Enlightening Athletic Warriors

Xenith, makers of protective headgear for football, have published a great paper on the shift taking place in concussion awareness in sports, and the changes they believe are necessary to keep generations of athletes safe — and potentially healthier for the long-term, after they are finished with their student athletic careers.

From the paper:

Playing through an ankle sprain is understandable, but this mentality has been carried too far with regard to concussive episodes. Nerve cells do not heal the way other body tissues heal. In short, no one’s brain is “tough”. Players may come forward to reveal symptoms of a concussive episode, but it remains likely that players will work to stay on the field. It will be up to those around the players to recognize and report injuries.

Certified athletic trainers are often closest to players regarding physical injuries, and are therefore in a logical position to spot concussive episodes, or elicit honest information from players. Efforts to increase or mandate the presence of athletic trainers are certainly likely to result in better injury recognition.

In the absence of certified athletic trainers, coaches, officials, parents, and players still have a role. One concept, promoted by Dr. Gerry Gioia of Children’s National Medical Center, is called “Carry the Clipboard.” The Centers for Disease Control (CDC) offers free materials, designed to attach to a clipboard, providing a helpful checklist for awareness and management of concussive episodes. Carry the Clipboard suggests that one adult at each sporting event be assigned to carry the CDC information on a clipboard, designating that adult as responsible for recognizing players who appear to be debilitated, and for contacting a local expert.

Even though players may attempt to conceal their own symptoms, their teammates may be valuable partners in reporting a concussive episode. This unique form of honor code creates a team approach to risk reduction. Parents being attuned to their child’s behaviors may be the most critical element.

A major cultural shift is underway, which should lead to increased recognition of concussive episodes. As the veil is lifted on this injury, a significant short term increase in diagnoses may result. Over time, a corresponding decrease in actual injury risk and diagnoses should occur.

Read all of it here:
http://www.xenith.com/mission_control/assets/Uploads/BuildingtheEnlightenedWarrior.pdf

Fourteen Years Later, Someone Finally Got It…

 

Pat LaFontaine shares about his experience at BrainLine

 

I’ve been watching the video on BrainLine – NHL Hockey Hall of Famer Pat LaFontaine Shares His Story

Hear hockey great Pat LaFontaine recount his story and the steps he took during his recovery after several brain injuries.

It’s a great retelling of a story about how he sustained multiple concussions and could never get answers from anyone… until he was so impacted, it was obvious to everyone that something wasn’t right. It’s also a very telling look into an often hidden world of athletes who know something is wrong, but are told time and time again by doctors and trainers and other expert folks, that they just have a psychological issue and if they just suck it up, they can get back in there and get back to regular play.

Around 19:10 in the video, LaFontaine talks about how he had to keep calling his doctor (the new one who actually had a clue what was going on) to reassure him that the source of his emotions and depression and headaches and not feeling right was physiological. He thought that the doctor was just being nice, because he felt like he was losing his mind.

How true it is.

When you’re going through the disruption of a TBI, you can genuinely feel like you’re going crazy. Things are strange, you don’t feel like yourself, your emotions may be off the charts or completely changed, and nothing seems to be clicking. And trying to get help can be next to impossible, if the doctors you see are not familiar with brain injury/concussion.

This is so important — I wish more doctors and trainers and coaches of student athletes would pay attention to this and keep up to date with the most current research and best practices, so they can not only help people  understand what’s happened to them, but they can also take steps to prevent repeat injuries before healing is complete. Concussions among student athletes is much higher than most guess (and former studies showed), and second subsequent injuries before the brain has healed can be devastating. Second impact can complicate concussion symptoms, and if doctors and coaches and trainers are all pressuring the players to get back in the game and/or telling them that they’re really fine, they can get hurt again — and have even worse problems to deal with after the fact.

I was one of those student athletes who went back in the game after the concussions I sustained, but I’m different from many, in that my coaches and trainers had an eye out for me and kept me out of play (against my will). I was very luck. Lots of student athletes don’t have that same level of vigilance and care.

The one problem was that I’m also one of those folks who never got proper medical care until about three years ago. This was long after the period in which I could file for any sort of assistance or get accurate medical records documenting my injuries — so the chance of me getting any help from any organized sources is slim to none.

I’m on my own.  And even though I have doctors who know about my TBI history, I’m still on my own when it comes to advocating for my own care and well-being. They mean well, I’m sure, but when they tell me that I don’t need to worry about how much sleep I’m getting, because I may not need at least 8 hours a night, it’s not particularly helpful. And when they look you over, plying you with questions about your mood in search of clues about psychologically based depression, completely ignoring the physiological aspects of mood and emotion, well, that’s even more depressing.

I can tell you from personal experience that dealing with post-concussion syndrome is a real bitch, when you have no idea what it is, you think you’re losing your mind, everyone around you is telling you to just “shake it off” — or they have no idea you have anything to shake off, and all they can do is give you a hard time about struggling the way you do. And then you go to the doctor, and they tell you to take a meditation class or relax more or go on vacation to get your mood back in order… this is not helpful, in the case of TBI.

According to the medical/mental health system, without proper medical documentation of my injuries, in the eyes of others, I’m probably mentally ill. All that emotional volatility, the perseveration, the rumination, the difficulties getting started and stopping what I’m doing, the extreme swings in energy levels… Even some of my friends who are psychotherapists have written me off as mentally ill and refusing treatment. These are the same people who have flatly discounted the effect of TBI in my life and claim that all I need is to deal with my difficult childhood to get on with my life.

They’re wrong on so many different levels. Especially about me  refusing treatment — I’m not. I’m actually getting treatment at the level I need — on the neurological level, not on their preferred level. I know that I’m not mentally ill, and so does my neuropsych. And so does every other person who is intimately familiar with TBI and understands the nature of the issues I face on a daily basis. To say it’s maddening to watch the mental health field have a heyday with folks who have been neurologically impacted, would be an understatement. And hearing stories of doctors playing psychotherapist is equally irritating. But at the same time, I can’t let the shortcomings of our “modern” mental health industry impact my own peace of mind and my own mental health.

There’s no sense in that.

So, I seek out answers for myself.  And I share what I find, in hopes that others like me may realize that someone out there actually gets it. They’re are not alone, and there is hope.

Where there is good information and good communication, there is a chance for change.

How Can I Recognize a Possible Concussion?

One of the nice things about being a blogger is that I can add my information to the general wealth of data about subjects of interest to me – in this case, mild traumatic brain injury. This blog is about more than telling my side of the story — it’s about fleshing out info that other trusted sources provide, in ways that are personal and individual… and hopefully contributing to the general understanding about traumatic brain injury, and sports-related concussion in particular.

The CDC has a wealth of information on concussion in youth sports over at their Heads-Up site.

What’s missing is a bit of in-depth explanation about the different points they make.

Since this month is Brain Injury Awareness Month, I hope to contribute to the awareness piece with further info and examples from my own concussion experiences.

From the CDC site about recognizing concussions:

To help recognize a concussion, you should watch for the following two things among your athletes:

• A forceful bump, blow, or jolt to the head or body that results in rapid movement of the head.

AND

• Any change in the athlete’s behavior, thinking, or physical functioning.

Athletes who experience any of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play.

Signs Observed by Coaching Staff

• Appears dazed or stunned
• Is confused about assignment or position
• Forgets an instruction
• Is unsure of game, score, or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness (even briefly)
• Shows mood, behavior, or personality changes
• Can’t recall events prior to hit or fall
• Can’t recall events after hit or fall

Symptoms Reported by Athlete

• Headache or “pressure” in head
• Nausea or vomiting
• Balance problems or dizziness
• Double or blurry vision
• Sensitivity to light
• Sensitivity to noise
• Feeling sluggish, hazy, foggy, or groggy
• Concentration or memory problems
• Confusion
• Does not “feel right” or is “feeling down”

Remember, you can’t see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. But for some people, signs and symptoms of concussion can last for days, weeks, or longer.

Now, for some explanation to fill in the blanks…

To help recognize a concussion, you should watch for the following two things among your athletes:

• A forceful bump, blow, or jolt to the head or body that results in rapid movement of the head.

The head, atop the neck, holds our precious brain — which has the consistency of pudding, and is surrounded by fluid which protects it from the bony inside of our skulls. Unfortunately, the bony insides of our skulls can have rough/sharp edges which can rake across the surface of the brain and cause damage that way, should the head/bodybe knocked so hard that the brain pushes past the protective fluid and scrapes against the inside of the skull.

You can see a video of different types of brain injury at YouTube. It’s very informative, and I recommend it.

When the body or head is hit hard enough, the brain can hit against the front inside part of the skull, be injured there — and then fly back against the rear of the skull (called coup-contracoup — which means head-back0fhead — injury), causing damage to the rear part of the brain as well. Under ideal conditions, the protective fluid provides an ample buffer to shelter the brain, and the inside of the skull is not really sharp and uneven. Unfortunately, there are no guarantees that that’s the case.

Forceful bumps or blows or jolts to the head can be things like:

• being hit on the head by a ball, such as in soccer or baseball
• colliding with another player and bumping heads
• being elbowed or kicked in the head
• colliding with the catcher and slamming your head against his/hers when you’re trying to steal homebase
• falling and hitting your head on the basketball court floor

Another way the brain can be injured by a hard hit to the body, is a whiplash effect — where the connections that are located at the base of the skull and neck are twisted and torn by the head snapping forward and backwards really hard. You don’t need to be knocked out, and you don’t even need to have your head hit, to sustain a concussion in sports.

Forceful bumps or blows or jolts to the body can be things like:

• being tackled hard in football
• being fouled hard and knocked to the floor in basketball
• falling during a soccer game
• colliding with another player when going after the same ball
• landing hard after any kind of fall, even if your head doesn’t hit the ground
• running into the wall when you’re eplaying squash/raquetball

It’s important to remember that these very common collision/impact occurrences (which are part and parcel of just about any sport) will NOT necessarily lead to concussion. If everyone who was tackled hard, or fell, or was fouled hard and ended up on the floor/ground sustained a concussion, there would be a whole lot of impaired people walking around.

Being hit or tackled or falling during a game or practice is NOT a guarantee of a concussion. This is where the next criteria comes in… the “and” part.

AND

This AND is important. The first set of criteria — the bump, blow, or jolt to the head or body are no guarantee that a brain injury has occurred, but they can serve as a trigger to watch out for the following. The next point is what acts as an alert that a concussive event has occurred.

• Any change in the athlete’s behavior, thinking, or physical functioning.

Signs Observed by Coaching Staff

• Appears dazed or stunned
• Is confused about assignment or position
• Forgets an instruction
• Is unsure of game, score, or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness (even briefly)
• Shows mood, behavior, or personality changes
• Can’t recall events prior to hit or fall
• Can’t recall events after hit or fall

Symptoms Reported by Athlete

• Headache or “pressure” in head
• Nausea or vomiting
• Balance problems or dizziness
• Double or blurry vision
• Sensitivity to light
• Sensitivity to noise
• Feeling sluggish, hazy, foggy, or groggy
• Concentration or memory problems
• Confusion
• Does not “feel right” or is “feeling down”

Here are some examples from my own experience:

When I sustained a concussion from a hard tackle during a football game in high school, there was an immediate change in my thinking and physical functioning.

• First of all, I was not thinking as quickly as I was before the hit. Even I could tell I was slower — I wasn’t following the calls by the quarterback very well, and I was clearly a little dimmer than I had been before the hit. I had trouble understanding what was said in the huddles before the following plays, and I had trouble following the instructions I was given. For example (I can’t remember the exact details, but this is how it was), when I was told to go long and then cut left at a certain point, I went long, but I didn’t cut left.
• Secondly, I was not as coordinated as I had been before the hit. I ran clumsily — like I was drunk — and I couldn’t catch the ball when it was thrown right to me. I also stumbled a lot, and I fell a few more times. For all I know, I did more damage to myself, but I was so totally focused on continuing the game and not letting my teammates down, I refused to take myself out of the game. They had to stop the whole game, completely, to get me to quit playing. I was that stubborn.

When I sustained another concussion from a fall during a soccer game a year or two later  in high school, there was yet another immediate change in my physical functioning and behavior.

• First of all, I was a lot less coordinated than I had been before I fell. I couldn’t control the ball as well as I had before, and it felt like I was moving in slow motion. I stumbled and fumbled, and there was obviously something different about how I was playing.
• Second, I was not the same player I’d been before my fall. Before, I had been aggressive and confident on the field. Afterwards, I was hesitant, confused, and I hesitated before shooting on the goal (or just plain failed to shoot). I had a number of opportunities to score, but I didn’t, because I was uncertain and confused. I was also less able to be a team player. I didn’t pass the ball to my open teammates as frequently as I should have. I also became more withdrawn and was not communicating with the coaching staff on the sidelines. It was like I was in my own little concussed world, suspended in a foggy soup that slowed down all the input and output.

Athletes who experience any of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play.

Absolutely, positively. This must be done. Unfortunately, I myself never received any medical evaluation or treatment for my injuries. But on the bright side, I was removed from play in both instances. Nobody watched me afterwards to make sure I was symptom-free and it was OK for me to return to play. Then again, by the time I got to those games, I’d had a number of TBIs already, so I already showed symptoms of impairment. Still, the changes I did experience, on those two separate instances, were clear indicators that I’d undergone a concussive event. I only wish someone had known what to look for, and helped me out.

Another important piece of the CDC info is:

Remember, you can’t see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. But for some people, signs and symptoms of concussion can last for days, weeks, or longer.

This cannot be overstated. Concussion, hidden as it is inside the skull, can also be hidden by time. It can take hours or days for symptoms to show up, which is why it is so important that not only coaches, but also teachers and parents and teammates are all familiar with the danger signs and informed about how to respond appropriately.

One of the things that can show up later, are behavioral issues. Indeed, behavioral issues are the bugaboo of mild traumatic brain injury, because on the surface everything looks fine, and the brain may have recovered from its initial trauma, but there are microscopic changes under the surface that can have long-lasting effects. If you know someone who plays sports, whose behavior has suddenly started to change for the worst – suddenly they have a lot of anger, rage, irritability, distractability, sensory issues, fatigue, insomnia —  it could be they had a concussion during a game or some other event — and nobody realized it, including them.

Concussion doesn’t just affect the student athletes — it affects everyone who interacts with them, everyone who loves and cares about them. It’s in all our best interests to learn about it, learn what to watch for. And to report it to someone who can help.

As the CDC says, most people recover quickly and fully, and it doesn’t need to wreck their lives. But if you don’t pay attention to the first warning signs, it is all too easy to re-injure yourself (having a concussion increases your chances of experiencing another one from 2-6 times). So, paying attention, right from the get-go can help prevent other problems from happening.

In retrospect, I wonder what might have happened, if I’d stuck with track and field and cross country exclusively, and not played any team sports that involved tackling or the danger of falling/collisions. I wonder if I would have been so susceptible to drugs and alcohol, if my behavior would have been so problematic. Thinking back, I had a ton of problems when I was a kid that actually resolved as a result of organized sports. Unfortunately, the thing that helped me most, also introduced more problems to my mix.

Well, I can’t worry about it. What’s done is done, in my case. I’m just happy I’m as functional and well-off as I am, today.

I also hope that coaches and trainers and teachers and teammates are learning enough, today, to help avoid the kinds of situations I got myself into… and help address the after-effects of the kinds of injuries that I — and hundreds of thousands of others young athletes — experienced. The CDC material is really helpful, and they have lots of free information and additional materials available.

Check ’em out. It’s worth the trip.