Head Injury / Brain Injury-
The cartoons depict it as stars circling over the head. The term “bell rung” is used as an analogy to describe it. The effects are NOT like the other analogy of “cobwebs” that simply can be “shaken off.” ESPN used to feature clips including them in a hyped, manly segment called, “Jacked Up.”
What is it? It’s a concussion and it is no joke. The Centers for Disease Control and Prevention (CDC) estimates that there are nearly 3.8 million incidences of sports-related concussions every year and that there are on average about 1.7 million people who sustain a traumatic brain injury annually.
Signs and Symptoms of Concussion:
•Unaware of period, opposition, or score
•Headache* or pressure in the head
•Balance problems or dizziness*
•Feeling dinged, foggy, stunned, or dazed
•Visual problems: seeing stars or flashing lights, double vision
•Hearing problems: ringing in ears
•Irritability or emotional changes
•LOC or impaired conscious state
•Poor coordination or balance
•Concussive convulsion/impact seizure
•Gait unsteadiness/loss of balance
•Slow to answer questions or follow directions
•Easily distracted/poor concentration
•Displaying inappropriate emotions: laughing or crying
•Inappropriate playing behavior: e.g. running in the wrong direction
•Significantly decreased playing ability
*Headache, dizziness, and confusion are the most common reported symptoms of a concussion.
Historically, NFL, college and high school athletes have been encouraged to shake off concussions and get back on the field. Recently a NFL player went limp on the field after a hit to the head and was described as “shaken up” on the field. It was ignorant and wrong. Players have historically been encouraged to play hurt and that headaches or the “pops” taken to the head on the field are not like the injuries of broken bones or torn ligaments. In fact, they are far worse and effects much more permanent.
Reports estimate NFL players die on an average 15 years before the average American male. Before an athlete even gets to the NFL, he faces death practice after practice and game after game. It’s hard to imagine in the nation’s favorite (and most violent) sport. It’s not a popular thought and can be minimized because the odds are small of a traumatic event (defined as brain injury serious enough to effect body movement, brain capacity or death) and the fact the gradual, lasting effects of head injuries won’t be noticed by the victim for decades.
Congressional hearings held at the end of 2010 brought crucial attention to the safety of our children. And the fact it is not just a football issue, girls’ soccer is second to football in number of concussions; and many other sports have a significant amount of concussions as well. Yet, football is the biggest culprit and the glorification of toughness the biggest obstacle.
Children and Head Trauma
Too many high school and youth athletes suffer concussions without their coaches or parents even knowing it. And too many of these young athletes return to action too quickly — risking dangerous outcomes.
It’s difficult to even estimate the number. High school athletes reported having 100,000 to 400,000 concussions per year across our country. Younger brains are more vulnerable to injury and unlike in the NFL, there’s often no one on the sidelines trained to diagnose brain injuries. These individuals often release liability, don’t experience manifestations or symptoms until their 30’s, and have little or no “insurance” to address this problem.
In the last two years, eight kids have died from concussion-based problems and dozens more have suffered catastrophic brain injuries.
According to a recent study by the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, 40.5% of high school athletes who have suffered concussions return to action prematurely, risking more severe problems.
It’s sobering to note that only 42% of high schools have athletic trainers and those trainers obviously can’t attend all of a given school’s athletic events. Additionally, the vast majority of non-school related youth sports leagues, including football, conduct their events without any trainers or trained medical personnel in attendance.
Furthermore, coaches and parents are woefully uneducated when it comes to brain injuries. The result is too few concussions are properly identified, and the ones that are don’t receive the recommended treatment. Education is critical when it comes to concussions because multiple concussions increase both the short-and-long-term risks for young athletes.
Even more encouraging, legislation requiring coaches to be educated on concussion detection and proper protocol in dealing with head injuries is popping up around the country.
Recent laws in Texas, Washington and Oregon have mandated better concussion training and medical services in youth sports. Sadly, the statutes are all named after boys who were recently killed or seriously hurt by football-related brain injuries.
Secondary impact syndrome is a rare but extremely serious complication that can arise from a head blow — even a seemingly minor one — before a person has fully recovered from a prior head injury. The brain swells rapidly after the second impact, causing immediate complications and damage, such as shutting down the brain stem and resulting in respiratory failure and paralysis or death.
In the milliseconds after a concussion, there is a sudden release of neurotransmitters as billions of brain cells turn themselves on at the exact same time. This frenzy of activity leads to a surge of electricity, an unleashing of the charged ions contained within neurons. It’s as if the brain is pouring out its power.
The healing also has to be uninterrupted. In the aftermath of a traumatic brain injury, the brain remains extremely fragile. Because neurons are still starved for energy, even a minor “secondary impact” can unleash a devastating molecular cascade. All of a sudden, brain cells that seemed to be regaining their balance begin committing suicide. The end result is a massive loss of neurons. Nobody knows why this loss happens. But the loss is permanent.
The “Little” Hits to the Head Add Up
Repetitive small hits to the head can cause as much damage as big blows. The University of North Carolina tracks the numbers of hits to the head the players in their football program take during a season, including games and practices. The average is 950 blows to the head each season. That’s an important number because researchers are discovering that it’s not just the major blows to the head that are dangerous. They all count.
Neuroscientist Kevin Guzkiewicz believes that repetitive low-impact hits are enough to cause cumulative damage to young brain tissue but not enough to cause immediate symptoms.
“There’s what we call a dose response,” Guskiewicz says. “After a certain number of hits, the damage starts to show.”
ALS v. CTE: The Long-Term Impact of Brain Trauma
Amyotrophic lateral sclerosis, or ALS, is a disease of the nerve cells in the brain and spinal cord that control voluntary muscle movement. It is also known as Lou Gehrig’s disease. Despite bearing his name, medical journals have questioned whether Gehrig’s demise -and that of some other athletes and soldiers that have long been thought to have ALS- might have been catalyzed by concussions and other brain trauma.
Researchers have found pathological evidence that repetitive head trauma -such as that experienced by football players- may result in a motor neuron disease similar to ALS. It is often identified with CTE – Chronic Traumatic Encephalopathy, degenerative brain damage. CTE actually progresses undetected for years, silently eating away at brain cells, until it causes dementia and other cognitive problems.
A unique pattern of protein deposits has been found during autopsy studies of brains from professional athletes who had played contact sports. Researchers have discovered CTE in the brains of more than 50 deceased former athletes, including more than a dozen NFL and college players, pro wrestler Chris Benoit and NHL player Reggie Fleming.
The media has published an estimate that 14 former NFL players since 1960 have been given diagnoses of ALS, a total about eight times higher than what would be expected among men in the United States of similar ages. However, we found that list and it is rather crudely generated. The truth is we have little idea how many have been affected. Worse still, how many guys played in high school and college only to vanquish mysteriously?The known victims thus far are: Eric Scroggins (Linebacker at USC who played 3 games for the 49ers in 1982), O.J. Brigance (Linebacker out of Rice who played 11 years in CFL and NFL from 1996-2002)(featured on ESPN’s Outside the Lines, a must-watch story), Glenn Montgomery (Defensive Tackle out of Houston who played 7 years in NFL), Pete Duranko (Notre Dame Defensive End who played 7 seasons in AFL and NFL), Peter Demmerle (WR at Notre Dame who was drafted but did not play in NFL), Steve Smith (Penn State Fullback who played from 1987-1995 in NFL), Tony Proudfoot (Defensive Back from 1971-1982 in CFL), Bob Waters (former 49ers Quarterback, one of 3 members of the same team to get ALS, along with Matt Hazeltine and Gary Lewis), Matt Hazeltine (15 year Linebacker out of California), Gary Lewis (running back and 7 year NFL’er), Orlando Thomas (6 year NFLer from 1995-2001, who played Safety), Wally Hilgenberg (Iowa Linebacker, who played 16 seasons in NFL), and now, Kevin Turner (Fullback out of the University of Alabama, who played 7 years in the NFL). This list could go on for pages.
A few foundations have been formed and most of the athletes are working or worked to help the understanding and fund raising for ALS before their untimely demise, including the Glenn Montgomery Foundation and the Brigance Brigade.
1. All Sports Leagues – At All Levels – Should Be Required to Develop a Concussion Policy Statement and Implement An Educational Campaign Around Concussions
“Athletics will never be stripped of all danger … but the brain is more than a joint or a limb. It’s the seat of the self. We overlook that fact at our peril and – much worse – at our children’s.”
–Jeffrey Kluger, “Headbanger Nation,” Time, January 31, 2011
Sports leagues should develop concussion policy statements which include the league’s commitment to safety and the teaching of safe playing methods; a description of concussion and repetitive brain trauma; the process if an athlete is suspected of having a concussion; and information on when athletes can safely return to play.
A well-conceived concussion policy statement is important at all levels of sports, but is especially critical at the high school and youth levels because younger brains take longer to heal from a concussion and are more susceptible to Second Impact Syndrome.
Part of every league’s concussion policy should spell out the communications and education strategy for increasing awareness and understanding of brain injuries amongst the league’s constituents.
Parents, coaches, trainers, and athletes should be asked to sign the concussion policy statement at the beginning of each sports season — ideally in conjunction with a mandatory concussion safety and prevention seminar.
2. Make the King-Devick Concussion Test Mandatory in All Sports At the High School Level On Down
The most critical aspect of a concussion safety plan is the quick identification of a possible concussion during games and practices.
The King-Devick test is a simple and objective rapid sideline-screening test for concussions that can be administered by coaches, trainers, and parents in two minutes or less. Some sports medicine professionals have called the test “the missing link” in concussion safety protocols.
Research has shown the King-Devick test to be an accurate and reliable method of identifying athletes with brain injuries. It can be an excellent objective tool for determining whether players should be removed from games or not.
A University of Pennsylvania School of Medicine study published in the Journal of Neurology on April 26, 2011 demonstrated the usefulness of the King-Devick Test. The study examined 39 boxers and Mixed Martial Arts contestants and found post-fight test times for those who suffered head trauma worsened by an average 11.1 seconds. Those who had lost consciousness were on average 18 seconds slower. Those who did not suffer any head trauma actually improved their times by more than a second on average.
“This rapid screening test provides an effective way to detect early signs of concussion, which can improve outcomes and hopefully prevent repetitive concussions,” said Laura Balcer, the study’s senior researcher.
The King-Devick test is a one-time, one-to-two-minute test that requires an athlete to establish a baseline time at the beginning of each season. Athletes are timed reading a series of single digit numbers displayed on three flash cards. If the athlete suffers a suspected head injury in a practice or game, the athlete is given the test again. If the time needed to complete the test is more than five seconds slower than the athlete’s baseline test, a concussion can be confidently diagnosed. The athlete should then be removed from play and evaluated by a licensed medical professional.
There are other accurate concussion tests, however, they are more complex and should be administered by professional healthcare providers. The King-Devick test is easy to learn, understand and administer, making it very valuable for high school and youth sports programs. As such, its use should become standard at the high school level on down.
3. Every State Should Adopt Concussion Legislation Similar to Colorado’s Jake Snakenberg Youth Concussion Act
The Colorado youth sports concussion act is named for Jake Snakenberg, a football player at Grandview High School in Aurora Colorado who died in 2004 as a result of repeated concussions, or Second Impact Syndrome.
Briefly this legislation entails the following:
•Requires coaches who suspect an athlete has a concussion to immediately remove that athlete from play for the remainder of the game or practice.
•In order for the athlete to return to play, written clearance from a licensed health care provider is needed.
•All coaches of athletes ranging in age from 11-19 are required to take a free 30-minute online concussion course that teaches them to recognize concussion symptoms.
At its most basic, the policy is “When in doubt, sit them out.”
“This would’ve meant a lot to Jake, and he would be very proud, just as we are, that his name is associated with keeping kids safe … No family should ever have to go through what my family has been through,” said Snakenberg’s mother Kelli Jantz.
One strong addition to this type of legislation would be to make the entire team take the concussion course so players would be more apt to see signs of concussion in their teammates. In many cases, teammates can see the signs of concussion before coaches do.
The Snakenberg Act has been endorsed by the NFL (which after years of resisting the research on concussions, and attempting to sweep it under the rug, is finally — albeit gradually and reluctantly — acknowledging that improved awareness, prevention and treatment measures are needed). At least nine other states have similar laws on the books and 10 others are considering concussion legislation.
Former Denver Broncos’ receiver Ed McCaffrey personally endorsed the Colorado bill, saying, “We know way more today than we did when I played and it is important that we take advantage of that knowledge.”
When safety measures can be implemented without substantially changing the nature of the sport, they should be put into practice.
4. Education and Pay Attention to EVERY Incident.