Interestingly, this week I attended a sport and concussion lecture where both the doctor who was giving the lecture and one of the attendees both had daughters who were soccer goalies. Both had had problems with repeat concussions, from getting kicked in the head.
Not attending such lecture, but perhaps noticing all the press about concussions and the NFL, is the captain of the U.S. Women’s national soccer team, who announced today that she is taking an indefinite leave of absence and won’t play in an upcoming tournament in Portugal. http://www.usatoday.com/sports/soccer/2010-02-11-800829453_x.htm
Lori Chalupny, a 26-year-old St. Louis native, said she is taking a respite to deal with concerns regarding concussions, so she won’t be at the Feb. 24 Algarve Cup. http://www.globe-democrat.com/news/2010/feb/12/lori-chalupny-will-not-play-us-algarve-cup-matches/
“I am taking some time off so I can get some additional testing done for these concussion-related issues,” Chalupny said in a statement released Thursday by the St. Louis Athletica of Women’s Professional Soccer, the team she plays for.
“I need to go through this now to ensure my health for the future. I certainly don’t like the idea of missing a tournament like the Algarve Cup, or missing any time with Athletica,” Chalupny said. “I just need to get some rest and take care of issues.”
http://www.stltoday.com/stltoday/sports/stories.nsf/soccer/story/E62EAB88FC10F3CF862576C8000B8FFA?OpenDocument
The Athletica’s training camp starts March 1.
Chalupny took a time out for four months in 2006 after sustaining a concussion while playing in a tournament in China. She was accidentally kicked in the head by a player in a game against France at the Four Nations tournament in China.
During the U.S. soccer team’s opening match against Norway in the 2008 Beijing Olympic Games, Chalupny was accidentally punched in the jaw. She was benched the rest of that game, but played in subsequent Olympic games. The U.S. team won a gold medal.
Chalupny was also a member of the 2007 U.S. Women’s World Cup team.
Rest and no return to play are always the safest course with sport concussion. How long and how many concussions begin to leave cumulative disability, is still unknown. That is why we strongly believe in continuous testing until complete resolution of symptoms before returning an athlete to play. The harder challenge is how to make these determinations with accidental concussion, where there is less risk of a repeat blow to the head, but perhaps a greater risk of long term consequences.
Olympic Sports Like Snowboarding and Skiing Rival Football In Terms of Injuries
A year ago, Natasha Richardson reminded all of us that sport concussions happen in sports other than football and that average people can suffer, not just famous athletes. With the Winter Games approaching it will be world class athletes who may stir up the conversation again, but in a newer sport, one without a tradition of safety: snowboarding.
There are already worries that snowboarders in Vancouver will be cracking their heads as they compete in the counterculture sport, as The San Francisco Chronicle called it, which was admitted to the Olympics in 1998.
The Chronicle noted that “maneuvers in the halfpipe have grown from exhilarating to terrifying in the four years since Shaun White won the gold in Turin, and the champ’s face smacked against the lip of the pipe at the Winter X Games last weekend, sending his helmet flying.” http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/02/07/SP921BR2N0.DTL
The International Olympics Committee is criticized for not setting safety standards for snowboarding, and letting the International Skiing Federation govern it.
The Miami Herald also weighed in on the issues, in a story headlined “Winter Olympics Flirting With Danger.” http://www.miamiherald.com/sports/olympics/story/1467130.html
The article cites snowboarder Kevin Pearce, who hit his forehead on the wall of a half-pipe and sustained traumatic brain injury. He is now at a long-term rehabilitation facility.
“Combine snow, ice, expressway speeds, six-story heights,” The Herald writes. “Think NASCAR on a slippery track or gymnastics with a helmet but without a mat. Imagine plunging down a slope as hard as concrete in a skinsuit or sliding down a roller coaster on a steel cookie sheet or flying through the air without a parachute.”
Not only snowboarders but skiers face serious injury, prompting some to call for safety reforms.
Will snowboarding reform? Will the thrill of the daredevil be replaced by some common sense about permanent damage to the minds of these young people?
We have been discussing the different trends of two of America’s most popular sports with respect to head injury risk in recent weeks. Today, at http://subtlebraininjury.com.blog we talk about the NFL’s growing commitment to player brain safety. Last week we talked about NASCAR’s preference for ratings rather than safety. The NFL seems to have learned that protecting its assets (the players) is more important than making the sport more sensational. NASCAR has clearly not.
We can only hope that the leaders of this Olympic sport show plan ahead rather than react to some tragedy.
There are already worries that snowboarders in Vancouver will be cracking their heads as they compete in the counterculture sport, as The San Francisco Chronicle called it, which was admitted to the Olympics in 1998.
The Chronicle noted that “maneuvers in the halfpipe have grown from exhilarating to terrifying in the four years since Shaun White won the gold in Turin, and the champ’s face smacked against the lip of the pipe at the Winter X Games last weekend, sending his helmet flying.” http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/02/07/SP921BR2N0.DTL
The International Olympics Committee is criticized for not setting safety standards for snowboarding, and letting the International Skiing Federation govern it.
The Miami Herald also weighed in on the issues, in a story headlined “Winter Olympics Flirting With Danger.” http://www.miamiherald.com/sports/olympics/story/1467130.html
The article cites snowboarder Kevin Pearce, who hit his forehead on the wall of a half-pipe and sustained traumatic brain injury. He is now at a long-term rehabilitation facility.
“Combine snow, ice, expressway speeds, six-story heights,” The Herald writes. “Think NASCAR on a slippery track or gymnastics with a helmet but without a mat. Imagine plunging down a slope as hard as concrete in a skinsuit or sliding down a roller coaster on a steel cookie sheet or flying through the air without a parachute.”
Not only snowboarders but skiers face serious injury, prompting some to call for safety reforms.
Will snowboarding reform? Will the thrill of the daredevil be replaced by some common sense about permanent damage to the minds of these young people?
We have been discussing the different trends of two of America’s most popular sports with respect to head injury risk in recent weeks. Today, at http://subtlebraininjury.com.blog we talk about the NFL’s growing commitment to player brain safety. Last week we talked about NASCAR’s preference for ratings rather than safety. The NFL seems to have learned that protecting its assets (the players) is more important than making the sport more sensational. NASCAR has clearly not.
We can only hope that the leaders of this Olympic sport show plan ahead rather than react to some tragedy.
Helmets Protect Skiiers, Snowboarders From Head Injuries
It is nothing new but a recent journal article argues that skiing and snowboarding enthusiasts should be wearing a helmet along with the rest of their gear, according to the Canadian Medical Association Journal.
The study found that helmets decrease the risk of head injury for skiers and snowboarders by 35 percent. http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=23501
Traumatic brain injury is the No. 1 cause of death for skiers and snowboarders, the Canadian Medical Association says. Head injuries make up as much as 19 percent of injuries in ski and snowboard accidents, while neck injuries are up to 4 percent.
According to an analysis of 12 studies done in North America, Europe and Asia, it is beneficial to wear helmets during recreational activities, other some argue that helmets can lead to neck injuries.
Remember Natasha Richardson? A Canadian death from skiing. There is never a guarantee that a helmet will eliminate brain injury, as the forces which can injure a brain include many that a helmet will not eliminate. But the helmet should eliminate almost all skull fractures and if designed properly, reduce some of the impact forces on the brain when the head hits something while skiing. The problem with skiing helmets, like all helmets, is making them energy absorbing without making them stick to the surface in falls. When a helmet sticks to a surface in a high speed fall, the neck can be broken.
The study found that helmets decrease the risk of head injury for skiers and snowboarders by 35 percent. http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=23501
Traumatic brain injury is the No. 1 cause of death for skiers and snowboarders, the Canadian Medical Association says. Head injuries make up as much as 19 percent of injuries in ski and snowboard accidents, while neck injuries are up to 4 percent.
According to an analysis of 12 studies done in North America, Europe and Asia, it is beneficial to wear helmets during recreational activities, other some argue that helmets can lead to neck injuries.
Remember Natasha Richardson? A Canadian death from skiing. There is never a guarantee that a helmet will eliminate brain injury, as the forces which can injure a brain include many that a helmet will not eliminate. But the helmet should eliminate almost all skull fractures and if designed properly, reduce some of the impact forces on the brain when the head hits something while skiing. The problem with skiing helmets, like all helmets, is making them energy absorbing without making them stick to the surface in falls. When a helmet sticks to a surface in a high speed fall, the neck can be broken.
Congressman Skewers College Football Conferences For Their Lenient Concussion Guidelines
A member of the House Judiciary Committee Monday blasted the Southeastern Conference and the Big 12 over their policies regarding student athletes and concussions, according to the Associated Press.
http://www.nytimes.com/2010/02/02/sports/football/02concussions.html
Rep. Steve Cohen, D-Tenn., levied the criticism during a hearing in Houston on head injuries and college football. Specifically, Cohen questioned why major college football conferences had not adopted rules on dealing with concussions that went beyond what the National Collegiate Athletic Association requires, according to AP.
During the hearing, Cohen raised the question during his discussion with Ron Courson, who is director of sports medicine at the University of Georgia and part of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports.
Cohen “seemed incensed,” according to AP, when Courson said that none of the conferences had tougher regulations regarding concussions than the minimums mandated by the NCAA.
Cohen accused the college athletic programs of caring about “money, money, money,” AP reported.
On Monday there was also testimony by Texans guard Chester Pitts, who told the committee that he hopes his 3-year-old son Chester III never plays pro football, The Houston Chronicle reported in a very comprehensive story.
http://www.chron.com/disp/story.mpl/sports/fb/texansfront/6846505.html
Pitts said that NFL football was “too rough a game,” according to the Chronicle. He played 112 NFL games without missing a start.
Pitts testified that he sustained his worst head injury while playing for San Diego State, and that the team hid his helmet to stop him from returning to the game, the Chronicle reported.
And former Rice University running back Trevor Cobb testified Monday that he had at least six concussions when he was playing football in high school, Rice and the NFL.
Monday’s hearing, held at the Prairie View A&M; College of Nursing, was the third one held by the House committee on brain injury and sports. It dealt with high school and college athletes. The first two hearings dealt with the NFL and its policies regarding concussions and players.
Neuropathologist Dr. Bennett Omalu, co-founder and director of the Brian Injury Research Instistute of West Virginia University, also testified in Houston Monday. He is a pioneer in linking concussions from football to permanent brain damage in players.
Omalu recommended that youths under 18, whose brains are still developing, should not be allowed to play until at least three months after concussion, so they won’t sustain permanent brain damage from additional hits on the field, the Houston Chronicle reported.
http://www.nytimes.com/2010/02/02/sports/football/02concussions.html
Rep. Steve Cohen, D-Tenn., levied the criticism during a hearing in Houston on head injuries and college football. Specifically, Cohen questioned why major college football conferences had not adopted rules on dealing with concussions that went beyond what the National Collegiate Athletic Association requires, according to AP.
During the hearing, Cohen raised the question during his discussion with Ron Courson, who is director of sports medicine at the University of Georgia and part of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports.
Cohen “seemed incensed,” according to AP, when Courson said that none of the conferences had tougher regulations regarding concussions than the minimums mandated by the NCAA.
Cohen accused the college athletic programs of caring about “money, money, money,” AP reported.
On Monday there was also testimony by Texans guard Chester Pitts, who told the committee that he hopes his 3-year-old son Chester III never plays pro football, The Houston Chronicle reported in a very comprehensive story.
http://www.chron.com/disp/story.mpl/sports/fb/texansfront/6846505.html
Pitts said that NFL football was “too rough a game,” according to the Chronicle. He played 112 NFL games without missing a start.
Pitts testified that he sustained his worst head injury while playing for San Diego State, and that the team hid his helmet to stop him from returning to the game, the Chronicle reported.
And former Rice University running back Trevor Cobb testified Monday that he had at least six concussions when he was playing football in high school, Rice and the NFL.
Monday’s hearing, held at the Prairie View A&M; College of Nursing, was the third one held by the House committee on brain injury and sports. It dealt with high school and college athletes. The first two hearings dealt with the NFL and its policies regarding concussions and players.
Neuropathologist Dr. Bennett Omalu, co-founder and director of the Brian Injury Research Instistute of West Virginia University, also testified in Houston Monday. He is a pioneer in linking concussions from football to permanent brain damage in players.
Omalu recommended that youths under 18, whose brains are still developing, should not be allowed to play until at least three months after concussion, so they won’t sustain permanent brain damage from additional hits on the field, the Houston Chronicle reported.
A Dozen NFL Players Agree To Donate Their Brains For Concussion Research
More than a dozen present and former NFL players have pledged to donate their brains for research on concussion, the Associated Press reported Monday. http://www.latimes.com/sports/football/nfl/wire/sns-ap-fbn-nfl-concussions-players-brains,0,1348935.story
The players, who include Hall of Fame member Mike Haynes and Chicago linebacker Hunter Hillenmeyer, will donate their brains and spinal cord tissue after their deaths to the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine.
Boston University researchers claim they have found ties between repeated head trauma and brain damage among football players, a former NHL player and boxers, according to AP. The researchers have criticized the NFL about its allegedly lenient approach to concussions.
Among those who have committed to donate their brains to the research project are: Sean Morey of the Arizona Cardinals; Matt Birk of the Baltimore Ravens; and Lofa Tatupa of the Seattle Seahawks. In addition, the wife of Hall of Fame member John Mackey, who has dementia, has agreed to donate his brain to the research project, AP reported.
In response to the issues raised by the Boston University researchers, and following a congressional hearing on pro football and concussions, the NFL has instituted tougher rules in terms of letting players take the field after getting hit in the head.
This is such an important thing, even though it will take generations to make an impact. The only real way to determine the full extent of brain damage is through autopsy, because the neurons and other brain cells which get damaged, are too small to see except under a microscope.
The players, who include Hall of Fame member Mike Haynes and Chicago linebacker Hunter Hillenmeyer, will donate their brains and spinal cord tissue after their deaths to the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine.
Boston University researchers claim they have found ties between repeated head trauma and brain damage among football players, a former NHL player and boxers, according to AP. The researchers have criticized the NFL about its allegedly lenient approach to concussions.
Among those who have committed to donate their brains to the research project are: Sean Morey of the Arizona Cardinals; Matt Birk of the Baltimore Ravens; and Lofa Tatupa of the Seattle Seahawks. In addition, the wife of Hall of Fame member John Mackey, who has dementia, has agreed to donate his brain to the research project, AP reported.
In response to the issues raised by the Boston University researchers, and following a congressional hearing on pro football and concussions, the NFL has instituted tougher rules in terms of letting players take the field after getting hit in the head.
This is such an important thing, even though it will take generations to make an impact. The only real way to determine the full extent of brain damage is through autopsy, because the neurons and other brain cells which get damaged, are too small to see except under a microscope.
NASCAR Vows To Return To Roots As a ‘Contact Sport’
Some people, including officials for the sport, think that NASCAR needs energizing. That’s why the organization plans to loosen up some of its rules so that the races become more of “a contact sport” (we guess like football) this year, NASCAR chairman Brian France said recently.
“We’re going to open it up, because we want to see what you want to see,” France said during a Jan. 21 http://espn.go.com/espn/page2/index?id=4851656
press conference. “More contact. This is a contact sport. We want to see drivers mixing it up. We want to see the emotion of the world’s best drivers just as much as everybody else does. And that’s the goal in 2010 and beyond.”
Here is a YouTube video of France making the remarks: http://www.youtube.com/watch?v=J7dWRhRnj58
You don’t have to be a genius to figure out that these rule changes, meant to increase “contact,” will likely lead to more accidents and injuries, possibly brain trauma.
NASCAR fans and drivers alike have been griping that the sport has become too namby-pamby and watered down, losing much of its excitement, because of restrictive rules on practices such as “bump-drafting.”
Bump-drafting is a controversial practice that some NASCAR veterans have labeled “idotic.” http://auto.howstuffworks.com/auto-racing/nascar/nascar-basics/stock-car-racing-techniques4.htm
It’s fancy tailgating, where NASCAR drivers nudge the car ahead of them, moving it forward, and their forward along with it. The front car slows down, and that gives the car behind a chance to pass and move ahead, creating some excitement.
But bump-drafting can turn dangerous, because the front driver’s wheels can lose traction and the car can go into a spin. So the practice has led to fatal NASCAR accidents.
NASCAR banned bumping at the Talladega race in November, and drew the ire of diehard race fans.
Despite the past fatalities and accidents, the bump-drafting ban didn’t sit well with fans or some drivers. “There’s an age-old saying that NASCAR, “If you ain’t rubbing, you ain’t racing,” NASCARr president told the Associated Press. http://sports.espn.go.com/rpm/nascar/cup/news/story?id=4845878
At the January press conference, France basically said NASCAR was lifting its old restrictions and putting racing back in the drivers’ hands. The ban on bumping is being scrapped, in time for the NASCAR season opener, the Daytona 500, which is a restrictor-plate race. Those plates give a racecar more power and speed.
NASCAR officials are hoping the changes will bring back the excitement to racing, while seemingly not being too concerned about the increased chance of injuries of this new “contact sport.”
In his AP interview, Helton maintained that the sport is much safer than it was five or six years ago, with the improvements on the cars and tracks. It remains to be seen this year.
Is it energizing the sport needs, or greater ratings? One of our favorite sports, boxing, it is the goal to cause a concussion/brain damage to your opponent. In football, it is at least a by-product of the best plays. Now we have perhaps our most dangerous sport, car racing, wanting to increase its ratings by making it a contact sport. It may not be the goal to kill the opponent, but it certainly is a foreseeable outcome.
“We’re going to open it up, because we want to see what you want to see,” France said during a Jan. 21 http://espn.go.com/espn/page2/index?id=4851656
press conference. “More contact. This is a contact sport. We want to see drivers mixing it up. We want to see the emotion of the world’s best drivers just as much as everybody else does. And that’s the goal in 2010 and beyond.”
Here is a YouTube video of France making the remarks: http://www.youtube.com/watch?v=J7dWRhRnj58
You don’t have to be a genius to figure out that these rule changes, meant to increase “contact,” will likely lead to more accidents and injuries, possibly brain trauma.
NASCAR fans and drivers alike have been griping that the sport has become too namby-pamby and watered down, losing much of its excitement, because of restrictive rules on practices such as “bump-drafting.”
Bump-drafting is a controversial practice that some NASCAR veterans have labeled “idotic.” http://auto.howstuffworks.com/auto-racing/nascar/nascar-basics/stock-car-racing-techniques4.htm
It’s fancy tailgating, where NASCAR drivers nudge the car ahead of them, moving it forward, and their forward along with it. The front car slows down, and that gives the car behind a chance to pass and move ahead, creating some excitement.
But bump-drafting can turn dangerous, because the front driver’s wheels can lose traction and the car can go into a spin. So the practice has led to fatal NASCAR accidents.
NASCAR banned bumping at the Talladega race in November, and drew the ire of diehard race fans.
Despite the past fatalities and accidents, the bump-drafting ban didn’t sit well with fans or some drivers. “There’s an age-old saying that NASCAR, “If you ain’t rubbing, you ain’t racing,” NASCARr president told the Associated Press. http://sports.espn.go.com/rpm/nascar/cup/news/story?id=4845878
At the January press conference, France basically said NASCAR was lifting its old restrictions and putting racing back in the drivers’ hands. The ban on bumping is being scrapped, in time for the NASCAR season opener, the Daytona 500, which is a restrictor-plate race. Those plates give a racecar more power and speed.
NASCAR officials are hoping the changes will bring back the excitement to racing, while seemingly not being too concerned about the increased chance of injuries of this new “contact sport.”
In his AP interview, Helton maintained that the sport is much safer than it was five or six years ago, with the improvements on the cars and tracks. It remains to be seen this year.
Is it energizing the sport needs, or greater ratings? One of our favorite sports, boxing, it is the goal to cause a concussion/brain damage to your opponent. In football, it is at least a by-product of the best plays. Now we have perhaps our most dangerous sport, car racing, wanting to increase its ratings by making it a contact sport. It may not be the goal to kill the opponent, but it certainly is a foreseeable outcome.
NFL Players Brain Injury Committee Holds First Meeting
The committee formed by the NFL Player’s Association to tackle, so to speak, the issue of brain injuries and professional football has its first meeting this week in Palm Beach, Fla. http://www.google.com/hostednews/canadianpress/article/ALeqM5hN5mqFoFXXSvkaDO9Nec2JaZ1GKQ
The Mackey-White Traumatic Brain Injury Committee was named after two Hall of Fame players: John Mackey, who has Alzheimer’s disease, and Reggie White, who passed away at the young age of 43 after retiring from the NFL. See http://news.bostonherald.com/sports/football/other_nfl/view/20100127nfl_establishes_brain_trust/srvc=home&position;=recent
The special committee is made up of past and current NFL players, researchers and physicians. They want to start a discussion on brain trauma and professional football, evaluate the latest research and begin work on recommendations for player safety.
The issue of the dangers of players, NFL and high school, going back on the field after sustaining concussions a hot topic in the past few months, receiving a lot of press. Congress recently conducted hearings on head injuries, taking testimony from players, doctors and NFL commissioner Roger Goodell.
The Mackey-White committee is being chaired by Arizona Cardinals wide receiver Sean Morey and Dr. Thom Mayer, medical director for the NFL union.
Chris Nowinski, an ex-college football player and pro wrestler, is a member of the committee. Nowinski, who has had at least a half dozen concussions, has taken on less dangerous work now. He is president of the Sports Legacy Institute and co-director of the Center for the Study of Traumatic Encephalopathy at Boston University.
The Mackey-White Traumatic Brain Injury Committee was named after two Hall of Fame players: John Mackey, who has Alzheimer’s disease, and Reggie White, who passed away at the young age of 43 after retiring from the NFL. See http://news.bostonherald.com/sports/football/other_nfl/view/20100127nfl_establishes_brain_trust/srvc=home&position;=recent
The special committee is made up of past and current NFL players, researchers and physicians. They want to start a discussion on brain trauma and professional football, evaluate the latest research and begin work on recommendations for player safety.
The issue of the dangers of players, NFL and high school, going back on the field after sustaining concussions a hot topic in the past few months, receiving a lot of press. Congress recently conducted hearings on head injuries, taking testimony from players, doctors and NFL commissioner Roger Goodell.
The Mackey-White committee is being chaired by Arizona Cardinals wide receiver Sean Morey and Dr. Thom Mayer, medical director for the NFL union.
Chris Nowinski, an ex-college football player and pro wrestler, is a member of the committee. Nowinski, who has had at least a half dozen concussions, has taken on less dangerous work now. He is president of the Sports Legacy Institute and co-director of the Center for the Study of Traumatic Encephalopathy at Boston University.
Congressional NFL Hearings – Dr. Ronald Benson Testifies about Neuroimaging Advances
I began my treatment of the Congressional hearings on the long term brain damage of concussion in the NFL yesterday at my Brain Injury Lawyer Blog – http://www.waiting.com/blog/2010/01/nfl-concussion-hearings-in-congress.html I will continue that discussion on this blog for the next several blogs, as I tackled an even more important topic at http://waiting.com/blog that of why an experienced brain injury attorney is even more important in a severe brain injury case than it is in a non-coma brain injury case.
Much of the controversy at the hearings was over the statements of Ira. R. Casson, M.D., formerly co-chair of the NFL concussion committee, that there was insufficient scientific evidence to prove this narrow question: Whether playing NFL football causes permanent brain damage. Fortunately, Dr. Casson’s academic skepticism was not the sole testimony heard by the committee. The committee also heard about evolving neuro-imaging techniques in the diagnosis of concussion, principally from Ronald Benson, M.D. of Department of Neurology, Wayne State University Medical School. Dr. Benson’s prepared remarks begin much differently than Casson’s:
1. Misdiagnosis. Frankly all six points could all be summarized with the statement that because the diagnosis of TBI is subjective, that misdiagnosis of the existence and severity of brain injury is the norm.
2. TBI is Often Labeled Psychiatric. I have said this before and will say it again: The challenge in diagnosing and treating brain injury is not in afixing a label of organic or psychiatric on the symptoms, but on treating the entire spectrum of brain related disability. Any TBI diagnostician who labels an emotional symptom after concussion as psychiatric or pre-existing, is missing the point. Brain injury impacts the emotions and those with pre-existing emotional problems are those most likely to be impacted.
3. Neuropsychologists Disagree. As is now common knowledge within the field of brain injury, neuropsychology is as polarized as our politics and almost on party lines. Neuropsychology is made up believers and non-believers that concussion can cause permanent brain damage. There is a lot of objective and subjective evidence for the believers to rely on. There is the academic skepticism of (similar to what Dr. Casson testified to) for the non-believers to rely on. There is no middle ground. For that reason, virtually every forensic case has two neuropsychologists who radically disagree.
4. TBI Symptoms Overlap. The neurons and the emotions are both in the brain. It is fundamental that one cannot injure neurons without effecting emotions. It is less evident but as true that one cannot impact emotions without changing neurons. Our brain’s hard wiring is the synergistic total of our genetic organic network and the sum of the changes to that network as a result of our experiences and pathologies that occur whether by disease, by trauma or via living.
5. Without Seeing the Pathology, No Objective Way to Prove TBI. I disagree with Dr. Benson to some degree on this issue. Differential diagnosis is not about looking at the results of some test, in any field of medical science. It is about a learned professional looking at the clinical history, listening to the patient’s story and reviewing more objective tests. Without the subjective application of an experienced mind to the entire spectrum of the problem, no diagnosis can be made, certainly not in a field as complex and subjective as brain injury. Neuroimaging may improve the accuracy of such diagnosis in the future but the goal is not to find an objective test we can rely on but to have better and less biased professionals engage in more thorough differential diagnosis. There is no 15 minute diagnosis of brain injury and no 15 minute solution.
6. Outcome unpredictable. Something I wrote over a decade ago was an essay entitled “Miracles and Tragedies.” http://tbilaw.com/essays.mildsevere.php I wrote that essay as I contemplated the “miracles in severe cases”and the “tragedies in so-called mild cases.” Such ironic criss-crossing of outcomes has been a universal theme of my career. I am continually amazed at how much better catastrophically brain injured survivors can get while aghast at how many mild brain injury survivors get worse and worse. I have gained greater insight into the problem since I wrote that essay but only because of the frequency that the criss-crossing of outcomes occurs. It is heartening to see a nationally recognized doctor educating Congress about that irony.
In our next blog more about advances in MRI and neuroimaging.
Much of the controversy at the hearings was over the statements of Ira. R. Casson, M.D., formerly co-chair of the NFL concussion committee, that there was insufficient scientific evidence to prove this narrow question: Whether playing NFL football causes permanent brain damage. Fortunately, Dr. Casson’s academic skepticism was not the sole testimony heard by the committee. The committee also heard about evolving neuro-imaging techniques in the diagnosis of concussion, principally from Ronald Benson, M.D. of Department of Neurology, Wayne State University Medical School. Dr. Benson’s prepared remarks begin much differently than Casson’s:
I would like to share with you some observations from eight years of evaluating traumatic brain injury cases, the vast majority of which I obtain neuropsychological testing and advanced MRimaging:That was a hell of an introductory statement from Dr. Benson. He seemed to capture the challenge in representing the survivors of brain injury in those seven bullet points. He goes on to detail the excitement of using state of the art MRI techniques to diagnosing mild traumatic brain injury, which I will discuss in future blogs. But today, I want to focus on the first six bullet points.
- 1) People with TBI are frequently misdiagnosed, often by multiple physicians;
- 2) The most frequent diagnostic category given is psychiatric—anxiety, depression, conversiondisorder;
- 3) Two neuropsychologists studying the same patient may differ considerably regarding existence of TBI;
- 4) TBI symptoms overlap considerably with those of “primary” psychiatric disorders;
- 5) Without the ability to “see” the brain injury with imaging, there is no completely objective way to determine what is TBI and what is something else, e.g., posttraumatic stress, conversion, malingering;
- 6) People with brain injury seem to vary considerably in severity of symptoms and recovery in the face of similar falls, crashes, etc. This may speak to population differences in resistance to injury or effectiveness of neural recovery mechanisms and is in agreement with Collins, et al. who found large differences in recovery from single concussion (North American Brain Injury Society Annual Meeting, 2009);
- 7) Advanced MR imaging techniques, including susceptibility-weighted (SWI), diffusion tensor (DTI) and MR spectroscopy (MRSI) are able to reveal brain injuries where CT scans and conventional MRI appear normal.
1. Misdiagnosis. Frankly all six points could all be summarized with the statement that because the diagnosis of TBI is subjective, that misdiagnosis of the existence and severity of brain injury is the norm.
2. TBI is Often Labeled Psychiatric. I have said this before and will say it again: The challenge in diagnosing and treating brain injury is not in afixing a label of organic or psychiatric on the symptoms, but on treating the entire spectrum of brain related disability. Any TBI diagnostician who labels an emotional symptom after concussion as psychiatric or pre-existing, is missing the point. Brain injury impacts the emotions and those with pre-existing emotional problems are those most likely to be impacted.
3. Neuropsychologists Disagree. As is now common knowledge within the field of brain injury, neuropsychology is as polarized as our politics and almost on party lines. Neuropsychology is made up believers and non-believers that concussion can cause permanent brain damage. There is a lot of objective and subjective evidence for the believers to rely on. There is the academic skepticism of (similar to what Dr. Casson testified to) for the non-believers to rely on. There is no middle ground. For that reason, virtually every forensic case has two neuropsychologists who radically disagree.
4. TBI Symptoms Overlap. The neurons and the emotions are both in the brain. It is fundamental that one cannot injure neurons without effecting emotions. It is less evident but as true that one cannot impact emotions without changing neurons. Our brain’s hard wiring is the synergistic total of our genetic organic network and the sum of the changes to that network as a result of our experiences and pathologies that occur whether by disease, by trauma or via living.
5. Without Seeing the Pathology, No Objective Way to Prove TBI. I disagree with Dr. Benson to some degree on this issue. Differential diagnosis is not about looking at the results of some test, in any field of medical science. It is about a learned professional looking at the clinical history, listening to the patient’s story and reviewing more objective tests. Without the subjective application of an experienced mind to the entire spectrum of the problem, no diagnosis can be made, certainly not in a field as complex and subjective as brain injury. Neuroimaging may improve the accuracy of such diagnosis in the future but the goal is not to find an objective test we can rely on but to have better and less biased professionals engage in more thorough differential diagnosis. There is no 15 minute diagnosis of brain injury and no 15 minute solution.
6. Outcome unpredictable. Something I wrote over a decade ago was an essay entitled “Miracles and Tragedies.” http://tbilaw.com/essays.mildsevere.php I wrote that essay as I contemplated the “miracles in severe cases”and the “tragedies in so-called mild cases.” Such ironic criss-crossing of outcomes has been a universal theme of my career. I am continually amazed at how much better catastrophically brain injured survivors can get while aghast at how many mild brain injury survivors get worse and worse. I have gained greater insight into the problem since I wrote that essay but only because of the frequency that the criss-crossing of outcomes occurs. It is heartening to see a nationally recognized doctor educating Congress about that irony.
In our next blog more about advances in MRI and neuroimaging.
American Airlines Flight 311 – Understanding the Vulnerability of the Brain in an Air Crash
On previous blogs, I have talked about how the survivor of an on the ground air crash is exposed to significant concussional forces. The reason is that the extreme speed of a jet as it lands can create siginificant acceleration/deceleration forces. Unlike a modern car, it does not have a shoulder harness/airbag combination to protect the brain from those forces. The below video shows how severe those forces can be on the head, neck and back.
http://www.blogger.com/img/videoplayer.swf?videoUrl=http%3A%2F%2Fv23.nonxt7.googlevideo.com%2Fvideoplayback%3Fid%3D738fa4231a89e5ca%26itag%3D5%26begin%3D0%26len%3D86400000%26app%3Dblogger%26et%3Dplay%26el%3DEMBEDDED%26ip%3D0.0.0.0%26ipbits%3D0%26expire%3D1269891760%26sparams%3Did%252Citag%252Cip%252Cipbits%252Cexpire%26signature%3D47F16D3AFC9A2EE22915B712CF38978D5237DF30.6BC93A452E002757F15D7C12B8BBEBB5E220CC42%26key%3Dck1&nogvlm=1&thumbnailUrl=http%3A%2F%2Fvideo.google.com%2FThumbnailServer2%3Fapp%3Dblogger%26contentid%3D738fa4231a89e5ca%26offsetms%3D5000%26itag%3Dw320%26sigh%3DNyTlnWDi5ZGKEC6gqh-h2AFIja0&messagesUrl=video.google.com%2FFlashUiStrings.xlb%3Fframe%3Dflashstrings%26hl%3Den
For more on how vulnerable a brain is to such forces, go to http://subtlebraininjury.com/biomechanics1.html
It has been more than a week now since this crash. If anyone on board is still confused, has headaches or dizziness, it is time they got some expert help. For dizziness or vertigo, it is essential that they see a neurootologist, a doctor who specializes in balance disorders. See http://vestibulardisorder.com For other post concussion symptoms, they must see someone who will take the head injury seriously.
http://www.blogger.com/img/videoplayer.swf?videoUrl=http%3A%2F%2Fv23.nonxt7.googlevideo.com%2Fvideoplayback%3Fid%3D738fa4231a89e5ca%26itag%3D5%26begin%3D0%26len%3D86400000%26app%3Dblogger%26et%3Dplay%26el%3DEMBEDDED%26ip%3D0.0.0.0%26ipbits%3D0%26expire%3D1269891760%26sparams%3Did%252Citag%252Cip%252Cipbits%252Cexpire%26signature%3D47F16D3AFC9A2EE22915B712CF38978D5237DF30.6BC93A452E002757F15D7C12B8BBEBB5E220CC42%26key%3Dck1&nogvlm=1&thumbnailUrl=http%3A%2F%2Fvideo.google.com%2FThumbnailServer2%3Fapp%3Dblogger%26contentid%3D738fa4231a89e5ca%26offsetms%3D5000%26itag%3Dw320%26sigh%3DNyTlnWDi5ZGKEC6gqh-h2AFIja0&messagesUrl=video.google.com%2FFlashUiStrings.xlb%3Fframe%3Dflashstrings%26hl%3Den
For more on how vulnerable a brain is to such forces, go to http://subtlebraininjury.com/biomechanics1.html
It has been more than a week now since this crash. If anyone on board is still confused, has headaches or dizziness, it is time they got some expert help. For dizziness or vertigo, it is essential that they see a neurootologist, a doctor who specializes in balance disorders. See http://vestibulardisorder.com For other post concussion symptoms, they must see someone who will take the head injury seriously.
Conan O’Brien Concussion – Amnesia without Confusion
As I have been discussing for much of the last month on this blog, amnesia and confusion are not the same thing. An example more vivid than even a football quarterback was the concussion Conan O’Brien suffered on camera on his show last week. See for one of the multitude of stories on it at the Huffington Post: http://www.huffingtonpost.com/2009/09/29/conan-obrien-falls-hits-h_n_302471.html To really understand the lesson we can learn from this concussion, one must listen to the contrast between what Conan did shortly after his brain injury and what he remembers about it.
He clearly was dazed for a few seconds, but within 10-15 seconds he was on character, making a joke, running the show, directing his people what to do. As I watched, I clearly thought of the concussed quarterback, calling the plays, directing his teammates, avoiding rushing linemen and completing a pass. Yet despite all that activity, he remembers nothing of what he did after the event, nor even the moments leading up to the concussion.
Can anyone now doubt that you don’t have to lose consciousness to suffer a concussion?
He clearly was dazed for a few seconds, but within 10-15 seconds he was on character, making a joke, running the show, directing his people what to do. As I watched, I clearly thought of the concussed quarterback, calling the plays, directing his teammates, avoiding rushing linemen and completing a pass. Yet despite all that activity, he remembers nothing of what he did after the event, nor even the moments leading up to the concussion.
Can anyone now doubt that you don’t have to lose consciousness to suffer a concussion?