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Could suffering a brain injury lead to violence later in life?

posted by SK Brain Injury    |   September 18, 2011 12:41

It seems like head injury awareness is everywhere these days. From veteran hospitals and construction sites to cheer practice and Pee-Wee hockey games, it appears that people are beginning to understand just how serious a head injury can be. One of the more important aspects of that awareness is the realization that with these types of injuries, many of the associated risks may not become apparent until long after the swelling has subsided and bruises have healed, or there may be no bruises at all. Memory loss, brain damage and difficulties with school have all been seen in children who suffered a blow to the head, and sometimes these conditions don’t manifest for months or years after the accident. Now, according to a new study published in the journal Pediatrics, there could be yet another risky, long-term side effect for children with brain injury: An increased risk for violent behavior. 

The study, which followed 850 high school students for five years, showed that of the 88 study participants who had suffered head injury, 43 percent of them were involved in some form of violence in the year following their injury. That’s almost a 10 percent increase in violent activity when compared to study participants who had never suffered a head injury. These numbers may seem staggering to some, but come as no real surprise to the medical community.

“Given what we know about brain injuries’ ability to affect behavior, these results are far from shocking. Depending on the nature of the injury, it’s not unusual for a patient’s judgment of what is and what isn’t acceptable behavior to change after significant brain trauma,” says Mark Proctor, MD, of Children’s Hospital Boston’s department of Neurosurgery.  “It’s a little bit like what happens when some people drink. Their inhibitions and normal judgment change, sometimes fairly significantly.”

A change in a patient’s mood or judgment following a head injury is known as disinhibition, where the person suddenly displays a lack of restraint, or regard for social norms not previously shown in their behavior. It’s not fully understood how blows to the skull result in disinhibition, but it is a fairly regular occurrence after serious brain injury, and can be seen in less severe cases as well.

“There are many cases where a child has suffered a head injury and then acted differently afterwards,” Proctor says. “Often the parents believe their child’s brain trauma was the trigger.”

To treat potential cases of disinhinbition, as well as other affects of head injury, patients at Children’s Hospital Boston’s Brian Injury Center are cared for by experts from many services, including Neurology, Neurosurgery, Trauma Program, Sports Medicine and Neuropsychology. Once admitted to the program, the multifaceted care team screens the patient for potential future concerns like academic difficulties or problems reintegrating to their normal life. By establishing concerns early and keeping up with the long term-care of each patient, the team at the Brain Injury Center is often able to offer treatment options before problems occur, instead of addressing them after the fact.

“Depending on the nature of the injury, it’s not unusual for a patient’s judgment of what is and what isn’t acceptable behavior to change after significant brain trauma.”

It’s a preemptive strategy, which is one of the cornerstones of Children’s Brain Injury Center’s mission. In addition to furthering the treatment of children with brain injury, the Brain Injury Center is dedicated to educating the next generation of health care practitioners and increasing awareness in the community through continued training and outreach programs.  “People are finally beginning to recognize that kids with brain injury are more likely to have future problems in school, and possible social problems, as they recover,” Proctor says. “The more aware of that fact people are, the more likely they will be help identify these problems before they become too much of an issue.”

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Visual Test is Effective in Diagnosing Concussions, Study Suggests

posted by SK Brain Injury    |   September 18, 2011 12:14

A sideline visual test effectively detected concussions in collegiate athletes, according to a team of researchers from the Perelman School of Medicine at the University of Pennsylvania. Concussed athletes scored an average of 5.9 seconds slower (worse) than the best baseline scores in healthy controls on the timed test, in which athletes read a series of numbers on cards and are scored on time and accuracy. This quick visual test, easily administered on the playing field, holds promise as a complement to other diagnostic tools for sports-related concussion.

Up to 3.8 million Americans sustain sports-related concussions each year, yet current methods fall short from objectively and quickly measuring the presence and severity of a concussion. Evidence-based protocols are needed, both on sidelines to prevent injured players from returning to play too soon, and off the field, for physicians to more accurately and effectively diagnose, treat and rehabilitate patients suffering from concussions.

"This test has demonstrated its ability to provide objective evidence to aid medical professionals and trainers in determining which athletes need to come out of games after a blow to the head," said Laura Balcer, MD, MSCE, professor of Neurology and senior author on the paper. "We'll continue to measure the test's effectiveness in different groups -- players who play the same position who have and have not suffered concussions, for instance. It is our hope that the new test, once validated, can be folded into the current sideline battery of tests for concussion, as no single test at this time can be used to diagnose or manage concussion."

The King-Devick test, originally used as a dyslexia test, detects impaired eye movements and rapid eye movements called saccades, indicating diminished brain function. A previous study, published in Neurology, of this visual screening test for concussion found that boxers and mixed martial arts (MMA) fighters who had head trauma during their matches had significantly higher (worse) post-fight time test scores. Fighters who lost consciousness were on average 18 seconds slower on the test after their bouts.

In this follow-up study, published online in the Journal of the Neurological Sciences, 219 collegiate athletes were given the 2 minute test as a baseline at the start of the sports season. Athletes who sustained concussions -- an impulse blow to the head or body that results in transient neurologic signs or symptoms -- in games or practices during the season were given the test immediately on the sidelines.

Athletes who suffered concussions had significantly higher (worse) time scores compared to baselines. In the injured group, there were occasional accuracy errors while reading the cards, with one athlete making four errors and two others making one mistake each following a blow to the head. Two of these three did not have significantly slower test-taking times, suggesting that there may be a tradeoff of accuracy for increased time to complete the test in some concussed athletes. Researchers proposed adding a defined amount of time to the cumulative score for every error on the test, to account for the tradeoff of accuracy for time.

Researchers also looked at test improvement over time and post-game fatigue. A group tested following an intense scrimmage showed no signs of fatigue and actually improved their test scores compared to baseline. Another group tested before and after the season showed modest improvements, likely a result of learning effects common in many performance measures.

This rapid sideline visual screening tool can complement other diagnostic assessments for sports-related concussion.

The study was funded in part by a National Eye Institute grant and done in conjunction with the University of Pennsylvania's Athletic Department and researchers from the Departments of Neurology, Orthopaedics, Epidemiology, and Ophthalmology in the Perelman School of Medicine, along with researchers from the Illinois College of Optometry and the King-Devick Test, LLC.

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Technology Helps Concussion Monitoring

posted by SK Brain Injury    |   September 6, 2011 22:22

With concussions becoming a growing concern among athletes at both pro and Joe levels, new products are on the way to help coaches and parents better determine when a player might have suffered one.

Over the next few weeks, a U.S. company called Battle Sports Science is making its Impact Indicator available throughout Canada and the United States. It is a sensor that is fastened to a helmet chin strap and detects when the user’s head undergoes an impact likely to cause a concussion.

Football versions of this device should be on the way to Canada in two weeks, said Battle Sports CEO Chris Circo, and one for hockey is expected to be available in late September or early October.

When attached and operating, a green light will be illuminated at the player’s chin. If the light turns red, it’s indicating that the player has been hit hard and should be evaluated before returning to play.

“Most leagues and organizations have some protocol that they typically follow (for assessing possible concussions) but (a red light is) saying this kid has had an impact . . . They need to be looked at before they’re allowed to be hit again,” Circo said.

The Impact Indicator is programmed to turn red if it senses an impact of 240 HICs (head injury criteria), noting that research shows there’s about a 50 per cent chance of a concussion being suffered at this level of impact.

Circo explained that HICs take into consideration gravitational force (G-force) and how long the impact was felt. The 240-HIC threshold, he explained, is essentially a G-force of 75 sustained for five milliseconds.

With a personal history of concussions himself, Circo had a motive for moving forward with such a product. Circo, now 42, had three concussions as a child. When he was an adult, he started having seizures. After a battery of tests, it turned out the condition was the result of those childhood concussions.

“There are long-term effects on people who sustain concussions,” he said “We have to do something about this.”

In recent years, the dangers of concussion and their longer-term effects have gained more attention. Parents have become increasingly concerned about the safety of their children in sports after seeing some high-profile athletes, such as Pittsburgh Penguins star Sidney Crosby, being seriously affected by concussion. Crosby, perhaps hockey’s biggest star, missed half of last season because of concussion, and his status remains uncertain as the NHL season approaches.

Because concussions are difficult to detect and young athletes, just like the pros, often want to avoid sitting out, the Impact Indicator is meant to act as an “extra pair of eyes” for coaches, trainers or parents, Circo said.

A handful of National Football League players, including Detroit Lions defensive tackle Ndamukong Suh and Denver Broncos receiver Eddie Royal, wear the Impact Indicator, Circo said, even though the device is geared more toward younger athletes.

Circo said the Impact Indicator will cost about $200 in Canada and be good for two seasons of play.

Ottawa-based Impakt Protective Inc., also has developed a helmet device, called the Shockbox, that detects and records impact to an athlete’s head.

It’s a sensor that gets placed inside an athlete’s helmet. When the Shockbox detects a significant amount of impact — a G-force of 60 or more — it sends an alert wirelessly to a smartphone or laptop computer within a range of about 100 metres.

It will send an orange signal for hits creating a G-force of between 60 and 90, and red for anything greater than 90.

“A number of clinical studies have pointed 90 G or more as being where 65 per cent of concussions occur,” said Impakt Protective CEO Danny Crossman.

It comes with software that will prompt the recipient of the alert to perform standardized tests on the player affected to determine whether the athlete has been concussed. It also will maintain history on players’ occasions in which they sustained a significant hit, and whether it resulted in an actual concussion.

Crossman said, for the next year or so, the Shockbox will be in trials with unnamed National Hockey League and junior hockey teams. About a year from now, it’s expected to be available as a feature embedded in hockey helmets, and some time after sold separately and as a feature in helmets for other sports. As a stand-alone item, he said it will sell for about $90.

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CFL Players Understand the Brain Injury Risks of Playing Professional Football

posted by SK Brain Injury    |   September 6, 2011 22:20

CALGARY — Head injuries have become an increasingly hot off-the-field topic over the last year as more is learned about the long-term effect of concussions.

Players getting “their bell rung,” or concussions, are a major part of football.

Former Ottawa Rough Rider Jay Roberts donated his brain for study after his death on Oct. 6, 2010 at the age of 67. Former Toronto Argonaut and Hamilton Tiger-Cat Bobby Kuntz also donated his brain to the Canadian Sports Concussion Project. The 79-year-old died on Feb. 7 this year.

Both men were found to have suffered from CTE, a degenerative disease believed to be associated with repeated concussions, scientists announced this summer.

The Canadian Football League introduced a new style helmet in 2010 to better protect its players’ heads, but the helmets, ironically, are prone to popping off on contact.

Ricky Ray and Kerry Joseph hear the talk and see helmets fly on football fields weekly in their roles as quarterbacks with the Edmonton Eskimos. Neither are exceedingly worried about their own safety.

“When you hear about situations that are happening in hockey and some of the older guys in football, it makes you think a little bit when you have a little bit of down time,” Ray said. “But when you’re out there playing, it’s a physical game and that’s what makes it a lot of fun.

“You’re just playing and it doesn’t really go through your mind unless something’s coming up in the news.”

Joseph calls himself blessed to have not dealt with concussion issues in his nine-year CFL career.

“You do take a lot of head shots (as a quarterback),” he said. “I think you just have to be really cautious about it. I think we’re wired to be tough and go out regardless of what the situation is and I think you just have to be wise and be smart, especially when it comes to situations like (depression).

“The game of football can only last so long and you have to go on with life. You feel for guys who go into those depression states, guys who go through those rough times and you just have to really let go of that macho-man (persona) for health reasons.”

Joseph, 37 and recently married, said athletes need to look at the big picture.

“I don’t have any kids, but if you’ve got a family, you have to be wise about some things. Football has been good to us, but you have to realize that there’s life beyond football,” he said. “You have to be careful.”

Ray is 31. He and his wife, Allyson, are parents to a five-month-old girl named Chloe. Moving forward in his life hasn’t got him worried about concussions.

“I got my bell rung quite a few times, but nothing that has really concerned me yet, so you just get back in there and keep going,” he said.

The 18 quarterback sacks Ray endured over three recent games in August were less enjoyable.

“Some of it’s fun,” he said. “If you didn’t like the physicalness, go play flag football in recreation league.

“This is football, and it’s something we’ve grown up playing. You’re going to take some hits no matter what position you’re playing and you’ve got to enjoy it the best you can.”

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US Legislation Takes Aim at Childhood Brain Injuries

posted by SK Brain Injury    |   September 6, 2011 22:18

CONCORD — U.S. Rep. Pat Meehan, R-7, of Upper Darby, recently discussed legislation that would benefit children with traumatic brain injuries through a seven-year initiative known as the National Pediatric Acquired Brain Injury Plan.

Meehan is a co-sponsor of the PABI Plan as outlined in House Resolution 2600. U.S. Rep. Leonard Lance, R-N.J, introduced the resolution.

Meehan said the legislation is important because the human brain develops until age 25 and traumatic brain injuries can occur as a result of several incidents, such as athletic activity and wartime combat.

“I’m concerned about young athletes who suffer repeated trauma to the head. Innocent contact during a game or practice can lead to a devastating injury,” Meehan said recently at Garnet Valley High School. “Additionally, many returning men and women of the military have suffered brain trauma during combat. By establishing a national treatment standard, we can help better address brain injury — the leading cause of death and disability for young Americans.”

Meehan said the legislation would create a Center of Excellence in each of the 50 states, along with the District of Columbia and Puerto Rico.

He said the centers would allow for the collection of records and research on traumatic brain injuries in every state and eventually form a standardized, evidence-based system.

Meehan was joined by Patrick Donohue, whose daughter, Sarah Jane Donohue, was the victim of shaken baby syndrome just five days after she was born in 2005. In October 2007, Patrick Donohue, of New York, founded The Sarah Jane Brain Foundation in an effort to gain awareness about the syndrome and traumatic brain injuries.

In January 2009, the international advisory board of the Sarah Jane Brain Foundation developed the PABI Plan.

Donohue said more than 600,000 American youth enter the emergency department every year with a new brain injury. Of that, 80,000 require hospitalization and 11,000 die, he said. Meehan spokeswoman Maureen Keith said no new spending is required for the seven-year plan. It will be supported with discretionary funds set aside for the United States Department of Health and Human Services.

In addition to Meehan, there are about 60 other co-sponsors of House Resolution 2600, including U.S. Rep. Bob Brady, D-1, of Philadelphia. The bill has been referred to the House Committee on Energy and Commerce.

Jim McCrossin, athletic trainer for the Philadelphia Flyers, also stressed the need for parents and athletic trainers to pay attention to whether their child or student is acting differently.

He said that might be a sign the child needs medical assistance as a result of a traumatic brain injury.

Dr. Kenneth Marx, an emergency physician at Reading Hospital and a lieutenant colonel in the U.S. Army Reserve Medical Corps, said soldiers can suffer from traumatic brain injuries as a result of the force from an improvised explosive device.

Garnet Valley High School Athletic Director Joe DiAntonio said a computerized program was implemented four years ago to test for concussions in students involved in contact sports at the high school.

The program was expanded to include all high school athletes and will be introduced at the middle-school level.

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Concussions Dominate Talks at Quebec Hockey Summit

posted by SK Brain Injury    |   September 2, 2011 17:17

The epidemic of head injuries and concussions in the game was front and centre Saturday at the Molson Export Quebec Hockey Summit.

The continuing uncertainty surrounding Sidney Crosby's return from a head injury loomed large as discussions were held on ways to improve the game throughout the province during the two-day event at the Bell Centre organized by Hockey Canada, Hockey Quebec, the Quebec Major Junior Hockey League and the Montreal Canadiens.

Canadiens general manager Pierre Gauthier said that the priority always has to be the health of the person, rather than the ramifications of any player's absence from the lineup.

“Everyone wants to get those types of hits out of the game and not just because we want to get Mr. Crosby back on the ice,” Gauthier said. “We obviously hope for that, but it's for every player, and not just for them as hockey players but more importantly as people because the consequences can be severe and affect them for the rest of their lives.

“There are kids who suffer two or three concussions in a year and are pushed to keep playing. I can tell you that if one of my sons gets a concussion, his season is over.”

Hall of Fame left wing Luc Robitaille was among the panelists.

“The more people get together and talk, sooner or later you're going to come to some kind of conclusion,” said Robitaille, who is now president of the Los Angeles Kings. “I love the game and I think any opportunity we have to help the growth of the game, we should always participate. I never forgot where I came from.”

Tampa Bay assistant coach Martin Raymond, AHL head coaches Clement Jodoin and Benoit Groulx, former NHL goalie Marc Denis and Daniele Sauvageau, head coach of the 2002 national women's team which won Olympic gold in Salt Lake City, also took part in Saturday's full-day session.

“We had an extraordinary day filled with really positive content and now we're going to take the time to analyse it and decide how best to use it,” QMJHL president Gilles Courteau said.

Philadelphia forward Maxime Talbot and Montreal coach Jacques Martin participated in hot stove sessions on Friday night.

“This is really big for a regional summit,” Hockey Canada president Bob Nicholson said. “There was good information there, so hopefully talking to us a year from now you'll see some really good steps coming out of this.”

Jodoin, who rejoined the Canadiens' organization to coach their AHL affiliate in Hamilton, dismissed any concerns about Quebec hockey facing a language bias.

“For me, there's no language. We're talking about hockey,” Jodoin said. “In my career, if I had been frustrated about everything because I'm French, I wouldn't be here. Stop looking for excuses. Play, compete, perform. If you're not performing, you're not in a position to talk.

“Our national teams have been performing. It didn't matter if we had two, three or four French Canadians. We shouldn't talk about French Canadian, we should talk about talent. We have some talent but we have to develop more players by having a plan. What's our plan? Start with a plan.”

Somewhere in that plan the province's hockey minds are going to want to address defence. The dearth of NHL defencemen developed in Quebec was one of the more the intriguing issues raised Saturday.

While Quebec continues to produce talented offensive stars such as Vincent Lecavalier, Martin St. Louis, Patrice Bergeron, Daniel Briere and Claude Giroux, both the quality and quantity of NHL defencemen developed in la Belle Province have been in short supply for some time.

Blair Mackasey, the Minnesota Wild's director of pro scouting, believes that it is not a question of anything cyclical.

“I really think it's minor hockey,” said Mackasey, a native Montrealer and former Hockey Canada director of player personnel. “I think this is the route we're going and we want to produce skill. For people in Quebec it's skill, skill, skill, but defence is also a skill. It's not just scoring goals or speed, the ability to contain a man one-on-one or poke check a man or stick check a man, that's as much a skill as any offensive skills. But I just don't think we pay enough attention.”

Tampa Bay has fairly cornered the market on Quebec blue-liners with the trio of Bruno Gervais, Marc-Andre Bergeron and Mathieu Roy. San Jose has a pair in Marc-Edouard Vlasic and Jason Demers, as does Pittsburgh with Kris Letang and Alexandre Picard.

The other Quebec defencemen with NHL experience are Anaheim's Francois Beauchemin, Dallas' Stephane Robidas, Buffalo's Marc-Andre Gragnani, Minnesota's Marco Scandella, Vancouver's Yann Sauve, and New Jersey's Maxim Noreau.

Courteau acknowledged that the numbers don't lie.

“I agree with some of the comments that we need to work on improving our situation,” Courteau said. “Right now we should have a couple of good defensive defencemen because our games don't all finish 10-9 or 6-5, but there's always room for improvement.”

Mackasey believes that keeping the puck out of the net needs to be as big a point of pride as putting it in.

“I think that kids in Ontario and in the West tend to relish more the role of being a defenceman,” Mackasey said.” I think people appreciate more of what they do and the aspect of not only scoring goals but stopping goals. I don't think kids that play that kind of game here in Quebec are rewarded enough. I don't think they get the attention and when you don't get the attention, you lose the motivation.”

And once that desire to play organized hockey wanes, those bigger, slower kids who Mackasey says are the ones who find themselves plugged into the defenceman's role in Quebec are readily lured to an increasingly popular alternative.

“Yeah, instead of starting hockey in August, the big 12-, 13-, 14-year-old kids are playing football from July until November and saying to heck with hockey,” he said.

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New Brain Injury Database to Help Diagnose and Treat Brain Injuries

posted by SK Brain Injury    |   September 2, 2011 17:09

BETHESDA, MD – The National Institutes of Health, in partnership with the Department of Defense, is building a central database focused on traumatic brain injuries (TBI) that officials say will aid in better prevention, diagnosis and treatment.

The Federal Interagency Traumatic Brain Injury Research (FITBIR) database, funded at $10 million over four years, is designed to accelerate comparative effectiveness research on brain injury treatment and diagnosis. It will serve as a central repository for new data, link to current databases and allow valid comparison of results across studies.

"There are many traumatic brain injury studies whose value to scientific research and clinical care could be greatly enhanced by transforming the data into a common, easily available format," said Walter Koroshetz, MD, deputy director of NIH's National Institute of Neurological Disorders and Stroke (NINDS).

The FITBIR database will collect uniform and high-quality data on traumatic brain injury, including brain imaging scans and neurological test results. The data will be obtained with informed consent and stripped of any patient-identifying information.

"Uniform data makes it much easier to compare intervention results across a broad range of studies, providing innovative and unique insights that are not possible from a single study," said Matthew McAuliffe, PhD, co-director of the FITBIR database and a member of NIH’s Center for Information Technology (CIT). "This is part of a larger effort by the government to make taxpayer-funded research more broadly available and usable."

The database is expected to aid in the development of:
  • A system to classify different types of traumatic brain injury
  • More targeted studies to determine which treatments are effective and for whom and under what conditions (comparative effectiveness research)
  • Enhanced diagnostic criteria for concussions and milder injuries
  • Predictive markers to identify those at risk of developing conditions that have been linked to traumatic brain injury, such as Alzheimer’s disease
  • Clearer understanding of the effects of age, sex and other medical conditions on injury and recovery
  • Improved evidence-based guidelines for patient care, from the time of injury through rehabilitation
  • According to officials, NIH CIT was chosen to build the database because of its experience and success in developing the National Database on Autism Research. Reusing the database structure is expected to save 35-50 percent of the project costs and significantly reduce the time to achieve meaningful results.

The database builds upon a larger effort to create common data elements for the study of traumatic brain injury – which are essentially definitions and guidelines about the kinds of data that should be collected, and how to collect these data in clinical studies. The Common Data Elements project emerged from a collaborative interagency effort involving more than 50 American and European universities and several federal agencies, including NINDS, Defense and Veterans Brain Injury Center, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Department of Veterans Affairs and the National Institute on Disability and Rehabilitation Research within the Department of Education.

The Defense Health Program, through agreement with the U.S. Army Medical Research and Materiel Command (USAMRMC) is the lead DoD component funding the FITBIR database. The Division of Computational Bioscience within NIH CIT is building the database, and will provide ongoing system administration and hosting services once the database is complete in about two years. USAMRMC and NINDS will provide programmatic support and foster collaborative research to populate the database. Researchers will be given detailed information about the FITBIR database, and encouraged to participate at the time they submit proposals for new studies.

Currently about 1.7 million people in the United States sustain traumatic brain injuries each year from common causes such as auto accidents and falls. In addition, American servicemembers in Iraq, Afghanistan and other parts of the world face unique risks of traumatic brain injury from routine military operations, enemy fire and improvised explosive devices. According to the DoD, in the past 12 years, more than 200,000 servicemembers deployed worldwide have been diagnosed with traumatic brain injury, adding to the urgent need for preventive methods and treatments. Total costs of traumatic brain injury in the United States – including medical care, lost wages and other expenses – exceed $60 billion.

Treatments also remain limited despite improved surgeries and rehabilitation techniques for people with brain injuries. Cases of traumatic brain injury are highly variable, involving different causes, locations within the brain and different kinds of damage to brain tissue. Such variability makes it difficult for clinicians to treat patients, predict long-term outcomes and investigate new therapies. Also, studies often report different kinds of data on patients, obtained through various tests and measures, further impeding comparison of data across studies.

"Despite the great burden of neurotrauma incidence, developing objective diagnostics and treatments has proven especially challenging for the medical community,"  said Col. Dallas Hack, director of the U.S. Army Combat Casualty Research Program and joint chairperson for the Defense Health Program. "Only by combining efforts through initiatives such as the FITBIR database can we hope to make major progress in this field."

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Family Seeks Answers After High School Football Player's Post-concussion Suicide

posted by SK Brain Injury    |   August 31, 2011 22:10

NOKESVILLE, Va. — Austin Trenum’s bed remains half-made, the way a typical teenager would leave it. On a shelf is his scarred black helmet, the one he was wearing when he tackled the quarterback near the sidelines during Brentsville High’s game against Handley some 11 months ago. Austin’s mouthpiece remains tucked neatly in the face mask, ready to be taken out for the next play.

For Austin, there was no next play.

Downstairs in the Trenum home, in the living room to the left of the television, is a memorial in photographs to the 17-year-old college-bound senior who wore No. 43 in football, No. 14 in lacrosse, all sorts of crazy hats when he felt like it, a “fro-hawk” of curly hair, and a pair of women’s sunglasses on a lark one day while riding back from the beach.

Austin’s final play left him with a concussion. Two days later, with the rest of the family downstairs in the house, he went up to his room and hanged himself.

To the grieving parents, there is no doubt that one caused the other. Shortly after his death, Gil and Michelle Trenum made the difficult decision to donate Austin’s brain for research. Seated around their dining table, they told their son’s story, hoping his death can leave a legacy for others of lessons learned — that concussions still aren’t taken as seriously as they should be; that athletes, parents, coaches, trainers and even emergency room workers are often ill-informed as to how to treat them; that more of a culture change is needed in a sport in which blows to the head are considered badges of honor.

“I grew up in a football culture,” Michelle Trenum said. “I’m from Texas, and my father went to college on a football scholarship, and we have three boys that were all playing football. We referred to ‘getting your bell rung,’ ‘getting the snot knocked out of you,’ those types of things. I never realized they were traumatic brain injuries. I thought as long as you were getting up, you were OK.”

“If our son did not have a concussion, he would be here right now,” she added, fighting back tears. “Actually, he wouldn’t be here, he would be in a dorm room.”

Concussion awareness in sports is on the rise. The NFL has done an about-face in recent seasons, instituting return-to-play rules and other strict guidelines after years of being accused of not taking the issue seriously. Hearings have been held on Capitol Hill. Only four months before Austin’s death, the football world was stunned by the suicide of University of Pennsylvania co-captain Owen Thomas, who was found to have a brain disease that could have been caused by repeated head blows to the head.

But the full trove of medical knowledge has yet to filter down to the high school level, and it wasn’t there on the night Austin was injured. His parents took their groggy son to the emergency room — Friday night is already one of the worst times to go to the hospital — and were told to watch for bleeding symptoms and to make sure their son had 24 hours of restful activity.

So he watched game film the next day. He went fishing with a friend in the afternoon. He went to a concert with his girlfriend that evening. He texted. He played video games. On Sunday, he was doing homework. He planned to go to his girlfriend’s house later to watch the Redskins game. All of which seemed suitably restful.

But he also missed a routine turn while driving a car near the home. He couldn’t remember something obvious while talking to his friend while fishing. He woke up early Sunday and went downstairs to play video games, something totally out of character for him. He had also mentioned that he had been getting a “football headache” after every game, something he hadn’t told his parents before. They did know that Austin, who played linebacker and fullback, had at least one concussion the previous season, and probably two others that fit symptoms he had described.

For seemingly no reason at all, Austin went upstairs Sunday afternoon and never returned. Afterward, it wasn’t hard to connect the dots. He had no history of depression. Nor does his family. He was well liked at school. He was in the top 6 percent of his class and a shoo-in for James Madison University. He was making plans. All the soul-searching for answers led to only one.

“It was literally out of the blue,” Michelle Trenum said. “There was nothing in his life, in his character, in his emotions that would have ever — we know it was a concussion.”

The Trenums received a call from Boston University’s Center for the Study of Traumatic Encephalopathy, where there is a bank of about 70 brains that have been donated for study, many from athletes and military veterans. It offered a chance for some answers.

“It was somebody who thought we had a valid point,” Michelle Trenum said. “I worried about my baby. It was very hard. He was an organ donor as well, and that was hard. But I thought I really want to know.”

The CSTE found that Austin had a multifocal axonal injury — structural damage to the brain. Among the areas affected was the portion of the brain that affects judgment and impulse control. The doctors can’t say for sure why Austin killed himself, but there is strong circumstantial evidence.

“We know that a concussion can be followed with depression,” said Dr. Robert Cantu, clinical professor of neurosurgery and co-director of the center. “And depression can be serious enough that hospitalization is required in a small number of cases. We also know that in his brain there were structural abnormalities — and (we are) clearly very concerned that there was cause and effect because of that. Do I know it with 100 percent certainty? No. Can I put what percent certainty I know it at? No. Do I think it’s more likely that not? Yes.”

The Trenums had their answer. Now they want to share it with others.

“It was scientific validation for what we knew,” Michelle Trenum said. “But it was an agonizing gift to be given that information because you realize there’s other parents out there that have unanswered questions and they’ve lost loved ones, too. It’s what you do with that. That’s why, with Austin, we would like his legacy to be that other people were helped, that other parents don’t have to go through this, that other teammates realize when a teammate has a traumatic brain injury, they realize it and bring it to the attention of the coach.”

The Trenums also learned how their son’s concussion should have been treated. Someone with symptoms as serious as Austin’s should have rest with virtually no brain stimulation at all. No watching game film. No fishing. No concerts. No video games. No texting. No television. It should be that way for as long as the symptoms last, even if it means days of inactivity.

“If it was my son again,” Gil Trenum said, “if he got another concussion, he would be just laying down on the couch.”

Gil Trenum is a member of the Prince William County School Board. He is wearing two plastic bracelets, orange from Austin’s senior class and yellow from the lacrosse team, in his son’s memory. He worked to get new guidelines implemented for all athletes at the county’s schools. New return-to-play criteria. Concussion training for trainers. A seminar that includes an eye-opening video, with attendance mandatory for students and their parents as a prerequisite for participating in any sport, not just football.

“I do want Prince William County to lead the way on that,” Gil Trenum said. “I think we can set the standard.”

And, along with that standard, would come the hoped-for culture change. The Trenums haven’t disavowed football — their youngest son still plays the sport — but they say it’s time for athletes, parents and coaches everywhere to realize that a concussion is a brain injury that needs serious, informed treatment.

Before it becomes a life-or-death issue.

“Car seats are a good example,” Gil Trenum said. “When I was a baby and came home from the hospital, my mom rode in the front seat of the car, holding me in her arms, no seat belt. That was the way things were done then. Now we’ve got technology changes. We’ve got procedural changes. We’ve got cultural changes. People would be shocked if you did that now.”

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New rear Access Helmet for Safer Post-accident Removal

posted by SK Brain Injury    |   August 31, 2011 22:07

voztec rear access helmet

Basic helmet design has come a long way since... wait, no it hasn't. Sure, Snell ratings and DOT approved helmets change every few years as our understanding of head trauma increases, but the basic skull bucket remains pretty much the same as it has for decades.

Voztec is looking to add a bit of innovation into the industry, and it's rear access system looks quite interesting. By way of a rear access door, the rider/driver puts their head into the lid and the door clamps shut behind them. In case of an emergency, the helmet can be lifted away from the person's face without having to move the injured person and risk further injury.

Voztec is working on rear access helmets for motorsports, horseback riding, snow sports, firefighters and the military. It's even penned a concept design for an NFL version of the rear access helmet.

This helmet is the fifth prototype that Voztec has developed, and it's now currently undergoing testing by a third party. Also, Voztec is looking for investors to help bring its rear access helmet to market, and we hope someone ponies up the dough because we'd love to get a closer look at this unique concept.

 

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Saskatoon Blades get a New Helmet to Measure hits

posted by SK Brain Injury    |   August 29, 2011 20:21

A small sensor on the back of Tommy Stipancik’s helmet won’t stop him from getting another concussion, but his team might get an early warning if a big blow rattles his head.

Stipancik, a Saskatoon Blades’ defenceman, is one of three team members wearing a cranium-impact analyzer during pre-season games and practices. The device — developed by a Saskatoon’s Rod Newlove — carries extra meaning for Stipancik, who is symptom-free after missing a year of hockey because of post-concussion issues.

“It was tough, the whole not-playing part,” Stipancik, 16, said following a Thursday practice at Martensville Arena. “But I wouldn’t do it any other way. It’s good I took the precaution and good I didn’t mess around with it. It’s my head. It’s got to last my whole life.”

The device — called a Safebrain — measures and logs G-force hits over a pre-determined level, providing early warning if a player takes a shot that could cause a concussion. A flashing LED alerts Blades’ trainer Steve Hildebrand, and the hit is also logged wirelessly into a laptop computer.

Trainers and doctors can tell when the player got hit, how much force there was, and even which way it jars his head.

“We don’t have the perfect answer for concussions, and if someone does, please let me know,” Hildebrand says. “But it’s a work in progress, and we’re just hoping this is another tool to help us.”

Newlove approached the Blades about testing the device. After getting approval from the Western Hockey League, they agreed to afix the chip to helmets belonging to Stipancik, Connor Cox and Chris Collins.

The three players will wear the chip during pre-season practices and games. Newlove says his device is also being used by a couple of minor-hockey teams in Edmonton as well as a midget girls’ squad in Saskatoon.

Newlove, a technician by trade, developed the idea a few years ago. He’s working with Dr. Martin Mrazik, an Edmonton clinical neuropsycholgist who for years has studied concussions and G-force impacts.

“Kids are trying to make the cut. A lot of times they’ll take a hit to the head and intentionally shake it off, even if they’re not feeling well,” Newlove said. “Things get buried that way. Part of the idea is for the coaching staff on the bench to be notified that this person actually took a fairly severe impact to the head.”

The system has gone through a dozen redesigns, with the current one “the final beta version,” Newlove says. The next one will be released for sale at a cost of $2,995 for 22 devices, a laptop and carrying case, plus $499 per year for a service plan.

Hildebrand says one change he’d like to see is the quarter-sized chip placed on the inside of the helmet rather than the outside. Newlove says burying a chip under the foam could negatively impact a helmet’s CSA rating, though he notes that some helmet models do have a recess in the foam that could aid that transition.

Meanwhile, Hildebrand said he’s both curious and excited to see the device in action as the Blades go through their pre-season. What kind of forces would it record during a fight where the helmets stay on, for example? And what will happen when a player really does take a hard shot with enough G-force to activate the LED lights?

“We did some tests,” Hildebrand says. “We threw the helmet to see the impact, and it went off way above G-force because we hucked it pretty good. I’m really curious to see, in many situations, how it’s going to be.

“It can become another tool — we go ‘hey, doc, this is when he got hit, this is the G-force, and we’re leaning towards this.’ Our thoughts are if you’re above the average, you’re probably more than likely going to be closer to concussion.”

Pittsburgh Penguins’ star forward Sidney Crosby has become the poster-boy for hockey concussions because of his high-profile battle with the issue dating back to last season. Lined up behind him are many players like Stipancik, whose concussion woes appear to have been an accumulation of hits at the under-16 and midget levels that finally prompted doctors to tell him he needed to take a year off hockey.

He fought headaches and nausea, and even suffered through anxiety that he suspects was tied to the concussion. The Blades kept Stipancik, a Vancouver native, in Saskatoon last season even though he wasn’t able to play through most of the campaign. He practised with the team, and ended up playing 12 regular-season contests near the end of the schedule.

Concussions are on everybody’s radar right now, including the WHL’s. They agreed this past off-season to follow the NHL’s lead by going to soft caps — that is, more foam — in shoulder and elbow pads.

“Obviously with Tommy, we’re very sensitive about it,” Hildebrand said.

“This is about understanding concussions. I don’t think we’re ever going to get to the point where we can prevent them fully. We’re doing everything possible as far as the new shoulder pads and elbow pads, and obviously mouth guards have been around for a while. We’re doing everything possible to try and prevent them, but I don’t think we’ll ever get to the point where we fully prevent them.”

Stipancik realizes that — but he says he’s also glad to see the new awareness about concussions in hockey.

“It’s your head. You can’t mess around it,” Stipancik said.


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