and trusting your hand is in the same place. For a person with vestibular problems, that's difficult because the brain may be receiving faulty information.

“From a rehab standpoint you work on gradually giving people exercises so that they're increasingly able to tolerate the kind of side-to-side movement as well as have a better awareness of where they are in space in any given time,” Lovell said. “You can't do that all at once. If you do it too quickly, you make a person feel worse.”

That's part of the danger. Crosby allows his training regimen was adjusted over the summer. It seemed to be whenever he'd reach a certain threshold of exertion, his symptoms would return.

Frustrating? Absolutely. Mystifying? Sure. Enough of a reason to consider hanging up his skates for good? No shot. He's not the first player to deal with debilitating concussions, just one of the most famous.

Boston's Patrice Bergeron, who missed nearly the entire 2007-08 season with injuries sustained when he was checked head-first into the boards, told Crosby to hang in there.

“I was reaching out to him and just letting him know what I've been through I guess and that patience and staying positive is, it sounds kind of cliche, but that's exactly what it is,” Bergeron said. “And just to stay with it then he's going to be, you know he's going to find a way to get back.”

Not one to make declarative statements, Crosby said during his press conference it was “likely” he would play again this season, and he's attacked training camp ferociously even if he's forced to wear a different coloured helmet to let his teammates know he's not cleared for contact yet.

The Penguins open the season on Thursday in Vancouver but Crosby won't be in the lineup. He remains on injured reserve, meaning he'll have to wait at least a week before he can return to game action, though the truth is that it will likely take longer.

The league is pulling for him. Washington Capitals star Alex Ovechkin — the NHL's exuberant yang to Crosby's steady yin — is ready to see Crosby's familiar No. 87 back out there.

“I hope he's not going to feel dizzy or not feel sick anymore, and he's going to play — because he's one of the top guys in the league, and it's very hard to play against him,” Ovechkin said.

The NHL could certainly use him, and the league has taken an aggressive stance against the kind of head shots that put Crosby's future in limbo. Former all-star Brendan Shanahan, now in charge of league discipline, has been cracking down on players during the pre-season for taking dangerous and unnecessary chances.

It's a step in the right direction for a league starting to gain some traction. The last time Crosby played on national television, the Penguins were losing to the Capitals in the Winter Classic, the highest-rated regular season game since 1975.

His presence would help hockey fill a bit of the void if the NBA's lockout continues.

“It's huge,” said Nashville's Shea Weber, who played alongside Crosby on the 2010 Canadian Olympic team that won gold in Vancouver. “I mean he's really the face of the NHL I think. He's the most dominant player in the world.”

Or, at least he was.

Crosby isn't sure what to expect whenever he's cleared. He'd love to be the player who seemed to be in the middle of his prime last winter. He's not sure when that guy will show up, if he does at all.

“I'd love to be able to say first game back I'm right where I left off but it's pretty unrealistic,” Crosby said. “With that being said that's where I want to be. This is the best I felt since I've played NHL and that's what I want to get to. I want to get back there as soon as I can.”

After a restless summer spent wondering if its iconic star would ever return, so does hockey.


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Ken Dyden's Call to Action

posted by SK Brain Injury    |   October 5, 2011 11:59

It was an extraordinary press conference. Four people were at the media table in a spare setting at Pittsburgh's Consol Energy Center: Penguins general manager Ray Shero, concussion specialist Michael Collins, chiropractor Ted Carrick and Sidney Crosby. They were serious and straightforward. Through nearly 45 intense minutes, they offered almost no smoke or spin.

The medical experts, not the GM or the hockey player, spoke first.

Dr. Collins, head of the University of Pittsburgh Medical Center's Sports Medicine Concussion Program, laid out the events surrounding the injury, Mr. Crosby's resulting symptoms, the diagnosis, the treatment and the ups and downs of his recovery since January. He was patient and thorough. He spoke as if he knew his audience was intent on hearing what he said and, despite his occasional medical jargon, would understand him in all the ways that mattered.

With a few lapses, Dr. Carrick, a chiropractor and founder of the Carrick Institute for Graduate Studies in Florida, did the same.

Beyond the details, the specialists needed to convey that they were competent, professional and responsible – that Mr. Crosby is in good hands.

At times, they talked about Mr. Crosby's brain as if he wasn't there himself. Yet Mr. Crosby seemed undistracted. Respectful, he watched and listened as if the experts were only his trusted advisers. He was still the captain of his own ship.

When it was his turn to speak, Mr. Crosby was composed and informative, not seeming to hold anything back. He spoke of how he felt at each stage after his injury. At first, he had felt himself in a fog, he said, as if he was living one step removed from his own life, a spectator to it. Objects around him weren't quite where he knew them to be; once, Dr. Collins related, Mr. Crosby, feeling he was falling, found his body reacting when he wasn't falling at all. Even the flickering images on a TV screen moved too fast for him, making him dizzy – this in someone who had always seen everything so acutely, who at only 24 had seemed somehow to figure out hockey and life. Now, his board had been scrambled. Normal life, his medical people said, would return when, at full exertion, his headaches stayed away. Normal life as Sidney Crosby would return when everything went back into its proper orientation and, when confident of that, he could resume his Crosby-like creating, scrambling the board for everyone else instead.

The medical experts and Mr. Crosby said no one could predict when that would occur. Given where he had been and where he was now in his recovery, and pushed by the media's questions and by their own professional and human hopefulness, they put science to one side and declared that it would happen. Asked if he had played his last game, Mr. Crosby replied without bravado, “I wouldn't bet on that.”

Before the press conference, it was clear; after, it is even clearer. The National Hockey League season that begins next week – whether Mr. Crosby plays at all, or how well – will be about Mr. Crosby.

This is a difficult time for the NHL, for its commissioner, Gary Bettman, and for hockey. It's no less difficult for the National Football League, for its commissioner, Roger Goodell, for the U.S. National Collegiate Athletic Association, and for football.

Head injuries have become an overwhelming fact of life in sports. The immensity of the number, the prominence of the names, the life-altering impact on their lives and, more disturbing, if that's possible, the now sheer routineness of their occurrence. The hit on Mr. Crosby didn't seem like much. If it hadn't been him, the clip of the incident would never have made the highlight reel.

But if so much can happen out of so little, where is all this going? Who else? How many more? How bad might this get? Careers and lives of players, we know now, have been shortened, diminished, snuffed out by head injuries. What once had seemed debatable, deniable, spin-able now is not. What once had been ignored now is obvious. Not just contact or collision sports, hockey and football are dangerous sports.

Mr. Bettman, Mr. Goodell and sports leaders who came before them have done only what the players, fans and media have wanted them to do. They know we want our athletes to be better than they have ever been. We want them to be superhuman versions of ourselves – faster, bigger, stronger, more skilled, more committed. We want them, no matter the risk or pain, to prove beyond even unreasonable doubt that they are not in this for the money but for the love of their/our sport and their/our team, and to demonstrate that at every moment by being willing to do whatever it takes. The players, fans and media want great plays and thunderous hits. They need “wows” to compete against every other challenge – in sports, entertainment, news, politics – for the public's attention. And the players, and their commissioners, Mr. Bettman and Mr. Goodell among them, for the most part have delivered.

If the result has been collisions that are too dangerous, you “tweak” the rules, “tweak” the equipment, “tweak” the strategies of play, often in the face of great resistance – and the leagues have done this. But still the careers and lives of their players are being compromised, and now everybody can see it.

As a hockey or football commissioner today, you can't not know that many of your players this year, next year and every year will suffer head injuries. Some will have their careers ended; some, such as Paul Kariya and Eric Lindros, before age gets them, will begin their downward slide from superstar to journeyman; and some retired players will die long before their time, their final years, for themselves and their families, in the living death of dementia. This isn't being alarmist. This is alarming.

Mr. Bettman and Mr. Goodell can see this. So can the heads of the hockey and football players associations. So, increasingly, can the players, their wives and their families, and their lawyers. The commissioners and their leagues – mostly – are now beyond simple denial, defensiveness and counterattack. The challenge is no longer awareness of the problem. It's awareness of the solution. If you are Gary Bettman or Roger Goodell, what do you do?

I come back to the Crosby press conference. I'm not sure how it could have been done better. The message was that we are in uncharted territory. We know some things, there is much more we don't know and we're going to do what we know and respect what we don't until we know better. This is serious, and we are serious. And we want you – all those who are watching – to experience what we have experienced and learn what we have learned because, as people who love sports, we're in this together. It is this same tone, attitude and approach on head injuries that Mr. Bettman and Mr. Goodell need to take.

For Mr. Bettman, it's time to say: This is a great game, but it has a big problem, one that will get only worse if we don't do what needs to be done now. Our players will not get smaller, they will not skate slower, the force of their collisions will not diminish. The equipment they wear will not improve fast enough to mitigate the greater risks they will face. “Tweaking” is not the answer.

Immediately, Mr. Bettman can say that we need to treat any hit to the head as what it is: an attempt to injure. A hit to the shoulder, torso or hip – depending – is understood as good positioning and good defence; not so a hit to the head. The head has always been thought of differently, requiring special protection with its own peculiar penalties. Highsticking is not for a blow to the shoulder or elbowing for a blow to the chest. In the future, if a play results in an incidental and minor hit to the head, or one that is the fault of the player being hit, no penalty need be called.

But now, the presumption needs to be that every hit to the head is an attempt to injure, with the onus on the player doing the hitting, through his actions and in the eyes of the referee, to defeat that presumption. As Mr. Crosby said in his press conference, if the league requires players to be responsible for their sticks, why not their bodies? Further, if an opponent purposely puts his head in a position to draw contact in order to cause a penalty to be called, just as with “diving” now, it is that player as “instigator” who will receive the penalty.

But what about the player who is carrying the puck with his head down, another oft-cited example intended to show how impossibly complicated it is to ban headshots?

In years past, the best way to move the puck forward was believed to be for a player to do it himself, stickhandling up the ice. Having his head down with his eyes focused on the puck was considered an advantage to him. It was only fair, then, that a defender have his own advantage and, unseen by the puck carrier, be able to blast him.

Now, the best way to advance the puck is seen to be by passing, so a player with his head down is at a disadvantage already and doesn't require further punishment. He can be easily stopped with no more than incidental contact. In such cases, a crushing hit to the head (e.g., Scott Stevens on Eric Lindros) is nothing less than an attempt to injure. The common explanations – “Because he deserved it” or “Because I can” – are not good enough in this age of concussions and dementia.

What then about fighting? If hits to the head are banned, why not punches to the head? This isn't the time to re-engage the debate over fighting. Not directly. That will only distract from the more critical issue that must now be addressed. The problem of fighting, for most critics at least, isn't fighting itself. It's the consequences of fighting. To many, fighting seems out of place in sports, turning away prospective fans from a game that needs many more. To some, rather than acting as a “safety valve” to reduce further fighting, it creates increased ill will and generates more fighting. So why allow it?

What is relevant here is whether fighting relates to head injuries. Is fighting dangerous or not? Once, hockey players did their own fighting. An elbow to the nose or a slash on the arm, and – big or small; good fighter or not – a player had to right his own wrong.

Most players were bad fighters. On their skates, they wrestled, slipped and flung themselves around. It was vaudeville.

Now, most fights are between designated fighters. Each such fighter knows what he's doing, and though usually well-matched enough to be able to protect themselves, these fighters are also skilled enough to hurt each other. And questions have now arisen: Why did post-mortem studies on the brains of Reggie Fleming and Bob Probert, two brawlers of different eras, show brain damage? Why did three contemporary fighters – Derek Boogaard, Rick Rypien and Wade Belak – who were young and rich, and seemed to have everything to live for, die in recent months? We don't know the answers, but we know enough to know we need to find them.

The NHL rulebook is judicious in distinguishing a bodycheck to the head from other contact to the head, treating fighting as its own separate category. For an illegal check, it is necessary that “the head is targeted and the principal point of contact.” But in a fight, is the head not “targeted”? Is the head not “the principal point of contact?” Is a fist not part of the body? And in fights today, with fighters who can truly fight, what's the difference between being hit in the head by Niklas Kronwall's shoulder or Zdeno Chara's fist? This is about head injuries, not fighting's place in hockey. This is about the outrageous damage that hits to the head are doing to lives and to a sport.

Every time big changes are discussed, the same flood of examples comes forward in support of the aggrieved hitter and the historical game, and every time it steals focus from the gravity of head injuries and derails significant action. No more. The truly aggrieved is not the player or the team who receives the occasional unjust penalty. It's the player or family who has to live with years of an unfull life.

For Gary Bettman, the challenge is not to be distracted by history, by the voices of those who grew up as “hockey people,” or by the overwhelming power of the status quo. He is the central custodian of the game. If he takes on head injuries aggressively – and he must – some of his changes might be ineffective, others might be embarrassingly inept, and he might very well be mocked by fans and the media. But he and we will learn, and it is far worse to be mocked by damaged players for not doing what clearly needs to be done.

Many of these steps can be implemented this season, and with significant impact if their purpose – to prevent or otherwise minimize head injuries – is not forgotten and the rules to support that purpose are applied unfailingly. Other steps will take longer and be of greater effect, but they can be set in motion.

The game will get better.

Most important, however, it's time to think about our sports a different way.

What would hockey look like if it were played in a “head smart” way? If the safety of the brain was central to the rules? What about football and other sports?

What would we have to do differently? When do hits to the head happen? In what circumstances? In what parts of the ice? Against the boards? Against the glass? By whom? With shoulders? With elbows or sticks? They don't happen often. During most of the game, with most of the players, they don't happen at all. Why then? Why them? What about the big hits?

What would we need to do to minimize the risk? Because this isn't about no risk. It's about smart, informed risk. How would we make hockey safer? What would need to change? How would this game feel different to play? To watch? What would be lost? Unable to do some of the things they did before, what would players do instead?

My guess is that a lot less would change and for many fewer players than we think. My guess is also that many of the changes would make our games better, and not only for reasons of safety. If some rules are changed, players and coaches will find ways to adapt and to gain a competitive advantage, because that's what players and coaches do. They're dreamers and imaginers. They're competitive. They need to win.

Once, players and coaches came up with the forward pass in both hockey and football and gave flight to sports that had become a static snarl of bodies. They'll do it again. The mediocre will dig in their heels – they fear they can't change – and usually that's enough to stop everything in its tracks. But this time we have no choice. Not everyone will be affected the same way. Some things will change more for young kids but not for adults, or for girls and not boys, or for boys and not girls. The crucial point is that at every age and every level “head smart” will become the way we play.

This “head smart” movement should be global, not North American. We all face the same problems. Efforts might begin by gathering the most thoughtful coaches and players of a sport – in an area or in a country – and the best head-injury experts to begin putting together a “head smart” model for their sport. These models, as well as those created by other individuals and groups, would be put forward to the public and tested and debated through websites and later through local and international workshops and conferences. “Head smart” models generated in one place and in one sport would challenge and inform models in others, to make each model continually better.

The NHL, NFL and other sports leagues would engage with these efforts, sometimes as partners (in studies, in testing out proposals), sometimes financially, always in promoting the importance of the work.

The Crosby press conference suggests an opportunity. The future doesn't have to be one of pointed fingers and shouted denials. None of us knows the answer. All of us know the problem. We are all in this together. We love our sports. We love to play them and watch them. We love to argue over them. We love the inspiration and the excitement they bring. We want sports to be part of our lives forever. We know that sports will not go away, but we also know that the role they play in our lives is at risk. This is a fearful time, but it can be an exciting time.

The NHL and Gary Bettman and the NFL and Roger Goodell have an opportunity. This is the moment.


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BIAC Newsletter

posted by SK Brain Injury    |   October 3, 2011 10:10

Here you will find the latest edition of the Brain Injury Association of Canada's newsletter, Impact.

For more information you can visit their website at

ImpactBIACNewsletterOct11.pdf (1.88 mb)

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Providing Support to Elderly Caregivers

posted by SK Brain Injury    |   September 29, 2011 23:36

The Comox Valley Head Injury Society (CVHIS) has a new community resource for seniors who provide care to brain injury survivors in the Comox Valley.

Funded with support from United Way Central and Northern Vancouver Island, the Seniors Caregiving Counselling Program offers free clinical counselling for seniors who provide care to brain injury and stroke survivors.

CVHIS developed this program to support the needs of the many senior caregivers in our community whose mental health and well-being has been impacted by the challenging experience of providing care to brain injury survivors. This program is particularly suited to senior caregivers experiencing depression, anxiety, stress, fatigue, anger, grief and social isolation.

The primary intended outcome of this program is to promote the mental health and well-being of seniors caregiving for brain injury survivors by offering a free counselling resource tailored to their specific caregiver needs.

• The participant must be a resident of the Comox Valley.

• The family caregiver must provide care to a brain injury survivor (includes stroke).

• The family caregiver or brain injury survivor must be 65 or older.

Individuals interested in further information can call the Comox Valley Head Injury Society at 250- 334-9225 or e-mail

“Depression is one of the most common mental health problems affecting seniors today and is especially prevalent among senior caregivers," says Jeremy Coombs, executive director of the Comox Valley Head Injury Society. "Unfortunately, many seniors caring for brain injury survivors are not getting the help they need. The Senior Caregivers Counselling Program is an attempt to provide resource to support the well-being of seniors caring for brain injury survivors.”


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