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Kids and Concussion

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

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

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

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

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

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

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

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

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

down on hits that could lead to concussions.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Concussion and Suspensions in the NFL

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

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

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

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

Instead, it has another huge problem on its hands.

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

Incredibly, McCoy returned to the field moments later.

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

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

Everyone but the Browns.

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

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


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

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

Duh!

The NFL needs to institute the following protocols:

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

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

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

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

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

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

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

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

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

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

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

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

Is a one-game suspension for James Harrison enough?

Not even close.

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

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

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

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

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

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

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

Yep, makes sense.

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BIAC: Impact Newsletter

posted by SK Brain Injury    |   December 15, 2011 08:57

There is a new edition of BIAC's newsletter Impact available. Click on the attachment to download your own version of the newsletter.

ImpactBIACNewsletterDec2011LRFinal.pdf (1.27 mb)

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Advanced Imaging Assists in Brain Injury Treatment

posted by SK Brain Injury    |   December 12, 2011 16:00

Improvements in the imaging of a human brain during maturation may allow for more effective understanding and treatment of brain injuries incurred during youth and adolescence.
 
Research published in Neuron has examined the structural changes that occur in the brain during development and is the first comprehensive study of coordinated anatomical maturation.
 
The study has highlighted a number of sex specific differences in brain development and found that functionally-connected brain regions often mature together, which could inform treatment strategies in the cause of traumatic injury.
 
Dr Armin Raznahan, from the National Institutes of Mental Health in Bethesda, Maryland, said that developments in this area of imaging have progressed "rather slowly" to date.
 
He said: "We drew from the largest and longest-running longitudinal neuroimaging study of human brain maturation … to analyse patterns of correlated anatomical change across the sensitive developmental window of late childhood, adolescence and early adulthood."
 
Earlier this week, researchers at the Max Planck Florida Institute announced that they had successfully conducted the first realistic 3D reconstruction of a brain circuit, bringing scientists closer to understanding how the brain can be damaged.

News brought to you by Serious Law specialists in brain injury.

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Ski-Helmet Law in Nova Scotia

posted by SK Brain Injury    |   December 9, 2011 16:00

Nova Scotia bolted into the lead this week in the epic race among North American jurisdictions to make us slightly safer — barely overtaking King County, Wash., which in June banned swimming and wading in rivers without wearing a life jacket.

Bill 131, tabled Tuesday at the House of Assembly in Halifax, would make it illegal to ski or snowboard without a helmet, effective Nov. 1, 2012. A helmet cuts the risk of head injury by at least 60%, according to a news release from the Nova Scotia Department of Health and Wellness. And Minister Maureen MacDonald assures me there will, indeed, be helmet cops on the slopes. The minimum fine is $250.

 

Ms. MacDonald offers two justifications for this: brain injuries, and the terrible consequences they often entail; and the money it costs to treat them. According to the province, a “traumatic brain injury” costs roughly $400,000 a year to treat. And since 2000, 11 helmetless skiers and snowboarders have suffered such an injury on the slopes of Nova Scotia. Call it one a year.

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Headaches Common in Brain-Injured Children

posted by SK Brain Injury    |   December 9, 2011 12:00

Kids who have a concussion or other traumatic brain injury are more likely to develop headaches for up to a year afterward than children who have had a bodily injury, according to a new study.

While not entirely surprising, the results point to a difficult long-term problem for kids and their parents because adequate treatments are lacking, researchers say.

"It's an issue because they may have problems with sleep, and the headaches can make it harder to concentrate," said lead author Dr. Heidi Blume at Seattle Children's Research Institute.
More than half a million children go to the hospital each year for brain injury.

Blume and her colleagues tracked more than 400 children who had come into the emergency room with a brain injury -- 402 kids had a mild injury and 60 kids had a moderate or severe injury.

Oftentimes the damage was caused by rough play in sports, falls and car accidents.

Blume's team compared these head-injury cases to kids who had come into the emergency room with an arm injury.

Parents and children kept a diary of any headaches the kids reported for a year.

After three months, 43 out of every 100 kids who experienced a mild brain injury complained of headaches.

Among kids with moderate or severe brain injuries, 37 out of every 100 complained of headaches.

In comparison, 26 out of every 100 kids who had an arm injury reported having headaches three months later.

Blume said headaches can have a big impact on kids' lives, affecting their performance in school and forcing them to drop out of sports, band or other activities that could potentially trigger headaches.

It's unclear why the children with mild brain injury were more likely to have headaches than those who suffered more severe damage.

"That is a conundrum that we don't fully understand, but it's been noted before" in research on adults, said Karen Barlow at Alberta Children's Hospital in Calgary, Canada.

"There might be something about the moderate and severe traumatic brain injuries that interfere with the mechanisms of sensing pain," Barlow speculated, "but we haven't gotten to the bottom of that."

The researchers did not determine whether kids who suffered a brain injury were also more likely to have had headaches before the injury than the kids who had an arm injury.

They did find that the risk for having headaches after a head injury was especially pronounced among girls.

Girls who had a mild brain injury were more than twice as likely to have headaches as girls who had an arm injury, whereas boys had nearly similar rates of headaches regardless of the type of injury.

"I'm not surprised about this because it's what I see in clinic," Blume told Reuters Health.

The study, published in the journal Pediatrics, did not determine why there was a difference between the sexes.

Girls might be more likely to report headaches, Blume said, "but I don't think it can all be chalked up to a difference in reporting. I think there's something else going on."

Women and girls are more likely to suffer migraines than men and boys, which could be due to hormone levels, and perhaps hormones might also play a role with headaches after brain injury too.

The greater chance of having headaches among girls could also reflect changes in the way boys' and girls' brains develop, Blume said.

The challenge for any child suffering headaches after a brain injury is that there are few ways to treat them.

"Right now we have no studies to guide the treatment of post-traumatic headaches in children," said Barlow, who was not involved in the new study.

Rest and hydration are usually offered, but Barlow said there's only anecdotal evidence backing them up.

Fortunately, it appears that 12 months after a brain injury, the headaches seem to go back to the levels seen among kids who have had an arm injury.

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Online Library for Brain Injury Launched

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

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

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

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

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

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

The online library’s address is www.sportconcussionlibrary.com.

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Derek Boogaard: Brain Damage

posted by SK Brain Injury    |   December 8, 2011 16:00

THROUGH THE NIGHT and into the next day, as the scrolls across the bottom of television screens spread the news of Derek Boogaard’s death last May, the calls of condolences came, one after another.

Punched Out, Part 3

This article, the third of a three-part series, chronicles Derek Boogaard's descent, on and off the ice, and the posthumous determination by researchers that he had a degenerative brain condition believed to be caused by repeated blows to the head.

Among them was a call from a stranger, first to Joanne Boogaard in Regina, Saskatchewan, then to Len Boogaard in Ottawa. It was a researcher asking for the brain of their son.

An examination of the brain could unlock answers to Boogaard’s life and death. It could save other lives. But there was not much time to make a decision. Boogaard, the N.H.L.’s fiercest fighter, dead of a drug and alcohol overdose at 28, was going to be cremated.

There was little discussion.

The brain was carved out of his skull by a coroner in Minneapolis. It was placed in a plastic bucket and inside a series of plastic bags, then put in a cooler filled with a slurry of icy water. It was driven to the airport and placed in the cargo hold of a plane to Boston.

When it arrived at a laboratory at the Bedford V.A. Medical Center in Bedford, Mass., the brain was vibrantly pink and weighed 1,580 grams, or about 3 ½ pounds. On a stainless-steel table in the basement morgue, Dr. Ann McKee cleaved it in half, front to back, with a large knife. Much of one half was sliced into sheets about the width of sandwich bread.

The pieces of Boogaard’s brain were labeled as SLI-76. They were placed into large, deli-style refrigerators with glass doors, next to dozens of other brains.

The  Boogaard family waited for results. One month. Two. Three. Two other N.H.L. enforcers died, reportedly suicides, stoking a debate about the toll of their role in hockey.

Four months. Five. The news came in a conference call to the family in October.

Boogaard had chronic traumatic encephalopathy, commonly known as C.T.E., a close relative of Alzheimer’s disease. It is believed to be caused by repeated blows to the head. It can be diagnosed only posthumously, but scientists say it shows itself in symptoms like memory loss, impulsiveness, mood swings, even addiction.

More than 20 dead former N.F.L. players and many boxers have had C.T.E. diagnosed. It generally hollowed out the final years of their lives into something unrecognizable to loved ones.

And now, the fourth hockey player, of four examined, was found to have had it, too.

But this was different. The others were not in their 20s, not in the prime of their careers.

The scientists on the far end of the conference call told the Boogaard family that they were shocked to see so much damage in someone so young. It appeared to be spreading through his brain.  Had Derek Boogaard lived, they said, his condition likely would have worsened into middle-age dementia.

And that was when Len Boogaard’s own mind went numb.

Rehab, Pills and a New Team

The Minnesota Wild prepared for the start of the 2009-10 season. Derek Boogaard watched from a distance.

The team said that Boogaard, the pre-eminent enforcer in the N.H.L. and a hugely popular Wild player, was sitting out a few weeks because of a concussion. Instead, he was at the Canyon treatment center in Malibu, Calif., being treated for addiction to prescription drugs.

Boogaard was embarrassed and worried that news of his addiction would shatter his reputation. He was also concerned that someone would take his role. From rehabilitation, he tracked the preseason fights of teammates and texted friends to gauge how badly he was missed.

He rejoined the team after missing the first five regular-season games and had his first fight on Oct. 21, at home against the  Colorado Avalanche’s David Koci. Boogaard started with a left-hand jab to Koci’s chin, then grabbed Koci’s jersey and knocked him down with two right-hand punches.

Boogaard skated, expressionless, to the penalty box.

From the outside, everything seemed normal. It was not.

“His demeanor, his personality, it just left him,” John Scott, a Wild teammate, said. “He didn’t have a personality anymore. He just was kind of — a blank face.”

Boogaard fell asleep while playing cards on the team plane, a teammate said. He passed out in corners of the team’s dressing room. He was uncharacteristically late for meetings and workouts. Wild trainers and doctors warned Boogaard’s teammates not to give him their prescription pills.

Most N.H.L. teams have about 10 affiliated doctors — specialists and dentists with practices of their own. Boogaard had learned that there was no system to track who was prescribing what.

In one three-month stretch of the 2008-9 season with the Wild, Boogaard received at least 11 prescriptions for painkillers from eight doctors — including at least one doctor for a different team, according to records gathered by his father, Len Boogaard. Combined, the prescriptions were for 370 tablets of painkillers containing hydrocodone, typically sold under brand names like Vicodin.

Derek Boogaard increasingly wanted more pills. He became adept at getting them.

In downtown Minneapolis, Boogaard’s favorite hangout was Sneaky Pete’s, a sports bar that becomes a raucous club on weekend nights. Stripper poles are erected on the dance floor, and a throbbing beat escapes beyond the velvet rope out front. Boogaard was a regular.

Young men fueled with alcohol begged Boogaard to punch them, so they could say they survived a shot from the Boogeyman. People bought him drinks. They took pictures of him and with him. They chanted his name. When the attention got overbearing, Boogaard escaped behind the bar, where his bobblehead likeness sat on a shelf.

“He was like Norm in ‘Cheers,’ ” said Stewart Hafiz, whose family owns the bar.

And Boogaard often bought painkillers, thousands of dollars’ worth at a time, from someone he knew there, according to Boogaard’s brother Aaron.

He gobbled the pills by the handful — eight or more OxyContins at a time, multiple people said, at a cost of around $60 each — chewing them to hasten their time-release effect. The line between needing drugs for pain and wanting them for celebration blurred.

“I didn’t trust him to have that amount on him,” said Aaron Boogaard, who lived with Derek in summer off-seasons. “He knew it, too, so he would give them to me to hold, and I would hide them around the place, and he’d come to me when his back was hurt — or whatever was hurting him.”

“What was I going to do?” he added.

Wild coaches saw the decline for a couple of seasons. Boogaard’s admirable work ethic had faded, and no one could pinpoint why.

“I just said to him one day: ‘What’s up? What’s up with you? Where is the guy I know?’ ” said Matt Shaw, who coached Boogaard as an assistant with the minor league Houston Aeros and, later, with the Wild. “Because he was not himself. And he didn’t have an answer. He didn’t want to look me in the eye.”

Boogaard had been drafted by the Wild in 2001, a seventh-round pick given little chance of making the N.H.L. The Wild shepherded him through three seasons in the minor leagues and molded him into the most fearsome player in hockey. They saw how his gentle humility blossomed into fearless swagger. They felt how the game changed when he strode onto the ice.

But by the 2009-10 season, Boogaard was 27, and his body carried a lot of mileage. He missed the start of the season while in rehabilitation, and his contract was to expire at season’s end. He played 57 games, and had no goals and nine fights.

The Wild quietly dangled him as trade bait, then made a half-hearted attempt to re-sign him for about $1 million a year.

There were plenty of other suitors. The New York Rangers and the Edmonton Oilers each offered four-year contracts paying more than $1.5 million a season.

Boogaard’s family wanted Edmonton. It was familiar and close to home in western Canada.

He chose New York. He signed a four-year, $6.5 million contract — a rather ordinary salary among his new Rangers teammates, but striking among the fraternity of enforcers who play only a few minutes a game.

“It’s one of the great cities to be at and you’re always on center stage when you’re out there, so I’m excited,” Boogaard told The Star Tribune of Minneapolis the night he signed.

The Rangers knew about Boogaard’s substance-abuse problem and time in rehabilitation, family members said. The team surely knew of his concussions and myriad other injuries.

But any concern the Rangers had was outweighed by their eagerness for his brand of toughness and intimidation. They needed an enforcer, and they wanted the best.

Manic, Sullen and Lonely

Boogaard had played 21 games for the Rangers when he took the ice in Ottawa on Dec. 9, 2010. After leveling an opponent with a legal check, Boogaard was chased by Matt Carkner, a 30-year-old enforcer who had spent most of his career patrolling the minor leagues.

The two bickered as they glided across center ice. They barely stopped before  Carkner cracked Boogaard’s face with a right hand.

Boogaard usually responded to such shots with an angry flurry. This time, he turned his head away and held on to Carkner. He did not throw another punch.

All fall, Boogaard’s family and friends had noticed an indifference in his fighting. Boogaard was listed at 260 pounds, but weighed nearly 300 when he joined the Rangers. Team officials expressed concern about his effectiveness on the ice, even his safety in a fight, his agent said.

But much of that was disguised by Boogaard’s sound beating of  Philadelphia’s Jody Shelley on Nov. 4 and a  rare goal, the first since his rookie season, against Washington on Nov. 9.

Days later, the Madison Square Garden crowd chanted Boogaard’s name as he  pounded Edmonton’s Steve MacIntyre. During a rematch minutes later, few noticed a  MacIntyre jab that broke Boogaard’s nose and most likely gave him a concussion. Boogaard missed one game and played the next.

Then came Carkner. He lifted Boogaard and slammed him down. Boogaard landed on his right shoulder. The back of his head struck the ice. He rose slowly and went to the locker room.

“I noticed he kind of stopped fighting and I took him down and landed on top,” Carkner told reporters. “Obviously, if you land a punch on a guy like that it feels good. It feels good to take down a big man like that.”

The Rangers said Boogaard was out indefinitely with a shoulder injury. Ten days later, they revealed he was having headaches.

When Len Boogaard arrived in New York from Ottawa in January, he barely recognized his son. Several times over several days, the toughest man in hockey bawled in his arms.

“I had to hold him,” Len Boogaard said of Derek. “It was like when he was younger, when he was a little kid growing up. He just sobbed away uncontrollably.”

For weeks, Boogaard mostly shuttered himself inside his $7,000-a-month apartment on the 33rd floor of the Sheffield, on 57th Street near Columbus Circle in Manhattan. The view of Central Park was obscured by the blinds Boogaard kept closed.

The Rangers told him to avoid the rink because the commute, the movement, even watching hockey could bring nausea. The team delivered a healthy meal to his door every afternoon, but Boogaard usually threw it away. His kitchen counter overflowed with fast-food packages.

The fog of Boogaard’s postconcussion syndrome slid into a hazy shade of loneliness. Early in the season, a stream of friends had gone to New York to see him play and take in the sights.

But with Boogaard out of the lineup, the number of visitors waned. Boogaard grew desperate for company. His January cellphone bill needed 167 pages to detail calls and text messages, some to people who had not heard from him in years. February’s bill consumed 222 pages. It listed 13,724 text messages.

Those who went to New York noticed his memory lapses were growing worse. Boogaard joked about them, saying he had been hit on the head too many times. But they also came to worry about his darkening personality and impulsive behavior. His characteristic sweetness and easy manner, his endearing eagerness to please, had evaporated.

Friends said Boogaard was at turns manic and sullen. He went days without showering. He made grand and scattered plans. He talked about buying land in British Columbia and building one big house for himself and cabins for family members. He spent thousands on night-vision goggles, hundreds on walkie-talkies, and $150 on candy at a Duane Reade drugstore.

Len Boogaard, knowing that his son had been enrolled in a substance-abuse program since September 2009, was surprised to see so many prescription bottles in the bathroom with the names of Rangers doctors. He was also surprised to hear from his son that he had been given four days’ notice for his next drug test.

Len Boogaard played a DVD of family photos and home movies. He reminded his son of everything he went through to reach New York — the family moves, the bullying, the naysayers of youth hockey, the struggles through juniors and the minor leagues.

Boogaard cried, and his father held him.

Few knew that Derek, usually on Sunday evenings, carried thousands of dollars in cash and drove his Audi to Huntington, Long Island. He met a man in a parking lot there and bought Ziploc bags full of painkillers, according to Boogaard’s best friend in New York, Devin Wilson.

Boogaard sorted the pills into pastel-colored plastic Easter eggs, which he stashed around his apartment, a one-man game of hide and seek. He carried one in a pocket whenever he left, the contents adjusted for how long he expected to be gone.

“You could tell he didn’t trust himself,” said Wilson, a teammate when they were teenagers who stayed with Boogaard many weekends last spring.

By March, Boogaard resumed light workouts with the Rangers, whose doctors continued to supply him with prescription drugs. Mark Messier, the team’s Stanley Cup hero in 1994 and now a team executive, tried to motivate him with a pep talk.

A day or two later, a noodle-legged Boogaard fell during on-ice workouts. The Rangers recognized the symptoms.

It was early April, the last week of the regular season, and Boogaard was on his way back to drug rehabilitation in California.

Friends thought he was vacationing. He called and texted from his cellphone and ate in nice restaurants. After a couple of weeks, granted a recess from rehabilitation, he flew to New York and drove his car to Minneapolis. He dropped off more pills at his apartment and returned to rehabilitation in Los Angeles.

Boogaard rented a Porsche for $5,000 and spent $1,200 on one dinner that week, part of $32,000 he put on his Visa card over two weeks. Aaron Boogaard, four years younger, joined him in Los Angeles and stayed at a nearby hotel. The brothers exercised and boxed at a gym. They went to the beach every day.

“There’d be meetings going on and things like that, and he wouldn’t really be doing anything,” Aaron Boogaard said. “I’d try to say: ‘Dude, shouldn’t you be doing that stuff? I think everybody else here is doing it. Why don’t you?’ ”

Boogaard was under the guidance of the Substance Abuse and Behavioral Health Program, financed jointly by the N.H.L. and its players union. They would not make the co-directors — David Lewis, a psychiatrist, and Brian Shaw, a clinical psychologist and professor at the University of Toronto — available for comment.

Cassidy Cousens, the founder and program administrator of the Authentic Recovery Center in Los Angeles, where Boogaard was assigned, would not discuss his case. Cousens said that patients generally go through a detoxification program and are subjected to random drug tests several times a week. Some are allowed to leave the grounds with an approved escort — a staff member for the first few weeks, a friend or a family member after.

“It might look odd to someone outside,” Cousens said. “But integrity is not lacking on the ground.”

On Thursday, May 12, about a month into his rehabilitation, Boogaard was granted a second extended recess. He left with Aaron to attend the graduation of their sister, Krysten, from the University of Kansas. The plan was to meet up with their other brother, Ryan, in Minneapolis for a few days first.

That morning, Derek Boogaard sent a message from the airport in Los Angeles to Wilson in New York. There was a picture of a drink in his hand.

“Bloody Mary No. 6,” Boogaard wrote. “And we haven’t even left the ground yet.”

‘His Chest Wasn’t Moving’

The night of May 12 began with a painkiller, a 30-milligram Percocet that Aaron Boogaard later  told the police he handed his brother at their two-bedroom apartment in Minneapolis. Derek, hours out of rehabilitation, was bent on a party.

He wore dark jeans, a blue-and-white checkered shirt and Pumas. He had dinner with friends at a steak-and-sushi place, where he drank Jack Daniel’s and Cokes. The group shuffled among Sneaky Pete’s and three other downtown Minneapolis bars. At some point, or several points, Derek fueled the buzz with more prescription painkillers.

Once home in his second-floor apartment on North First Street, he spent time in the bathroom. He went to his bedroom at the end of the hall.

Friends left. It was after 3 a.m. Aaron made pancakes in the kitchen. Derek called him back to the bedroom four or five times. Sitting at the end of the bed, he babbled and said the bed was spinning.

“He was miserable,” Aaron said.

Eventually, the calls from the bedroom stopped.

Asleep at last, Aaron thought. He left to spend what remained of the night at a girlfriend’s place. He returned at about 3 p.m. to shower and change. He poked his head into Derek’s room. Still in bed. He shouted that he was leaving for the airport to get their brother Ryan and left again.

Nearly three hours later, Ryan and Aaron arrived and stepped into the back bedroom, expecting to find their older brother sleeping off a hangover. It was about 6 p.m. on Friday, May 13.

“I looked and it didn’t look right,” Ryan said. “Like, his chest wasn’t moving.”

Derek Boogaard’s brothers stared at the giant body sprawled on the bed. On the dresser were framed photographs of their grandparents. There were pictures of former pets, including a bulldog named Trinity.

At the foot of the bed was a brown stain, where Derek had thrown up on the beige carpet.

“He was white,” Ryan said. Like his father, he is a police officer, a member of the Royal Canadian Mounted Police in rural Saskatchewan. “And I touched his arm and I knew right away because rigor mortis had already set in.”

Aaron began jumping up and down, screaming. Ryan told him to  call 911, then took a couple of steps into the hallway and collapsed.

Lying on the floor, he called his father’s house in Ottawa. Len Boogaard’s wife, Jody, answered and heard nothing but unintelligible wails. She thought it was a prank call and nearly hung up. Finally, she made sense of the words contained in the screams.

Len was in the backyard. He grabbed the phone.

“I knew this was going to happen,” he cried.

The Hennepin County  medical examiner ruled it an accidental overdose of alcohol and oxycodone, the active ingredient in painkillers like OxyContin and Percocet.

“The coroner said with that mixture, he probably died as soon as he closed his eyes,” Aaron said.

Researchers’ ‘Wow’ Moment

It did not take long for Dr. Ann McKee to see the telltale brown spots near the outer surface of Boogaard’s brain — the road signs of C.T.E. She did not know much about Boogaard other than that he was a 28-year-old hockey player. And the damage was obvious.

“That surprised me,” she said.

A neuropathologist, McKee is one of four co-directors of Boston University’s Center for the Study of Traumatic Encephalopathy and the director of the center’s brain bank. She has examined nearly 80 brains of former athletes, mainly retired football players and boxers who spent their careers absorbing blows to the head. The center’s peer-reviewed findings of C.T.E. have been widely accepted by experts in the field. The National Football League, initially dismissive, has since donated money to help underwrite the research.

The group may now have its most sobering case: a young, high-profile athlete, dead in midcareer, with a surprisingly advanced degree of brain damage.

“To see this amount? That’s a ‘wow’ moment,” McKee said as she pointed to magnified images of Boogaard’s brain tissue. “This is all going bad.”

The degenerative disease was more advanced in Boogaard than it was in Bob Probert, a dominant enforcer of his generation, who played 16 N.H.L. seasons, struggled with alcohol and drug addictions and died of heart failure at age 45 in 2010.

In the past two years, C.T.E. was also diagnosed in the brains of two other former N.H.L. players: Reggie Fleming, 73, and Rick Martin, 59.

The condition of Boogaard’s brain, however, suggests the possibility that other current N.H.L. players have the disease, even if the symptoms have not surfaced.

The N.H.L. is not convinced that there is a link between hockey and C.T.E.

“There isn’t a lot of data, and the experts who we talked to, who consult with us, think that it’s way premature to be drawing any conclusions at this point,”  N.H.L. Commissioner Gary Bettman said. “Because we’re not sure that any, based on the data we have available, is valid.”

The researchers at Boston University say that C.T.E. is a nascent field of study, but that there is little debate that the disease is caused by repeated blows to the head. They said that the N.H.L. was not taking the research seriously.

“We don’t know why one person gets it more severely than another person, why one person has a course that is more quick than another person,” said Dr. Robert A. Stern, a neuropsychologist and a co-director for the Center for the Study of Traumatic Encephalopathy. “But what we are pretty sure of is, once the disease starts, it continues to progress.”

Linking C.T.E. to Boogaard’s rapid descent in his final years is complicated by his drug addiction.

“He had problems with abuse the last couple years of his life, and that coincided with some of the cognitive and behavioral and mood changes,” Stern said. “What’s the chicken? What’s the egg?”

For years, the N.H.L. has tiptoed between the allure of its fast-paced, hard-hitting action and the need to protect star players. Its best player, Sidney Crosby, returned to the Pittsburgh Penguins last month after sitting out since January following two hits to the head, four days apart. Several star players in recent years have been forced to retire early because of postconcussion symptoms.

The N.H.L. formed a concussion-prevention program in 1997. In 2010, it banned blindside hits to the head. In March, the league altered its treatment protocol, requiring teams to examine all suspected concussions in a “quiet” room, away from the bench.

But the league has shown little interest in ending on-ice fighting. The message is decidedly mixed: outlaw an elbow to the head during play, but allow two combatants to stop the game and try to knock each other out with bare-knuckle punches to the head.

“If you polled our fans, probably more would say they think it’s a part of the game and should be retained,” Bettman said. He noted that fights were down slightly this season.

“The issue is, do we increase the penalty?” Bettman added, referring to the five-minute punishment typically handed to both fighters. “Because it is penalized now. And there doesn’t seem to be an overwhelming appetite or desire to go in that direction at this point in time.”

Chris Nowinski, a former Harvard football player and professional wrestler who is another co-director of the Boston University center, is the one who usually makes the initial call to a grieving family to request the brain. He does not want to put an end to hockey. He wants leagues to take every possible precaution to ensure that athletes are both better protected and better informed.

In October, Nowinski attended a Bruins game in Boston. There was a fight, and he watched quietly as thousands of people stood and cheered while the players fought.

“They are trading money for brain cells,” he said.

A Father Hunts for Answers

Len Boogaard, a cop and father, tries to make sense of it all. On leave from his desk job in Ottawa — a back injury years ago forced him off the streets — he patches together the remains of Derek’s world.

Like a detective, he dials contacts in Derek’s phone to ask who knows what. He explores hundreds of pages of phone records to reconstruct Derek’s relationships, his moods, his sleep patterns. He follows paper trails, trying to link the history of his son’s prescriptions to vague diagnoses in team medical reports.

Since the day of the funeral in May, Len Boogaard said, he has not heard from the Rangers.

The team refused to answer a detailed list of questions regarding their medical treatment of Boogaard during the season and his time in rehabilitation.

It also refused requests to speak to General Manager Glen Sather and the team physician, Dr. Andrew Feldman, among others, about Boogaard. Instead, it e-mailed a four-sentence statement from Sather that read, in part, “We worked very closely with Derek on and off the ice to provide him with the very best possible care.”

Boogaard’s death took on added weight when, in August, two other N.H.L. enforcers were found dead. Rick Rypien, 27, reportedly committed suicide after years of depression. Wade Belak, 35 and recently retired, reportedly hanged himself 16 days later. (The family has said it was an accident.)

Each bit of news, packed with a wallop, provided a backdrop for further debate about the role of fighting and the toll on enforcers. So did the start of the N.H.L. season in October, as teams began the ritual of glossy video tributes and moments of silence. The eccentric former coach and current television commentator Don Cherry chastised former enforcers who second-guess their past roles as “pukes,” “turncoats” and “hypocrites,” and the debate flared.

Arguments enveloped Canada, in particular, where culture and tradition have collided with tragedy. No one quite knows what to make of it.

In Minnesota two Sundays ago, the Wild honored Boogaard with a pregame tribute. The team sold Boogaard jerseys, T-shirts and autographed memorabilia that it had stored from two seasons ago. Fans crowded the team store. Some proceeds went to Boogaard’s favorite charity.

Boogaard’s parents and siblings were escorted onto the ice and presented with flowers, a painting of Derek and a framed game-worn jersey of his. The arena was darkened. A 4-minute-45-second tribute was shown on the video boards.

The Wild had drafted Boogaard in 2001, groomed him to fight and paid him several million dollars over five seasons to be the N.H.L.’s top enforcer. He punched his way to local adoration and leaguewide fear and respect.

The tribute showed Boogaard running over opponents, smiling with fans and talking to children. It showed each of the three N.H.L. goals he scored.

It did not show a single punch.

The Wild would not answer questions about the video. They also refused to address specific questions about Boogaard’s medical care, concussions, addiction and rehabilitation, or the availability of drugs through team doctors. Requests to speak with General Manager Chuck Fletcher and the medical director, Dr. Sheldon Burns, were refused.

For those who knew Derek Boogaard, there are questions that may never be resolved and regret that may never be relieved.

In July, Aaron Boogaard was charged with a felony for distributing a controlled substance — in this case, one pill to his brother the night of his death. The charge was dropped in October. He also told the police that he flushed pills down the toilet after placing the 911 call. He pleaded guilty to tampering with the scene of a death and received probation and 80 hours of community service.

He is trying to revive his own hockey career, and with his name has come the expectation to fight. Last season, in 53 games with the Laredo (Tex.) Bucks of the Central Hockey League, Aaron Boogaard had two goals and 172 penalty minutes. He fought 20 times.

Now 25, he plays for the C.H.L.’s Rio Grande Valley Killer Bees in Hidalgo, Tex. He wears No. 82, marking the year Derek was born. Aaron fought six times in a recent 10-game stretch. At the Wild tribute, he had a bruise under one eye and said he had knocked out an opponent with one punch the night before.

His mother has asked him to quit hockey. But he has no Plan B, either.

“I mean, honestly, what else am I going to do?” Aaron said.

Between trips to Minneapolis to tend to Aaron and his legal issues, Joanne Boogaard distracted herself by gutting and rebuilding her kitchen in Regina. A corner of the refurbished family room is a sort of shrine to Derek. A thigh-high cabinet holds mementos, like photographs and jerseys. Two boxes hold his ashes.

As much as anything, Derek Boogaard always feared being alone.

“We weren’t going to bury him somewhere and just leave him by himself,” Joanne Boogaard said.

Len Boogaard tries to make his own peace. Several times during the summer, he drove back and forth between Ottawa and Minneapolis, about 20 hours each way. For company, he took two bulldogs — Trinity, one that Derek and a girlfriend bought in Louisiana, and a puppy Len Boogaard named Boogey. They stayed in the apartment where Derek died. The lease expired in October.

It was that month that the wait finally ended for the results from Boston. A conference call connected the scientists to Boogaard’s parents and siblings.

The Boogaards learned of the surprising severity of the brain damage. And they heard about the prospects of middle-age dementia.

It was then that Len Boogaard stopped listening. Something occurred to him that he did not expect.

For months, he could not bear the thought of his son’s death. Suddenly, he was forced to imagine the life his son might have been left to live.

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David McGuire Finishing up His Cross-Country Run

posted by SK Brain Injury    |   December 8, 2011 12:00

A man from New Westminster has been running a marathon a day since April to raise awareness about brain injuries.

In 2005 David McGuire woke up in hospital, nine days after taking a simple bath. He says no one really knows what happened.

"That's the last thing I remember," he says. "So what we know, well, what happened was I either slipped and fell in the bathtub and hit my head causing my brain to bleed more, or my brain started to bleed causing me to lose consciousness."

Frustrated with the lack of support for people recovering from brain trauma, the 38-year-old decided to take control.

McGuire began to run about 10 km a day, which he says was the only thing he could do on his own.

Fast forward six years and McGuire is on the last leg of a cross-country run to get people talking.

"To me it's starting that conversation, like what seatbelts were like when we were kids. You didn't legally have to wear seatbelts so it's changing the dialogue to get it to the point where you buy a bike, you do the stuff, you have a helmet.

"It's doing simple things," McGuire stresses. "Like putting on a helmet or telling someone if you hit your head that will make all the difference."

He plans to finish his run on Dec. 9 at Beacon Hill Park in Victoria.

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Former NFL Players sue League over Concussion and Durg Effects

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

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

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

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

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

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

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

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

NFL 'PULLED AN END-RUN'

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

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

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

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

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

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

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

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

For the NFL: Not immediately known.

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