Articles Posted in Traumatic Brain Injuries

A groundbreaking study published last week by the New York Times has reverberated through the sports world. “A neuropathologist has examined the brains of 111 NFL players – and 110 were found to have CTE, the degenerative disease linked to repeated blows to the head,” the paper writes.

A few days later, National Public Radio reported that the NFL was ending a $30 million research partnership with the National Institutes of Health. Citing original reporting by ESPN, NPR said that after almost five years nearly half of the funds the league committed to the study of brain injuries remained unspent “following a bitter dispute in 2015 in which the NFL backed out of a major study that had been awarded to a researcher who had been critical of the League.”

It goes without saying that youth and high school sports are a far cry from the NFL, but with these two stories in the news it is worth revisiting the issue of youth sports and TBI for two reasons. First, anyone playing in the NFL only got there after years of youth, high school and college football. It has long been established that head injuries have a cumulative effect, so it is incumbent on all of us to ask what can be done to minimize these injuries long before young people get to the professional level. Second, and more importantly, whatever one may think of the NFL’s approach and attitude toward concussion issues, professional football players enter each game with the best equipment possible – including helmets built to standards far more exacting than anything a middle or high school student wears onto the field. That, in turn, requires us to look carefully at both the practices and the laws governing youth contact sports to see whether we are doing everything we can to prevent injuries to children.

Two recent articles in the online health publication MedPage Today are the latest of a growing number of pieces questioning the effectiveness of “Heads Up” – the youth sports concussion awareness and prevention program sponsored by the federal government’s Centers for Disease Control and Prevention.

As the journal outlines, “Heads Up was launched in 2003 by CDC’s Injury Center and 26 partners, including the National Football League, YMCA and medical societies. Organizers produce and distribute resources, statistics and overviews of concussion laws and policies focused on high school sports, youth sports, parents, schools and health care providers.” The NFL has sponsored its own variation on the program, canned “Heads Up Football.” Despite their similar names, the NFL’s program is not formally connected to or endorsed by the CDC, according to MedPage Today. It’s use, however, is mandatory in youth football programs here in Oregon according to the journal (the only other state that requires coaches and youth football programs to use Heads Up Football is Vermont, though the program has gained widespread acceptance nationwide). Heads Up Football is designed to promote safe tackling and blocking techniques.

The question, however, is whether it works and a lot of that is a question of enforcement. The article notes that a study in Texas found that “among 185 school athletes who were examined for concussions at the hospital’s sports clinic in 2014, 38% had returned to play the same day they suffered the head injury – without being cleared by a medical professional and despite medical guidelines and state law that should have kept the students on the sidelines.”

A recent article in The Oregonian recounts the story of a 13-year-old Gresham girl severely injured late last month while she and a friend were crossing the street on their way home from school. According to the newspaper the seventh grader and a friend were using a marked crosswalk when a 44-year-old Gresham woman “ran a red light and hit the girls” with her delivery van.

One of the girls “suffered a significant brain injury and several fractures.” The eventual extent of her recovery remains uncertain. The other child was less seriously injured and has been released from the hospital.

The newspaper reports that friends of the severely injured girl’s family have set up a crowdfunding page to help them cope with what are likely to be years of significant expenses in the wake of this Oregon reckless driving crash involving injuries to two children (The Oregonian’s story below includes a link to the GoFundMe page).

Last week marked a significant moment in the ongoing discussion about football, especially professional football, and concussions. As the New York Times notes, “after years of denying or playing down a connection, a top NFL official acknowledged at a hearing in Washington that playing football and having CTE were ‘certainly’ linked.”

Chronic traumatic encephalopathy, or CTE, is a degenerative brain disease that has increasingly been linked to former athletes in football and other contact-intensive sports. It “is believed to cause debilitating memory and mood problems,” the paper reports. Concerns about CTE are sometimes confused with equally serious concerns about sports-related concussions. Though the problems are related they also differ in fundamental ways. Concussions and other traumatic brain injuries are usually linked to single incidents where a blow to the head may cause problems that last for days or even weeks, and which can grow more intense if a person suffers repeated concussions.

CTE is thought to grow out of repeated blows to the head over long periods of time – including blows that individually do not cause concussions or concussion-like symptoms but whose cumulative effect can lead to long-term mental and physical issues. Last week’s Times story focuses on explaining the difference between the two and highlighting the degree to which CTE science “remains in its infancy.”

Last week’s announcement that OHSU’s children’s hospital has acquired a state-of-the-art MRI unit for use during operations is excellent news for Oregon families that may someday be faced with traumatic brain injuries or other injuries to children requiring sensitive surgery.

According to a recent account in The Oregonian the $2 million machine and its accompanying $19 million surgical suite are significant because this type of MRI can be used during operations in the operating theater itself, in contrast to traditional MRI units which are housed separately and can only be used before or after surgery. “The MRI travels overhead on rails and then retracts after the pictures are taken, allowing surgeons to see what’s going on while they’re operating,” the paper reports. The machine is scheduled to go into service next month.

This is significant because, as OHSU’s head of neurological surgery tells the paper: “Brain surgery often succeeds or fails by a millimeter, but during surgery the brain can shift by 10 times that much.”

A lengthy article published earlier this month by the New York Times (see link below) is a fascinating addition to the growing public conversation here in the United States on youth sports and concussions.

The piece tells the story of one family’s struggle to change the laws related to concussions and youth sports in Scotland after their 14-year-old son “died after being hit in the head multiple times during a rugby match in which he should have been pulled from the field.” In the wake of their son’s death the bereaved parents became very public advocates for a re-thinking of youth sports and partnered with some of Britain’s most prominent doctors to “produce some of the most comprehensive concussion guidelines in the world.” The key difference between Scotland and the United States, according to the paper, is that the governing bodies of individual sports are no longer allowed to set their own protocols for when an athlete should be pulled off the field and how he or she should be assessed. Instead, “blanket guidelines aim to protect all amateur athletes and take the guesswork out of assessing potential concussions by calling for players to be removed from the game at the first suspicion of injury.”

While no equivalent national standard exists here in the United States we in Oregon are lucky enough to have something along these lines at the state level. In 2009 legislation known as “Max’s Law” required Oregon school districts to use a standard set of concussion guidelines. Four years later a companion piece of legislation known as “Jenna’s Law” extended that requirement to non-school athletic programs such as club sports, travel teams and leagues organized at the municipal or county level.

Raised awareness of the frequency of concussions among young people, particularly athletes, and the importance of treating them properly has led to a growing amount of scientific research on the subject. A particular focus of attention has been the best way to treat people in the immediate aftermath of a traumatic brain injury. Athletes, of course, should be removed from a game immediately, but the longer-term question of treatment during the days following an accident has received less attention.

According to a recent article in the New York Times new research is questioning one commonly recommended post-TBI treatment technique. Known as “cocoon therapy” the procedure, according to the newspaper, “entails mostly lying in a dark room for multiple days.” The Times reports that a new study suggests that among children “resting for longer than 24 to 48 hours is not beneficial for most young patients.”

“More isn’t always better,” the paper quotes a doctor at UCLA saying. “There was no advantage to prolonged rest.” It adds that this was not the conclusion the researchers expected to find when they set up the clinical trial. Instead, the study “found that the patients advised to rest for five days reported more physical symptoms like headache and nausea in the first few days, and more often experienced emotional symptoms like irritability and sadness over 10 days… The available evidence suggests that young patients with a concussion should rest away from school and work for the first 24 to 48 hours, experts said.”

An OHSU study just published in a medical journal may have uncovered key evidence linking Alzheimer’s disease and traumatic brain injuries and, more importantly, hinted at a way both can be addressed medically according to a recent article in The Oregonian.

According to the newspaper, a scientific paper prepared by OHSU and a university in New York “discovered that a traumatic brain injury fouls up the brain’s waste removal system, causing toxic proteins to build up among the cells. A similar phenomenon exists with Alzheimer’s.” The article goes on to note that if TBI and Alzheimer’s do, indeed, stem from similar chemical causes then there is “hope that scientists will find a drug one day to slow the development of Alzheimer’s or neurodegeneration after a brain injury.”

According to The Oregonian’s account of the study, the breakthrough lies in the discovery of “the brain’s waste removal system.” It continues: “Scientists had long suspected that the brain, which is separated from the body by a protective blood-brain barrier, had a mechanism for flushing out waste. But they did not have a clue about the process.” Now, they do. Another important feature of the study is its identification of the failure of this waste-flushing process as the core cause of both Alzheimer’s and of many traumatic brain injuries – a link between the two conditions that has long been suspected but has been difficult to prove scientifically.

A former NFL player and a former pro wrestler traveled to Capitol Hill this week to warn fellow athletes about the dangers of traumatic brain injuries – but unlike many recent TBI-focused events in Washington in recent months the emphasis of this news conference was teens, not fellow retired pros.

According to a report published by CBS News both “Chris Nowinski, a Harvard graduate and former professional wrestler… and Ben Utecht, a former NFL player for the Cincinnati Bengals and Indianapolis Colts, still suffer years later as a result of these all-too-common injuries.” Testifying before the Senate Special Committee on Ageing, both men focused not on the dangers to professionals like themselves, but on the damage and long-term consequences too many young people risk.

Nowinski told the senators that he suffered a head injury during a wrestling match at age 24, but ignored the symptoms for five weeks. “I lied about my symptoms for five weeks, thinking I was doing the right thing… My ignorance cost me my career, cost me at least five years of my health… and I don’t know what it’s going to cost me in the future,” he said. His biggest fear is CTE – a “progressive neurodegenerative disease (that) can emerge from repeated blows to the head.” He also spoke about the growing body of evidence hinting at a link between traumatic brain injuries sustained in youth and the onset of Alzheimer’s and similar diseases later in life.

Yesterday at the White House President Barack Obama hosted a special event designed to spotlight the dangers of concussions and traumatic brain injuries in youth sports. As someone who has worked and written on these issues for years it is inspiring to see them receiving this kind of attention at the presidential level.

Citing the Centers for Disease Control, the White House website notes that “kids and young adults make nearly 250,000 emergency room visits each year as a result of brain injuries from sport and recreation. And that doesn’t include visits that young people made to their family doctor, or those who don’t seek any help.”

To put these issues in the spotlight, Mr. Obama was introduced at the event by a teenage girl who suffered a concussion while playing soccer. The President told attendees that concussions “are not just a football issue. They don’t just affect grown men who choose to accept some risk to play a game they love and excel at. Every season, you’ve got boys and girls who are getting concussions in lacrosse and soccer and wrestling and ice hockey, as well as football.”