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Concussion Specialist on Guidelines for High School Sports

posted by SK Brain Injury    |   August 26, 2011 21:56

DECATUR, Ill. • Dr. Wendell Becton believes there's no such thing as a mild concussion.

Becton, a sports medicine physician, says all concussions have the potential to be severe and result in long-term consequences.

Sports-related head injuries have gotten a lot of attention lately with Pittsburgh Penguins' captain Sidney Crosby's ongoing absence from the ice after a concussion in January. There was also the suicide of Dave Duerson, a safety with the 1985 Chicago Bears, and speculation that his death may have been spurred by brain damage he suffered while playing football.

On top of that is state legislation proposed to protect student athletes.

Becton, who has treated concussions in athletes ranging from children to MajorLeague Baseball players, says he supports a bill recently passed in the Illinois House. It would require school boards to work with the Illinois High School Association to institute concussion education programs for parents, players and coaches and set up guidelines to ensure that students who suffer concussions are evaluated properly and recover fully before returning to activity.

The majority of concussions heal completely, but that healing takes time, especially in young people, Becton said. The top thing that can be done for a patient with a concussion is ensuring complete rest.

"It's tough to watch your team," said Rylan Brassington, 14, of Mount Zion of the time he spent sitting out from hockey after getting a concussion in mid-December.

Rylan was checked from behind during a game in St. Louis.

"I got, like, crushed," he said.

"The key to concussions is early diagnosis," Becton said. "If you run right back to your sport or a lot of physical activity or your normal life, like schoolwork and stuff, that's like a big second stress on the brain."

Returning to activity too early or receiving another blow to the head can trigger post-concussion syndrome, a condition marked by concussion symptoms lasting longer than three weeks, he explained.

Education is an important task, said Becton, adding that he sometimes feels backlash from athletes and parents who want the youngsters to return to their sports before it is safe to do so. He said he tried to explain that a few moments of glory on the field were not worth a potentially permanent brain deficit.

"It's quite a butting of heads in battle sometimes to explain the importance to the parents and the players of why they don't need to go back to contact and get a second hit while their brain is still recovering from a concussion," Becton said. "... You don't waver or compromise on the recovery."

"Concussions occur very commonly from hits that are unseen," Becton said.

Rylan's mother, Shelley Brassington, said she didn't immediately recognize the symptoms of a concussion in her son, who went to school and took a test after his weekend injury. When he kept complaining of a headache, she thought he might be coming down with an illness.

She sought care for her son from Becton, who assessed Rylan with the ImPACT test, a computerized test for determining when it is safe for an athlete to return to play after a concussion. The assessment measures such criteria as attention span, working memory, nonverbal problem solving and reaction time.

(Becton offers baseline evaluations for student athletes, so a record of their pre-injury cognitive function can be kept on file.)

Rylan safely returned to hockey after sitting out about five weeks.

Becton said that in the case of a concussion, it was important to determine how the injury happened and how the patient felt immediately afterward.

"We talk about the circumstances of the injury," Becton said, citing loss of consciousness, memory of the incident, dizziness, balance problems, headache, visual problems, nausea, nervousness and numbness or tingling as important factors.



Making the NHL take Concussion More Seriously

posted by SK Brain Injury    |   August 26, 2011 21:54

No one ever accused the National Hockey League of being proactive. A week or so ago, the league got much pre-season attention when it held a camp in Toronto to evaluate a few possible tweaks to the rules - making nets shallower, adding a green line inside the net (to make it easier to judge when a puck is all the way in), a proposal to make penalized players serve the entire penalty, even if their team is scored upon while short-handed.

Fiddles, all. The annual debate about what rules to tweak and how to make Americans care about the game is a great diversion from the woozy, battered elephant in the room, one the NHL would rather keep on ignoring. The league (along with some other major sports leagues) has a serious problem with its players sustaining unacceptable brain injuries. Case in point: The best hockey player out there - Nova Scotia's Sidney Crosby - hasn't actually suited up for a match since last January, and looks unlikely to do so for some time yet.

Why? Mr. Crosby's head hurts. It's been hurting since he sustained two bodychecks to his head last season. After the first hit, sustained on New Year's Day during the NHL's outdoor "Winter Classic" game, Mr. Crosby continued playing. Four days later, he was hit in the head again, and began showing symptoms of a serious concussion. Despite plenty of rest and the best specialists a fat sports medicine budget can buy, the symptoms keep returning. His agent said this week there's no guarantee he'll be able to attend training camp.

And yet the NHL still refuses to take this issue seriously, preferring instead to safeguard "the integrity of the game." It's introduced some superficial changes, of course, as both the public and players demanded: No blind-side hits to the head. Shaken-up players have to cool off for 15 minutes before they can return to the ice. Trainers can't just ask them to count the fingers before sending them back over the boards. Such are the policies that the league seemingly believes are sufficient to protect its star players from potentially career-ending injuries.

The league has statistics it says prove its point. Most of the injuries that result in players missing games, according to the NHL, are either accidental or result from a legal hit. When it's suggested that all hits to the head should be illegal, even if they are accidental or occurred during what would otherwise have been a clean bodycheck, much outrage in the league's offices and among hockey puritans ensues. Anyone who dare suggest such a step is accused of disrespecting Canada's national game or wanting to turn hockey players into "wusses." The NHL has convinced itself that people like hockey because hockey is a tough, hard-hitting sport. Anything that would reduce that impression, by the league's logic, would threaten the popularity of the sport.

But that's not the case. Fans like heroes they can cheer for, and Mr. Crosby - a young, personable, clean-cut role model among a plethora of less enviable sports figures - is a better ambassador for the game than two goons pounding away at each other could ever hope to be. He helped re-energize hockey in Pittsburgh and rekindled interest across the United States. He is a genuine superstar in a league that has for too long gone without one, and now he may never play again.

Indeed, unless the NHL is willing to crack down on all hits to the head, given the emerging science showing how serious repeated head injuries can be to a player's long-term health, Mr. Crosby could be forgiven for taking the money he's already made and retiring now, the better to enjoy a comfortable, migraine-free life of good health, with his short-term memory intact.

That would be a loss to hockey fans everywhere, and a serious blow to the NHL. But unless the league sets aside its fear of alienating its fans and starts

worrying about its star players, quitting may well be the best thing the league's most talented athletes can do for themselves. If that finally forces the league to get serious on head injuries, they'll have done hockey a favour, too.

The above is an opinion piece from the National Post.




School Sports Focus more on Concussion

posted by SK Brain Injury    |   August 25, 2011 21:11

As high school football teams begin practice this week and games in less than a month, they will be doing so with new legislation in place that reinforces concussion awareness and prevention.

The Missouri and Illinois governors each signed bills in July that address the issue, and education of concussion-related topics continues to dominate conversations at local, statewide and national levels of the sport.

"Concussions are the hot topic in football right now," Travis Brown, the athletics director for the St. Louis Public High League, said Friday during a coaches' safety seminar for the PHL.

The similar legislation in both states mandates that a student must receive medical approval before resuming play. The Missouri bill signed by Gov. Jay Nixon on July 13 requires players appearing to have a concussion or brain injury to sit out for 24 hours, which mirrors the return-to-play policies of both the Missouri and Illinois high school athletic associations. Both mandate education for coaches and athletes about concussion symptoms. The Illinois law was signed July 28.

The two state athletic associations are spearheading much of the education process. Craig Anderson, assistant executive director for the IHSA, said head coaches and officials will receive concussion awareness training in meetings. He said awareness, as much as anything, is key.

"I think coaches are becoming more aware. The awareness is there now. I think in our state — and hopefully across the nation — kids are getting proper instruction," Anderson said. "My hope is that we will steadily see a decrease in concussions."

Anderson noted that an uptick in the number of concussions is possible in the near future, and that may be a good thing. A researcher from Purdue University estimates that 67,000 concussions occur in high school football nationwide, and the same amount go unreported. With a broader awareness, Anderson said, the number of concussions reported may initially go up.

The speaker at the PHL's concussion training, Dr. Tom Martin, a neuropsychologist from the University of Missouri, reminded the coaches that younger athletes are particularly at risk of brain injuries. He said it is difficult to compare the concussion treatment of a high school athlete to one seen at the professional level because the adult football player has a different, often quicker, healing process.

Martin emphasized that younger athletes are more vulnerable to concussions, have more severe symptoms and may take longer to recover than an adult athlete.

When it comes to preventing the injury, he said there are several ways.

"I think prevention can take on many faces," Martin said. "One is looking at ways to change rules to minimize possibility for a brain injury, and the second one is education is key so people understand the signs and symptoms."

And education is exactly what Brown hoped Friday's event would accomplish.

"My goal is to educate all the parents and the student athletes and the coaches and make the community at-large aware of concussions," Brown said. "My goal is to spread this to everyone involved. Parents need to know the signs of concussions. They need to know the symptoms of concussions. The kids may not play in a school organized league, but they may play in a recreational league in their community. They need to educate their student athlete."



Brain Injury Linked to Parkinson

posted by SK Brain Injury    |   August 25, 2011 21:06
Traumatic brain injury has entered the public's consciousness as the silent, signature wound brought back by many of our military warriors from Iraq and Afghanistan. But such injuries don't only happen in warfare, they happen to civilians too. Think car crashes, a slip and fall, two football players colliding helmet to helmet.
While most people know the results of a traumatic brain injury — ranging from a simple headache to long-term problems with memory and thinking, depending on the severity — few are aware that such an injury can also increase one's risk later in life for Parkinson's disease, the neurodegenerative disorder that affects roughly 1 percent to 2 percent of the population over the age of 65.
Now scientists at UCLA have found the mechanism for this elevated, long-term risk of Parkinson's: the loss of a specific type of neuron.
In a pre-clinical study, the researchers found that a moderate traumatic brain injury in rats caused a 15 percent loss in the brain cells known as nigrostriatal dopaminergic neurons shortly after the trauma, and that this loss continued to progress to a 30 percent loss 26 weeks after the initial injury.
The loss of these particular neurons can result in the cardinal motor symptoms observed in Parkinson's patients, including akinesia (problems with movement), postural tremor and rigidity. Further, when combined with a second known risk factor for Parkinson's, the pesticide paraquat, the loss of dopaminergic neurons doubled to 30 percent much faster.
The study, which appears in the current online edition of the journal Neurotrauma, was conducted by first author Che Hutson, a former UCLA graduate student, and senior author Dr. Marie-Francoise Chesselet, a UCLA professor of neurology, along with colleagues.
While traumatic brain injury was known to be a risk factor for Parkinson's, no one knew why. Nor was it known whether traumatic brain injury acts synergistically with pesticides such as paraquat, one of the most widely used herbicides in the world, which is known to be toxic to human beings and animals and has been linked to the development of Parkinson's.
Nigrostriatal dopaminergic neurons are involved in the production of dopamine, which plays an important role in the regulation of movement, among other things. The current study demonstrated that while a traumatic brain injury does not cause Parkinson's, it can make individuals more susceptible to the disorder, Chesselet said.
"We found that with a moderate traumatic brain injury, the loss of neurons was too small in number to cause Parkinson's disease, but it is enough to increase the risk of PD," she said. "By decreasing the number of dopaminergic neurons, any further insult to the brain will be attacking a smaller number of neurons; as a result, the threshold for symptoms would be reached faster."
Second, Chesselet noted, "shortly after a traumatic brain injury, these neurons are more vulnerable to a second insult."
The research looked at both the long-term effects of traumatic brain injury and the acute, or short-term, effects, combined with an exposure to low doses of paraquat. In the acute study, rats receiving moderate traumatic brain injury alone experienced a 15 percent loss of dopaminergic neurons. The addition of paraquat increased the effect, causing a 30 percent loss of neurons.
In the long-term study, which did not include the addition of paraquat, the rat's brains showed a 30 percent loss of dopaminergic neurons 26 weeks after the injury. This suggests that in the long term, traumatic brain injury alone is sufficient to induce a progressive degeneration of dopaminergic neurons.
"These are the first data revealing that in a model of experimental traumatic brain injury, not only do nigrostriatal dopaminergic neurons degenerate, those that survive become sensitized to paraquat toxicity," said study author David A. Hovda, a professor of neurosurgery and director of the UCLA Brain Injury Research Center.
"These results suggest that greater attention should be given to the long-term risk of Parkinson's after traumatic brain injury, and that the epidemiology of both risk factors, brain injury and exposure to paraquat, should be evaluated in combination," Chesselet said.
Other authors of the study included Dr. Christopher Giza of UCLA; Carlos Lazo, now at Emory University; and Farzad Mortazavi, now at the Boston University School of Medicine.
Funding for the study was provided by the UCLA Center for Gene Environment Studies in Parkinson's Disease (supported by the National Institutes of Environmental Health); the UCLA Morris K. Udall Center (supported by the National Institute of Neurological Disorders and Stroke); a Ruth Kirschtein National Service Research award; a University of California Toxic Substances Research and Teaching student fellowship; an American Psychological Association minority fellowship; the Michael J. Fox Foundation for Parkinson's Research; and the UCLA Brain Injury Research Center.
By: Mark Wheeler



Coaches Adapting to New Concussion Rule

posted by SK Brain Injury    |   August 25, 2011 21:00

Cody Spanberger had a concussion every year at Granite City High School. Three he got playing football. The other he had during baseball season, which he didn't report.

"We didn't really tell anyone about that," said Spanberger, "because it was not likely to happen again."

That attitude might not cut it this year. A new state law is requiring that any student athlete even suspected of having a concussion get an OK from a doctor before playing again. The law is meant to curb the kind of serious — even fatal — brain injuries that young athletes can get after repeated, jarring blows to the head on the playing field.

But with football season moving into high gear, some are questioning how the new rule will be applied — and whether it will have a real impact on the rough-and-tumble world of student sports.

"Kids can be competitive to a fault," said Collinsville High School Athletic Director Chris Kusnerick. "Our hope is that they'll be honest and our trained medical professionals will be able to recognize when a condition warrants attention."

Put me in coach

The law Gov. Pat Quinn signed late last month essentially forces coaches to remove any player who might have had a head injury during a practice or game. It applies to all sports and all ages and mandates that school districts work with the Illinois High School Association on developing plans to make sure the rule is followed.

The onus is put on coaches, trainers, players and referees to spot signs of a concussion, which the legislation broadly defines as "loss of consciousness, headache, dizziness, confusion or balance problems."

Jason Bennett, a St. Louis University athletic trainer and physical therapist, said concussions have gone overlooked for far too long because the injuries aren't taken seriously.

"If an athlete can get up and run around, and there's no obvious injury, there's a less serious sense of urgency," he said.

He said athletes who head back to the field before a concussion is healed run the risk of 'second impact syndrome." The potentially fatal condition can result from even a mild blow that rattles the brain, stopping its ability to regulate blood flow. This can cause swelling, permanent brain damage or death.

Of the 138 traumatic deaths of high school football athletes over the past 30 years, 17 were attributed to second impact syndrome, according to the American Academy of Pediatrics.

Former Collinsville High School quarterback Austin Hails is familiar with concussions: He sat out four varsity games last year after a rough play.

"I hit my head and I remember standing up and doing the signs for a play," Hails recalled.

But other than having a case of the giggles and forgetting who his opponent was, Hails said, his head was in the game.

"I was ready to go back in way before they said I was OK," he said.

I'm ready to play today

Hails and Spanberger, who both graduated in May, highlight the potential challenge of enforcing the new rule: It's sometimes difficult to tell when someone has a concussion. In his experience, Hails said, players would rather risk further injury than ride the bench.

"There was one kid on my team who was having some head pain and he didn't want to sit out," he said. "So he didn't say anything to the trainer."

Coaches say keen eyes of trainers, refs and physicians will be key to making the new legislation work. Many area teams keep trainers and physicians on the field during varsity matches to help them spot suspect symptoms that players might not be aware of, or trying to cover up.

"My biggest fear is when the underclassmen go on the road, they may not have trainers on the field," said Joe Iorio, Columbia High School athletic director.

Coaches say teaching proper technique early on also helps.

"If I don't think a kid is ready for contact, they won't put on pads and a helmet," said Jeff Hasty, who coaches 6-year-olds for the O'Fallon Little Panthers Sports Club.

The minute a player complains of a headache or other concussion symptom, Hasty pulls them off the field until they've been checked out.

In the end, education will be key to making sure kids stay safe while not altering the spirit of the game, said Eddy Harkins, president of the Tri-County Junior Football league, which has teams in Madison, St. Clair and Monroe counties.

"It's an impact sport, a collision sport. We encourage that," he said. "It's safe when we teach it properly."



Arizona First US to Mandate Concussion Education

posted by SK Brain Injury    |   August 24, 2011 20:52

PHOENIX, Aug. 16, 2011 /PRNewswire/ -- Barrow Neurological Institute at St. Joseph's Hospital and Medical Center, The Arizona Interscholastic Association (AIA), and the Arizona Cardinals today announced a major breakthrough in concussion prevention and research that will immediately affect more than 100,000 Arizona student athletes.  

Today, Arizona becomes the first in the United States to mandate all male and female athletes undergo concussion education and pass a formal test before play through a new program specifically geared toward students. The program is expected to become a model for other states to follow.

Arizona ranks second in the nation for traumatic brain injury and until now, there has never been a mandated education and testing program designed for student athletes to teach them about the dangerous effects of concussion.

Twenty-eight states, including Arizona, have concussion laws that require concussion education, removal from play and return to play. Arizona is the first to define and create the education directly targeting students through a new e-learning module and the AIA is the first to require that every student complete and pass the education module in order to participate in athletics. This program, designed by AIA, Barrow and the Arizona Cardinals, is expected to change the face of high school sports in Arizona.

"The AIA recognizes the seriousness of this debilitating brain injury and is proud to be taking the lead in changing the way athletes are educated about traumatic brain injuries associated in sports," says Harold Slemmer, Ed.D., Executive Director of the AIA. The AIA is an association of public and private high schools throughout Arizona that oversees interscholastic activities including athletics in 275 schools.

"There are approximately 3 million sports-related concussions nationally each year," says Javier Cardenas, MD, neurologist at Barrow in Phoenix, who has taken a statewide lead in concussion prevention. "Players recognizing the signs and symptoms of concussion can prevent death and disability."

All student athletes through the AIA will receive their concussion education through Brainbook, an interactive online site created by Barrow and Arizona State University. Designed to look like a social media site, the students are taken through a series of educational content, activities and videos. At the end of the module, the students are required to pass a formal exam before being cleared to play. The module is the first collaborative educational effort between a pro football team, a hospital, and an interscholastic agency. Brainbook is currently being evaluated for implementation in other states throughout the nation.

In addition to the education program, Barrow has received a $250,000 grant from the Maddock Foundation to develop a research registry which will track concussed student athletes. This will be a powerful tool for Barrow neurologists and researchers to make never-before-known insights into the long-term effects of concussion.

The AIA, Barrow and the Arizona Cardinals have been partnering for the past year to create this milestone program. The NFL and the Arizona Cardinals have been very instrumental in passing concussion legislation.

"We are pleased to have worked with Commissioner Goodell's office to help protect young student athletes in all sports," says Michael Bidwill, President of the Arizona Cardinals. "This education module and research program today takes the Arizona legislation passed in February to the next level. We are very proud to be part of this revolutionary program."

Article source: Barrow Neurological Institute at St. Joseph's Hospital and Medical Center




Concussion Awareness Law, in North Carolina, Signed by Governor Bev Perdue

posted by SK Brain Injury    |   August 24, 2011 20:48

On Thursday, June 16th, Governor Bev Purdue signed into law a bill to protect North Carolina middle and high school student-athletes against concussions. This piece of legislation, known as the Gfeller-Waller Concussion Awareness Act, is designed to raise awareness of the significance of concussion injuries, as well as emphasize the importance of safety in sports.

Matthew Gfeller died in August 2008 after sustaining a head injury during a high school football game in Winston-Salem. He played for R.J. Reynolds High School.  Jaquan Waller, a football player at J.H. Rose High School in Greenville, died in September 2008, after sustaining a head injury during a game. Waller suffered from Second Impact Syndrome, a condition that occurs when a person sustains multiple concussions in a short period of time.

The key points of this bill include:

1. Mandatory concussion education is required for all parents, coaches, administrators,  and athletes to read & sign annually.

 2. If an athlete displays any signs or symptoms of concussion during competition or practice, they are immediately removed from play and not allowed to return-to-play that day.  Prior to returning to sport, they must be evaluated and cleared by a medical provider with training in concussion management.

3. A venue-specific Emergency Action Plan is required for each facility hosting athletic events. 

 The act currently applies to all public middle and high schools, and will begin 2011-2012 school year.

 CFPSM would like to thank our providers, staff, patients and their families who helped by contacting their local representatives in the House and Senate to support this act. The multiple letters, emails, and phone calls for this act were heard, appreciated, and made a difference in the lives of the student-athletes across North Carolina.

 CFPSM’s Carolina Sports Concussion Clinic was established in August 2008. Our mission is to educate the community on concussion prevention, recognition, and proper management. To date, our providers have evaluated and managed over 500 concussions.  Dr. Josh Bloom is also a member of the North Carolina High School Athletic Association’s Athletic Safety Task Force Committee.

 For more information on the Carolina Sports Concussion Clinic, please visit:

 To read the full article regarding passing the Gfeller-Waller Concussion Awareness Act, please visit:





School Sports: Concussion Testing

posted by SK Brain Injury    |   August 24, 2011 20:44

Cary, NC – Ready or not, Fall is around the corner and once again school will be in session. That means many teens are already practicing for their school sport, whether it’s football, soccer, cheerleading or any other physical activity.

As parents, we make sure that our children are well prepared for school and sports by providing all the equipment needed. But, what about preparing for the possibility of a future head injury? 

Gfeller-Waller Concussion Awareness Act

Now you can have a baseline ImPACT test done for all high risk athletes before a head injury like a concussion occurs.

In June, Governor Bev Purdue signed into law a bill to protect North Carolina middle and high school student-athletes against concussions. This piece of legislation, known as the Gfeller-Waller Concussion Awareness Act, is designed to raise awareness of the significance of concussion injuries, as well as emphasize the importance of safety in sports.

Matthew Gfeller died in August 2008 after sustaining a head injury during a high school football game in Winston-Salem. He played for R.J. Reynolds High School.  Jaquan Waller, a football player at J.H. Rose High School in Greenville, died in September 2008, after sustaining a head injury during a game. Waller suffered from Second Impact Syndrome, a condition that occurs when a person sustains multiple concussions in a short period of time.

What exactly qualifies as a concussion?

A concussion is so much more than just a bump in the head, or getting one’s “bell rung.”  A concussion is a mild traumatic brain injury and results in a wide variety of symptoms.

These symptoms fall into four categories:

  • Physical
  • Cognitive (those that affect thinking & concentration)
  • Emotional
  • Sleep related

These symptoms are a result of either a direct blow to the head, or a blow to another part of the body which transmits a force through the head resulting in the brain being shaken, compressed, or twisted within the skull.

When the brain is functioning normally, there is a nice, steady balance of impulses shooting from one cell to the next.  When this balance is disrupted, a change in emotional responses occurs and these symptoms become apparent.

Measuring Head Injury

Since this metabolic imbalance cannot be seen on imaging such as CT scan, or MRI, how can the severity of these injuries be measured?  Healthcare professionals used to rely solely on the description of symptoms provided by the athlete.

An athlete could say “I have a headache” or “I feel dizzy when I turn my head from side to side” but it was difficult to measure the cognitive deficit that had likely occurred.

Now, there are options and ways to measure neurocognitive function using a computer-based test. In Cary, physicians at Carolina Family Practice & Sports Medicine (CFPSM) developed the Carolina Sports Concussion Clinic.

This clinic, in addition to obtaining a thorough medical history and asking specific questions regarding symptom patterns, has added the use of ImPACT testing to its toolbox. ImPACT helps providers make appropriate clinical recommendations based on an athlete’s composite scores in four categories:

  1. verbal memory
  2. visual memory
  3. visual motor speed
  4. reaction time

In the Fall of 2008, CFPSM provided baseline ImPACT testing for all high risk athletes in the Wake County Public High Schools.  Once these baseline tests were established, athletes were then referred to CFPSM after sustaining a concussion and a repeat test was performed as part of the athlete’s office visit.

Once an athlete was evaluated, his or her ImPACT scores were also taken into account in making a diagnosis of concussion as well as developing an individualized plan for each athlete’s recovery.

Can I get a baseline test for my child?

Each year, CFPSM has added new schools and organizations to its baseline testing pool.  Student-athletes at Campbell University, St. Augustine’s College, Cardinal Gibbons High School, East Coast Eagles Hockey, and various youth sports programs have initiated baseline ImPACT testing as part of their pre-participation standards.

Other area schools like Cary Academy are considering implementing baseline testing for the 2011-12 school year. Check with your school to make sure they offer this test to their student athletes.

If you or your child is in an extracurricular sport, you can get the whole team tested. Baseline testing can be done in a group setting, takes less than an hour to complete, and is reasonably priced.

As athletic participation remains a popular recreational choice for youth, adolescents, and adults alike, concussion awareness will continue be to at the forefront of the Carolina Sport Concussion Clinic’s presence in the Wake County community.





Students, coaches act pre-emptivey against concussions

posted by SK Brain Injury    |   August 15, 2011 19:10


Right before halftime several years ago, a Council Rock North football player approached athletic trainer Mike Horan with a strange complaint. He couldn’t remember the first quarter of the game.

When Horan performed a sideline evaluation for signs of a concussion, the player had no problems with balance, dizziness, headaches and his eyes were fine. He also remembered all the words that Horan asked him to repeat.

A few minutes later, Horan did the tests again, and the only problem was that the player did not remember the first quarter.

Not satisfied, the trainer involved a team doctor, who suspected a concussion and held the boy out the rest of the game. The next day, a computer test confirmed a mild concussion.

With head injuries, one symptom is one too many, trauma experts say. But the signs of a concussion can be subtle and sometimes take hours, days, even weeks to appear, increasing the risk of a second, life-threatening head blow because the player is not benched.

One tool for diagnosing a concussion is a computer-based neurocognitive test players take before a head injury that provides a baseline for memory, reaction time, speed and concentration. But not all area high schools use ImPACT testing, and those that do, may not use it consistently, though that could soon change.

Pending legislation in the Pennsylvania Assembly would create standards for managing concussions and trauma brain injuries involving student athletes, bench students who show symptoms of a concussion, require student athletes to undergo baseline testing and sport coaches to undergo concussion education training.

Meanwhile, for this upcoming school year, the Council Rock and Neshaminy school districts will require high school athletes who participate in contact sports to undergo ImPACT testing as part of a pilot project.

Student athletes will also be required to attend an educational program on concussions prior to testing. The coaches at participating schools will attend a training program on preventing concussions and recognizing their signs.

More than 700 fall athletes in the three high schools schools will be tested this month and another 600 will be tested throughout the school year, said Kim Everett, trauma prevention coordinator for St. Mary Medical Center in Middletown, which with the Bucks County Intermediate Unit’s Brain STEPS team and Princeton Brain and Spine Center brought the testing pilot to the districts.

Earlier this week, 466 athletes were tested including cheerleaders, football, soccer and field hockey players, Everett said. Another 75 to 100 kids at each school still needed to be tested as of Thursday. Monday is the first day of the fall sports season.

Only about 10 of the nearly 70 of Council Rock High School North football players failed to attend testing Tuesday, athletic trainer Mike Horan estimated. A makeup session will be held Monday, and students who miss it will be barred from practice until the test is administered.

“This is that important of an issue to us,” Horan added.


The human brain is a soft organ protected by a hard skull. Normally the fluid around the brain protects the organ from banging into the skull, but if the head or body is hit hard enough, the brain can shift, resulting in injury.

The Centers for Disease Control and Prevention estimates that U.S. emergency departments annually treat 135,000 sports- and recreation-related traumatic brain injuries, including concussions, among children ages 5 to 18.

Any sport involving a high rate of movement and sudden stops can result in a concussion, and most — 80 percent to 90 percent — are considered mild, meaning the person did not lose consciousness, according to the CDC.

But a mild concussion is a potentially serious injury that, if not treated properly, can result in brain damage, doctors emphasize.

Emerging research suggests that an athlete who has a concussion is more susceptible to a second one, and some studies have connected repeated concussion injuries with depression, Parkinson’s disease and amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease.

The greatest health risk is second-impact syndrome, which carries a high risk of death and permanent brain damage. It occurs when the brain has not adequately healed from an initial concussion and an athlete returns to play and has another concussion.

St. Mary Medical Center’s trauma unit is seeing an increase in the number of concussions among young athletes, Everett said. But too often the injuries are not immediately diagnosed or followed up on.

Kids today are physically larger than in previous generations, which creates a higher risk for concussions during contact sports and play, said Dr. Raymond Talucci, director of trauma services at St. Mary Medical Center.

“These hits can be quite violent at times,” he said.

A delay in diagnosis can occur because a diagnostic imaging scan may not show any immediate brain damage, though symptoms emerge later. This is the reason why observing how a person behaves and functions after a head blow is a better indicator of a concussion, Talucci said.

“If the CT is negative it does not mean the child is not injured,” Talucci emphasized. “If a kid has a bad enough injury to require a CT, he’s in trouble.”


The way that ImPACT testing works is, when a concussion is suspected, the original test results are compared with a post-injury retest. The test not only can help diagnose a concussion and its severity, but show when a player has recovered enough to return to play.

Many Bucks and eastern Montgomery county districts use ImPACT testing to some extent, but they’re not using it as effectively or widely as they could, Everett said. The main reason is a lack of staff to administer the test to all athletes participating in contact sports, Everett said.

Since 1999, Council Rock North has required ImPACT testing for its football team, which averages about two player concussions a year, Horan said. Six years ago, the school added mandatory testing for all other contact sports teams. Council Rock High School South added the student athlete testing last year.

For the last two years, Council Rock North students had been allowed to take on online version of the ImPACT test at home, and provide proof they took it. But a home environment doesn’t allow for the test control conditions necessary for a true baseline score, he said.

Neshaminy High School has offered ImPACT testing since 1999, but it has not been consistently used, athletic director Bryan Schendlinger said. Last school year, for example, only about one-quarter of football players were tested.

Neshaminy High School athletes had one or two serious concussions last year, but fewer minor concussions than the prior year, Schendlinger said. Where he is seeing more head injuries isn’t with football, it’s girl’s lacrosse.

Students typically will tell him or a coach if they are hit hard enough, but sometimes it can depend on the game situation, Schendlinger said.

“Some kids will turn other kids in,” he added.

Council Rock North senior Ferguson Amo, 18, plays football and runs track. Concussions are something he frequently thinks about.

He had one before, when he fractured his frontal sinus cavity after he was accidentally kneed in the head during gym class.

While coaches emphasize safer tackling techniques, head blows happen, the Upper Makefield teen added. That is why he thinks requiring the testing is a good idea.

“It’s going to be helpful. Nobody wants to end up like (the brain damaged football player) in the video we watched,” he said

Newtown Township resident A.J. Garboski, 17, plays football, hockey and baseball, all high-risk contact sports. He has been hit in the head, but doesn’t worry about concussions much.

About seven years ago he had a mild concussion after a head blow during a Pop Warner football game, but he hasn’t had a problem since, he said. But he agrees with the new testing requirement.

“It is good knowledge we all need to learn about,” he said. “It’s about our safety.”




Living within the system: The story of two women battling to overcome the complexities of social assitance

posted by SK Brain Injury    |   August 11, 2011 19:01

SBIA is a member of DISC and hopes that the SAID program will be implemented as soon as possible.


For many people with disabilities, life is a constant battle for survival to make ends meet. The same things that many Canadians take for granted, a heated home, a vehicle, food in the fridge, a telephone and a computer, are often out of reach for many Canadians with a disability.
According to a recent report by the Council of Canadians with Disabilities, more than 16% of adults with disabilities lives in poverty. It’s an issue that’s often overlooked for a variety of reasons, mainly due to a lack of knowledge or understanding about the issue.

In late spring, I sat down with two persons with disabilities, Gayle Dixon and Jana Friel, both of whom have struggled to live a quality life within a system that tends to perpetuate poverty. I was also joined by Judy Hannah, SACL Project
Coordinator for the Grassroot Alliance, and one of the key individuals behind the Disability Income Support Coalition

Gayle’s Story:
Now in her early 50s, Gayle has a warm disposition, her eyes bright and cheerful. From Gayle’s laugh and smile, one would have little idea that in reality, life for Gayle has been a constant battle of making ends meet while struggling with her emotional disability including chronic depression.
It’s a disability that Gayle has endured for most of her life.
Gayle thinks back to the years following her mother’s death, which happened in the mid-90s. “I had a fear of leaving my house by myself, and friends had to take me shopping and to appointments, and my nerves were really bad,” said Gayle.

“I was really depressed, and I just wasn’t coping with life very well.”

A salvation of sorts came about for Gayle 11 years ago by happen stance when she watched a television show featuring service dogs. The dogs are highly trained to provide support to persons with disabilities such as visual and hearing. Service dogs also guard diabetic owners, and have known to have saved numerous lives of diabetics who go into diabetic shock.

“After I saw the show, I went to my doctor and asked if maybe a service dog might help me, and she said why not?” said Gayle. After a long search for a suitable dog and a huge community effort where more than $5,000 was raised to pay for service dog training, Gayle got Murphy, a young Black Labrador. Murphy, as it turned out, would be the first service dog in Saskatchewan to provide support for an emotional disability.

Gayle’s situation is slightly more unique than others who are on social assistance. She owns her own small house – an inheritance from her mom. She also owns her own car, albeit very old and used, which helps her make frequent trips to the leash-free park to exercise her service dog. Gayle’s fortune of having a house, however, is offset by the system which has penalized her for having property. It’s an issue that Judy has been working for years to change.

“Because Gayle has her own house, Social Assistance covers the taxes and utilities, but reduces her allowance so that she receives only $473 a month to live on.”

“After her basic housing expenses are paid for, Gayle has $58 a week to use to pay for everything. Her food, clothing, entertainment, car repair ... everything” says Judy.

The bond between Judy and Gayle has grown over the years. Gayle’s experience with the system has given Judy a disturbing glimpse into living life on the bare edge of existence.

“I remember one time last winter you had a cold”, said Judy as she turned to Gayle and smiled. “You had a few colds last winter and you called me and said you wanted to buy a box of Kleenex because you had a cold. I told her ‘well, go buy a box of Kleenex then!”

“Do you remember what you said? You said it would cost $1.29 to buy a box of Kleenex and when you’re living on so little money you have to always think twice if you’re going to buy a box of Kleenex, you know?”

Gayle nods her head. “I’m barely surviving. Barely surviving. The price of food has gone up and I mean, you go grocery shopping and it doesn’t go as far as it used to. And you can’t buy really healthy food, and so you buy a lot of Kraft Dinner and macaroni because that’s cheaper.”

As Gayle can testify, being on social assistance means not only a question of living on the edge of existence; it’s also a question of dignity. Every main expenditure must be tracked and explained to a social assistance worker in the Ministry. Failure to account for how money received is spent can mean a reduction of benefits, or loss of the assistance altogether.

Gayle is still haunted by a harrowing experience she had with her furnace, which had unexpectedly broken down. “I phoned Sask Energy and told them my furnace wasn’t working. I had to explain that I owned my house but was on social assistance.”

Because the furnace breakdown was an unforeseen expense, Gayle required special permission from her social assistance worker to approve a visit from Sask Energy. However, her frantic attempts to contact her worker before the end of the day were unsuccessful. “I had to spend that night without heat. It was very cold but I didn’t have any choice, I couldn’t get help.”

Judy nods. “You have to ask for everything from your social assitance worker. If you need anything special or extra you have to ask.”

“For those of us who don’t depend on assistance, we never do that. If we need the furnace fixed, we just get it done.” Gayle’s experience is hardly uncommon for those who have long-term disabilities and have little option other than social assistance to survive. One of the major drawbacks for persons with disabilities who are on social assistance is they are severely restricted by any attempts to plan or save money for the future.

Constantly managing every precious penny, Gayle once decided to set aside her GST tax credit for savings and investment, if only to plan for her future and give herself a cushion for unexpected expenses, like maintaining her old car.

“I was saving my tax credits so I could keep it for things like repairs for my car,” says Gayle. “Went I went to report to my social assistance worker, they saw that I was setting aside money for savings.” “It wasn’t a lot of money, but when they found out, it was a big problem. I came really close to getting kicked off of social assistance and if that had happened, I’d have no options left to survive.”

Gayle’s harrowing experience from her attempts to save money has played a big role in motivating her to become involved in reforming the system. She was one of the first people involved in the now-established Disability Income Support Coalition (DISC), and she has helped to lobby for Saskatchewan Assured Income for Disability, or SAID program.

“I started coming to meetings and getting interested in trying to make a difference,” said Gayle. “I’ve been on Social Assistance for over 10 years, so I know what it’s like and I know how the system can be very difficult for people who depend on support.”

“I like coming to the DISC meetings, because we’re all of one mind. We’re all working for the same thing which is to get people onto the SAID program.” The SAID program, which following years of planning, meetings and lobbying,
was established in 2008. The program is unique in that it provides assistance for people with significant and enduring
disabilities, and gives individuals who receive the assistance greater control over how the money is spent.

“SAID’s reporting structure will be much less restrictive,” says Judy. “It gives recipients greater control over their lives, and it won’t force them to report every single expenditure for approval.”

Also unlike social assistance, SAID doesn’t punish its recipients for saving money says Judy.

“Here Gayle was, being responsible by trying to put her tax credit money aside and the system wouldn’t let her do that.” “When it’s fully developed, SAID would allow for money to be set aside and nobody would question her about it.”

“If you’re on welfare you’re not allowed to save for the future. On SAID, Gale can set money aside for home maintenance, and if she does, nobody will threaten to cut her off. “

“SAID is gonna be great because there’s so many people with disabilities that are just barely surviving,” says Gayle.

“We need the government to really listen to us and to be able to meet with DISC to understand why we need the SAID program.”

Judy quickly interjects. “What Gayle is asking for is just to be able to live, really. And social assistance doesn’t allow that, plus the lack of dignity from being on welfare, and she has to go every year for intake where people with disabilities are asked ‘do you still have a disability?’”

“That’s something that will change when they go on to SAID. They will have to report in every three years. But these disabilities never disappear – if anything your condition often deteriorates over time, so it will give more dignity to their lives, and even the people who are on it already have said it feels different.”

Judy remains very positive that the SAID program will soon be expanded to include more persons with disabilities.

“Kudos to the government,” says Judy. “They launched SAID and they got people in residential care on the program.”

Ironically, even with her long-term debilitating disability, Gayle has yet to be approved for the SAID program, due largely to backlogs and red tape. Still, she holds out hope that within a year or two, she’ll finally be approved.

“They got people in residential housing on SAID 18 months ago,” says Judy. “Since that time, nobody else has gotten on. Right now the government is testing an assessment tool, and the hope is that they’ll finish testing by the end of this summer and start getting more people like Gayle on SAID this fall and winter.”

Gayle is adamant that not being on social assistance will provide her with a precious feeling of dignity and control. “If I get on SAID I’ll feel like I have respect for myself. I’ll feel like I’m not just existing and that I’m actually able to live.”

“I’ll feel like I’m worth something.”

Jana’s Story:
Jana Friel is a 29 year old woman with an intellectual disability. Born and currently residing in Regina, Jenna has lived independently for the past 8 years at an independent living apartment in the city.

I met Jana recently at an SACL Self- Advocacy forum. Warm and engaging, Jana immediately directs us to a meeting place. She does not lack independence and assertiveness. Indeed, Jana has lived a great portion of her life independently, extending all the way back to when she entered the work force at a tender 16 years of age.

“I started working while I was still going to school. I was at home and I like to go out but I was also bored. So I asked my mom if I could work and she took me in to talk to the manager, and they hired me on the spot.”

Because of Jana’s disability, she depends on social assistance to help cover her basic living expenses. The system, however, has very strict rules for the amount of money people can earn while working. Up until February of this year, the Ministry penalized individuals who earned more than $150 a month. 75% of any monthly earnings over the $150 amount were deducted off of her assistance check.

Jana wasn’t generally affected by the penalty – working reduced part-time hours, Jana’s earnings were under the cap. However, with her employer issuing paychecks every other week, there are two months out of every calendar year where three pay stubs are issued.

The combined total of the stubs exceeded the earnings cap, and as a result, Jana’s social assistance benefits were penalized.

“I felt sad when they took money away,” says Jana. “I worked hard for my money but I had no more in my bank account. I have to have enough money for rent, the phone bill, groceries and other things to live on. I didn’t have any money to do other things like go to a movie or go out with friends.”

“I worked hard for my money but I had no more in my bank account.”

Jana wasn’t only sad. She was angry.

With the help of Judy and the DISC, Jana managed to meet Social Services Minister June Draude face-to-face about the penalty.

“I met with Minister Draude last summer and I talked to her about how I once got three pay stubs in a month, and asked her what do I have to do to keep my money?”

“She said that wasn’t right.” Indeed, following that meeting, Minister Draude enacted an adjustment a few months later which raised the earnings cap by $125 to $275 a month.

For Jana, her big wish right now is to work more hours, perhaps even getting a second job. “I would like to work on the days I don’t have anything to do, like three or four days a week and work 16 or 20 hours a week.”

“The problem is,” says Judy “if she were to work more hours, she would still lose money, because the earnings exemption isn’t very high.”

“We’re working on raising that further. Jana deserves to keep the money she’s earning.”

For Jana’s parents, Shirley and Mark Friel, the concerns they share for Jana go beyond making ends meet month- to-month (which often, she can’t). They think about Jana’s long-term future, and what supports will be there to ensure she will be taken care of after they’re gone.

“Every month we have to subsidize Jana for things like clothes, and some groceries and cleaning supplies,” says Shirley. “It really doesn’t take very long for her money to be used up.”

“Exactly,” says Mark. “I’ve talked face to face with people from Social Assistance who issues these checks and they know that all the parents are providing some help to their children. The big question is how would Jana survive if

Shirley and I weren’t here?”

Right now the Friel’s are putting money away through the Registered Disability Savings Program (RDSP), where money can be put away until the recipient reaches the age of 59.

Still, Shirley and Mark don’t stop worrying about Jana’s future.

“Prior to the RDSP, which I think is phenomenal, the long-term is helped a little, but Jana needs to look at the pure long-term,” says Mark. “If I last until I’m 80 years old, and I can keep putting money in yearly into a RDSP, and look after any shortfall, then that’s okay.”

“But what if I don’t live until I’m 80? It’s on my mind every day.”

“We know that while we’re alive we make sure that she’s got things she needs in her apartment,” says Shirley. “But we know if we were to be gone suddenly from the picture that the system would probably take over, and Jana might not be able to retain that independence and live on her own.”

While advances like the RDSP have been made in helping to provide greater security for the future of individuals with disabilities, Shirley and Mark are still haunted by pessimism.

“Are things moving fast enough? No. Hell no,” admits Shirley.

“But are they moving forward? Yes. And hopefully for those who come after as we look back on the days of integration and mainstream integration that we fought so hard for with Jana to stay and remain in her neighborhood schools.” “What has happened in the years to follow has been to benefit parents bringing very young children into
schools, and finding programs in place, and supports in place that weren’t there when we enrolled Jana.”

Shirley’s voice dims. “Things are moving forward, but there are still a lot of issues. Right now Jana can’t earn much more than a couple hundred dollars of her own money before they start clawing back on what is already a very low income.”

“Will we live long enough to see persons with disabilities have enough money to live a quality life? I’m not sure.”

“I don’t think we’ll see it in our lifetime.”
A few weeks later, I happened to meet Gayle again, this time she’s beaming with her new service dog, Angel. We sit down and talk about how things are coming along – matters are up and down. Her car is acting up, and she fears that she might have to get expensive repairs done. With Angel at her side though, I sense that Gayle feels like things will turn out alright.

We talk about her future. I ask Gayle what her life dreams are.
Gayle pondered my question for a bit. “I’d like to be able to buy treats for my dog. She works so hard for me that I wish I could buy something for her in return.”

“I’d love to be able to buy Christmas presents for my friends. I try every year to make things for my friends just to say thanks for all they do to help me.”

“I’d like to go to a movie if I saw one that I thought was good. I have a friend that lives on the other side of the river and we don’t see each other very often because it costs so much for transportation.”

“I’d love to phone her up and say ‘hey, can we meet for coffee or something?’”