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Brain Injury Effects on Children: Larger than Experts First Thought

posted by SK Brain Injury    |   January 24, 2012 11:15

Young children who suffer a severe head blow may not overcome the traumatic brain injury (TBI) as well as previously believed, and interventions may be needed even years after, according to two new studies out of Australia.

For the first study, Australian researchers looked at 56 children, 40 of whom were injured between ages 2 and 7 and the other 16 who served as a control group. They found that a decade after each of the 40 suffered a TBI, evidence persisted of intellectual deficits. The study is published this week in the journal Pediatrics online and will be included in February's issue.

They looked at the intellectual, adaptive and executive abilities of the children, as well as their social/behavioral skills. Those with severe TBI tested lowest on IQ exams compared to a control group — as much as 18 to 26 points lower. They also found that regardless of how serious the injury was, recovery "seemed to plateau in the five- to 10-year range," the researchers said.

A release announcing the findings noted that "this is important because it counters the theory that children 'grow into the deficits' and suggests that even many years post-TBI, intervention may be necessary and helpful."

Most of the children in this study were injured by car accidents or a serious fall. They were tested at the time of their injury, then tested again three, six and 18 months after the injury, as well as again at five years and 10 years.

The findings apply to major brain trauma, not to cases of mild concussion or bumps on the head.

"Most of the deficits occurred in higher learning skills such as organization, planning and reasoning, because these are centered in the frontal regions of the brain, which are most often affected in head injuries," wrote Alice Park on a blog for Time magazine.

"These regions are also the ones that develop fastest early in life, so any injury that disrupts the normal trajectory of nerve growth can have long-lasting effects," said lead author Vicki Anderson, director of critical care and neuroscience research at Murdoch Children's Research Institute in Melbourne, Australia. Scientists have long talked about the brain's plasticity and its remarkable ability to reroute signals when something injures the brain. Some researchers believe that injuries to very young children are more apt to be overcome for that very reason than brain injuries in older children and adults. But Anderson noted that young children's brains are not fully developed and, after injury, development lags and may not catch up. "If you look at the trajectory of improvement over time, normal kids have one trajectory, while those with brain injuries have the same trajectory but start out at a much lower point," Anderson told Time.

The study did note a positive: Brain development after a traumatic brain injury does not appear to grind to a halt, as some had theorized.

The other study, also published in Pediatrics this week, found that socioeconomic status might be an even stronger predictor of intellectual development than simply having suffered a traumatic injury to the brain. They told CNN that lower socioeconomic status, high parental stress and low parental involvement affect a child's recovery after TBI and that might account for it.

Article from Deseret News

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Canada Pledges $1.5 million to the Reduction of Concussion

posted by SK Brain Injury    |   January 23, 2012 11:39

The federal government will spend $1.5-million to help reduce concussions in kid's sports.

The money goes to ThinkFirst Canada, Hockey Canada, the Coaching Association of Canada and the Canadian Centre for Ethics in Sport to support efforts to reduce the rate and severity of sports-related head injuries.

Montreal Canadiens Max Pacioretty lies on the ice after being hit into a glass stanchion by Boston Bruins defenceman Zdeno Chara during the second period of NHL hockey play in Montreal, March 8, 2011.

The groups will work on increasing awareness of the problem among coaches, players and parents.

Among other things, they hope to develop guidelines for fitting helmets, and provide better information about the risks and signs of head injuries and when it's safe to return to playing after an injury.

The groups will look at the information about concussion and head injuries that's currently available and try to fill in any gaps.

Concussions in sports have become a hot topic in the last year, especially in the wake of the problems of NHL star Sidney Crosby, and the program aims to raise people's awareness and knowledge about head injuries.

Bal Gosal, the federal Minister of State for Sports, said it's estimated that 90 per cent of severe brain injuries can be prevented.

“We want our children to be active, healthy and have fun while participating in team sports and physical activity,” he said. “But we also want our children to be safe.”

The government says accidental injuries are the leading cause of death for people under the age of 19. More than 40 per cent of brain injuries in children and youth aged 10-19 years treated in hospital emergency departments result from sports and recreation activities.

Much of the new information will be aimed at producing low-cost or free information that can be easily downloaded, including a brain injury and concussion mobile app.

Article from the Globe and Mail

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What's the Appeal of Extreme Sports, Given the Risk?

posted by SK Brain Injury    |   January 20, 2012 19:11

They do it because they have to. They need the feeling of exertion, that head rush of air and attitude. They want what Warren Shouldice knows is hard to explain unless you flip head over skis, knees over board, and kick snow in the face of danger.

That’s what drew Shouldice to freestyle aerials and helped him become a world champion after he had broken his neck and compressed his back. It’s what powered the late Sarah Burke to four Winter X Games championships and made her a success in the superpipe, skiing’s answer to snowboarding’s half-pipe.

“It’s almost no fun doing it if there’s no risk involved,” said Shouldice, a 12-time World Cup medalist in a daredevil game. “The trick is making it a manageable risk.”

When Burke died Thursday, nine days after falling during a training run in Park City, Utah, it saddened a nation and a sporting community world-wide. Burke was 29 and happily prepping for her sport’s inclusion in the 2014 Sochi Olympics. She had been injured many times before – a broken back, a torn shoulder – but nothing could dampen her love of skiing and the need to push herself to the brink of manageable risk and beyond.

Such is the appeal of many established and extreme sports, both for participants and spectators. The risks and rewards provide the thrills. Alpine skiing, particularly the ultra-fast downhill, has been a major attraction for decades. But the advent of the X Games upped the adrenalin quotient considerably.

The Games were the brainchild of ESPN producer Ron Semiao. In 1993, Semiao was looking for programming to fill the cable channel’s fledgling ESPN2. He spotted a series of oddball sports that seemed to have a culture all their own and suggested to his bosses that ESPN create a made-for-TV sporting event. Two years later ESPN launched the first Extreme Games, a week-long competition that featured bungee jumping, mountain biking, skateboarding and street luge. Ratings weren’t great and some critics panned the spectacle as “moronic.” But ESPN stuck with it and made the games an annual event, later adding a second winter sports program. It also changed the name to X Games.

The popularity of the X Games took off and today they rival the Olympics in some respects. The X Games pull in more than 100,000 spectators and draw a television audience of around 44 million. They have also attracted major sponsors such as Ford, BF Goodrich, Sony and athletes such as Shaun White make up to $8-million annually in sponsorship deals.

The X Games are so popular, ESPN has announced plans to expand from two annual events to six, three summer and three winter. Bids from potential host cities have been flooding in, including one from Whistler B.C., which sees the X Games as a complement to the 2010 Olympics. Meanwhile rival network NBC has started a competing series called Dew Tour with PepsiCo and the Olympics have taken up some X Games sports, including Burke’s specialty halfpipe skiing, which will be in the 2014 Games in Sochi.

The X Games “have gone viral,” says Lee Berke, who runs consulting firm LHB Sports, Entertainment & Media Inc. in New York. “It’s very grassroots in its appeal.” Berke added that the X Games have won over major sponsors because the viewing audience is so young, largely 18-34, which means many have yet to form brand loyalties.

But at the root of it all is the question: why? Why do athletes gamble with their lives by doing something so inherently dangerous? Like flying upside down off a 22-foot snow wall or skiing from ridiculous heights?

Asit Rathod has a wonderful life. He’s single, active, works at a sales job in Portland, Ore. But as often as he can, he climbs to the top of Mt. Hood and skis off a cliff with a parachute on his back. He’s done it many times and is now eyeing bigger verticals – Mount Kilimanjaro and Mount Everest.

Ask him why he does it and Rathod’s passion runs wild.

“People always say, ‘Why do you feel the need to risk your life?’ It’s about the power of adventure. In day-to-day life, adventure has been ripped from us in the way we drive, the way we eat. You get to that place where you have to have that adventure,” he said. “The risk is always the excitement.”

Rathod was a good friend of Shane McConkey, who died in 2009 when he skied off a cliff in Italy and his chute failed to open. Over the past four years, Rathod has lost “six, seven good friends” to extreme-sport accidents yet he has no plans to take up something with a safer track record.

“You remember their spirit. You remember their smile,” he said of his fallen comrades. “If anything, it gives you more inspiration to do what you’re doing. It’s like Nietzsche said, ‘The secret to reaping the greatest fruitfulness and the greatest enjoyment from life is to live dangerously.’”

Jacques Rogge, the president of the International Olympic Committee, was saddened by the news of Burke’s death but insisted freestyle skiing is no more dangerous than any other winter sport. “There are always risks attached to sport,” he stated.

Mitigating those risks is the relentless challenge. The International Ski Federation is presently examining how to equip downhill skiers with air bags to protect them during high-speed spills. FIS has been working with Dainese, the Italian company that makes protection for mountain bikers and motorcyclists. Canadian downhillers Erik Guay and Jan Hudec have been involved in the testing. Three years into the project, FIS is hoping to have a race suit fully ready for the end of this year.

Not so high tech, yet just as important, is the way young athletes are trained for their sport. Alpine Canada is holding a series of speed skills camps to instruct young racers on how to ski safely. At Calgary’s Canada Olympic Park, there are plans to expand on an acrobatics room with trampolines and foam pits for budding freestylers. The kids, ages 9 to 14, practise there first before graduating to jumping off a ramp and landing in an air bad. Eventually, after hundreds of practice jumps, they move to the snow and begin in moderation.

“What we’re doing is hiring top coaches to train top athletes,” said Daniel Lefebvre, COP’s director of education/sport development. “You have to build their confidence.”

Shouldice, who recovered from both of his bad crashes but is currently sidelined with a concussion, endorses all of that – solid training and coaching. He also believes Burke’s death, whole tragic, will not adversely affect freestyle skiing.

“I don’t think this is going to change anyone’s opinion of freestyle,” he said. “Yes, there are risks. There are risks driving to work every day, Look at the number of people in freestyle and this is our first death. A lot of sports can’t say that.”

Article from the Globe and Mail


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Med Students will Receive Training for Treatment of PTSD in Veterans

posted by SK Brain Injury    |   January 19, 2012 10:12

 Academic institutions are partnering with a military support initiative led by the Obama administration to improve care for post-traumatic stress disorder, depression and traumatic brain injury.

First lady Michelle Obama announced that 130 medical education programs have agreed to participate in a program ensuring that physicians are trained to recognize and treat combat PTSD and TBI. Obama spoke about the initiative Jan. 11 at Virginia Commonwealth University School of Medicine in Richmond, one of the participating schools.

"By directing some of our brightest minds, our most cutting-edge research and our finest teaching institutions toward our military families, they're ensuring that those who have served our country receive the first-rate care that they have earned," she said.

The effort is part of the administration's Joining Forces initiative, which coordinates support from different sectors of the economy for service members. Joining Forces Executive Director Brad Cooper said the majority of military personnel return from war without injury, but one in five soldiers are impacted by PTSD. A 2008 report by the Rand Corp. estimated that about 300,000 service members had developed PTSD or major depression stemming from deployments to Afghanistan or Iraq.

Many medical colleges offer training for treating PTSD, but most do not, Cooper said. Schools agreeing to join the Joining Forces program have pledged to ensure that future physicians are taught the clinical challenges of caring for veterans and other service members, many of whom are in their 20s and 30s and will need treatment over their lifetimes.

"The commitment is going to help train the nation's future physicians on military cultural issues, including PTSD and TBI as a focus," Cooper said. "They will also develop new research and clinical trials so that we can better understand and treat these conditions -- and share information and best practices through a robust collaborative forum that previously did not exist."

Participating schools will have access to websites that allow them to share educational resources, said John E. Prescott, MD, chief academic officer with the Assn. of American Medical Colleges. The initiative also will survey medical schools to understand the current scope of PTSD and TBI research and advances in clinical careThe American Medical Association applauded the Joining Forces initiative for its work, said AMA President-elect Jeremy A. Lazarus, MD. "By highlighting these issues to physicians, encouraging continuing medical education activities and working with Joining Forces initiative partners, the AMA is committed to ensuring that service members and their families receive the quality care they deserve."

Article from


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Schools Need to Become Brain Injury Conscious

posted by SK Brain Injury    |   January 16, 2012 15:00

OUT OF concerns about brain damage, the National Football League and college teams are finally taking concussions seriously. But while this cautious new attitude is admirable, it can also create a false sense of security for parents of children itching to play football, hockey, or soccer. For if concussions are the cause of brain damage, the thinking goes, then youngsters have nothing to fear as long as they avoid concussions. That’s not true. There is reason to fear brain injuries from head traumas that don’t result in concussions.

That’s the logical conclusion from the latest evidence, admittedly incomplete, from the Boston University researchers who’ve done landmark work into sports-related brain injuries. But the research, outlined in last Sunday’s Globe by Derrick Z. Jackson, should be thoughtfully reviewed by any parent, coach, or administrator of a school-sports program.

The most chilling case is that of Owen Thomas, the popular captain of the University of Pennsylvania football team, who committed suicide at age 21. His brain, studied by the BU team, showed extensive evidence of chronic traumatic encephalopathy - the degenerative condition linked to behavioral changes, dementia, and premature death in former football and hockey players. The surprise wasn’t just that Thomas was so young; it was that he had never been diagnosed with a concussion. That suggests the disease came about because of repeated sub-concussive head impacts from playing football during his adolescence and young-adult years.

Thomas’s case, combined with other research, leads Robert Cantu, the co-director of the BU center, to recommend that children younger than 14 stay away from sports that involve repeated collisions, with potential hits to the head. That’s merely one person’s advice, not yet anything close to a scientific consensus. But it’s not too early to urge parents to think the risks through carefully. No one should simply assume that if a sport is sanctioned by a school, it’s risk-free for young kids to participate.

The most common sources of brain trauma in team sports are football, soccer, and hockey. Football trauma can be reduced by having less strenuous practices, with limits on hard hitting; the sudden force of two players colliding at a high speed can jostle the brain. School football leagues, like the pros, should strictly penalize helmet-to-helmet tackling and the “launching’’ of tacklers into other players. But even with these precautions, parents should be wary: Football is a violent sport, and young players and their parents should be fully aware of the risks.

In soccer, injuries can occur when players repeatedly head the ball. The game can be played effectively without heading, and that’s an obvious way to all but remove the threat of brain trauma. Soccer leagues may reasonably await more evidence before making a major change to their sport, but limiting use of the head in practice seems like a sensible precaution, even before all the evidence is in.

Hockey is the most vexing case, because some of the worst head traumas occur in fights that have nothing to do with the playing of the game. At the youth level, bans on fighting and rules on hard checking into the boards should be strictly enforced. Meanwhile, coaches would best serve their players’ long-term hockey aspirations by emphasizing skill over aggression.

There is much more to be learned about possible links between chronic traumatic encephalopathy and youth sports. Thankfully, BU is moving ahead with its ground-breaking research. But parents, kids, and especially those in charge of youth sports programs shouldn’t wait for all the data to be in before taking precautions.

Article found in the Boston Globe

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Stem Cell Implants May Help Treat Brain Injuries

posted by SK Brain Injury    |   January 16, 2012 12:31

Implanted stem cells have substantially improved cerebral function in animals with brain trauma, but how they did it has remained a mystery. Now an important part of this puzzle has been pieced together by researchers.

In experiments with both lab rats and an apparatus that enabled them to simulate the impact of trauma on human neurons (brain and nerve cells), researchers at the University of Texas Medical Branch at Galveston identified key mechanisms by which implanted human neural stem cells (developing into neurons) help recovery from traumatic axonal injury.

A significant component of traumatic brain injury, traumatic axonal injury involves damage to axons and dendrites, the filaments that extend out from the bodies of the neurons, the Journal of Neurotrauma reports.

The damage continues after the initial trauma, since the axons and dendrites respond to injury by withdrawing back to the bodies of the neurons, according to a Texas statement.

"Axons and dendrites are the basis of neuron-to-neuron communication, and when they are lost, neuron function is lost," said Ping Wu, professor at UTMBG, who led the study.

"In this study, we found that our stem cell transplantation both prevents further axonal injury and promotes axonal regrowth, through a number of previously unknown molecular mechanisms."

Article found on Daily News and Analysis

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U.S. First Lady, Michelle Obama, Announces Brain Injury Initiative

posted by SK Brain Injury    |   January 12, 2012 10:26

First lady Michelle Obama announced Wednesday a commitment by medical schools to increase training of doctors and research of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The agreement is in conjunction with "Joining Forces," Obama's and Dr. Jill Biden's organization that encourages society's support of military personnel and their families.

More than 100 medical schools from the American Association of Medical Colleges have committed to initiative as well as 25 schools from the American Association of Osteopathic Medicine. The announcement was made at Virginia Commonwealth University in Richmond, VA, where the medical school has been a national leader in TBI research, partnering with Hunter Holmes McGuire VA Medical Center Veterans Affairs Hospital.

"I'm inspired to see our nation's medical schools step up to address this pressing need for our veterans and military families," Obama said. "By directing some of our brightest minds, our most cutting-edge research, and our finest teaching institutions toward our military families, they're ensuring that those who have served our country receive the first-rate care that they have earned." 

"Studies show that as many as 1 in 6 veterans from Iraq and Afghanistan have reported symptoms of PTSD," Obama said. "Since the year 2000, more than 44,000 have suffered at least a moderate grade of TBI."

The Rand Corp. said in a report in 2008 that about 300,000 military service members who have returned from Iraq and Afghanistan report symptoms of post traumatic stress disorder or major depression. The report also states that only about half have sought treatment. The Department of Defense reports that 229,106 military personnel have been diagnosed with TBI since 2000.

"We all must remember in this country, the end of war marks a very long period of transition," Obama said.

Veterans and returning military personnel are asked to make sharp transitions home from combat zones, she said, and although most returning do not suffer from PTSD or TBI, the transition home is when issues and incidents bubble to the surface.

"If you are struggling, please don't be afraid to speak up. If you know someone else is struggling, encourage them to seek help. Asking for help is a sign of strength," Obama said. "It can help fight the stigma of PTSD and other mental health issues, not just for military but for all Americans."

Many military members do not seek treatment for mental and psychological illness because they worry it will harm their careers, the report from the Rand Corp. said. PTSD and depression among military personnel returning from service could cost the nation as much as $6.2 billion in the two years following deployment.

The first lady closed her remarks by encouraging the medical students, doctors, researchers in this new venture and reminding the military they will have support.

"And to all of the troops and veterans we have here, that no matter where you are, no matter what you're going through, please know that America will be there for you and your families," she said.

Article found at

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Hiding Concussion in the NHL

posted by SK Brain Injury    |   January 11, 2012 12:14

As Colby Armstrong proved, concussions remain the easiest injury to hide.

The matter of Armstrong keeping his head injury a secret from the Maple Leafs for two days in the heightened awareness of the Concussion Era is instructional. It reveals more than ever the difficulty the NHL will have in trying to curb this epidemic.

“You’ve got to remember it’s still an easy injury to mask — because you can’t see it,” said former Flyers captain Keith Primeau. “You look at an X-ray, you can see a fracture, whereas the head, it might hurt but you have the ability to continue on.”

Not only continue on, but play at a decent level.

Primeau knows that firsthand.

The Toronto native had four recorded concussions in a career that saw him play more than 900 NHL games. The concussion diagnosis was only made when his symptoms were so severe he couldn’t function as a player anymore.

“I would have never divulged that,” he said.

Sound familiar?

It was only when Armstrong became nauseous after Monday’s morning skate before a game against Los Angeles that the Leafs learned he’d suffered a concussion after hitting Ryan Kesler in a game against Vancouver on Saturday night.

You can’t blame the Leafs in this instance. One can also understand Armstrong’s motivation in hiding the injury. He’s a character player who wears an “A” on his sweater not for his scoring prowess but for the intangibles he brings to the team.

But it’s tough to deliver on that when you’ve only played in nine games so far this season and missed 32 games last season. The potential permanent damage from head injuries likely isn’t even in the equation for him at this point.

The pressure to play is much greater — and may come more from the player himself than anyone else.

“I think it’s more internal pressure and desire to compete than any other extenuating circumstances,” said Primeau. “They want to be out there performing. They don’t want what they consider to be a simple headache to be the reason they’re not.”

Dave Scatchard knows that feeling well, too. He was a grinder for 13 NHL seasons, someone who also found a way to keep going even when concussed at times. He remembers telling team officials he was having neck problems when he knew he’d suffered a head injury after getting sucker-punched after scoring a goal.

The reason he didn’t tell the truth was he feared for his job.

“No player wants to be seen as damaged goods or get a reputation as a concussion guy,” said Scatchard, who made it clear he was talking about his own experience and not about Armstrong specifically.

But the concussions eventually exact a price.

Scatchard retired last summer after five spots were found on his brain during an MRI. He has trouble with memory, can’t push his three young kids on a swing without getting dizzy and can’t get his heart rate above 135 or more symptoms return.

He has been at the Mayo Clinic this week for cognitive testing.

“It’s extremely, extremely frustrating,” said Scatchard. “I expected to be in a better place than I am right now.”

Crowded places are also a problem for Scatchard, which can make Christmas shopping tough.

“I was trying to pick out my wife some nail polish to put in her stocking and there were so many nail polishes,” he said. “I was trying to read each label and see the colours and everything and I just freaked out and left. I never got any nail polish. That’s what I deal with daily. Some days I feel pretty good and other days I have a really tough time.”

It can also be hard these days for Scatchard to watch the game he loves.

“When I was a young guy, I loved seeing big hits like Don Cherry Rock ’em Sock ’em and things like that and now every time I see a big hit or see a player lying on the ice, my stomach just turns. It’s just so bad for a player and I pray to God they’re going to be okay and healthy. I don’t want anybody to have to deal with these issues.”

Article found at

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Ken Dryden Discusses Violence and Head Shots in Hockey

posted by SK Brain Injury    |   January 8, 2012 09:54

A year ago, Sidney Crosby went down with a concussion and the way we see hockey changed. A few days ago in the World Junior Championships, Canada's junior team lost to Russia in a way it shouldn't have lost, and almost won in a way nobody should win. Each speaks to something in our nature.

Where does it come from, this fight that is in us?

Surely, it must have to do with the hard land and hard climate of our past, when illness or injury weren't allowed to keep us from the fields or the forests. That was survival. So when we created our games, we'd play them in the only way we knew how.

Or, in an indirect way, maybe the answer's as simple as the difference between a puck and a football or soccer ball. A puck is hard and small. In hockey's earliest days, when it flew out of play it could travel far and stop the action for many inconvenient seconds. It could injure someone watching. Not so a football or soccer ball. So hockey created boards to surround the ice. Low ones at first, to keep the puck in play; higher ones later when more spectators found reasons to watch the game. For hockey players from the beginning, there was no out-of-bounds. There was no escape.

So the struggle that is hockey began. At first, it was on a much smaller ice surface, seven against seven not six against six, and with no substitutions and no forward pass, there was no way to open up the clutter; no escape even to rest. For the entire game, it was body pushing against body; the boards an unmovable opponent everywhere around the perimeter. To score, a player had to get close to an opponent's net, and in the offensive zone it's as if the oval of the rink suddenly becomes a funnel, the struggle, the strain growing ever more intense.

To get to the net is a fight.

The most legendary player of hockey's first hundred years was Rocket Richard. He was not much more than average size. He possessed no blinding speed, no overpowering shot. The lingering image of him now more than 50 years after his last game is his eyes. Wide, wild, his pupils so focused on his task — to get to the net — they'd bore a hole through anything that stood in their way.

It's the Europeans who first saw this unrelenting will in Canadian players. Before European amateurs were allowed to play against the NHL's best, the Europeans saw only the Penticton Vees, Whitby Dunlops, Trail Smoke Eaters, and those who came before them. By the mid-1950s, the Europeans had closed the talent gap, they could skate and pass as well or better than their Canadian opponents, but still Canada would win. The Europeans had come to hockey late from soccer or bandy (much like field hockey on ice), games played on big, wide-open spaces with strategies, skills, and attitudes to match. Even their "Olympic-sized" hockey rinks were bigger. They'd dazzle in the open ice, but in the funnel to the net, unaccustomed to the smash of bodies, they'd look for a final pass.

Canadians first saw this fighting spirit in ourselves in the 1972 Canada-Russia series, and we only truly saw it when the series was over. Before then, Canadians saw Canadian players who looked slow and undisciplined, thuggish at times, and Russian players who looked the way we'd always seen ourselves. Then, when the eight-game series seemed finally over — after a crushing loss in what had been a very promising first game in Moscow — with the Russians leading the series three games to one with one game tied and the final three games in Moscow, things changed. We won the sixth game, then came from behind to win the seventh. In the last game, down 5-3 at the end of the second period, we scored three goals, including Paul Henderson's winning goal with 34 seconds remaining.

There was a lot not to be proud of in that series. But we were proud that we won, and we were proud that we didn't give up. In a series where one player scores the game-winning goal in the final three games and the series-winning goal in the last minute of the last game, there can be only one hero — Paul Henderson. But there were two — Henderson and Phil Esposito. Moments after the series' lowest moment, our Game 4 loss in Vancouver, Esposito had given his "speech" in a TV interview. With sweat pouring down his face and fight still oozing from him, he took on those who booed us and doubted us. He embodied what we'd show ourselves to be in Moscow — the never-quit, never-say-die Canadians others had always seen us to be.

Canadians love this about their players. We get cut, we lose teeth, and we scarcely miss a shift. This isn't about ourselves; it's about the team. We're going to feel pain anyway; we might as well play. It's the fight that's in us. It's those boards we put up around us when we created this game that gave us no place to escape; no choice but to suck it up. It's the teeth-baring grin we show when we go into the corners and into that funnel to the net. And it's an ethic that's more important now than ever. To fans who "bleed" blue or orange or black, who feel more deeply about their team than they do about themselves, they need to know that the player with the multimillion dollar contract who wears the jersey feels the same.

And it's why most Canadian fans love Don Cherry. If anyone doubts that affection, go to CBC's nextHockey Day in Canada. I was with him three times, in Iqaluit, Shaunavon, Saskatchewan and Whitehorse. No matter how many former stars are also there or who they are, the fans want to see one person — Cherry. No question. No contest. These fans love the dynamic between Cherry and his sidekick, Ron MacLean, on Coach's Corner. MacLean is often described as Cherry's perfect foil, but in fact, the reverse is true. MacLean is Cherry's perfect setup man. Cherry goes over the top; MacLean catches him and comes back with something that seems almost reasonable — and on it goes. But beneath the shtick of outrageous clothes and bluster is a funny, entertaining character who has something to say. No one survives more than 30 years at the centre of a storm with just shtick.

Whatever Cherry's talking about, he's really talking about Canada and Canadian spirit. When European players first began playing in the NHL in any numbers, he trashed them. They weren't Canadian, not in nationality, not in spirit. Just because you wear the jersey of a hockey player, he said to them, doesn't mean you're a hockey player. Prove it. When they did, he wouldn't see it because they weren't Canadian. If they proved it a different way, not with their fists but on the scoreboard, as Wayne Gretzky and Mario Lemieux did, he wouldn't see it either.

Week after week his message carries the same basic truth: In hockey, as in any of other side theme of life he goes off into — "Hey, you kids out there" — you've got to be willing to fight. Who can argue? And to Cherry if you accept that, you've got to accept that any kind of fight or fighting is right. You've got to stand up — shoulder against shoulder; fist against fist.

This is where the debate over head shots and fighting grows confused. Giving up head shots or fighting is not giving in to do-gooders who never played the game. It's not giving in to Americans. It is not giving up something Canadian. It's not even giving up Don Cherry; certainly not his spirit. But it is taking on Cherry or anyone else on hits to the head. The surprise is that Cherry and so many former players who are now commentators defend or minimize these hits — the race for the puck, the last-second shove that catapults an opponent into the end boards and a completely unknowable fate; the cruise-by elbow or shoulder to an unsuspecting player. The hit like the one the Edmonton Oilers' Andy Sutton put on the Carolina Hurricanes' Alexei Ponikarovsky a few weeks ago. Sutton could see that Ponikarovsky couldn't see him, so this was not a knee-jerk reflex. It was entirely premeditated. He had several feet to decide what to do and chose to drive Ponikarovsky's head into the glass — because he could. But Sutton is a good guy. Good guys don't do bad things, so bad things done by good guys can't be bad things.

These are cheap shots and always were. Cherry and the others didn't play this way. Is this fight? Is this standing up? Where's the courage and toughness in this?

"Fight" is not "fighting." Fight is never giving up. Gretzky, Orr, Richard, Lemieux, Lafleur — they were great fighters. They fought with their head, hands, legs, will, and need to be special, and rarely with their fists. The toughest players aren't those who hit but those who are willing to be hit, to fight their way into open ice, to fight their way to the net, to fight expectation and disappointment to score the game-changing goal. Give up fighting and get more stick-swinging?

Who were the stick-swingers? A handful of players; almost nobody — and certainly not these players. Fight is the playoffs, the Olympics, and World Cup, where fighting and head shots are rare because the stakes are so high and the distractions so consequential that there's no place on the ice for goons. "Fight" is fighting spirit. It's Canadian hockey at its best.

After the 1972 Canada-Russia series, the skill gap between the Europeans, the Russians in particular, and Canadians seemed to grow. In the 1990s and early into this century, most of the NHL's top scorers and trophy winners were European or American. That has changed in recent years. Canadians learned that more than fight was needed.

In soccer, England had its "1972 moment" in 1953 when Hungary came to Wembley and won, 6-3. England won the World Cup in 1966, and since that time the skill level of its players has improved, but much less so than for those in the rest of the world. England keeps hoping that "English pluck" can make up the difference. It can't.

We learned in Canada what England has never learned. We learned that to win: Match them with skill; beat them with will.

The debate about head shots and fighting is not a debate about Canada, Canadian hockey, or the Canadian spirit. It's about giving up the fighting, but keeping the fight.

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Ken Dryden | News

Gabrielle Giffords TBI Came at a Breakthrough in Brain Medicine

posted by SK Brain Injury    |   January 8, 2012 09:40

When U.S. Rep. Gabrielle Giffords was shot in the head one year ago today, many thought there was little chance she would survive, let alone open her eyes, walk or talk.

But the Arizona congresswoman, who will attend a vigil on Sunday in Tucson to remember the rampage that left six dead and wounded her and 12 others, had determination, abundant resources and, most importantly, a new era in brain medicine on her side.

"We're at an evolution today with traumatic brain injury, much like where doctors were with cancer and heart disease some 40, 50 years ago," said Dr. Geoff Manley, chief of neurotrauma at the University of California San Francisco School of Medicine. "We're just now learning that people like Giffords can not only be treated but can have meaningful recoveries."

Giffords benefited from aggressive approaches to surgery and therapy born out of wars in Iraq and Afghanistan. Military doctors found that soldiers formerly dismissed as the "expectant dead" could recover with the right treatment. That approach, unheard of less than two decades ago, played a key role in Giffords' treatment and recovery.

The world also benefited from Giffords' ordeal. The spotlight on her story brought a greater awareness to a number of areas - the importance of Level 1 trauma centers, the potential of brain trauma therapy, the grueling recovery process, the need for long-term treatment to be more available to most people and the call for more research to take the field out of its infancy.

Hundreds involved

Giffords, 41, can now walk - albeit with a significant limp. She also can talk in broken speech and understand everything said to her. She still has substantial weakness on the right side of her body, a product of being shot through the left side of her brain, but she continues to improve.

Whether she has a political future hinges on her progress.

Giffords' medical journey started in Tucson and continued in Houston and North Carolina. She moved faster than expected through a series of milestones made possible by teams of surgeons, nurses, rehabilitation therapists and other specialists and support staffs.

"You're talking hundreds of people," said Dr. Brent Masel, medical director at the Transitional Learning Center in Galveston and the national spokesman for the Brain Injury Association of America. "It's an enormous project. Repairing a life is an enormous project and it takes a while."

Months of therapy

The recovery process was long and intensive, beginning with emergency responders to the shooting and a Giffords aide who kept pressure on her head wound and held her upright to prevent choking, an act her staff credits with saving her life. She underwent multiple surgical procedures at University Medical Center in Tucson and at Memorial Hermann - The Texas Medical Center. Then she engaged in months of therapy, a process that likely would've been truncated for other patients because of their insurance companies, Masel said.

The materials used to treat and rehabilitate the congresswoman included drills and scalpels used in surgery; a computer-generated synthetic implant that replaced part of her skull; plastic piping, straps and pulleys that helped to increase strength in her weakened right side; and an adapted shopping cart that helped her relearn to walk.

It wasn't cheap. The tab for her therapy alone, which was paid for by her federal employee workers' compensation insurance, has totaled about $1.26 million since she began inpatient and then outpatient work, based on daily cost estimates from the Brain Injury Association of America.

Giffords has acknowledged that most people wouldn't be able to afford such treatment, and her staff has worked with Masel and others to draw more attention to the value of extended therapy for traumatic brain injuries, said her spokesman, Mark Kimble.

A good patient

It is largely a result of her exhaustive regimen of physical, occupational, speech and music therapies, along with her and her family's positive outlook, that has allowed her to progress more quickly than expected in her recovery, said Dr. Gerard Francisco, chief medical officer at TIRR Memorial Hermann, where Giffords has been participating in therapy since Jan. 26.

While Giffords could previously only communicate in short one- or two-word bursts, she is becoming better able to talk in full sentences, said Francisco. He said she has "good days and bad days."

'She's very fortunate'

Giffords is also able to initiate questions and converse, said Dr. Nancy Helm-Estabrooks, a speech specialist who, along with another therapist, worked with the congresswoman at no cost during a two-week intensive program in Asheville, N.C. There, Giffords engaged in a range of activities designed to challenge her to express ideas by speaking, drawing, gesturing and interacting with an iPad and laptop.

The exercises have supplemented her more than 11 months of therapy through TIRR Memorial Hermann to add to her progress, Helm-Estabrooks said.

"This underscores what we've been telling people - that brain injury recovery takes place over long periods of time and have to be supported by the appropriate rehab approach," Francisco said. "She's very fortunate that she has the resources."

Other techniques she gained from were a direct result of increased exposure to brain injuries during the age of improvised explosive devices in Iraq and Afghanistan. Dr. Peter Rhee, Giffords' lead trauma surgeon in Tucson who served as a military surgeon in those countries, led the procedure to remove part of Giffords' skull in the immediate aftermath of the shooting. The procedure, pioneered in the military, relieved pressure on Giffords' swelling brain that could have been fatal. It was among a series of more aggressive approaches to surgery and treatment that have been used with wounded troops and were implemented with the congresswoman. 

Manley acknowledged that treatment of traumatic brain injury still has a long way to go. Giffords has shown that recovery is possible, he noted, but now the field needs to build on the momentum - find better ways to diagnose patients and predict outcomes, produce more data on what works best and when, and pioneer even more cutting-edge treatments.

Tissue regeneration

Memorial Hermann doctors are conducting such cutting-edge research, specifically using stem cells. The research, a Department of Defense - funded trial about to enroll people who have suffered brain injuries, involves the injection of stem cells from the patients' bone marrow. Doctors hope those stem cells can regrow healthy tissue.

"Seeing patients like Gabby is really inspiring us to come up with new treatments - treatments that will return patients to normal, not just recover to a certain extent," said Dr. Dong Kim, Giffords' neurosurgeon at Memorial Hermann. "In the next 10 to 20 years, thanks to therapy that regenerates brain tissue, I think you'll see that."

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