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Why are so few adults wearing bike helmets?

posted by SK Brain Injury    |   August 1, 2011 20:55


Every day in Canada, 36 people end up in hospital from bicycle injuries. That rate hasn't changed much in the last decade, according to new data. But even with more kids wearing helmets when they cycle, the number of adults who insist on riding helmet-free holds stubbornly steady.

Data from the Canadian Institute of Health Information show that the number of Canadians ending up in hospitals from bike accidents remained fairly unchanged between 2001 and 2010 -- about 4,300 a year.

The number of cycling-related head injuries decreased significantly in that decade: from 907 to 665. But among the most severe injuries -- those ending up in trauma units -- 78 per cent were not wearing a helmet.

"That data suggest that perhaps helmets are helping and it is a shame that people are not hearing the message about wearing helmets," says Claire Marie Fortin, CIHI's manager of clinical registries.

When CTV News cameras headed out to some popular cycling trails in Toronto, it wasn't hard to find adults who weren't wearing helmets.

"Why didn't I wear a helmet? Because I am a fool. I don't think it will happen to me," cyclist Kevin Boland said.

Another cyclist said he doesn't wear a helmet out of convenience, because he doesn't like taking the helmet on and off. Others told us helmets were too uncomfortable.

Across Canada, many provinces have laws requiring kids under 18 to wear helmets when cycling. But only four -- British Columbia, New Brunswick, Nova Scotia and Prince Edward Island -- require all cyclists to protect their heads with helmets.

"Some of our provinces have zero legislation even for children can you believe that?" says concussion expert Dr. Charles Tator of Toronto Western Hospital.

"So we have a big job to do to convince our legislators and to convince the public that we should have comprehensive legislation right across the country for bicycles, scooters and inline skates and on our road."

But it is a tough battle. The British Medical Journal has just published a survey showing that two thirds of its readers voted against mandatory bike helmets -- and many of those readers would have been health care workers.

In Vancouver, where bike helmets are mandatory, there are plans for a legal challenge of the helmet law that's scheduled for mid-August. Many of those fighting the law say making helmets mandatory infringes on their rights.

Some even call the law discriminatory against cyclists, noting that drivers who are also at risk in an accident don't have to wear helmets. They note there are only a few hundred hospitalizations for head injuries among cyclists. By comparison, in 2004, there were close to 6,000 hospital admissions for head injuries in car crashes.

The cyclist who is challenging the law argues in his court filings: "Bicycle helmet legislation is discriminatory as it applies, with demonstrable justification, only to individuals who ride bicycles without being equally applied to individuals who drive automobiles or walk."

With a report from CTV's medical specialist Avis Favaro and producer Elizabeth St. Philip





Head injury dementia link

posted by SK Brain Injury    |   July 25, 2011 17:15
A study conducted by researchers at the Southern General Hospital in Glasgow and the University of Pennsylvania is thought to be the first to find a physical abnormality in the brain tissue of people who have had a head injury.

A previous link had been established between dementia and sports where repetitive blows to the head are common, such as boxing and football.

However, this study has revealed a similar link with people who have suffered other kinds of head injury.

Dr William Stewart, head researcher of the Glasgow team said: "We know from clinical studies that there's a link between sustaining a head injury and developing dementia, and what we're interested in is trying to understand what might be happening in the brains of these patients," reported the BBC.

The link was established when researchers examined the brain tissue from 39 people who had recovered from a brain injury, and 39 people who had never had a brain injury.

Abnormalities were found in one third of those who had had an injury.

Dr Stewart said: "What's quite remarkable, and causing much excitement, is that the patients who'd had a head injury had quite large numbers of proteins – or abnormalities – in their brain.

"That's very similar to what we'd see in older patients and, in particular, people with Alzheimer's, yet these patients were in their 40s and 50s and the only thing which marked them apart from the control group was that they'd had a head injury."

Significantly, the study suggests a brain injury could kick-start a process in which the brain is damaged in other ways. Dr Stewart hopes that this finding will lead to further research to uncover how and why dementia develops.

"Part of the challenge in dementia is that a lot of the work we do is with people who already have it.

"What we don't understand is how they get to that stage and what sets off the process in their brain. What we might be able to do is to study patients after a head injury and work out what's happening inside their head."

Veterans study

A large study on older veterans has raised fresh concerns about mild brain injuries and concussions that hundreds of thousands of troops have suffered in recent wars.

The studies, reported at the Alzheimer's Association International Conference in France, challenge the current view that only moderate or severe brain injuries put people at a higher risk of dementia.

The veterans study was led by researchers at the San Francisco VA Medical Center.

Dr Kristine Yaffe, a University of California professor and director of the Memory Disorders Clinic at the Medical Centre who led the study said: "It's by far the largest study of brain injury and dementia risk. It's never been looked at in veterans specifically."

As reported at, researchers reviewed medical records of 281,540 veterans who got care at Veterans Health Administration hospitals from 1997 to 2000 and had at least one follow-up visit from 2001-2007. All were at least 55 and none had been diagnosed with dementia when the study began.

As the dementia risk is more common with age, the large number of cases studied was needed to compare those with and without brain injuries.

Records showed that 4,902 of the veterans had suffered a traumatic brain injury, or TBI, ranging from concussions to skull fractures. Over the next seven years from 2007, more than 15 percent of those of those who had suffered a brain injury were diagnosed with dementia versus only 7 percent of the others. Severity of the injury made no difference in the odds of the developing dementia.

Despite evidence that even a concussion or a mild brain injury can put you at risk, said Laurie Ryan, a neuropsychiatrist who used to work at the Walter Reed Army Medical Center, William Thies, the Alzheimer's Association's scientific director told people not to panic, as this doesn't mean that every soldier or student athlete who has had concussion is in danger. He said: "Pro-football players and boxers "are almost a different species from us" in terms of enduring repeated blows they take to the head."



Governor General and Mrs. Johnson have become patrons of BIAC

posted by SK Brain Injury    |   July 24, 2011 12:08

OTTAWA – The Brain Injury Association of Canada is proud to announce that Their Excellencies the Right Honourable David Johnston, Governor General of Canada and Mrs. Sharon Johnston, have agreed to be Patrons of the organization. The board, volunteers and staff of the Brain Injury Association of Canada are very honoured by this timely announcement, prior to our Annual Conference in August in Prince Edward Island. "We are particularly pleased that the Governor General and Mrs. Johnston have agreed to be Patrons of the Brain Injury Association of Canada. The Governor General's vocal recognition of the value of volunteerism and philanthropy to the quality of Canadian communities is important to the brain injury community. Active support of volunteering and philanthropic giving are key contributions to our nation’s social, cultural, and economic prosperity makes this a strong partnership," said Harry Zarins, Executive Director of the Brain Injury Association of Canada.

In an instant a life is changed, forever. Every day we participate in activities that produce endless risks for sustaining a brain injury: car accidents, a fall from a bike, or a blow to the head. It is estimated that thousands of Canadians incur a traumatic brain injury (TBI) and mild traumatic brain injury (mTBI), also known as a concussion, each year, the majority being young adults. Statistics indicate that the incidence of brain injury is two times greater in men. The Brain Injury Association of Canada (BIAC) strives to raise awareness of the incidence of acquired brain injury (ABI) in Canada.

A brain injury may make it necessary for the injured person to require full time assistance. Families often become the primary caregiver and support person. Many families are left to cope on their own. They sometimes have little understanding of the effects of the injury and the demands that will be made of them by an injured family member. Families need support from others who understand the effects of acquired brain injury.

The Brain Injury Association of Canada (BIAC) provides a shared forum for the support of both families and survivors. BIAC also advocates for the enhancement of support services. Prevention through public education, and safety legislation is the key to the reducing the occurrence of ABI amongst Canadians. The Brain Injury Association of Canada engages in extensive public education initiatives through its many local community associations across Canada. Neuroscience and injury prevention research is another key to addressing ABI. The Brain Injury Association of Canada endeavours to support and promote research in Canada and internationally.

At the founding meeting in July 2003 in Montreal, members from brain injury associations from across Canada, representing survivors, families, medical and research professionals identified the need to create the Brain Injury Association of Canada. Our mandate is to improve the quality of life for all Canadians affected by acquired brain injury and promote its prevention. BIAC is dedicated to the facilitation of post-trauma research, education and advocacy in partnership with national, provincial/territorial and regional associations and other stakeholders. BIAC is incorporated as a national charitable organization under the Canada Corporations Act and the Canada Revenue Agency.





Former NFL players: League concealed concussion risks

posted by SK Brain Injury    |   July 24, 2011 12:01


Los Angeles (CNN) -- Seventy-five former professional football players are suing the National Football League, saying the league knew as early as the 1920s of the harmful effects of concussions on players' brains but concealed the information from players, coaches, trainers and others until June 2010.

The players "did not know the long-term effects of concussions" and relied on the NFL to protect them, the suit says.

The lawsuit also names as a defendant the football equipment maker Riddell Inc., which has been the official NFL helmet brand since 1989.

"For decades, defendants have known that multiple blows to the head can lead to long-term brain injury, including memory loss, dementia, depression and (chronic traumatic encephalopathy) and its related symptoms," says the 86-page lawsuit, filed in Los Angeles County Superior Court on Tuesday.

"This action arises from the defendants' failure to warn and protect NFL players such as plaintiffs against the long-term brain injury risks associated with football-related concussions. This action arises because the NFL defendants committed negligence by failing to exercise its duty to enact league-wide guidelines and mandatory rules regulating post-concussion medical treatment and return-to-play standards for players who suffer a concussion and/or multiple concussions."

NFL spokesman Greg Aiello said Monday night that the league had not seen a copy of the suit but would "vigorously contest any claims of this kind."

Riddell declined to comment, issuing a statement saying only, "We have not yet review(ed) the complaint, but it is our policy to not comment on pending litigation."

NFL to require sideline test after head blows

The 75 former players accuse the NFL of engaging in "a scheme of fraud and deceit" by having members of the NFL's Brain Injury Committee "deny knowledge of a link between concussion and cognitive decline and claim that more time was needed to reach a definitive conclusion on the issue."

"When the NFL's Brain Injury Committee anticipated studies that would implicate causal links between concussion and cognitive degeneration it promptly published articles producing contrary findings, although false, distorted and deceiving, as part of the NFL's scheme to deceive Congress, the players and the public at large," the suit says.

"The defendants acted willfully, wantonly, egregiously, with reckless abandon, and with a high degree of moral culpability," the former players charge in court documents.

The suit notes that in 1994, the NFL studied concussion research through funding the NFL Committee on Mild Traumatic Brain Injury. The committee's published findings in 2004 showed "no evidence of worsening injury or chronic cumulative effects" from multiple concussions, the suit says. In addition, in a related study, the committee found that "many NFL players can be safely allowed to return to play" on the day of a concussion, if they are without symptoms and cleared by a doctor.

However, "it was not until June 2010 that the NFL acknowledged that concussions can lead to dementia, memory loss, CTE and related symptoms by publishing (a) warning to every player and team," says the suit.

"The NFL-funded study is completely devoid of logic and science. More importantly, it is contrary to their (the NFL's) Health and Safety Rules as well as 75 years of published medical literature on concussions," according to the suit, which asks for a jury trial and damages.

Even when the warning was issued, the NFL did not warn any past players, including the plaintiffs, or the public of "the long-term brain injury caused by concussions," the suit says.

"By failing to exercise its duty to enact reasonable and prudent rules to protect players against the risks associated with repeated brain trauma, the NFL's failure to exercise its independent duty has led to the deaths of some, and brain injuries of many other former players, including plaintiffs," the lawsuit says.

Film aims to show NFL's culture of playing on

Chronic traumatic encephalopathy is a degenerative, dementia-like brain disease linked to repeated brain trauma. The disease has been found in the brains of 14 of 15 former NFL players studied at the Boston University School of Medicine Center for the Study of Traumatic Encephalopathy as of May.

They include former Chicago Bears safety David Duerson, 50, who shot himself in the chest in February, leaving behind a note requesting that his brain be donated for study.

His widow, Alicia, said Wednesday that she had mixed emotions about the lawsuit. The Duersons weren't part of the lawsuit, according to court documents.

"I truly believe the NFL must have known on some level because there were always doctors present, you know, with these guys," Alicia Duerson said. "But I guess the other part of me is saying the 12 families who have lost their loved ones and their husbands or father that did have CTE, I feel like we're the families who they probably needed to help in this lawsuit as well.

"Dave would approve of it, I think, because he did want his brain donated, and he felt there was a problem with his brain, and he felt because of all the blows he took to his head that it caused him to have this problem," she said. "So David sacrificed his brain so they could research and develop and get better safety procedures and stuff like that for the NFL and for future football players.

"The final days of his life, it was very difficult for him because he was such a brilliant man, and he was very gifted, and for him to forget simple things like directions or having to write things down constantly and reminders for himself ... he was aggravated a lot," she said.

Former NFL player suffered from brain disease

Another player who showed signs of brain damage was former NFL defensive lineman Shane Dronett, who committed suicide at age 38 in 2009. His family said this year that Dronett's symptoms, which began in 2006, included bad dreams that eventually came nearly nightly, along with fear, paranoia and episodes of confusion and rage.

A wide variety of information on the subject -- including the first case of "punch-drunk" boxers, published in 1928 -- has been available to the league over the decades, the suit alleges.

In June 2007, the NFL scheduled a concussion summit because of congressional scrutiny and media pressure, the suit says.

"Unfortunately, the NFL in keeping with its scheme of fraud and deceit issued a pamphlet to players in August 2007, which stated: 'there is no magic number for how many concussions is too many,'" the suit says.

During hearings by the House Judiciary Committee in October 2009, U.S. Rep. Linda Sanchez, D-California, "analogized the NFL's denial of a causal link between NFL concussion and cognitive decline to the tobacco industry's denial of the link between cigarette consumption and ill health effects," the lawsuit says.

A brain with chronic traumatic encephalopathy contains dense clumps of a protein called tau, which is associated with repeated head traumas -- concussions or subconcussive hits -- that are not allowed to heal. The disease can also diminish brain tissue and is associated with memory loss, depression, impulsive behavior and rage.

The NFL was founded as the American Professional Football Association in 1920 and changed to its current name in 1922, the suit says. By 1924, there were 23 franchises in the league, court documents say. In 1970, the American Football League, which operated from 1960 to 1969, merged with the NFL.

The lawsuit didn't specify a monetary figure for compensatory and punitive damages.





Reseachers creating a safer helmet

posted by SK Brain Injury    |   July 12, 2011 09:02

Researchers at the Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences and Wake Forest Baptist Medical Center said they have developed commercial smart football helmets that measure the force of blows to the head.

Research initiatives to make players safer on and off the field have been in development for the past decade at many universities, including Wake Forest University, UNC Chapel Hill and Virginia Tech. All have worked on the development of helmet sensor technology to help detect traumatic head injuries.

The research is focused on future helmet design and rules to limit head trauma exposure and assist trainers, coaches, doctors and players for evaluation of a possible injury and to identify or rule out possible concussions.

Dr. Daryl Rosenbaum, the lead researcher at Wake Forest Baptist Medical Center, who is conducting research on traumatic brain injury, said the helmets can help identify players who have taken a hard hit and prompt immediate real-time evaluation for signs of a concussion rather than waiting for the player to notice something is wrong.

The smart helmets are far from making their way into high school athletics in North Carolina. The average price for a Riddell, Schutt and Nike adult football helmet can range from $200 to $300. Rosenbaum said the smart helmets would cost schools an additional $150 to $300 more per helmet.

"We have submitted a proposal to Toyota to fund the use of helmet sensor technology in local high schools in order to study the effects of football-related head trauma. We just had the system installed at Wake Forest University and used the helmets during spring training," Rosenbaum said.

Don Steelman, the assistant athletic trainer for Wake Forest University football, said the wireless system provides real-time readings from impacts from the helmets.

The system is pretty easy to use. The sensors have a threshold that will set off an alarm when a player takes a hit, notifying the coach which player may be at risk, Steelman said.

"I think the research will help protect players by helping to develop better helmets but also help us identify players who are not learning the proper way to play," Steelman said.

The state has taken a step toward dealing with head injuries among players.

On June 16, North Carolina joined 20 other states to enact legislation directed toward concussion education for interscholastic sports. The Gfeller-Waller Act is designed to raise awareness of the dangers of head injuries and puts decisions about whether a player should return to the field in the hands of a medical professional. The bill is named for two high school students from the state who died on the football field due to head-related injuries.

The same week the legislation passed, the National Organizing Committee on Standards for Athletic Equipment (NOCSAE) approved three research grants worth $500,000 and reapproved a $610,000 grant voted on last winter for traumatic brain injury research. The Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences receives no money from NOCSAE for their research and is funded through private donations.

Professor Stefan Duma, the researcher who developed the accelerometer technology as well as a comparative test for football helmets using a five-star system, has been the primary force behind the development of this type of technology for past eight years.

Having recorded over 1.5 million head impacts since Virginia Tech's 2003 football season, Duma said a better way to have improved safety is through newer helmets.

"This system can benefit anyone who wears an adult helmet. High school, college, NFL; it's all the same."

The research has helped to build better helmets that slow the acceleration of the head when it takes a hit, said Duma.

"The biggest reason why it helps is that we can quantify exactly how players are hit by a physician, by the level, how often, how hard and by what direction. Since we know the exposure that allows us to develop and design better equipment and that's where it's really critically important," Duma said.

Since releasing his helmet rating system, Duma said many helmet manufacturers have come out with better helmets that help to slow the acceleration of an impact. Duma said he is strongly encouraging schools to change to newer helmets.

Not everyone thinks helmet sensors are the answer to preventing head injuries.

"Helmets are not going to prevent concussions," said Dr. Fred Mueller, director of the National Center for Sports Injury Research at UNC Chapel Hill. "If you had an athletic trainer in every high school and middle school in the state, it would help a lot. The problem is the funding is just not there."



Cyclists deaths raises helmet law debate

posted by SK Brain Injury    |   July 6, 2011 08:19


LONDON, Ont. - It happened twice in one day this week, an unusually deadly toll for this region.

The deaths of two adult cyclists, neither wearing safety helmets, raises the question: Should Ontario's bicycle helmet law -- only kids are covered now -- be extended to make the head protection mandatory for adults?

While it's tough to say whether a helmet would have saved the life of Jonathan Valenta, 21, who died Monday of injuries following a collision on a country road, London police said a helmet would likely have saved the life of a 53-year-old local man who fell and struck his head on the pavement following a collision in the city's east end.

Ontario's law requires only cyclists under age 18 to wear the helmets, so both men were within the safety law.

But the London police point man on traffic safety, Sgt. Tom O'Brien, says he thinks now is a good time to consider amending provincial laws about protective headwear.

"When these laws were legislated, roads weren't so busy -- not as many cars. It may be time for the government to step in and make (helmets) mandatory for everyone like they did with seatbelts, when people said it was (their) choice to wear them," O'Brien said, adding a serious injury can affect anyone regardless of age.

If your unprotected head hits something hard, that in and of itself, regardless of the collision could kill you."

Even if a cyclist not wearing a safety helmet survives a collision, the risk of serious, life-limiting injuries shouldn't be forgotten, warned Ruth Wilcock, executive director of the Ontario Brain Injury Association.

"They could have a catastrophic injury -- anything from having memory loss, to being in a coma or a vegetative state . . . and brain injury is the leading case of death and disability for those under the age of 45," she said.

"Studies have shown wearing a helmet reduces the severity of injury by 88%, if it doesn't completely avoid the injury."

Wilcock said she also thinks the province should consider changing the helmet law.

"It would be helpful if the law would make (adults) wearing helmets mandatory. Some people still wouldn't wear them, like some don't wear seatbelts, but more would comply."

Ontario's bike helmet safety law began more than 20 years ago, when longtime former London MPP Dianne Cunningham -- amid calls from injury-prevention groups -- introduced a private member's bill to make the helmets mandatory. One of Cunningham's sons had suffered severe head injuries as a teenager from an automobile accident.





Attached is the July 2011 issue of About Brain Injury newsletter

posted by SK Brain Injury    |   July 5, 2011 12:35



Apps the way to go with brain injury rehab

posted by SK Brain Injury    |   June 28, 2011 12:26

Mobile assistance: Smart technology can help people overcome memory loss (iStockphoto)

Mobile assistance: Smart technology can help people overcome memory loss (iStockphoto)

Digital helper Portable touch-screen technology can help patients overcome the debilitating effects of memory loss due to brain injury, according to an Australian study.

Researchers at the Royal Rehabilitation Centre in Sydney have been using smartphones and electronic tablets to help patients remember daily tasks such as taking medication, remembering appointments and recalling names and faces.

Chief investigator Belinda Carr, professional leader of occupational therapy at the Royal Rehabilitation Centre, says many brain injury patients suffer problems with their memory.

"When patients experience a brain injury, some people can't remember information from one day to the next," she says.

The research team attempted to overcome this by using personal digital assistants (PDAs) to prompt memory.

Carr says the research, due to be presented at the Occupational Therapy Australia Conference starting tomorrow on the Gold Coast in Queensland, shows patients using the smart technology had "significant fewer memory failures".

"The number and seriousness of memory failures improved [and] importantly the client's caregivers reported lower frequency of forgetting," Carr says.

The study, undertaken between 2006 and 2009, involved 42 people with brain injuries ranging from severe memory problems to moderately severe memory impairment. The patients were predominantly men with an average age of 35 years.

While the control group used diaries to assist their memories, other participants in the trial were given PDAs to log information such as appointments and times for medication.

Participants were then given an hour of one-on-one training each week for eight weeks in using the PDA.

She says the training in the use of the gadgets is critical to the program's success and the participants are given small cue cards that stay with the technology to remember how to input information.

Greater gains

Carr says the study builds on previous research that shows the use of diaries helps people with brain injuries to improve their functional memory.

But she says the work shows modern touch-screen technology is an even better tool in helping people with brain injuries.

She says there are many contributing factors behind this, including the willingness of the patients to use the new technology.

"People with brain injuries are predominantly young males under 25 years and carrying around a diary now is not very cool," she says. "Having an iPhone doesn't make them look any different [to everyone else] so they want to use it."

Carr says the reduction in memory failures does not mean patients' memories are improving, rather the alarms on the new technology are prompting them to do something.

The technology allows the people with brain injuries to be more independent and, critically, reduces the amount of carer hours that need to be funded, she says.

It can also help in a return to work with the technology prompting them to remember tasks they are meant to perform.

Carr says the research suggests technology could also be useful in overcoming memory loss through diseases of ageing.

"Our study had an upper limit of 65 years," she says. "[But] this research has a follow-through for people with dementia and other age-related memory loss."

Since the original study the PDAs have been upgraded, with clients at the rehabilitation centre now using smartphones and electronic tablets, says Carr.

"We're finding many apps are very useful for our clients," she says, citing an app that can help locate a phone when it is lost.

Carr hopes apps will be developed "specifically to help people with brain injuries" but believes use of the technology as an aid for patients will grow.

"More and more we will see iPhones and iPads being used in a therapeutic setting," she says.





Concussions: What to Watch For

posted by SK Brain Injury    |   June 21, 2011 14:03


Posted: Feb 20, 2011 5:45 AM ET

Last Updated: Feb 21, 2011 11:00 PM ET

Concussions, head shots, cheap blows. There's been a lot of talk in pro sports lately of doing something to cut down on the number of injuries that occur in games played by very large, very strong and very talented athletes - especially in hockey and football.

Yet, in 2010, two of the highest profile athletes to miss significant chunks of the season were Canadians in a mostly-American game: baseball: Jason Bay of the New York Mets and Justin Morneau of the Minnesota Twins

Bay missed the last two months of the season after his head bashed into the left-field wall while he made a running catch at Dodger Stadium in Los Angeles in late July. Two weeks earlier, Morneau slid hard into second base during a game in Toronto, colliding with the shortstop.

Both players made what are considered good plays: Bay was able to hang on to the ball for the final out of the inning and Morneau's hard slide impeded Toronto's shortstop in his effort to throw out the runner going to first base. And in both incidents, the players - while apparently momentarily dazed - were able to get to their feet and walk off the field. "Always a good sign," as the announcer says at the end of the video of Morneau's incident posted on the official site of Major League Baseball.

Both players were out for the rest of the season because of ongoing symptoms of concussion.

What is a concussion?

A concussion is an injury to the brain resulting from a blow to the head. Your brain is protected from everyday bumps and jolts by the cerebrospinal fluid that it floats in, inside your skull. A hard enough jolt, though, causes your brain to smack into your skull.

Most people don't black out when they suffer a concussion. In fact, they may feel little more than a bit dazed at first and - like Jason Bay and Justin Morneau - be able to get up and walk away with little sign of injury.

A concussion is the mildest form of traumatic brain injury. In medical parlance, traumatic is used to indicate "sudden" as opposed to "chronic" which develops over a long period of time.

What are the symptoms of concussion?

Classic concussion symptoms include confusion and amnesia, especially of the event that caused the concussion.

Other immediate symptoms may include:

  • Headache.
  • Dizziness.
  • Ringing in the ears.
  • Nausea or vomiting.
  • Slurred speech.
  • Fatigue.

Other symptoms may show up in the days and weeks following the incident. They include:

  • Memory or concentration problems.
  • Sensitivity to light and noise.
  • Sleep disturbances.
  • Irritability.
  • Depression.

Like any head injury, it is important to watch the patient closely for 24 hours. If the patient loses consciousness often or has trouble waking up, you should seek immediate medical attention.

What should I look for if I suspect my child has suffered a concussion?

Kids can be particularly at risk for concussion - even if they're not involved in sports. Falling off a couch or bumping into a table could provide enough of a blow to cause a concussion. Watch for:

  • Listlessness, easy to tire.
  • Irritability, crankiness.
  • A change in eating or sleeping patterns.
  • A lack of interest in favourite toys.
  • A loss of balance or unsteady walking.

You should seek medical attention if your child loses consciousness, suffers a seizure, vomits repeatedly, has a headache that keeps getting worse, or has lasting or recurrent dizziness.

What is post-concussion syndrome?

It's when a combination of concussion symptoms persist for weeks or months after the injury that caused the concussion. They can persist for a year or more in some people.

It's unclear why the symptoms persist. Some experts believe the event that caused the concussion does structural damage to the brain or disrupts neurotransmitter systems. Others believe the syndrome is related to psychological factors, especially since the most common symptoms - including headache, dizziness and sleep difficulties - are similar to those of people suffering from depression.

When is it safe to resume activity after a concussion?

Definitely not on the same day the concussion is suffered. Beyond that, it depends.

The Second International Symposium on Sport Concussion, held in Prague in 2004, led to the creation of the Sport Concussion Assessment Tool (SCAT2). It's a standardized tool that medical professionals can use to diagnose athletes - and athlete can use to help determine if they're suffering from a concussion and whether they're ready to resume activity.


SCAT2 includes six steps to take before an athlete should return to play, with at least 24 hours for each stage. However, if symptoms recur, the athlete should return to the first stage. The New York Mets report that Jason Bay has been symptom-free since December, when he resumed working out. He's expected to be at full strength when the baseball season opens in April.

As for Justin Morneau? The Minnesota Twins say he continues to make good progress and has been hitting, fielding and throwing. But they won't know whether he's over his post-concussion issues until he starts playing in games during training camp later this month.





'Emotional roller-coaster' ahead for Giffords

posted by SK Brain Injury    |   June 20, 2011 09:13

In the long run, Rep. Gabrielle Giffords should flourish from returning to a home life with her husband. But in the days and weeks ahead, she and her family will have to make difficult adjustments to this new phase in her recovery.

While Giffords gets used to living outside a hospital for the first time in more than six months, her family — especially her astronaut husband, Mark Kelly — will learn to care for a person who still has significant cognitive and physical problems caused by a devastating gunshot wound to the head.

"It's really an emotional roller-coaster," said Dr. Richard Riggs, chairman of physical medicine and rehabilitation at Cedars-Sinai Medical Center in Los Angeles.

The 41-year-old lawmaker left the hospital on Wednesday and moved to her husband's home in a Houston suburb not far from the Johnson Space Center.

Visitors came and went, including Kelly's brother Scott, also a NASA astronaut, and Giffords' mother, Gloria, who brought groceries.

It's a far cry from hospital life, where staff members monitor who visits, how long they stay, and even things like how much light is in a room. The rules help patients recovering from brain injuries by minimizing excess stimulation that they can find confusing and irritating.

Story: Giffords released from Houston hospital

Pets, children, phone calls, mail delivery, cooking — these are routine interruptions Giffords has lived without for nearly six months, Riggs said.

"There's going to be commotion, there's going to be activity," Riggs said.

In the long-term, it will help Giffords reintegrate into society, he said. In the short-term, the stimulation will likely be exhausting.

At the same time, the family will be torn between being caregivers and maintaining their normal relationship with Giffords. While Giffords will have a 24-hour home care assistant and will go to the hospital daily for intensive therapy, her family will still carry some of the burden.

"It's a hard balance," said Cara Camiolo Reddy, head of the brain injury program at UPMC Rehabilitation Institute in Pittsburgh. "You want to be there and care for them, but you also want to get back to your normal relationships with that person, so there's a lot of challenges there emotionally."

Some patients don't know, for example, that it's unsafe for them to drive or climb the stairs unassisted. Relatives are torn between wanting to give their family member freedom while also protecting them, Camiolo said.

"The patient will ask, when can I go back to work? When can I drive? Why do you keep following me?" Camiolo explained. "The patient can get angry at the family member for not letting them do things."

The benefits of being at home, though, can be great.

Giffords will get to try out the activities she's been practicing — things like getting into and out of a bathtub, walking on an uneven surface, like a sidewalk, or opening and closing the refrigerator, Riggs said.

"In the hospital you get rehab, but lose focus of why this is important," Riggs said. "When you put them at home, in the real-life situation, they do get motivated."

Giffords' husband acknowledged his wife didn't like being confined to the hospital she transferred to in late January, weeks after she was shot on Jan. 8 at a meeting with constituents in Tucson.

"Living and working in a rehab facility for five months straight has been especially challenging for her," he said.

Six people were killed in the rampage that injured Giffords and 12 others.

It will be months before doctors know what permanent impairments Giffords will have and whether the Democrat will be able to return to her job in the House of Representatives, or seek Arizona's open Senate seat. Chief of Staff Pia Carusone recently told the Arizona Republic that Giffords can speak, but struggles to put together complex thoughts and sentences. And while she can walk with assistance, she still sometimes needs a wheelchair — like when she was in Florida in May watching Kelly rocket into space as commander of space shuttle Endeavour.

Outside the hospital, a person's deficiencies also become more apparent, not only to the family but to the patient. Typically, after going home, the patient begins to comprehend the extent of their injuries and the long-term consequences, Riggs said.

It can be frightening and depressing, he said.

Ron Barber, a Giffords' staff member who was also shot in the rampage and is still recovering from gunshot wounds to the face and leg, said he and his wife were initially apprehensive when he was released from the hospital.

But within two days — after a nurse helped them rearrange furniture so he could get around and a home care assistant arrived — they realized how much better it was to be home.

"Being home, there's nothing like it," Barber said. "You're in familiar surroundings, with family."