There have been many articles written about the suits that recently have been filed against the NFL, suits that charge that the league either knew about, hid, or ignored evidence that repeated concussions can cause long-term brain damage in players.

But AP went quite a few steps beyond that, spending the last two months interviewing about a dozen of the more than 300 former players who are plaintiffs in the various suits.    

http://www.cbssports.com/nfl/story/17085305/battling-with-memory-loss-dorsett-joins-concussion-lawsuit-against-nfl

AP’s conclusion won’t leave NFL officials with a warm and fuzzy feeling: “What emerged was, at best, a depiction of a culture of  indifference on the part of the league and its teams towards concussions and other injuries. At worst, there was a strong sense of a willful disregard for players’ well-being.”

Ouch. That may make the wings, chips and dip go down a little harder tomorrow if you’re an NFL official.

One of the former players that AP interviewed indepth was Tony Dorsett, who played for Pittsburgh and Dallas. An NFL Hall of Fame member, Dorsett offers up a chilling anecdote, particularly in light of what we know about concussions today.

Dorsett, who is only 57 now, recalled getting the worse hit in the head that he ever had in his career during a 1984 Cowboys-Eagles game. The Cowboys gave Dorsett a very brief exam in a locker room, and then sent him back out to play.  

To do something like that today would, in theory, be unthinkable. Dorsett would have undergone a thorough exam by a doctor, and undoubtedly would have been benched. Dorsett told AP that he was dazed and couldn’t think straight during that 1984 game, and that there were similar incidents were he suffered a concussion and was sent back out on the field.

Those helmet-to-helmet hits have taken their toll. Dorsett showed AP some of his brain scans, which indicate that the left side of his brain, which governs organization and memory, is lacking enough oxygen.

“He already forgets people’s names or why he walked into a room or where he’s heading while driving on a highway, and fears his memory issues are getting worse,” AP reported.

But that’s not the half of it.

“Other players describe an off-camera NFL that is darker than the carefully scripted show presented during  Super Bowl week,” according to AP.

The widespread use of painkillers by players, with the alleged encouragement of the league, and pressure from peers and coaches to play even if you were in incredible pain, are among the issues outlined by AP.

Dorsett isn’t the only ex-player who is bitter about what happened. Another retired player told AP that he expects the NFL to drag out the litigation, in the hope that older players will be dead by the time the whole mess is resolved.

So enjoy that half-time show with Madonna tomorrow, everyone.     

As The New York Times pointed out Thursday, roughly two years ago champion snowboarder Kevin Pearce sustained TBI in an accident in Park City. And on Tuesday, Canadian freestyle skier Sarah Burke fell and hit her head a 22-foot halfpipe in Park City,  the same place where Pearce had his accident, according to The Times.

http://www.nytimes.com/2012/01/12/sports/canadian-freestyle-skier-sarah-burke-sustains-head-injury-in-halfpipe-fall.html?scp=1&sq=sarah%20burke&st=cse

Burke fell during a landing, where she apparently “bounced” from her feet to her head, sustaining serious injuries, according to Reuters.

http://www.nytimes.com/reuters/2012/01/12/sports/sports-us-skier-burke-injury.html?_r=1&ref=sports

After the accident 29-year-old Burke was transported by air ambulance to University of  Utah hospital in Salt Lake City. The skier, considered a shoo-in to win an Olympic Gold medal when the freestyle half-pipe premieres at the 2014 Games, had surgery to “repair a tear in her vertebral artery that resuled in an intracranial hemorrhage,” according to Reuters. She is in critical condition.

The head of neurology at the hospital, Dr. William Couldwell, released a written statement.

“With injuries of this type, we need to observe  the course of her brain function before making any definitive pronouncements about Sarah’s prognosis for recovery,” he said.

Things have not worked out so well for Pearce, according to The Times, since his Dec. 31, 2009 accident. He was in a coma, and then in hospitals for four months. He is still in rehab for his balance and memory.

Last month Pearce returned to his snowboard for a ride, the first time he’s tried that since his accident.

But according to The Times, at the ripe old age of 24 now, Pearce “has no plans to compete again.”    

http://www.nytimes.com/2011/12/30/sports/football/nfl-faces-retired-players-in-a-high-stakes-legal-battle.html?_r=1&scp=1&sq=concussion%20suits&st=cse

The Times put the whole mess in perspective in the story’s headline: “For NFL, Concussion Suits May Be Test For Sport Itself.” 

The litigation represents more than 120 retired players and their spouses. And as The Times frames it, the NFL now faces the prospect of having these players taking the witness stand to tell juries about the league’s past practice regarding head injuries, and to talk about the cognitive issues they are now blaming on their past concussions. 

The lawsuits in many cases charge that the NFL concealed, or ignored, data about the long-term impact of repeated hits to the head.

As reporter Ken Belson wrote, “Taken together, the suits filed in courts across the country amount to a multifront legal challenge to the league and to the game itself.”

As he notes, sympathetic juries, listening to the testimony of retired players such as Jim McMahon and Jamal Lewis, could come in with verdicts awarding millions of dollars to these retired athletes.

As The Times points out, retired gridiron stars who were once in their physical and mental prime, yet are now suffering from early-onset  dementia and brain disease, are bound to illicit feelings from jurors. And we’d guess that the feelings would not be about how great a job the NFL did to protect its gladiators.

Needless to say, such trials would no doubt result in a flood of bad publicity for the NFL, and its years of denial, denial that repeated concussions take a long-term toll on the brain.

But The Times notes that the players may not have a cake walk. One federal judge has already ruled that concussion claims raised by retired players are matters for collective bargaining, not trial. 

The NFL, which of course denies the charges raised in the pending lawsuits, will undoubtedly try to get the litigation dismissed. And even if the cases go to trial, the burden will be on the players to prove that their dementia or memory loss or anger-management issues were the direct result of injuries they sustained during their pro careers.

Those are just some of the legal issues raised in article by The Times. We recommend you read the whole story to find out more about the intricacies of these lawsuits.    

Earlier this month the Associated Press reported that Carpenter, who never sustained any known concussions during his NFL career in the 1950s and 1960s, had an advanced form or chronic traumatic encephelopathy (CTE).  Studies of the brains of other deceased pro athletes, football and hockey players, have found the same disease.

http://www.greenbaypressgazette.com/apps/pbcs.dll/article?AID=2011111208086

Carpenter, who also played for the Detroit Lions and Cleveland Browns, died a year ago at age 78. But his family agreed to donate his brain to science, as part of research into whether athletes are suffering in abnormal numbers from CTE, which doctors have linked to repeated brain trauma.

Carpenter showed many of the symptoms of CTE before he died. He was having memory problems, and could not control his anger, according to AP.  The examination of his brain didn’t show evidence of Alzheimer’s disease, just the CTE, the wire service reported. 

The lesson to be learned from Carpenter’s case is that an athlete doesn’t have to sustain a full-blown concussion, or concussions, in order to develop CTE. The cumulative effect of mini-concussions, so-called subconcussions, can apparently bring on CTE, as well.

“The amount of subconcussive trauma that he had — he probably had between 1,000 and 1,500 subconcussive blows a year, just from practice and play in games,” likely lead to CTE, Dr. Robert Cantu told AP.

Cantu, a researcher at Boston University, is doing work along with the Veterans Administration Center for the Study of Traumaic Encephalopathy, AP reported.

It’s true that Carpenter –  who finished his career with the Packers, winning two NFL championships — was never diagnosed with a concussion. But back in the day, when he was playing, concussions were not the issue they are today. He may have had some that were missed.

If in fact Carpenter never had a full-blown concussion, his case raises a troubling issue.

“Damage may be caused as much or more by the low-level, or subconcussive, blows to the head as by big hits replayed on the highlgiht shows that leave a player wobbly,” AP wrote.  

That was the finding of a study done Dr. Michael Lipton of New York City’s Montefiore Medical Center, a researcher who presented the results of his work to the Radiological Society of North America late last month.

BBC News reported on Lipton’s comments, which included, “Heading a soccer ball is not an impact of magnitude that will lacerate nerve fibers in the brain. But repetitive heading could set off  a cascade of responses that can lead to degeneration of brain cells.”

http://www.bbc.co.uk/news/health-15917035

In his test Lipton did brain scans on 32 amateur soccer players who frequently “headed” the ball. The bottom line was that there was no damage to the brains of players who hit the ball with their heads 1,000 times or less a year. But when there were more head hits than that, Lipton found “patterns of damage similar to that seen in patients with concussions,” BBC News reported.

To non-soccer players, hitting a ball with your head 1,000 times a year may appear to be a big number, but “it amounts to a few times a day for a regular player, say the researchers,” BBC News reported.

Obviously, Lipton’s study didn’t involve a large sample of players, and some are saying that much more research must be done to confirm his findings.

But anecdotally, there is at least one death that’s been blamed on “heading.” British soccer player Jeff Astle died in 2002, at age 59, after having cognitive issues. ”The coroner ruled that his death resulted from a degenerative brain disease caused by heading heavy leather footballs,” BBC News  reported. 

Soccer balls are not as heavy now as they were back in the day when Astle was playing, but they can move at speeds ranging from roughly 30 mph to 60 mph an hour.

In Lipton’s research, he used diffusion tensor imaging, which shows brain tissues and nerves. The test volunteers told researchers how many times they had headed the ball, and those who had done it often showed mild traumatic brain injuries in their scans, according to BBC News.

Lipton’s scans found that several areas of the brain were injured by repeated heading, including the front of the organ and the back of it near the skull. These parts of the mind govern ”attention, memory, executive functioning and higher-order visual functions,” BBC News reported.

The test volunteers who frequently headed the ball also didn’t perform as well on tests that measure verbal memory and reaction times.     

There are skeptics about Lipton’s findings. One claims the soccer players are suffering mild brain injury because they are slamming their heads with other players when they head the ball, not from heading the ball per se.

No matter how you slice it, soccer players are suffering brain injuries, and measures should be taken to protect them.

Sports writer Mike Bires of the Beaver County Times did a nice job of outlining the disturbing way that the Steelers organization is treating Polamalu. 

 http://www.timesonline.com/sports/steelers/bires-polamalu-s-concussions-a-growing-concern/article_6ea8f126-3465-56e4-b880-f43761424e9f.html

Within the past six weeks Polamalu, who has sustained multiple concussions since high school, took blows to the head twice. The Steelers said that Polamalu had been exhibiting ”concussion-like symptoms,” according to Bires.  

But team medical officials and the organization are claiming that Polamalu no longer has those symptoms, and may be ready to take the field again. Bires, and we, are pretty skeptical about that.

If it looks like a snake and moves like a snake, it’s snake. If the symptoms sound like a concussion, two times in a row within six weeks, we’d hazard to guess that it is not just a “coincidence,” which is what someone from the Steelers told a reporter, according to Bires. It sounds like concussions, not coincidence.

On Oct. 16, Polamalu took a bad it to the head and was benched. He called his wife to say he was OK, Bires reported. But just a week later, Polamalu was back playing.

People seem to be taking Polamalu’s future health very lightly. It’s common knowledge that the effect of concussions on the brain is cumulative, and it is damaging. And Polamalu has had a frightening number of concussions, seven, already from high school to present, according to Bires.

And that is not counting the past two hits that sound a lot like concussions to us. Polamalu still has to undergo more concussion tests this week before he is cleared to play, so we’ll see what happens.

Bire’s summed up Polamalu’s situation pretty well in his story, talking about the 30-year-old player’s two toddler sons, his $10.5 million bonus for signing a new deal this fall and his $6.4 million base salary.

“Considering his history with concussions and these two ‘concussion-like’ injuries the past six weeks, you have to wonder if he’ll still be playing in 2014, the last year of his existing contract,” Bires wrote. “Most importantly, Polamalu can only hope that these latest ‘concussion-like’ head blows don’t lead to anything more serious in the future.”

Don’t bet on it.   

When former National Hockey League linesman Pat Dapuzzo wanted Primeau to appear at a charity event, Primeau said he would do it on one condition, according to The New York Times.

http://www.nytimes.com/2011/11/28/sports/hockey/for-ex-nhl-linesman-dapuzzo-recovery-doesnt-stop-when-injuries-heal.html?_r=1&ref=hockey

Primeau wanted Dapuzzo to do what he had done: agree to donate his brain and spinal cord to the Boston University Center for the Study of of Traumatic Encephalopathy.  That is the center that is studying the brains of deceased football players and other athletes to see if they had developed that brain disease, which has been linked to repetitive head injuries. 

Primeau and Dapuzzo share a bond that many pro hockey players and pro football players share, namely that their careers were cut short by the many concussions they suffered because of those sports, according to The Times.

Dapuzzo’s story was more gruesome than most. On Feb. 9, 2008 Dapuzzo was hit in the face by a skate blade, and it literally cut his nose off. Physicians sewed it back on, but it wasn’t the only injury that he received. He had a concussion, multiple bone fractures to his face, and bone fragments in his ears that caused bad earaches, according to The Times.

But perhaps worse of all, Dapuzzo fell into clinical depression, depression so bad that he sometimes wouldn’t open the door when his hockey friends came by. According to The Times, Dapuzzo had suffered from depression previously, in the 1990s. Then he got some insight into what might have caused it.

After the horrible injuries he sustained in 2008, Dapuzzo underwent a battery of neurological tests, and learned that he had sustained other concussions. In one instance, Dapuzzo recalled that he was hit in a collision, vomited in the penalty box and played the rest of the game, even though “the Meadowlands Arena was spinning around” him, The Times reported.

In the mid-1990s, Dapuzzo missed an entire season while he got treatment for depression.

A New Jersey resident, Dapuzzo is still dealing with bouts of depression. But he was recently hired as a scout for the Toronto Maple Leafs, which was the hook for The Times’s story on him. And he says he is thankful to have that chance to work again.      

http://www.nytimes.com/2011/11/22/sports/hockey/sidney-crosby-ready-for-return-to-ice.html?_r=1&scp=3&sq=sidney%20crosby&st=cse

Crosby was benched for roughly 10 1/2 months, recovering from concussions that he suffered Jan. 1 and Jan. 5 this year. As The Times pointed out, it only took Crosby five minutes into his first game back to score a goal against the New York Islanders on Monday.

Crosby doesn’t seem any worse for wear. But we can’t help wondering what will happen when he takes another blow to the head. The effects of concussions are cumulative, as boxers and pro-football players can tell you. At least those that haven’t gotten dementia at a very young age because of their brain injuries.

And take our word for it, Crosby will take more hits to the head. That’s the kind of game hockey is.

Crosby is a superb hockey player. According to The Times, he was the “runaway scoring leader” at the start of the season. Then came the concussions.

On New Year’s night, Cosby was hit in the head by a sideswipe by Washington’s David Steckel. Cosby was hurt but stayed in the game. 

Four days later, Cosby was slammed into the boards by Tampa Bay Lightning’s Victor Hedman. Cosby remained in that game.

But here is what The Times said happened the next day.

“Crosby returned home, and the team announced that he had a mild concussion and would be out a few days. His symptoms worsened — headaches, spatial and balance problems, fogginess, in what Crosby would term a ‘roller-coaster’ experience. But he was allowed to begin off-ice workouts in late January and light skating in mid-March. By mid-April, however, he had to quit skating for three more months.”

Crosby returned to training in Septembr, was tested and was finally cleared by doctors Sunday to play again.

But Crosby does not seem to have learned his lession, from the quote he gave to The Times.

“There’s going to be more hits and probaby harder ones, and to know I got out of those ones OK, I think it gave me some reassurance,” he told the paper.

You are benched for nearly a year after several concussions, and that gave you “reassurance”? Really?  

The American Board of Medical Specialties (ABMS), which oversees the certification of physician specialists in the United States, has created a new subspecialty category: Brain Injury Medicine.

http://www.abms.org/News_and_Events/Media_Newsroom/Releases/release_Announcing_TwoNewSubspecialties_10312011.aspx

The ABMS Board of Directors and Assembly Representatives approved the subspecialty at their Sept. 20-21 meetings.   

Brain Injury Medicine will be offered by the American Board of Physical Medicine and Rehabilitation (ABPMR) and the American Board of Psychiatry and Neurology (ABPN), the two organizations who sought creation of the subspecialty.

“As medicine continues to evolve, new subspecialties are created or enhanced to broaden the scope and quality of care provided to patients,” said Kevin B. Weiss, MD, ABMS President and CEO.  “This will allow physicians seeking to practice in these areas to become certified, which will signal to their patients that they are highly qualified to practice in their specialty.”

According to the ABMS, the Brain Injury Medicine subspecialty was developed to provide: core competency standards for physician training in evaluating and providing non-surgical treatment of patients with brain injuries; a high level of care for patients with acquired brain injuries and their families in hospital and post-acute care settings and over the continuum of care to facilitate the process of recovery and improve medical and functional outcomes; and  Brain Injury Medicine administrative skills to assist physicians in activities such as program development, quality assurance, facilities planning and standards development.

“The new subspecialty was created because of the increased need for diagnosis and treatment options for patients with brain injuries and the growing need to monitor, assess and advance new technologies for patients,” said Anthony Tarvestad, JD, ABPMR Executive Director.  “With this new certification, brain injury medicine specialists will lead the way in providing optimal, advanced and cost-effective care for patients with brain injuries.”

Larry Faulkner, MD, ABPN  President and CEO has a similar comment.

“With increasing awareness of the prevalence and lasting effects of brain injury, it is expected that this new specialty will serve to advance the training and document the expertise of physicians who diagnose and treat patients with these potentially debilitating conditions,” Faulkner said in a statement. 

In its announcement about the new Brain Injury Medicine subspecialty, the ABPRM quoted one of its directors, Dr. Karen Kowalske, as saying, “Leaders in BIM (Brain Injury Medicine) have been laying the groundwork for recognition for the last 10 years.”

https://www.abpmr.org/documents/brain_injury_announcement.pdf

The move by the ABMS is important, according to the ABPMR. Now Brain Injury Medicine  training programs can become accredited, new programs can be developed and patients can rest assured that doctors who are board certified in Brain Injury Medicine  have completed advanced training in that field.

The first Brain Injury Medicine examination has been set for fall 2014. 

Truer words have never been spoken.

In this case, the quote is from Cynthia Boyer, senior clinical director for Bancroft NeuroHealth in Haddonfield, N.J. Her remark comes from a Page One story that The Star-Ledger of Newark published earlier this month on a pilot rehab program for veterans who have suffered traumatic brain injury (TBI). 

http://www.nj.com/news/index.ssf/2011/10/for_nj_vets_with_traumatic_bra.html

The article is about Bancroft NeuroHealth, which is one of 21 nationally accredited agencies that was awarded a federal contract this summer from the U.S. Department of Veterans Affairs to participate in a pilot program. 

The $23.5 million Assisted Living-Traumatic Brain Injury pilot program, according to The Ledger,  is trying to assist veterans adjust to life after their TBI, and to become self-sufficient again, to whatever extent they can.

Vietnam veteran Ronald Sharpe is profiled in the story. He survived combat as a Marine, only to return to the United States and years later get into a horrific car accident. Sharpe was in a coma for a few months, and when he came out of it he was blind “and the parts of his brain that enabled him to speak clearly, walk effortlessly and retain short-term memory were irreparably damaged,” according to The Ledger.

But under Bancroft’s rehab program, Sharpe got a job, was able to walk again and learned Braille. He lives in a group home now, and gets his rehab from Bancroft’s Cherry Hill facility.

Pilot programs like the one Bancroft is participating in are crucial in these times, when TBI has been described “the signature wound” of veterans of the wars in Iraq and Afghanistan.

Sharpe’s rehab includes classes on managing his finances; cooking classes; and speech therapy. The Ledger also reported that Sharpe lives in a home with three other people who have TBI, and he is doing well.

It would be great if this pilot program is deemed a success, and can made permanent to help vets with TBI. So far, so good.

In a sad footnote regarding Sharpe, The Ledger reported that he recently was diagnosed with prostate cancer. But he is still in good spirits. I wish him well.