Articles Posted in Traumatic Brain Injuries

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.”

An announcement last week by New York’s University of Rochester received little attention in the national media, but deserves more. According to a news release from the university’s medical center, researchers there have made a significant breakthrough in the study of sports-related traumatic brain injuries, especially to children.

The medical center says the development of a new testing model “provides a foundation for scientists to better understand and potentially develop new ways to detect and prevent the repetitive sports injuries that can lead to the condition known as chronic traumatic encephalopathy (CTE).” The key to the research is the discovery “that mice with mild, repetitive traumatic brain injury (TBI) develop many of the same behavioral problems, such as difficulty sleeping, memory problems, depression, judgment and risk-taking issues, that have been associated with the issue in humans.”

As the news release goes on to explain, the lack of a reliable animal-based testing model has held back research on repetitive TBI and other sports injuries. If the model stands up to further peer-reviewed research it could, over time, prove to be crucial not only in the diagnosis and treatment of sports injuries but in developing new treatments, equipment and procedures to prevent them. The news release quotes one of the Medical Center’s doctors summarizing the importance of the findings: “While public awareness of the long-term health risk of blows to the head is growing rapidly, our ability to scientifically study the fundamental neurological impact of mild brain injuries has lagged.”

When attention focuses on the question of sports and traumatic brain injuries we usually think of football, hockey or boxing. A new study from Boston University, however, highlights the potential TBI dangers of a sport we do not often think of as violent: soccer.

As outlined by the New York Times earlier this week, the study focuses on “encephalopathy, the degenerative brain disease linked to repeated blows to the head” which, it reports, “has been found posthumously in a 29-year-old former soccer player, the strongest indication yet that the condition is not limited to athletes who played sports known for violent collisions.” Equally intriguingly, the newspaper notes that the soccer player died of ALS, commonly known as Lou Gehrig’s Disease, and offers evidence that the repeated head trauma involved in soccer may have played a role in his development of the disease at the relatively young age of 27.

The man mentioned in the article was a top-level college and semi-pro soccer player. The Times quotes his parents remembering his love of the game, and the pride he took at being good at heading the ball. It quotes a doctor who performed a brain examination after the player’s death saying that he had “extensive frontal lobe damage” of a type more commonly associated with football than soccer. The article cautions that there is no way to establish an irrefutable link between the game and these brain injuries, but the BU study concludes that this, and other data, are cause for both concern and for further study.

When the news broke right before New Year’s that Michael Schumacher, arguably the world’s most famous race car driver, had been seriously injured in a skiing accident it immediately focused public attention on safety and winter sports.

According to numerous media reports Schumacher was skiing ‘off piste’ (a common term at European resorts referring to terrain which is open to recreational skiers but is not groomed or marked specifically as a trail) with his son at the French resort of Meribel on December 29 when he lost control, fell and struck his head on a rock. Schumacher suffered a traumatic brain injury and has been in a medically-induced coma ever since. He has undergone two surgeries and, according to CNN, doctors describe his condition as “stable but critical.”

That same CNN article (see link below) contains an especially important point regarding the accident. According to CNN “a French prosecutor investigating the ski accident… said that speed was not an important factor.” CNN reports French officials telling the media that Schumacher was traveling at “the speed of a very good skier on a slope which was not very steep” and also ruled out a fault with the race car driver’s skis. It has been widely reported that Schumacher was wearing a helmet at the time of the accident.

A story published last week in the Los Angeles Times spotlights both the help technology can offer in the fight against traumatic brain injuries, and the surprising resistance that such technology can, and does, encounter.

The paper reported on a “wireless alert system” that can be placed in football helmets. Sensors placed inside the helmet trigger an alert on a smartphone or a similar device carried by a coach or trainer on the sidelines if the wearer suffers a potentially concussion-inducing blow to the head. The system, according to the paper, “gains data from five sensors placed on a plastic-like, paper-thin lining placed on top of helmet padding. The sensors measure linear and rotational acceleration as well as the duration and location of a hit. A computer chip in the helmet transfers data to a hand-held alert monitor – typically carried by a trainer – via a low power signal similar to Bluetooth.” The system can be adjusted according to the level of play (middle school v high school v college).

One might have imagined that the main problem this raised for high schools was financial – the systems cost about $150 per unit. When one LA area high school offered the sensors to all 120 of its football players earlier this year, however, only 20 stepped up to purchase them. What surprised even the school’s head athletic trainer, however, was the reason: according to the LA Times “parents worried about sons being pulled from games and missing playing time. Several said they dropped the sensor topic after their sons declined to wear one.” The trainer told the paper, “In the society we live in, the knowledge is there but the parents, I don’t know – it confused me.”

The widely reported news that “the NFL has agreed to pay $765 million to settle a lawsuit brought by more than 4500 players and their families,” as The New York Times reported this week, is welcome news for former players suffering from traumatic brain injuries and other physical and mental problems linked to the violent, hard-hitting nature of life in the NFL. The broader potential for good in this settlement, however, lies in what it may do to raise awareness about a troubling, and persistent, problem.

At the Times noted, this week’s settlement can be seen as a legal victory for the NFL. It represents less than 5 percent of the league’s annual revenues and spares the NFL both the potential expense and the certain bad publicity of an endless stream of lawsuits by individual players and their families. The paper also notes that “among the terms of the agreement is that the settlement is not to be regarded as an admission of guilt by the league.” Such clauses are not uncommon in settlements like these, but it is difficult to believe that many fans – along with players, parents and coaches at all levels of the game – won’t interpret it that way.

Frankly, that would be a good thing. The League’s reticence on the subject of concussions and TBI has long served as subtle, if perhaps unintended, encouragement for players and coaches at lower levels of the sport. Measures like the one passed here in Oregon earlier this year to encourage youth safety have often encountered resistance from some players, coaches and fans.

On a day when the NFL has settled a landmark lawsuit over player concussion (a subject on which I’ll write more later this week) it is worth remembering the measures closer to home that we all need to take to protect our kids from traumatic brain and spinal cord injuries.

A recent report published by SafeKids Oregon outlines the scope of the situation: Last year 1.35 million children arrived in emergency rooms with sports related injuries. Fourteen percent of those injuries were to the head. The group at greatest risk are 12-15-year-olds, who account for nearly half of all youth sports injuries. Though football is the sport we most often associate with concussions and other head injuries, among young athletes the most dangerous sport in terms of concussions was ice hockey which, all by itself, accounts for 31% of all youth sports concussions. Football accounts for only 13%, a bit behind wrestling and tied with soccer. The study notes that in sports played by both boys and girls the latter tend to report higher incidence of concussions, but speculates that this may have more to do with social pressures than with the relative tendency of boys and girls to suffer from the injuries.

Most importantly, however, the study notes that “a Governor’s signature is the beginning of the game, not the fourth quarter.” Put another way: state laws designed to protect young athletes are only as good as the parents and coaches who enforce them. SafeKids Oregon notes that the federal government’s Centers for Disease Control and Prevention offers a free online training program, known as “Heads Up”, for adults supervising youth sports.

On Tuesday the Oregon Senate passed by a wide margin a bill that would allow children of any age to ride motorcycles, dirt bikes and other off-road ATVs. Let me be frank, it is hard to see how any responsible parent would allow a child that young to ride a motorized vehicle, but we all know that some will. Though presented during debate as a matter of personal freedom, this is truly a case in which society’s interest in protecting children has to be balanced against a conception of ‘freedom’ so individualistic that it comes to pose a threat to everyone else.

As reported in The Oregonian, Senate Bill 238 passed the Oregon Senate 22-7 with support from 12 Republicans and 10 Democrats. All but one of the seven ‘no’ votes came from Democrats. Supporters tout the measure “as a way to improve safety for young and off-road riders because it requires anyone under 16 to meet minimum size requirements, known as a “rider fit” test” before they can be certified to operate ATVs and other off-road vehicles. The paper notes, however, that another provision of the bill repeals the existing prohibition on children under age seven riding such vehicles. In other words, SB 238 would allow children at the ages of six, five or even four – children who might not yet have the balance to ride a bicycle – to sit atop a powerful quad-ATV and ride not only on their family’s property but also on public lands throughout the state.

It seems contradictory to toughen basic safety requirements for children in general while removing a common sense ban designed to protect small children – children whose cognitive ability, motor skills and general perception of danger are not sufficiently developed to operate a motor vehicle, even under parental supervision. Ironically, this bill passed the senate even as Oregon and the rest of the country are marking national brain injury awareness month, a time designed to focus attention on the dangers traumatic brain injuries pose to kids here and elsewhere.

A recent news release from SafeKids Oregon – “Concussions: What You Need to Know” – offers an important note of caution during this holiday season, highlighting the dangers of Oregon TBI injuries related to youth sports and offering important pointers for parents who want their kids to be as safe as they are active.

The news release highlights findings presented in a webinar organized by the group earlier this month (see the link below for the press release – which also contains a link to a video of the complete SafeKids presentation). As the SafeKids news release shows, more than a third of all traumatic brain injuries nationwide are caused by falls. Moreover, “more than one in three children who play team sports are injured seriously enough to miss practices or games, and some suffer life-long consequences.”

The report goes on to note that “concussions can happen to children in many activities so knowing how to identify and prevent them is important.” To that end, the webinar points users toward free online training sessions offered by the US Centers for Disease Control and Prevention. One set of videos is aimed at coaches and another (funded jointly by the CDC Foundation and the NFL) targets clinicians with the goal of improving both recognition and initial treatment.

In a recent article in the New York Times Dr. Robert C. Cantu, a professor of neurosurgery at Boston University, issued a thoughtful, yet passionate, call for parents and school officials to rethink the way we approach youth sports here in the United States.

Writing that he meets with some 1,500 concussion patients each year, Dr. Cantu lays out the case for lowering the degree and intensity of contact that younger children experience across a range of sports. “In light of what we now know about concussions and the brains of children,” he writes, “many sports should be fine-tuned.” Dr. Cantu writes that children under 14 are fundamentally more vulnerable than older teenagers or adults. “A child’s brain and head are disproportionately large for the rest of the body,” he notes. “And a child’s weak neck cannot brace for a hit the way an adult’s can. (Think of a bobblehead doll.)”

He begins the piece by focusing on football, where he believes tackling should be eliminated for children under 14, but emphasizes that head trauma, concussions and brain injuries are all more common in other sports than is popularly believed. His piece goes on to propose rule changes in soccer, ice hockey, baseball, softball, field hockey and girls’ lacrosse – many of which are not activities most of us think of as contact sports.

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