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Looking Back on 2011: Rise in Brain Injuries

posted by SK Brain Injury    |   December 27, 2011 13:00

The tragic toll from traumatic brain injury continues to climb among athletes who routinely hit their heads -- or use them as weapons -- during play on the field or fights on the rink.

The Boston University Center for the Study of Traumatic Encephalopathy, where researchers last spring diagnosed the late football star Dave Duerson as having chronic traumatic encephalopathy (CTE), now has 60 confirmed cases of athletes with CTE in its brain bank, according to neuropsychologist Robert A. Stern, PhD, co-director of the center.

Cases from the Gridiron

The first case of sports-related CTE was reported in Neurosurgery in 2005. The report enraged officials at the National Football League, who vehemently denied the possibility of a causal connection. By 2008, however, it had become clear that some football players indeed were experiencing sequelae of their frequent head trauma.

The Boston University research initiative was established at that time, soliciting tissue donations from deceased players. In addition to Stern, co-directors include Ann McKee, MD, Robert Cantu, MD, and Chris Nowinsky, a former football player and professional wrestler with a history of multiple concussions.

"When we first started our center three-plus years ago we expected to find CTE in a small number of athletes, and specifically in those who had a history of significant concussion," Stern told MedPage Today.

That turned out to be wrong. Not only have there been many more cases than anticipated, but many of the affected individuals had only subconcussive injuries – though lots of them.

"These are the types of hits that a lineman in football gets, where in every play of every game and every practice – some 1,000 to 1,500 times each season -- he hits his head against his opponents with a force of about 20 G, which is not a minimal force," Stern said.

The end results in susceptible individuals, according to autopsies done by his group, include widespread abnormalities similar to those seen in Alzheimer's disease, including neurofibrillary, glial, and astrocytic tangles and abnormalities in tau proteins.

The Rules Tighten

In response to the escalating concerns about brain injury, the National Football League has tried to crack down on dangerous play, instituting a program of enhanced enforcement for safety violations. This season, for instance, Detroit Lions player Ndamukong Suh received a two-game suspension after being observed stomping on another player's arm in a Thanksgiving Day game.

More recently, the Pittsburgh Steelers' James Harrison was suspended for one game in December as punishment for a helmet-to-helmet hit that left quarterback Colt McCoy of the Cleveland Browns with a concussion.

Even though the blow was witnessed by millions on television, the Browns' medical staff failed to realize he had suffered a head injury and cleared him to return to play a few minutes later. The Sport Concussion Assessment Tool -- mandatory in the NFL since 2009 -- was not administered to him until the next morning.

Stung by criticism of the oversight, the NFL responded this week with a new system in which trainers, stationed in the coaches' booth above the field, will watch specifically for potential concussions. They will then tell teams on the sidelines when they need to evaluate players with the assessment tool.

But a growing number of players are not satistifed with the NFL response and are determined to force the league to acknowledge their long-term health problems relating to concussions.

This week, four former players sued the NFL in U.S. District Court in Atlanta, according to an Associated Press report. In their lawsuit, Jamal Lewis, Dorsey Levens, Fulton Kuykendall, and Ryan Stewart allege that the league has been aware for decades of risks of head injury, and "has done everything in its power to hide the issue and mislead players associated with concussions." The players claim to experience problems such as headaches, memory loss, and sleep disruptions.

Hockey Under Scrutiny

The focus on head injury also now has expanded to violence on the hockey rink. The death of the National Hockey League player Derek Boogaard in May from an overdose of alcohol and pain killers, and the subsequent finding of extensive CTE – in a man only 28 years old – added to concerns about safety in contact sports.

Boogaard, known as Boogeyman, had been an "enforcer" for the NHL, meaning that he was a designated fighter who routinely collided with other players and engaged in fistfights on the ice to intimidate his opponents and delight the audience.

During the 2009-2010 season, he had been knocked down during a fight and struck his head on the ice, after which he complained of headaches. According to a story in the New York Times, he became withdrawn and sullen and was having memory losses while drinking heavily and taking numerous drugs such as oxycodone. He entered rehab, but left and became more reclusive, erratic, and returned to substance abuse.

He was found dead in his New York City apartment on May 13.

Unlike the NFL, the hockey league has shown no interest in banning fighting or otherwise changing the culture of the game, according to the Times article, despite the deaths of other scrappy players. These included Rick Rypien, who committed suicide at 27 after struggling with clinical depression during a career with the Vancouver Canucks marked by frequent fighting, and Wade Belak, who also had experienced periods of depression and died in uncertain circumstances at 35 after playing for a number of teams including the Toronto Maple Leafs.

The Alzheimer's Link

Research into CTE is still in its infancy, Stern said. But because of the similarity in pathologic findings between CTE and Alzheimer's disease, his group has been building on the substantial body of knowledge about Alzheimer's, using the latest technologies and techniques such as neuroimaging and basic science approaches.

"All the neurodegenerative diseases have complex neuropathogenetic pathways, involving genetics and epigenetics, environmental risk factors, and aging-related factors," Stern said. "Although the initiating event in CTE appears to be trauma, in all the neurodegenerative diseases early in the disease course there is some disturbance of neuronal integrity leading to a cascade of pathophysiologic events that ultimately results in neurodegeneration," he explained.

But not everyone with repetitive head trauma develops CTE, so Stern and his colleagues are now trying to tease apart other potential contributory factors, such as individual players' specific trauma history, age at first injury, total duration of trauma exposure, and the length of rest between injuries.

Stern also has recently been awarded a grant from the National Institutes of Health to develop biological markers that could be used to identify CTE earlier, rather than in postmortem neuropathologic exams. To do this, his group has enrolled 100 former NFL players who were linemen, linebackers, and defensive backs -- the positions with the greatest exposure to repetitive brain trauma -- and 50 noncontact sport athletes with no history of brain injury.

They are performing extensive clinical, neurologic, and neuropsychological examinations to look for factors common among those who develop the disease.

Stern and his colleagues also are collecting blood for DNA genotyping, doing lumbar punctures to analyze proteins such as tau, and conducting extensive brain scans including diffusion tensor imaging, as they puzzle out the steps in the lethal pathway to CTE.

Kids at Risk

It isn't just professional athletes who are at risk for these injuries. "We are appreciating more and more the particular potential vulnerability of, and long-term consequences to the young brain as a result of concussive and subconcussive brain trauma experienced through participating in certain youth sports," Michael Bergeron, PhD, of the University of South Dakota in Sioux Falls, told MedPage Today.

Participation in sports can provide numerous benefits to young people, as well as being fun. "However, the motivations of some adult stakeholders are sometimes in conflict with these objectives, and the professional model of development and high-impact styles of play for young players are increasingly encouraged, prevalent, and accepted," cautioned Bergeron, who is also the executive director of the National Youth Sports Health and Safety Institute.

"My hope is that there will be a change in the way children and adolescents train, compete, and safely return to play after an injury. By promoting healthy coaching, training, and competition overall and emphasizing fitness, skill acquisition, diversified athletic experiences -- and fun -- we can reduce overall injury risk, including head trauma," he said.


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Headgear in Rugby Won't Prevent Concussion

posted by SK Brain Injury    |   December 19, 2011 17:00

A medical study claims protective skull caps like those worn by Rugby World Cup winner Victor Vito do nothing to protect against concussion.

And as concern grows over the prevalence of head injuries, it can be revealed that the International Rugby Board has funded an onfield trial involving experimental protective helmets.

The helmets were put through their paces in a study involving 4000 players.

Over a period of about 30,000 playing hours, the group was split into three – one wearing the trial helmets, one wearing regulation skull caps, and another wearing whatever they normally played with, including no head gear.

In an article on an Australian academic website called The Conversation, Caroline Finch – a professor in injury research at Melbourne's Monash University – has written of the trial study, which was funded by the IRB.

"We did that in a randomised control trial – the gold standard for studying these sorts of preventative measures – and we found there was actually no reduction in head injury or concussion rates with protective helmets, at all," Finch wrote.

"We didn't even find it with the players in the modified helmets, which had thicker padding. So we've got no evidence really that soft-shell helmets help prevent concussion, although they may prevent against superficial injuries. But we certainly wouldn't be saying at this stage that this is a protective device that is going to prevent everything."

Finch wrote that an earlier lab-based study by Andrew McIntosh – an associate professor of biomechanics at New South Wales University's school of safety science – had shown that current headgear "might prevent superficial grazes but it won't prevent concussions".

"I have to say, too often people say the answer is to just put a helmet on, that's going to solve everything," she wrote.

Current IRB rules state most players who suffer concussion must complete a three-week playing and training stand-down.

The exception is for elite players, who are allowed to return to action earlier if they are deemed symptom-free by a neurological specialist.

Finch expressed concern about how the issue of concussion was being policed, referring to a recently published study by the British Journal of Sports Medicine which surveyed 2000 UK club players aged between 15-48.


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Brain Injuries in the NHL: Something to Worry About

posted by SK Brain Injury    |   December 19, 2011 15:00

No matter what the statistics might tell us, the optics are bad and getting worse. The NHL has something wrong with its head, specifically the concussed brains of its rank-and-file stick carriers, and no one is sure what to do about it, or if there is anything that can be done to make an inherently dangerous game substantially less a killing field.

Nothing on the KO front should surprise us anymore, but the hockey Twitterverse exploded Thursday night when the Flyers revealed that captain/hardened warrior Chris Pronger would be shut down for the duration, including the playoffs. Diagnosis: severe postconcussion syndrome. Bruins fans know the drill all too well, given the histories of Patrice Bergeron (now doing very well) and Marc Savard (not expected to resume his career).

Pronger’s move to neuropsych purgatory after missing 11 games came the week after the Penguins said superstar center Sidney Crosby, after playing in only eight games (2-10-12), would need more time out of action. Sid the Kid came back only last month after getting cranked twice within a week at the start of January.

According to multiple reports, the 24-year-old Crosby figures it was an elbow from the Bruins’ David Krejci Dec. 5 that exacerbated his latest woes. Krejci, it should be noted, is tough enough to withstand the daily NHL grind, but he is anything but a mauler. If Crosby can’t withstand Krejci-like knocks, his troubles may be far from behind him, possibly irreparable. At this point, no one would be surprised if, like Pronger, Crosby were to shut it down for the season, rest, and try again come training camp in September 2012.

Headed into weekend action, Pronger and Crosby were joined by fellow brothers of the concussed Claude Giroux and Brayden Schenn (both Flyers), along with the high-profile likes of Milan Michalek, the league’s top goal scorer from Ottawa, and Jeff Skinner, the Hurricanes’ scoring whiz who was last season’s Rookie of the Year. The slick Giroux recently topped the list of the game’s top point-getters.

The fact that such talented players are getting concussed brings a brighter, hotter spotlight to a persistent and difficult issue, but brain injuries have to be taken seriously, no matter if the player is a fourth-line plumber or a face of the franchise (see: Crosby, Pronger).

To its credit, the league has paid attention for a while, implementing baseline testing and return-to-work protocols that were ahead of, or at least in lockstep with, other professional leagues. Sadly, it dragged its feet disgracefully, if not negligently, in the days when Colin Campbell was meting out discipline from his corner office at league HQ. Players were egregiously smashed over the head by opponents (see: Matt Cooke’s hit on Savard) and Campbell too often let offenders skate, noting that the league’s rulebook didn’t give him the language or the license to suspend or fine the perpetrators. While he rifled through the pages to find only excuses, and the Lords of the Boards hemmed and hawed, heads remained on sliver platters, and nitwits such as Cooke feasted at the table of wanton destruction. Nice governance.

Again to its credit, the league has since moved Brendan Shanahan into the chief disciplinarian role and also placed him in charge of player safety. Things are improving under Shanahan’s watch, at least from a penance-and-pay standpoint. If the Lords and general managers let him keep up the heat, and the NHL Players Association supports his decisions rather than tosses up picayune objections, then it will become a safer workplace. Nothing gets a player’s attention like lost wages.

There are numerous other ways to dial back on the concussions. Such as:

- Shoulder pads and elbow pads need to be made smaller and their materials less destructive. In the last 15-20 years, manufacturers have preached improved protection through greater size and granite-like materials. Some of the paraphernalia has been softened. But even when not deliberately used to hurt people, the armor is hurting people.

- Stiffer penalties on hits to the head. The league last spring finally upgraded the rulebook, making some targeted hits to the head illegal. But brain injuries continue, and it’s increasingly clear that the Lords need to punish all hits to the head. They are in the business of selling violence, and as the game’s fathers they don’t want to give up what sells. As fathers, would they stop selling if these damaged players were their biological sons and not merely their issue of profit?

- Contrary to myth, people get hurt in hockey fights, often severely, and some suffer concussions. The NHL, when I asked again on Friday, would not reveal statistics on concussions. The game has grown five-fold from its Original Six days. It is a multibillion-dollar industry. The NHL is a tremendous product and will be all the greater when it realizes it can relegate its bar fights strictly to its Board of Governors meetings.

- When the most recent lockout ended in the summer of 2005, I was among those who saw the need of opening up play, and lauded the idea of taking the red line out of the offside equation. Good idea, bad result. Some of these concussions are because of incredible heads of steam that players gain now through center ice. There has to be a better way to mitigate trapping, grappling tactics in the neutral zone. I am convinced a slower game would diminish concussions. It would also lead to better, more artful puck control and playmaking. Bonus.

- Finally, the helmet. There has to be something better. And players need to be smarter about wearing their helmets properly, tightly, with fitted mouthguards. NHL icon Mark Messier a few years ago put his name on a Cascade product, its design borrowed from lacrosse. Be it Cascade or a different vendor, it’s time for a better mouse trap.

Some of these suggested fixes, despite varying degrees of pushback from both sides, and even from the audience (what, give up fights?!), are easy to implement. A handful of bright guys could get in a room today and cherry-pick from the list provided here and substantially change the culture of the sport and still maintain its entertainment factor.

When they all finally face the reality and get down to business, let these words be their guiding light: brain injury is not sport.


LA has found its new king

When the Kings were on Causeway Street Monday night, with John Stevens substitute teaching for fired coach Terry Murray, all the talk was that Darryl Sutter would be the new coach of the Crowns. Stevens was still the bench boss last night, with the Kings in Detroit to take on the Red Wings. But Sutter, who was fired a year ago as the Flames’ general manager, has agreed to take the job, according to a report in the Los Angeles Times. Sutter coached in San Jose when Dean Lombardi, now the Kings’ GM, ran the Sharks. There had been some thought that another NHL club had reached out in hopes of hiring Sutter. But the Times report said Sutter will take over the Kings Tuesday.

Back to where it began

Teemu Selanne, 18-plus years removed from his rookie season with the Jets when he scored 76 goals, made his first return to the city’s new NHL franchise last night. One of the game’s greatest goal scorers, he was shipped to Anaheim midway through his fourth season (1995-96) with the Jets. “I was totally shocked,’’ the Finnish Flash recalled last week. “Two weeks before that trade, the club told me, ‘Don’t worry, you’re going to be a big part of our future in Winnipeg.’ ’’ The trade came in February ’96, only weeks before the Jets left town to do business in Phoenix as the Coyotes. “I felt like I failed,’’ said Selanne, now 41 and likely playing his final NHL season in his second tour with the Ducks. “I was from Finland, and no one ever gets traded in Finland.’’

Helmets a fitting choice

Jay Bijeau was an assistant hockey coach for the men’s club squad at the Naval Academy a few years ago when the team, after consulting with the players, opted to buy Cascade helmets in hopes of better protecting the players’ heads. “Two of our guys had concussions at the time,’’ recalled Bijeau, these days a lieutenant commander on the USS Alaska submarine. “We felt it was the way to go.’’ The helmets arrived, soon followed by complaints, the players saying they didn’t like the fit. Twice, said Bijeau, Cascade reps visited and made certain the fit was perfect for each player. Bijeau eventually realized that the fit was fine, but the players simply didn’t like the look of the slightly larger Cascade design. “Top-of-the-line helmet, best product out there,’’ said Bijeau. “But the kids decided it wasn’t the helmet for them - and the bottom line was, they just didn’t like the look. And trust me, that’s all it was. The captains came up and said, ‘Look, no one wants to say it, but the reality is, the guys think they look goofy in these things.’ ’’ To his chagrin, said Bijeau, vanity ruled the day and the players went back to their old helmets. “Except the two guys who had the concussions,’’ said Bijeau. “They knew what it was like to live with that kind of injury.’’

Black and Golden oldies?

The disdain here for the canned music played at TD Garden during Bruins games is nothing new to my regular readers. As offensive as it has been in recent years, it seems even worse in 2011-12, and I know that may sound like an old man yelling from his porch, telling his kids to get off the lawn. So be it. But I can tell you that I’ve asked a number of 20-somethings and 30-somethings in the building to name those tunes, only to get blank stares or shrugged shoulders as response. In my opinion, it’s audio porn. Before the season’s over, I’d love to have one intermission - just one - when organist Ron Poster takes us through the tattered pages of John Kiley’s playbook. Ah, house lights down, a little “Norwegian Wood’’ (Beatles, ’65) over the PA and a picture of the smiling Kiley up on the Jumbotron. Please!


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Kids and Concussion

posted by SK Brain Injury    |   December 19, 2011 12:00

He may be the Mayor of Brantford but he's also a hockey dad and like a lot of other parents these days Chris Friel is disturbed by what he sees happening on the ice.

"The fun is being taken out of the game," Friel said. "There are kids who are getting hit and injured -some really badly -concussions are spiralling right out of control.

"These are the kinds of injuries that can really affect kids in the future."

He and others are so concerned they have formed a Dangerous Play in Sports task force to bring everyone involved with sports -governing bodies, referees, coaches, players and parents -together to help make playing both fun and safe. The task force is starting with hockey and includes representatives from local hockey associations.

"We want to put fun back into the game," Friel said. "There's a lot of the 'get'em, hitem, kill'em' out there right now and we want to get rid of that kind of attitude, take it out of the game.

"There's nothing wrong with a good clean hit but there is something wrong when the game becomes all about hitting."

Although the task force intends to look at all contact sports, it's starting with hockey because it's the sport that gets most of the attention when it comes to concussions. A lot of that attention is the result of hockey star Sidney Crosby being forced to stay on the sidelines for more than 10 months after suffering a concussion in January.

With Crosby unable to play, the NHL was missing its best player and his injury created widespread awareness of the devastating impact concussions can have on an individual. That awareness has become so pronounced parents, players, coaches and officials are taking steps to improve safety and cut

down on hits that could lead to concussions.

Just prior to the start of the season Hockey Canada approved a new head contact rule that reflects a zero tolerance approach to hits to the head, neck and face. Under the new rule, a minor penalty is to be assessed to a player who accidentally hits another player in the head, face or neck.

When the hit to the head is judged to be intentional, the offending player is to be assessed a double minor penalty or a major penalty and a game misconduct.

Locally, the Brantford Minor Hockey Association has implemented a concussion management program that includes baseline testing for representative teams this season. The goal of the program, which is operated in co-operation with the Clinical Medicine Research Group Ltd., is to ensure players who suffer concussions don't return to the ice too soon.

In addition to education and information about concussions, the program includes neuro-cognitive testing, proper medical management and research.

The program is in its first year and covers 12 teams from pee wee to midget and is being very well received by coaches, players and parents, said Todd Francis, the director of risk management for the Brantford Minor Hockey Association.

So far, about 12 players have been part of the program after suffering concussions.

Making sure kids who have concussions take enough time off to heal and don't return to the ice too soon is a big part of the program. But so is education and awareness for everyone involved including parents, trainers and coaches, Francis said.

"One of the things you have to remember is that minor hockey, like all of these sports, is driven by volunteers and one of the things we've done is provide them with pocketbook-sized card to help them recognize the signs of a concussion," Francis said. "We don't expect them or want them to be able to diagnose a concussion, that's not their job.

"But we want them to be able to recognize the symptoms so that a kid who gets hit hard and might have a problem doesn't go back on the ice until he or she is checked out. We want to give them the best information possible so they can make good, informed decisions."

The card includes the signs and symptoms of a concussion as well as a way of testing memory function and a player's balance.

Under the program, players who have suffered a concussion are examined by specialists who help determine the severity of the injury and develop a treatment plan.

The program is also an opportunity to collect data and keep track of players.

Association officials plan to review the program at the end of the season and are looking to expand it to all travel teams with the idea of encompassing all teams under the association's banner including house league.

He couldn't say for sure how many other associations across the province have a similar program. However, a lot of associations either have or are looking at introducing something similar because everyone involved in hockey is taking concussions far more seriously these days.

He believes its only a matter of time before such programs and policies become mandatory for all minor sports associations.

Francis is a Brantford Alexander's Alumni who played for the team when they were an Ontario Hockey League Junior A team in the early 1980s. He was drafted 35th in the second round of the NHL entry draft in 1983 by the Montreal Canadiens and played for several teams including the Brantford Smoke of the Colonial Hockey League in the mid-1990s. His playing career included the Oshawa Generals, the Flint Generals, Saginaw Generals and the Jacksonville Bullets as well as the Brantford Smoke when they were part of the Colonial Hockey League.

In addition to being the director of risk management for the Brantford Minor Hockey Association, Francis is part of the Dangerous Play task force.

The task force has the potential to do a lot for hockey and other sports but its important for people to understand what the task force is trying to accomplish, he said.

"There had been some discussion leading up to this and I think there was some apprehension amongst some groups as to what the task force was going to do," Francis said. "I think it's important people realize that we're not trying to change the rules of the game, that's the job of the governing bodies.

"What we want to do is bring everyone together to see what we can do to make playing sports a better experience for everyone involved especially the kids."

By way of example, the task force might be able to help improve communication between all of the groups involved in minor hockey especially between the coaches and hockey referees.

"One of the issues we need to address is the recruitment and retention of referees," Francis said. "Retention is a huge problem because some people start out refereeing but soon give it up because they get tired of the abuse and lack of respect."

In hockey, and he suspects a lot of other sports, a lot of people involved in a game get too caught up in specific calls that were made or missed by an official. Instead of having huge arguments about specific incidents, the idea of the task force is to look at the big picture and see what can be done to improve the game locally.

"Ultimately, we're all responsible for the product that gets put on the ice and we all want it to be the best product possible," Francis said.

And yes, he acknowledged, some of the work of the task force is to help market the community which already bills itself as the Tournament Capital of Ontario.

"We want people to come into our community, play in tournaments and when they go home we want them to leave with the feeling that they've had a good experience," Francis said.

Brad Cotton is a hockey dad, the trainer for his 12-year-old Michael's competitive team and a member of the Dangerous Play Task Force.

"We want our kids to be competitive but we also want them to be safe," Cotton said. "I think we have to remember that these kids have to have a life outside of hockey.

"The vast majority of them will have to be able to function in school or in a workplace outside of hockey. Even those who do make it to the NHL have to be able to function once their career is over."

To do that they need to be able to use their brains and society is just now starting to understand the damage caused by concussions, he said.

"These kids represent our future but what kind of a future will we have if they are brain damaged as a result of too many concussions," he said. "I worry about my son when he's on the ice, that's why I became a trainer.

"I want to do what I can to help keep him safe."

Carol DeMatteo was pleased to hear about the steps being taken by city and Brantford Minor Hockey Association officials with respect to keeping kids safe.

She is an associate professor at the School of Rehabilitation Science at McMaster University and runs the acquired brain injury follow-up clinic at McMaster Children's Hospital.

More sports leagues and associations need to follow the example set by Brantford just as parents and coaches need to pay closer attention when a child is hit in the head.

"People really need to pay attention when a child hits his or her head," DeMatteo said. "They need to take it seriously and not let their child go back to doing what he or she was doing because they're going to get another injury.

"I think it's also important to understand that we're learning more about the brain and we're learning more about how long it takes to recover."

People who have multiple brain injuries risk permanent damage, she said.

DeMatteo prefers to use the term 'brain injury' instead of concussion because that's what a concussion is, a brain injury. When people use 'concussion' to describe the injury it has a way of minimizing it and that has to change, she said.

Brain injuries can have a huge impact on a young person's life, she said.

"They're devastated because they're not able to go to school, they start feeling bad about themselves and their self-esteems suffers," she said. "We're starting to get a much better picture of how much these so-called 'little' concussions can affect their lives."


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Concussion and Suspensions in the NFL

posted by SK Brain Injury    |   December 19, 2011 09:00

In preparation for Week 15 of the NFL season, let’s ponder some burning questions involving the league’s movers, shakers and touchdown makers.

How should the NFL handle the Colt McCoy concussion fallout?
It is time for the league to get serious about independent testing.

Everything up until now has been lip service regarding the treatment of concussions suffered on the field. If the NFL is so concerned about the health and welfare of its players, it already would have had an independent neurologist on the sidelines for all games as part of its recent collective-bargaining agreement.

Instead, it has another huge problem on its hands.

An independent neurologist should be part of all future games following the severe concussion suffered by Cleveland Browns quarterback Colt McCoy on Dec. 8 in a matchup between the Pittsburgh Steelers and Browns. An illegal helmet-to-helmet hit from Steelers linebacker James Harrison left McCoy crumpled on the turf for a long stretch and required medical assistance from the Browns’ staff.

Incredibly, McCoy returned to the field moments later.

After the game, he complained of being in a "funk." Postgame reports indicated he became startled by a loud noise in the locker room and asked for the bright lights on television cameras to be turned off.

It was clear to everyone around him that he had suffered a concussion.

Everyone but the Browns.

The team at first denied he had suffered a concussion. Then it explained the team’s coach and medical staff failed to properly diagnose the concussion symptoms during the game because its doctors were preoccupied with other players suffering from concussions. All of which is true, but nonetheless is an inadequate response.

The fact he never got checked on the sideline is disturbing beyond belief.

The reason McCoy didn’t communicate his obvious concussion symptoms is because, frequently, the full effects of head trauma are not immediate. Adrenaline is pumping throughout his veins after such a violent collision on the field, so it’s no surprise he talked his way back into the game two plays later.

A player is in no condition to diagnose his own concussion.


The NFL needs to institute the following protocols:

1. An independent neurologist must be assigned to all NFL games and must be the only medical authority who clears a player to return to the field after a concussion or suspected head trauma. It is absurd for teams to use their own medical staff to make these determinations. The NFL has a long, sorry history of team doctors being influenced by coaching staffs whose highest priority is winning, not the health of players.

"I think it would help," Browns left tackle Joe Thomas told reporters. "If you give an independent neurologist just one thing to look for on both sides, then he can just focus on exactly that. We’ve got enough other people that check jerseys and watch for socks to be pulled up and everything else.

"Why don’t you have somebody that’s watching for concussions?," he wondered. "They’re making the refs try to look for it, too. They’ve got enough things to worry about, just like the coaches."

2. Any player requiring medical attention for suspected head trauma must be taken to the locker room and evaluated there. To conduct concussion testing on the field or on the sideline is a complete joke. Even officials go under a hood to view replay challenges as far off the field as possible to block out all distractions.

"We need to find a way to standardize everything and make it so there is no gray area, and there’s no question this has revealed the system might need to change a little bit – not with the Browns, but with the entire league," Browns tight end Evan Moore told reporters. "We’ve got to protect players, no question about it."

It’s not Browns coach Pat Shurmur’s fault McCoy went back onto the field.

Shurmur is preoccupied with the game and relies on medical staff to tell him what’s best for the player.

Nor is it the fault of the team medical staff, who didn’t see the hit as it happened because they were busy treating other players at the time. If McCoy seems fine at the moment, they’re just following the league rules by letting him return.

The problem is the league’s prehistoric protocols for handling concussions.

If the NFL is going to dispatch uniform police to every game to hand out fines for improper shoes, socks that are too long or inscriptions on towels, it had better put independent neurologists at all of its games.

Expecting officials to diagnose concussions on the field is just as ridiculous.

It is the pure definition of negligence for the NFL to keep letting this happen.

Is a one-game suspension for James Harrison enough?

Not even close.

The head-hunting Harrison refuses to change his practice of lowering his helmet and inflicting as much punishment as possible to opposing quarterbacks. Yet, the NFL chooses to banish him for just one game?

The league’s attempts at disciplining Harrison are an outrage.

He is a repeat offender multiple times. He has a bad reputation for lowering his helmet at impact. He must learn he doesn’t need to lead with his helmet to make a tackle.

Yet, for doing so, he gets a one-game suspension.

Meanwhile, the league suspended Detroit Lions defensive tackle Ndamukong Suh two games for a "stomp" that inflicts no harm upon Green Bay Packers guard Evan-Dietrich Smith.

If it’s a "SportsCenter" highlight that maims a quarterback but happens between the whistles, that’s one game.

If it ends up being a viral YouTube clip on Thanksgiving Day during a national telecast that happens after the whistle but then leads to a public uproar, despite no one being hurt, that’s two games.

Yep, makes sense.


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Online Library for Brain Injury Launched

posted by SK Brain Injury    |   December 9, 2011 09:00

Citing the need for athletes, parents and coaches to access more information on concussion and its effects, London, Ont.-based sports physician Dr. Paul Echlin, has created an online library for information on the head injury.

“Concussion is a serious brain injury that can cause short and long term disability among athletes. We can no longer turn our collective heads when a concussion occurs,” Dr. Echlin said in launching the online clearing house.

“Our young athletes need access to education tools such as the e-modules, a selection of video documentaries, and testimonials from their peers,” the concussion expert said. “All of these resources are now available on the website.”

The resource details concussion symptoms and treatments to avoid long-term brain injury including a concussion diagnostic tool from the Zurich International Conference on Concussion in Sport in 2008.

Also included are more than 2,300 peer-reviewed journal articles with the latest research on concussion; education tools aimed at football and hockey athletes; documentaries on concussion; testimonials of amateur athletes and parents, and professional athletes; 61 book chapters and thesis research.

The online library’s address is


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Former NFL Players sue League over Concussion and Durg Effects

posted by SK Brain Injury    |   December 8, 2011 09:00

Twelve former professional football players have sued the National Football League, claiming the league failed to inform them of the true risks of concussions and routinely used a drug that increased the likelihood of cerebral bleeding in players with head injuries.

Filed Monday in U.S. District Court in Newark, the suit by the players, including former New York Giant Jim Finn, says that despite "overwhelming medical evidence" that on-field concussions led directly to brain injuries and had tragic repercussions for retired players, the NFL failed to protect active players from suffering a similar fate and failed to inform players of the true risks.

The suit is the most recent brought by former players who accuse the league of concealing the harmful effects of concussions, but it appears to be the first to shine a spotlight on the use of Toradol, a non-steroidal anti-inflammatory drug that the players say they were given before games to reduce pain.

The lawsuit said Toradol masks pain, preventing the feeling of injury. In a press release, attorneys for the players said medical experts have also found that the drug induces greater cerebral bleeding, "greatly increasing the risk of long-term brain damage."

According to the complaint, players would line up in a "cattle call" before games to receive injections of the drug.

The players, who claim they suffer from mental impairment and other maladies, including short-term memory loss, depression, and migraines, say they did not receive any warnings about the drug's effect on head injuries.

"Plaintiffs were thus medicated without proper warnings, without proper consent, and without knowledge of the risks posed by the use of Toradol," the suit says.


The suit accuses the league of negligence, fraud, fraudulent concealment, negligent misrepresentation and conspiracy. The players are seeking punitive and compensatory damages.

League spokesman Brian McCarthy said in a statement that the NFL has made and continues to make player safety a "priority."

"Any allegation that the NFL intentionally sought to mislead players has no merit and stands in contrast to the league's actions to better protect players and advance the science and medical understanding of the management and treatment of concussions," McCarthy said.

The players' attorneys said in a release that their clients were ready to file suit months before any of the other NFL cases were brought, but held off after the league invited players to collaborate in forming a "global traumatic brain injury compensation fund" that would compensate them for their injuries. But after the NFL lockout earlier this year, the league struck a new collective-bargaining agreement that included concussion-related benefits that are less favorable than the terms discussed with the players, the attorneys said.

"The NFL pulled an end-run around our clients, in a move that added insult to their injuries," Christopher Seeger, who represents the players, said in the release. "Our clients were assured by the League's attorneys that senior NFL officials, including the Commissioner, were committed to forming a sizable compensation fund, but despite months of direct negotiations, the League ultimately chose not to honor their commitment," Seeger of Seeger Weiss said.

A spokesman for the NFL declined to comment further on the matter.

The case is Jim Finn et al v. National Football League, U.S. District Court, District of New Jersey. Case number not immediately known.

For the players: Christopher Seeger of Seeger Weiss; James Cecchi of Carella, Byrne, Cecchi, Olstein, Brody & Agnello; and Marc Albert of the Law Offices of Mark S. Albert.

For the NFL: Not immediately known.


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NFL Players Fear Head Injuries

posted by SK Brain Injury    |   December 6, 2011 21:00

Pittsburgh Steelers safety Troy Polamalu said he does not plan to change his style of play despite fears that he might eventually take a blow to the head that could result in serious long-term damage to his brain.

Speaking publicly for the first time Friday since he was knocked out of Sunday's win over Kansas City Chiefs because of what he and coach Mike Tomlin called "concussion-like" symptoms, the All-Pro safety said he feels good. He went through his second consecutive full practice Friday and is listed as probable and expected to play in Sunday's AFC North showdown between the Steelers and Cincinnati Bengals.


Polamalu would not answer, however, when pressed on whether he had actually suffered a concussion, reported. It was a continuation of the Steelers' reluctance to officially call it a concussion.

Polamalu did concede that he plays with a perpetual internal struggle between the constant threat of serious injury and not letting it affect his performance.

"That's the fear I think that any player faces," he said. "And that's the fear that any individual faces, overcoming any certain fears of being a coward, you know, and letting your teammates down or turning down a hit. That's the beautiful thing about sports is these fears are right in your face and it's pretty obvious if you turn them down or not.

"Oh, I have the fear, no question about it," Polamalu added. "But I'm willing to fight it, for sure."

Sunday was the second time in six weeks Polamalu left a game early with a head injury. Counting high school, college and the pros, Polamalu has been diagnosed with at least seven concussions.

Polamalu, known for his torpedo-like tackles, said he knows no other way to play.

"I don't know if it's possible, at this point, to change a style of play," he said via "I think that's the case for anybody in the NFL, especially regarding the rules and fines that we have.

They're going to continue to happen, just because we're instinctual players at this point. Of course we're professional athletes, but it's still tough to change these habits we've formed since we were eight years old."

Polamalu isn't the only Steelers star who had full participation in practice Friday and is considered probable to play Sunday.

Linebacker LaMarr Woodley (hamstring) is expected to start against the Bengals, too.

Woodley hasn't played since Oct. 30.


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"Heading" in Soccer Linked to Brain Injury

posted by SK Brain Injury    |   December 6, 2011 09:00

It may come as no surprise to many but scientists have found that repeatedly hitting a fast moving hard ball with your head – known as ‘heading’ in soccer – can damage the brain.

Using brain imaging techniques Israeli researchers found that 38 men who played soccer and said that they frequently ‘headed’ the ball had brain injuries similar to those seen in people with concussion, otherwise known as ‘mild traumatic brain injury’.

Soccer is one of the most popular games in the world and is often the preferred sport for primary school aged children as it is meant to be a ‘non-contact sport’ and therefore less likely to cause injury.

But the study authors, presenting their findings at the annual meeting of the Radiological Society of North America (RSNA) in Chicago, said that in adult recreational games the ball can travel at speeds of more than 50 kms an hour. In professional matches is can reach speeds of more than 125 km/hour.

The researchers said that it was repetitive headings were the problem, and that it was players who played a lot were at highest risk.

They established a threshold of 1000-1500 headings a year as the point where injury was most likely to occur.

"While heading a ball 1,000 or 1,500 times a year may seem high to those who don't participate in the sport, it only amounts to a few times a day for a regular player," observed radiologist and lead author Michael Lipton.

"Heading a soccer ball is not an impact of a magnitude that will lacerate nerve fibres in the brain," said Dr. Lipton. "But repetitive heading may set off a cascade of responses that can lead to degeneration of brain cells."

The researchers identified five areas, in the frontal lobe (behind the forehead) and in the temporo-occipital region (the bottom-rear areas) of the brain that were affected by frequent heading. Those areas are responsible for attention, memory, executive functioning and higher-order visual functions.

In a related study, Dr. Lipton and colleagues gave the same 38 amateur soccer players tests designed to assess their neuropsychological function. Players with the highest annual heading frequency performed worse on tests of verbal memory and psychomotor speed (activities that require mind-body coordination, like throwing a ball) relative to their peers.

"These two studies present compelling evidence that brain injury and cognitive impairment can result from heading a soccer ball with high frequency," Dr. Lipton said. "These are findings that should be taken into consideration in planning future research to develop approaches to protect soccer players."

Dr Litpon said the impact of heading in children was also on his agenda for study.

While heading is an essential part of the game, Dr Lipton hopes his team’s findings will be used to create safe guidelines for play in the future.


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"Heading" Soccer Balls Linked to Brain Injury

posted by SK Brain Injury    |   November 30, 2011 11:12

Coaches value players who have their head in the game, but a new study finds that may not be the healthiest thing for soccer players. Those who head the ball most frequently, the study showed, had damage in brain areas similar to that seen in people with concussion. 


The brain changes were found in players who headed the ball 1,000 to 1,500 times a year — which amounts to a few times a day — but not in those who did so less frequently. Reporting the findings at the Radiological Society of North America's annual meeting in Chicago this week, the study's author said the effects of heading may be cumulative — appearing not after the occasional header, but building up over time in players who frequently use their heads to play.


"I'm not advocating banning heading, but there may be a threshold level, which we defined, that indicates a safe range of heading," said author Dr. Michael Lipton, associate director of the Gruss Magnetic Resonance Research Center at the Albert Einstein College of Medicine in New York City, in a statement.


The researchers used a type of brain scan known as diffusion tensor imaging to examine the brain tissue of 38 amateur adult soccer players in New York City, who said they had been playing since childhood. Players reported heading the ball more than 400 times a year on average. Those in the top 25% of heading frequency had an average 1,320 headers in a year, and these players were most likely to show injury in regions of the brain that play a role in cognitive functions, including attention, memory, planning, organizing, physical mobility and high-level visual functions.


"These are changes in the brain that are similar to those we see with a concussion or TBI," said Lipton. In previous research, these players also showed lower scores on tests of memory and reaction time.


The evidence linking brain injury and heading has been inconsistent so far. For its part, the American Academy of Pediatrics says there isn't sufficient data to recommend that young players abstain from heading, but does suggest that players minimize contact between head and ball.


The new study is small and not peer-reviewed, so it must be considered preliminary. But the author said it was a compelling reason to pursue further study; other experts agreed that more study was necessary to determine what the implications might be for soccer players, especially younger ones who may be more vulnerable to brain injury and for those who practice daily, doing frequent heading drills.


More than 250 million people play soccer regularly, according to FIFA, the sport's international governing body. In the U.S., at least 18 million people play soccer, 78% of them under age 18.


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