Virginia Concussion Law Approved by State Legislators

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Posted on 16th March 2010 by Gordon Johnson in Brain Injury

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Virginia is on its way to having a law that will keep student athletes who suffer concussions off the field until they get medical clearance. http://hamptonroads.com/2010/03/bill-benching-student-athletes-concussions-okd

The bill from Sen. Ralph Northam, a pediatric neurologist, won unanimous approval from the Virginia House and Senate. It now just needs the governor’s signature.

The law mandates that school board craft guidelines for dealing with concussions, and that they also educate parents about the dangers of traumatic head injury.

The Concussion/Football Story Catches Fire In The Press

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Posted on 11th February 2010 by Gordon Johnson in Brain Injury

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Timed with the Super Bowl, the consumer press has been doing extension coverage of the issue of concussions, brain injury, football and the NFL. For someone who has been doing almost nothing but represent those with brain injury for over 15 years that is welcome news, even if it does come with the risk that all of the focus is on what are usually the least severe of brain injuries.

The recent stories prompted Dr. Johnny Benjamin an orthopedic spine surgeon, to write a blog about it on the Huffington Post. http://www.huffingtonpost.com/johnny-benjamin/player-safety-in-the-nfl_b_454703.html

In his piece, “Whose Responsibility Was Player Safety in the NFL?,” Benjamin notes that Time magazine did a cover story on the topic, and that even The New Yorker has tackled it. Even Business Week recently chimed in on concussion awareness.
http://www.businessweek.com/lifestyle/content/healthday/635745.html

“Knowledgeable observers should be concerned that the medical director of the player’s union, the NFLPA, did not do enough to adequately protect his client/patients, the players,” Benjamin writes. “Virtually all meaningful advancement, dialogue and pressure that were exerted were provided by interested individuals, physician, researchers and journalists outside of the NFLPA’s medical director’s office.”

The Associated Press has been avidly writing about the concussion/sports issue. It did a story on the Zackery Lystedt Brain Project’s quest to have all 50 states pass law s setting safety guidelines for athletes who suffer head injuries.
http://www.latimes.com/sports/football/nfl/wire/sns-ap-fbh-high-school-concussions,0,7027744.story

The brain project is named in honor of a teenager who sustained brain injury when he went back to in a football after having a concussion in 2006. The advocacy group is lobbying for state laws similar to legislation on Washington state that mandates that athletes under 18 who are suspected of having a concussion must get written permission from a doctor before returning to play.

The AP also wrote a pre-Super Bowl story where it asked players on the Indianapolis Colts and the New Orleans Saints teams how many concussions they have sustained. http://www.latimes.com/sports/football/nfl/wire/sns-ap-fbn-super-bowl-concussions,0,156838.story

Saints defensive lineman Anthony Hargrove reportedly is the Saints player who has had the most concussions on his team, but he can’t remember exactly how many he has had, according to AP.

The kicker, a quote from retired NFL player Rod Woodson, is great on that AP story.

“Players are starting to realize how important it is to take care of your brain,” he said. “You only get one of them.”

Congressman Skewers College Football Conferences For Their Lenient Concussion Guidelines

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Posted on 2nd February 2010 by Gordon Johnson in Brain Injury

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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.

NFL Football Concussions Versus Real World Brain Injuries

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Posted on 11th January 2010 by Gordon Johnson in Brain Injury

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I am always pleased when the news cycle shifts to concussion and brain injury because that raises public awareness that concussion means brain injury and that brain injuries can cause permanent brain damage. Thus, the NFL being grilled by Congress as to the safety of its players is a very good thing. Likewise, the greatly increased awareness of brain injury coming out of all the publicity that the Iraq and Afghanistan wars brain injuries is also increasing public awareness. But I always worry that people will think that because athletes recover from concussions so quickly, that accidental concussion does not have the potential to permanently injure someone.

The bigger problem in the legal arena is that there is some very bad research being published now that would directly correlate a young athlete’s recovery from a concussion to real world brain injuries. (I apologize to those who see the obvious that sports is also part of the real world, but I find the phrase works to distinguish better than the use of other terms, such as civilian, because of course athletes are civilians, too.)

So, before we spend the next several blogs commenting on the NFL Congressional hearings, I think it is important to discuss what makes accidental (real world) concussions potentially more serious than sports injuries. Here is a partial list.

Sport Concussion a Young Person Injury. First, sport concussions typically happen to those with the greatest chance of a good recovery from concussion, young and athletic people. If we were going to list the three or four most common risk factors for a bad result from concussion, age would be at the top of that list. The reason for this is multiple but includes the fact that younger brains have a gene that stimulates neuronal regrowth that just does not exist when a person is over 40. The closer someone is to 40 at the time of the concussion, the more likely they will have persisting deficits from the brain injury.

Men Are at Less Risk. Most sport concussions happen to men and men are at less risk of poor outcomes from brain injury. This may be seem politically incorrect to say, but women are just simply more vulnerable, not just because they are not as strong, but also because concussive type forces are more likely to damage the white matter of the brain and women are more white matter dependant in there thinking. Complicated topic for another blog.

The Blow is Expected. Sport concussions happen to people who most times are prepared to get hit. The sport concussions that are the most serious are usually to someone who is surprised or motionless at the time of the blow. In contrast, almost all accidental concussions are a surprise. When the body knows it is going to get hit, it protects itself, considerably reducing the extent of and the arc of the acceleration/deceleration.

Athletes are Stronger. Sport concussions happen to people whose bodies have stronger muscles, which also significantly reduces the speed and the length of the acceleration/deceleration arc. When I speak about arc, I am speaking about how far forward, backwards or sideways the head will move on the neck, after being hit. It is this motion that accounts for most of the force on the brain’s axons.

There are about another half of dozen things I could add to this list, but the point of this blog is to remember when you hear about permanent brain damage to professional athletes, there is a far higher risk of that occurring to a 40 year old person who is in a motor vehicle wreck.

Sport Concussion Guidelines Should be Applied to Real World Brain Injuries

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Posted on 11th September 2009 by Gordon Johnson in Brain Injury

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Continuing with our football quarterback analogy about the difference between confusion and amnesia, lets also focus on another material area where the brain injured athlete gets better diagnostic methods directed towards them than the average member of the public: serial follow-up exams. A little over a decade ago, the Brain Injury Association of the U.S.A. in working with the American Academy of Neurology developed the first set of the “sport and concussion guidelines.” That first set did several really important things, the most notable was that it clarified that a loss of consciousness was not necessary acute event for a diagnosis of a concussion. The Sport and Concussion guidelines were not the first time that was clarified, but it was the first time it came from the Neurological national association.

From a long term standpoint, the most important thing those guidelines did was to create return to play guidelines. If an athlete who was not knocked out ceased to be symptomatic within 15 minutes of the concussion, then that athlete could return to the game. If they continued to be symptomatic after 15 minutes, then they could not return to a game for seven days after they ceased to be symptomatic. As this rule created a waiting period from the time they ceased to have brain injury symptoms, it required the training staff and or team doctors, to continue to do followup exams, every day after the injury. If you franchise quarterback can’t go back in the game for seven days after apparent recovery, you will make sure they get checked out every day.

Sadly, no non-athlete gets that kind of serial followup. Since no one sees any serious risk of harm for returning to work too soon, no one really makes any effort to determine whether the symptoms are occurring on day two, day three. That is so tragic, because there is really no doubt that if we did evaluate mild traumatic brain injury survivors at 24 hours, 48 hours and 72 hours, that we would probably be able to distinguish between almost all of those who were at risk for long term disability.

In our next blog, we will discuss why it can take up to 72 hours to be able to tell how serious a concussion or mild traumatic brain injury is.