Michigan Boxing Club Settles Lawsuit Where Youth Suffered Brain Damage In A Match

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Posted on 28th June 2010 by Gordon Johnson in Brain Injury

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There’s been a settlement in a case involving a Lansing, Mich., boy who sustained traumatic brain injury during a boxing match.

http://www.freep.com/article/20100616/NEWS06/100616115/Boxing-club-settles-lawsuit-over-Lansing-boy-s-injury

The negligence lawsuit had been filed in 2008 by the family of Juan Contreras against the Crown Boxing Club in Lansing and its affiliate, USA Boxing, which governs amateur boxing. The amount of the settlement wasn’t disclosed.

Contreras, now 15,  was in a fight March 15, 2008 in Kalamazoo, Mich., where he sustained his brain injury. The youth had joined Crown Boxing In February of that year, and won his first match that month. The bout where he was badly injured was his second fight, which was against a 13-year-old.

 After being treated at hospitals in Kalamazoo, Lansing and Ann Arbor, Contreras is living at home now.

But he is in an impaired state of consciousness, and doesn’t respond to communication. But he breathes on his own, moves his limbs and opens his eyes.   

 

  

Massachusetts Sport Concussion Law – Unanswered Questions

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Posted on 25th June 2010 by Gordon Johnson in Brain Injury

In our continuing review of the proposed Massachusetts scholastic concussion law, it is important to comment on a couple of more issues.  First, the law seems to leave an awful lot up to the “Department” to standardized concussion standards.   Second not even the  ”Department” is given the discretionary power to rule just how many concussions are too many for a scholastic athlete.  The full language of the proposed law can be found at http://www.tbilaw.com/blog/2010/06/massachusetts-senate-approves-sports-concussion-bill.html

The proposed law begins with the following directive:

“The department shall direct the Division of Violence and Injury Prevention to develop an interscholastic athletic Head Injury Safety Training program.”  Then the Department is told: “the department may use any of the materials readily available from the Centers for Disease Control and Prevention and the American Red Cross.”

The CDC is a good start.  Some of the information they provide on concussion is first rate, including the Facts for Physicians http://www.cdc.gov/concussion/headsup/pdf/Facts_for_Physicians_booklet-a.pdf But I have been saying for a very long time that concussion diagnosis must include some significant investigation of amnesia, done hours and days after the injury.  The CDC has only a very superficial evaluation of amnesia.  What needs to be done is create a protocol to ask the injured person a series of questions about what happened in the period of time between five minutes after the concussion and two or three days after the concussion.

This should be easy with an athlete.  Ask them questions about what happened in the game after they got hurt.  How did the game end?  What did you observe while you were on the sidelines?  If the athlete went to the hospital, what was the weirdest thing you saw while you were in the ER?  The next day, what do you remember about what you did yesterday?

The second concern is the inquiry re: prior head injuries with no guidance as to how to apply what is learned from the inquiry.  The law doesn’t say when to hold a player out because there have been too many concussions.  I realize that this type of issue can’t be reduced to a bright line rule, but I believe the Department should promulgate some guidance on the issue. Further, there needs to be  clear cut rules when there are multiple concussions in the same year.  For example, no athlete should ever have the chance to suffer a third concussion in one season.  If I were a parent, there would be no chance for a third concussion ever.  At a minimum, a trained neurologist or neuropsychologist should clear anyone with a prior concussion to play at the beginning of the season.

I applaud the Massachusetts Senate for taking this initiative.  Lets hope they refine these rules so that they truly protect the scholastic athlete.  When to return an athlete to play is a cost benefit analysis.  You can’t sideline a professional quarterback indefinitely because of one concussion. But with an amateur athlete, there is no economic cost associated with being careful.

All those being trained under this new law should have that as their motto.

 

 

Massachusetts Sport Concussion Law Doesn’t go Far Enough

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Posted on 24th June 2010 by Gordon Johnson in Brain Injury

A couple of weeks ago we posted a news story about the Massachusett’s Senate passing a scholastic concussion law.  Today we added the language of that law to this blog: http://www.tbilaw.com/blog/2010/06/massachusetts-senate-approves-sports-concussion-bill.html In reviewing the proposed law, it is clear that the law does not go far enough.

While I have several concerns about the law, the biggest concern is that it makes a distinction between a return to play decision depending on whether an athlete is knocked out or not.  The law creates a bright line rule that there is no return to play if the athlete is knocked out.  But if there is no loss of consciousness, then the athlete is only kept out of the same game if “a medical professional”  makes the diagnosis of concussion.

This is inadequate to provide the protection necessary.  Until all scholastic athletic programs are attended by team physicians competent to make a concussion diagnosis, this invariably means that coaches and players will have an excuse to allow a return to play.  As I have said repeatedly on my blogs and webpages, it is not possible to tell the difference between the insignificant concussion and the significant concussion until at a minimum hours after the event.  The best way to determine concussion severity is amnesia, which may not become apparent for hours or days afterwards.  If we can’t distinguish between the severe and the mild concussion, we must error on the side of safety and hold out all concussed athletes.

The Lystedt law in Washington is the impetus behind this latest round of state actions to create more protection for high school athletes. See http://www.subtlebraininjury.com/blog/2010/05/nfl-commissioner-goodell-asks-44-governors-to-pass-youth-concussion-laws.html It is the Washington law based on the Lystedt case that Commissioner Goodell and the NFL have been pushing the other 44 states to pass.  That legislation is named after Zackery Lystedt, a high school player who went back into a game in 2008 after sustaineing a concussion, and then had to be hospitalized and nearly died. Yet, the law as proposed in Massachusetts would not have prevented Zachary Lystedt’s catastrophic brain injury because he was not unconscious after his first concussion.

One of the good aspects of the proposed legislation in Massachusetts is the calls for the development of a “an interscholastic athletic Head Injury Safety Training program to be completed by the following individuals: coaches, trainers and parent volunteers for any extracurricular athletic activity; physicians who are employed by a school or school district, or who volunteers to assist with an extracurricular athletic activity; directors responsible for a school marching band; and a parent or legal guardian of a child who participates in an extracurricular athletic activity.”

The problem of course is that unless the program focuses on the right diagnostic tools, it will just ensure that more excuses to send athletes back in exist, not to keep them back out.  The vast majority of concussions do not involve loss of consciousness (LOC).  Particularly with concerns about “second impact syndrome”, the distinguish with respect to LOC is dangerous and counter productive.

For more on second impact syndrome, see our blog today at http://waiting.com/blog/2010/06/second-impact-syndrome-from-cdc.html

Girls More Susceptible To Concussions Than Boys In Soccer

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Posted on 22nd June 2010 by Gordon Johnson in Brain Injury

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Girls are more likely than boys to get concussions while playing kids’ soccer, according to The Wall Street Journal. So maybe it’s time to think twice about having your daughter play the sport.

http://online.wsj.com/article/SB10001424052748704895204575320661089359330.html?mod=WSJ_hpp_sections_sports

There are a number of differences between the kinds of injuries that boys get versus girls while out on the soccer field. In addition to concussions, girls are more likely to suffer from heat illness and to injure a ligament on their supporting leg, The Journal said.

With boys, their dominant leg is most likely to be injured.

In statistics for high school soccer, 18.5 percent of  the injuries for girls are in the head and face, versus 12.4 percent for boys, according to data from the Center for Injury Research and Policy at Nationwide Children’s Hospital that was cited by The Journal.  

Neck injuries account for 1.8 percent of overall girls’  soccer injuries, and for 0.4 percent of boys’ injuries.

There are several theories about why the injuries for the two sexes differ, according to experts quoted by The Journal, having to do with their different physiques and the way they play. There is also the notion that girls are more willing to talk about their symptoms than boys.

The article offers an anecdote from a New Jersey man whose teen-aged son and daughter both play soccer. The boy has suffered muscle strain, while the girl has had a concussion and broke her nose once. The Journal quotes the  father as saying that “it’s disturbing when your kid is saying her head hurts and she doesn’t feel good.”

Well, it should be disturbing, and worrisome. Nonetheless, efforts to mandate that kids wear helmets while playing soccer have failed.  

Scientists believe that girls may get more concussons than boys ” because girls’ neck muscles are not as strong or because they are more likely to report their injuries,” according to The Journal. And crashes into other players, not “heading” the ball, cause the concussions.

Today high school soccer teams usually make players suspected of  having a concussion — with symptoms like loss of consciousness, headaches, confusion and dizziness – get an OK from a doctor before coming back to play. 

 That’s what the National Federation of State High School Associations says should be done. 

 

 

Texas Woman Dies Of Brain Injury After Being Hit By Line Drive

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Posted on 15th June 2010 by Gordon Johnson in Brain Injury

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Brain injuries can happen when we least expect them, not just during combat and football, but in the most non-threatening and seemingly safe environments. So it was for Wendy Whitehead. The first San Angelo Colts baseball game she ever went to was also her last.  

The 39-year-old woman, while spending a pleasant Friday evening at a Colts game in Texas, was hit in the head with a ball. The next day, Saturday, at noon Whitehead died from traumatic brain injury. http://www.gosanangelo.com/news/2010/jun/12/san-angelo-woman-hit-by-baseball-dies/

Whitehead, a San Angelo resident, had a seat along the third base line. At the bottom of the eighth inning, she was struck by a line drive. That injury ultimately ended  her life. 

Whitehead’s husband William is a surgeon, and he told the San Angelo Standard Times that he tried to save his wife by performing CPR on her while waiting for an ambulance to arrive. He also noted that this was the first time he and Wendy had attended a Colts’ game.

Perhaps the Colts should take a good look at their seating, and make sure that their fans are kept out of harm’s way. You’d haven’ t be pretty quick to get out of the path of a line drive, so maybe no one should  be sitting in that part of the stadium.  

But in defense of the team, it is very rare for a fan to be killed by a ball during a baseball game. It’s unfortunate that Wendy Whitehead became one of those unusual and uncommon cases.  

 

 

Why We Should Ban Body Checking In Youth Hockey Leagues

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Posted on 14th June 2010 by Gordon Johnson in Brain Injury

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The body checking that is so much a part of ice hockey could prove dangerous for youths whose brains are still developing, according to a new study.

As reported in the Journal of  the American Medical Association, there is a three-fold rise in severe injuries, including mild to severe concussions, in youth hockey leagues where body checking is permitted. http://pagingdrgupta.blogs.cnn.com/2010/06/08/youth-hockey-players-too-young-to-body-check/

The study followed a Canadian youth hockey league where body checking, defined by Webster’s as  “the fair block of an opponent who has the puck by bumping with the body, shoulder to hip, from the front or side,” is allowed.

In a blog CNN medical producer Stephanie Smith interviewed David Hovda, who is director of the UCLA Brain Injury Research Center. He warned that repeated blows to the head in hockey can injure a youth’s developng brain and hinder its potential growth.

The idea is not that we ban 11-year-olds from playing hockey, but that we try to limit their exposure to potential concussions. In other words, no body checking.

NFL Vet Kyle Turley, Showing Signs Of Brain Damage, Crusades To Make League Help Players Like Himself

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Posted on 13th June 2010 by Gordon Johnson in Brain Injury

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 Former Kansas City Chief Kyle Turley was the Ben Roethlisberger of his day. After sustaining several bad concussions playing, Turley began having what you could call anger-management issues and acted erratically.

http://profootballtalk.nbcsports.com/2009/09/18/kyle-turley-experiencing-potentially-serious-brain-issues/

He will always be remembered as the player involved in the infamous helmet-throwing incident when he was playing for the New Orleans Saints in a game against the New York Jets in 2001. Trying to protect the Saint’s quarterback,  Turley pushed  Jets safety Damien Robinson to the ground, ripped off his helmet and threw it across the football field. 

http://nfl.fanhouse.com/2010/05/20/helmet-tossing-kyle-turley-goes-country-to-settle-scores/

Turley was tossed out of the game, fined $25,000 by the Saints and ordered to take anger management courses.

Today it would hard to find any former player more active than Turley in the battle to make the National Football League really try to help present and former players who have brain injury.

 It makes sense that Turley is championing this fight,  because it looks his concussions have had a permanent impact on his brain. Last August he collapsed in a club, and later went in and out of consciousness. Now doctors suspect he may be showing the first symptoms of Chronic Traumatic Encephalopathy, a degenerative neurological disease that contributed to the deaths of ex-NFL players Andre Water and Justine Strezelczyk.

http://sports.yahoo.com/nfl/news?slug=ms-thegameface091809

Turley is a textbook case of how concussions might impact a player’s behavior, and not for the better. The helmet- tossing incident was not his only embarrassing moment in football.    

 After suffering a severe concussion in 2003 when he was playing for the Los Angeles Rams, Turley went into the locker room, took a shower and was sitting by his locker naked when team owner Georgia Frontiere came in. He stood up and gave her a big hug, standing there stark naked.  

 In a recent exclusive interview with the blog Arrowhead Addict,  Turley offered some talk about his problems after sustaining head injuries, why he’s donating his brain to research on head trauma, and about how the NFL has failed for so long to admit the relationship between football-related-brain injury and later brain disease.

http://arrowheadaddict.com/2010/06/08/aa-exclusive-interview-with-former-chief-kyle-turley/

Turley testified before a Congressional committee last fall about his experiences, and lack of proper care, after sustaining numerous head injuries while playing for three NFL teams.  He didn’t like what he heard when he was in Washington from the NFL and still doesn’t think the league is taking its responsibility to stop brain injury and help players very seriously.  

Turley, who is now pursuing a music career in Nashville, told Arrowhead Addict that he agreed with prior remarks by Terry Bradshaw, namely that the NFL has been reactive, not proactive, in terms of dealing with the repercussions of player brain trauma.

At the hearings on the NFL and brain injury, Turley recalled watching a league doctor deny that football was the cause of long-term brain injury in players.

 ”So many guys have gone without being approved for disability and having the ability to get treatment,” he told the blog. “Guys have died, guys that were great players in this game, you know Andre Waters and Justin Strzelczyk and a few other guys that have had the same, I mean, Mike Webster had the same brain trauma as Justin Strzelczyk and Andre Waters and these others. The long-term effects from playing the game of football. There’s no question that there’s a direct relationship….To deny that this evidence exists and deny that there is any relation to these issues from football was offensive and shows exactly the NFL’s stance on the matter.”

Turley is one of a number of  ex-NFL players who have agreed to donate their brains to the Boston School of Medicine, which is creating a bank of brains to examine as part of its research on head injury and future brain disease. That research may spare potential future players, like his 1-year-old son, from the  brain trauma and the anger-management problems that Turley has lived with, he said.  

 ”I’ve suffered some issues with my feelings with my head injuries from football and its been difficult for me to deal with certain things and it has caused me to have take different medications and all kinds of other things that I don’t want my son to have to do,” he told Arrowhead Addict.

  The NFL in April donated $1 million to help fund BU’s brain-injury research. Whether it was a PR stunt or genuinc gesture  on the part of the league remains to be seen.  

 Besides, Turley pointed out that $1 million is not a lot of money for the NFL to ante up.

“If they want to make a dent in this thing the NFL’s going to have to commit some serious dollars to this research so that they can come up with solutions and not just play this fame,”  Turley said in his blog interview.   

 

Woman With Brain Injury Sues Over Foreign Accent Syndrome

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Posted on 9th June 2010 by Gordon Johnson in Brain Injury

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It sounds unbelievable, and even doctors said they thought it was a joke. But there is a unique phenomenon where those who sustain a traumatic brain injury wind up speaking with a foreign accent.

 The Washington Post recently did a story on Foreign Accent Syndrome, which  the  paper described as a “a rare and little-understood medical condition that can follow a serious brain injury.” http://www.washingtonpost.com/wp-dyn/content/article/2010/05/28/AR2010052801724_pf.html

Less than 60 cases of the Foreign Accent Syndrome have been reported globally. And one doctor who has studied some of their brain images said that when he first heard about the syndrome, he thought it was someone’s joke, not real.

The Post story profiled one of them. Robin Vanderlip woke up speaking with a Russian accent after falling down stairs and hitting her head in May 2007. Vanderlip is an East Coast native, but people now constantly ask her where she is from.

The National Institutes of Health and the University of Maryland are both studying Vanderlip’s case. What happened to the 42-year-old woman has happened, and been reported on, before.

The first case was reported toward the end of World War II by a neurologist who was treating a Norwegian woman. She sustained a head injury from shrapnel and went into a coma. She woke up speaking with a German accent, which prompted her own countrymen to ostracize her.

There Post cites from other examples people demonstrating  Foreign Accent Syndrome after suffering a brain injury. They include: a Louisiana woman who began speaking with a Cajun dialect; a woman from England who now has a Jamaican accent; and a Boston resident with a Scottish burr.

Vanderlip has been extremeley despondent about her condition. She has a suit pending against the National 4-H Council, seeking $1 million in damages. She fell on the stairs in the council’s building in Chevy Chase, Md., falling backward and hitting her head. Her suit charges that the stairs were unsafe.

Massachusetts Senate Approves Sports Concussion Bill

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Posted on 7th June 2010 by Gordon Johnson in Brain Injury

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The Massachusetts Senate unanimously passed a bill regarding sports concussions in student athletes. http://www.bostonherald.com/news/politics/view.bg?articleid=1259191&format=text

The proposed legislation would set up a head-injury safety training program for coaches, trainers and parent volunteers who take part in school athletics. Doctors and nurses employed by a school would also be trained to spot signs of concussions.

Another part of the bill requires health officials to keep coaches  up-to-date on athletes who have had prior head injuries. That will enable schools to identify students at greater risk for repeated injuries.

Young people participating in sports or recreational activities sustain between 1.6 million to 3.8 million concussions each year, most of which are not diagnosed, according to the Centers for Disease Control.

The text of the bill is as follows:

SENATE, No. 2267

Senate, February 10, 2010

The committee on Public Health, to whom was referred the petition (accompanied by petition, Senate, No. 796), relating to safety regulations for school athletic programs, reported, recommending a new draft of the same title (Senate, No. 2267).

Susan C. Fargo,
For the committee

Version with line numbers

The Commonwealth of Massachusetts

In the Year Two Thousand and Nine.

AN ACT RELATING TO SAFETY REGULATIONS FOR SCHOOL ATHLETIC PROGRAMS.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

 

Chapter 111 of the General Laws is hereby amended by adding at the conclusion thereof the following new section:

Section 223

This Section shall apply to all public schools within the Commonwealth and to any other school in the Commonwealth whose athletic programs are subject to Massachusetts Interscholastic Athletic Association rules.  

The department shall direct the Division of Violence and Injury Prevention to develop an interscholastic athletic Head Injury Safety Training program to be completed by the following individuals: coaches, trainers and parent volunteers for any extracurricular athletic activity; physicians who are employed by a school or school district, or who volunteers to assist with an extracurricular athletic activity; directors responsible for a school marching band; and a parent or legal guardian of a child who participates in an extracurricular athletic activity.

In developing said program, the department may use any of the materials readily available from the Centers for Disease Control and Prevention and the American Red Cross.  The safety training shall include, but not be limited to current training in recognizing the symptoms of potentially catastrophic head and neck injuries, concussions, and injuries related to second impact syndrome.

As part of the interscholastic athletic Head Injury Safety Training program, school districts shall provide to students participating in any extracurricular athletic activity the following information;  a summary of department rules and regulations relative to safety regulations for student participation in extracurricular athletic activities;  including protocol for post concussion participation or participation in an extracurricular athletic activity after becoming unconscious; and written information related to the recognition of symptoms of head injuries, information regarding the biology and short-term and long-term consequences of concussions.

The department shall develop forms to provide coaches with up-to-date information of their athletes head injury history to enable them to identify those students who are at greater risk for repeated head injuries.  These forms would require students to provide information each season relative to their sports head injury history prior to receiving clearance to participate in an extracurricular athletic activity.  These forms would require the signature of both the student and their parent or legal guardian.  

A coach, trainer or volunteer for an extracurricular athletic activity shall not encourage or permit a student participating in the activity to engage in any unreasonably dangerous athletic technique that unnecessarily endangers the health of a student, including using a helmet or any other sports equipment as a weapon.

If a student participating in an extracurricular athletic activity becomes unconscious during a practice or competition the student may not return to the practice or competition during which the student became unconscious; or participate in any extracurricular athletic activity until the student receives written authorization for such participation from a physician.

If a student, suffers a concussion as diagnosed by a medical professional, while participating in an extracurricular athletic activity the student may not participate in any extracurricular athletic activity until the student receives written authorization for such participation from a physician.

The superintendent of the school district or the director of a school shall maintain complete and accurate records of the district’s or school’s compliance with the requirements of this section.  A school that is determined by the school’s superintendent or director to be out of compliance with this section shall be subject to penalties as determined by the department.

This section does not waive any liability or immunity of a school district or its officers or employees. This section does not create any liability for a course of legal action against a school district, or its officers or employees.

A person who volunteers to assist with an extracurricular athletic activity is not liable for civil damages arising out of an act or omission relating to the requirements of this section, unless the act or omission is willfully or wanton negligent.

The departments shall promulgate rules and regulations to carry out the provisions of section 223 of chapter 111 of the General Laws within 90 days of the effective date of this act; provided that these regulations shall become effective for the fiscal year following final approval of said regulations; provided, however, that not less than 12 months shall have elapsed between final approval of the regulations and the date of implementation in order to provide sufficient time to implement the regulations.