NFL Concussion Lawsuits Get Really Real Now | Brandi on Steroids

051203-N-9769P-549To be honest, I haven’t been following the NFL litigation that closely. It all gets to be too much to keep track of. But this is a great summary of what’s going on, and how it may impact the NFL, as well as the rest of the country.

The Year of Football Lawsuits just took its next and possibly biggest step of all. A New York Court has sided with the NFL’s Insurance Companies and ordered the league to do what noone has managed to do before.

Show its hand.

Some background for those unaware. Not only has the National Football League fought admitting anything and only rushed to settle the Ex-Players Lawsuit when it appeared it would have to open its drawers, files, closets, secret compartments and anyplace else they have documents on what it knew and when it knew it about the risks of Concussions for Players, it never wanted to pay for anything.

The NFL wanted its Insurers to pay it for them and the Insurance Companies said Hell no. The NFL sued. The Insurance Companies sued right back. Those Lawsuits have been slow rolling as the Settlement of the Players Suit was moving along. Now the Judge in the Insurance Companies Suit against the NFL has said it’s time to find out what this has all been about.

In the end, it boils down to this, for me (as well as the article’s author):

Maybe there’s a principle at stake here. But probably not. It’s probably all about the Ex-Players Settlement Money.

UNLESS…and it’s the biggest unless in the history of Sports in the United States.

Unless those Insurance Companies are also looking at all of their other Customers who are being sued, will continue to be sued and will be sued alot more for alot more money over Football and Concussions/CTE. Customers like Cities, States, Universities, Pop Warner and a whole lot of others. Maybe even including Television Networks and Football Sponsors.

If those Insurance Companies are thinking about them, they might have only one thing in mind right now.

Finding out if and how badly the NFL, its Owners, Commissioners, Executives, Lawyers, Doctors, Public Relations Firms and anyone else around them screwed the Country.

I had to read that line a couple of times, to make sure it said what I thought it did —

… how badly the NFL, its Owners, Commissioners, Executives, Lawyers, Doctors, Public Relations Firms and anyone else around them screwed the Country.

Not just the players, not just their families (although that’s reason enough to go ballistic on the NFL), but the Country. If the NFL opens its books and shows its hand — and we actually let it sink in, what a fraud and a disgracefully dangerous, soul-sucking, life-killing scam the NFL has perpetrated on this country, all for the sake of “entertainment” — some very rich people are going to have some explaining to do.

Think about it — the marketing of the NFL, their propagation of playing practices and enthusiasm for football, their large-scale investment in cultural shifts towards idealizing the game they make billions from… as well as the whole infrastructure of pee-wee football –> high school –> college ball –> NFL (which has been described as an “underground railroad” for poor African-American kids to break the cycle of poverty)… we’ve all been marinating in football fever for as long as I’ve been alive. The started the Super Bowl around the time I was born, and I grew up — like so many others — really steeped in that head-banging excitement, which was never, ever questioned or challenged.

Football was never considered as dangerous as it truly is — and that’s for a very good reason. The folks who stand to gain ma$$ive amount$ of money have paid well to keep that information out of the public eye and discussion.

But now it’s coming around, and we’re going to have to take a look at just what the cultural thought-control by these ve$ted interests hath wrought. And yes, they are going to have some explaining to do.

Between the Panama Papers and these lawsuits, as well as the anti-elite dust storms kicked up in this election year, it seems to be a theme.

I just wish it didn’t cost us so much, to get a clue.

You can read the rest of the excellent article here: NFL Concussion Lawsuits Get Really Real Now | Brandi on Steroids

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96% Of Deceased NFL Players Test Positive For Chronic Brain Condition

In case you hadn’t heard…

New studies show 87 out of 91 deceased NFL players have tested positive for brain disease due to concussions and head trauma

Source: 96% Of Deceased NFL Players Test Positive For Chronic Brain Condition

Tony Dorsett is not dead

Tony Dorsett – all those years ago

The public debate about football and its effects on cognitive health — that is to say, how all those years of head trauma can really screw you up, years later — is heating up even more. PBS ran the special “League of Denial” about the NFL’s cover-up of the brain-damaging effects of their brand of football, and now Tony Dorsett and several other former pro players have been diagnosed with early signs of CTE – chronic traumatic encephalopathy. Bleacher Report has a good write-up on it here, and ESPN has their own, which I read yesterday.

I was really encouraged to read that there’s actually a way to detect CTE in living people. Up to recently, the word was that it can only be definitively identified in the brains of dead folks. But apparently now UCLA has a fix for that. So, that’s encouraging.

But it’s never good when anyone has CTE, and both Joe DeLamielleure and Leonard Marshall were also diagnosed, but Tony Dorsett…? That was a pretty emotional discovery for me. He was one of the players who got me really excited about the game when I was a kid. I always loved football, but there was something about his performance that was even more compelling — and it almost made me a Cowboys fan, for a while. Almost.

The article over at Bleacher Report has a writeup and includes the full gamut of responses from readers — everything from “the players knew the risks, and they did it anyway,” or “they just want to milk the system” to “they’re upset because they’re not in the limelight anymore and they’re just a bunch of cry-babies looking for attention,” to “you’re an idiot – the NFL covered this up for 15 years,” to well-informed responses based on science, to flat-out denial that anyone other than linemen could sustain repeated head trauma. And here and there are counter-arguments to refute ignorance-based “rationale.”

There’s a lot of back-and-forth talk, some more useful than others, but the most important thing is, people are talking about it, and more awareness is building around the whole issue. It would be nice if folks could share information and keep an open mind without calling names, but this is the internet, after all. I do find it hopeful that people are quoting actual scientifically based facts. And what I find most interesting is how many readers are reporting that parents are not letting their kids play football.

One of the questions that comes to my mind is whether all the talk might be doing more harm than good. There’s a lot of knee-jerk reaction going on, and brain injury is such an emotionally loaded subject which hits so close to each of us, that a lot of people just stop listening as soon as they hear “brain injury”. It’s not that they don’t want to learn or understand — we’re wired to shut down our higher reasoning, when we feel threatened at a deep level, and brain injury hits a lot of us in our most vulnerable spot.

A broken bone you can see and set and watch heal on the x-rays. A broken nose you can push back into place, tape up, and wait to get better. But a broken brain? It’s invisible. It’s mysterious. You can’t even see the real issues on imaging results — at least, not those that are widely available at a reasonable cost. And you don’t have a clear-cut route to recovery. Plus, we have this really bizarre expectation (based, I’m sure on decades of science that told us it’s so) that you only have so many brain cells, that once you damage the brain, you’re done, and there’s no turning back.

Only in the past years has science amended its views — and it’s done so silently, without so much as a hint of an apology for training us all to give up on ourselves.

What’s more, I think we’re not helped by the sensationalistic (if true) focus that’s being brought to CTE and the long-term effects of repeat head trauma. All the press focusing in detail on the horrible things that happen to you after head trauma might be cementing the public perception that once you’re brain-injured, that’s it. Tony Dorsett says he’s being proactive and is going to fight this and live his life to the fullest. But given how little is generally known in the public about brain injury in general, who knows how seriously anyone is taking this? I read one article where the writer referred to his condition as his “demise” — a freudian slip, if ever I heard one.

Frankly, I’d be surprised if anyone gave him the time of day after his revelation. Yes, he is Tony Dorsett — that is, he was. Once people find out that you’ve got “brain issues,” they have a way of distancing themselves from you. It’s something they don’t want to think about. They can’t help but imagine what it would be like for them — and it scares the bejesus out of them. So, they choose not to talk about it. They’d much rather talk to Sidney Crosby, who apparently has no more head/neck trauma issues to speak of.

From personal experience, I can tell you, repeat head trauma — even mild traumatic brain injuries — can do a number on you. It can turn your emotions upside-down, trash your impulse-control, wreck your judgment, saddle you with a bunch of unpredictable and seemingly insurmountable physical sensitivities, put you in a state of constant headache and general pain… in the process destroying your relationships, costing you your job, turning your financial decision-making inside-out, and generally doing the same thing to your life that a frat party does to a frat house. And it can all happen without you ever intending it to — and never actually wanting it to.

Now, I know a lot of folks are going to say it’s a character issue, or it’s an issue of self-control or what-not. It’s not about character. It’s about how the brain works, and how our lives are ordered as a result. And when you’re brain-injured (and unaware that you’re dealing with brain injury), the very thing that’s supposed to keep everything in order is what’s the problem.

And because it’s your brain that’s impacted, you can never even realize till it’s way late in the game — for some, too late.

The thing is — if we can all get past the terribleness of it, please — there is a way out. Brain injury, even CTE, doesn’t need to be the end. The brain is an incredibly “plastic” organism that by nature re-routes its wiring and recruits other parts to take on functionality that the original parts may have lost. There have been cases of people with advanced brain degeneration never ever showing any signs of that condition — the book Aging with Grace talks about that. And you can’t tell me that all the people who have lived full lives to a ripe old age have never had any organic brain issues. The brain is a mysterious and amazing organism. Our limited understanding doesn’t change its infinite possibilities.

If there’s one thing that I hope comes out of all this — even if it’s long-term — it’s the knowledge and experience that recovery from brain injury is possible. It is NOT a death sentence. I hope someone out there gets a clue — and publishes widely on it — about how possible (even probable) it is that a person can restore quality to their life and continue to live with meaning and purpose and a sense of usefulness, even after repeat head traumas.

Making a huge issue out of football being a cause of a brain-wasting condition is only part of the story. Saying that repeat concussions is a recipe for madness and early-onset brain degeneration is not the whole truth.And focusing only on the awfulness (to raise awareness and funding) leaves me with the feeling that this terribleness is permanent and irreversible. Logically I know it’s not 100% accurate, but part of me fears might be.

Tony Dorsett is not dead. Not yet, anyway. Who knows what will take him out in the end? He says he’s got issues. He says it’s wrecking his life. He says he’s considered suicide. And he says he’s being proactive and is going to fight this thing. There is still a whole lot we don’t know about the brain, CTE, tau, and how we might be able to clear the junk out of the brain.

Personally, my money’s on exercise, sleep, a positive attitude, staying active both mentally and physically, keeping connected to a community, and solid nutrition without a ton of artificial crap crammed in between the real ingredients. But that’s just me.

Whatever other folks may choose, I hope they do choose it, and I hope they don’t give up just because things look a little grim, right now. Things always look grim, before you have a chance to do something about them. But once you get going… you never know where it’s going to take you.

In any case, the day is waiting. I have a lot that I want to accomplish today — this whole weekend, in fact.  So, speaking of staying active, it’s time for a morning walk before I get into the rest of my day. That should get things moving…

Onward.

Of Facebook and Football

These two things are a lot like each other

Some time ago, I decided to quit spending so much time on Facebook. I uninstalled the FB app from my smartphone and I took a break from the daily checking of statuses, which was eating up anywhere from 30 minutes to several hours of my waking time each day. It was costing me sleep, which I could not afford to lose, and it was getting me riled, which I can also not afford.

Seriously, it was getting me riled.

And tired.

And I wasn’t getting much else out of it. I felt “connected” in a certain way – but connected to what? All the resentments and frustrations and biases and prejudices and outrage… it’s like everyone I knew with an ax to grind invited me to their personal bitch-fest, apparently assuming that I shared their outrage and disbelief, and I’d happily chime in to add my two cents (which is about as much as those kinds of opinions are worth).

Truly, it seems to me that Facebook is a haven for people with a chip on their shoulder, who would rather complain about things than actually get up and do something about it all. Now, there are those who use it to connect in order to organize activities, and in the case where people need to coordinate their efforts with one another, it is proving helpful. I’m thinking about the Arab Spring and other popular movements where people are standing up for their rights.

But how many of the people I was interacting with on Facebook actually wanted to do something about the state of things? Not many. I mean, there were those who were doing interesting things with their lives and sharing pictures. But not much of it had anything to do with me, and in the end, it just left me feeling cold. Because it wasn’t actually real. I wasn’t actually there. And whatever I imagined about how it was and what it was like, that was still all inside my head… not real at all.

And you know what? When I wasn’t on Facebook, I didn’t actually feel less connected than I was, when I was on it, each and every day. If anything, I felt more calm, more relaxed, more focused on what was going on in my life, that I could actually do something about, versus sitting on the sidelines of life, commenting as a spectator.

I wasn’t in that brawl anymore — at least, I wasn’t an active spectator in all the brawls.

And it occurs to me, after last weekend’s NFL playoff game, when Stevan Ridley got hammered by Bernard Pollard and ended up not only knocked out, but demonstrating the classic “fencing response” (which is a clear indicator of a traumatic brain injury – follow this link to learn more about it) … and everyone has been putting in their two cents about how “that’s football at its finest” …. “Ridley brought it on himself by A) playing football, and B) lowering his head as he ran” …. “Harbaugh is a jerk for celebrating that injury” … “Pollard is a jerk for carrying on like that after the hit” … and so on… that so many of these folks are sitting on the sidelines, commenting away, without having any sort of skin in the game, without having any sort of knowledge of what’s really going on out there… all safe and sound and protected on their side of the television or computer screen. Precious few of the people talking are actually football players — pro or otherwise — they just watch and cheer and boo and comment. They’re onlookers who feel emboldened by the exploits of “their” teams and somehow feel that entitles them to make comments on the health and well-being and cognitive destiny of the ones who are actually on the field.

It’s all a bunch of posturing, brawling, sniping, snarking… people getting riled for the sake of getting riled, getting all worked up, perhaps because that makes them feel more alive and it gives them something to focus their energy on.

But it’s not real. It’s not really part of their lives. It has nothing to do with their day-to-day, the quality of which very possibly pales in comparison to the feelings they get when they watch football or get on Facebook.  It’s not real life for them in any way — it’s a feeling. It’s not genuine. It’s something that’s invented to entertain and distract people from what’s really happening in life. And the net result, unfortunately, is not something constructive, like added rest and relaxation. If anything, it is the exact opposite — more pain and suffering, masquerading as entertainment and distraction. And then the feeling fades… till everyone gets their next fix.

And that’s exactly the kind of stuff I want to get away from in my life — everyone else can have it. I’m more interested in doing something real with my time and energy. I’d rather be working on my skills and planning my life and be taking constructive steps to making things better for myself and my family and the people I care about, than sitting around sniping at others online, feeling gratified that all my “friends” agree with me.

Anybody can post a comment in a forum. Anybody can share something on Facebook. And it might be entertaining for people. It might be distracting from the pains and confusions of the day-to-day. But it’s not real. And in my experience, it does more to upset and disrupt and annoy and add to the overall discomfort of life, than to relieve any of that. Heck, even the “good” stuff is fluff that flies away on the next strong breeze.

Do I remember the details of any of the stuff I’ve read on Facebook over the past years? Not a heck of a lot. Very, very little, in fact.

But do I remember the feeling I usually get when I go on FB and find people just running their mouths about the crap of the day? Oh, yeah – you betcha. And it’s usually not good.

Life is about choices. And I choose not to bother with Facebook anymore. I also choose to not watch a lot of football, because when TBI actually happens to you — for real — and screws up your life, the sight of people launching themselves at each others’ heads with the intent to do harm, just isn’t much fun.

Well, enough talk. Time to get on with my (real) life. Onward.

Much better now

Is it my imagination, or is the NFL cleaning up its act? I watched Super Bowl XLV (or 45 for those of us using the regular numbering system) last night, keeping an eye out for the kinds of hits that have made headlines lately — and resulted in players being sidelined. I also sorta kinda kept an eye on Aaron Rodgers, whose concussions during the season caused lots of people to question whether or not he’d play.

When all was said and done, the Packers had won handily over the Steelers, and Rodgers was named MVP… which is great news if you’re looking for evidence that concussion isn’t an immediate disqualifier for the rest of the season. Or that having one or more concussions in a season makes you more susceptible to further brain trauma.

A lot of people have a lot of different perspectives. Dr. Mitchel Berger, a member the National Football League’s Head, Neck and Spine Medical Committee and chairman of the department of neurological surgery at the University of California, San Francisco School of Medicine, said of Rodgers after a season of multiple concussions:

“I think his risk is not that significant or greater than if he hadn’t had any this season,” Berger said. “Having had an event a month or six weeks ago, he’s essentially back to baseline, otherwise he wouldn’t have been cleared to play. Once we clear a player to go back, based on the guidelines, that player is clear to go and really doesn’t have any increased risk.”  (Read more: http://www.foxnews.com/health/2011/02/04/concussions-affect-aaron-rodgers-super-bowl-performance/#ixzz1DH4yugP8)

Some would disagree, of course, including those who think that anyone with a concussion needs to sit out an extended period of time. Dr. Bennett Omalu is such a person. He’s got a very different take on how to handle concussions among football players.

Dr. Bennet I. Omalu, the pioneering sport-forensic pathologist who first linked brain damage to tackle football nine years ago, warns that players are dangerously mishandled still—despite official claims this season of “safer” play through rule changes and “concussion management” for the injured.

. . .

Omalu maintains that every concussed football player needs isolation from physical and mental stimulation followed by lengthy rest, further shielding—as he testified one year ago for the House Judiciary Committee. “Two weeks is insufficient time for the recovery of (cerebral) membrane and micro-skeletal injuries caused by concussions. The absence of symptoms does not mean that the brain has healed,” Omalu, chief medical examiner of San Joaquin County, Calif., told congressional members on Feb. 1, 2010.

Two experts, two completely different opinions. Who’s right? Who can tell? But Aaron Rodgers looked much better last night, than he did after he got clocked back in December.

I suppose time will tell, over the long run, if the concussions have impacted Rodgers. For now, though, the Vince Lombardi Trophy is back in Green Bay, and Rodgers is MVP. A multiply concussed MVP, which probably feels like very good news to the NFL. See? Even players who get their bell rung a bunch of times in the season can still outperform the crowd.

Hm.

Well, anyway, I kind of got sidetracked with this whole Super Bowl business. The “much better” topic I wanted to discuss was how much better — and I mean noticeably better — I’ve been in the past few months. I’ve been taking on some pretty significant challenges at work as well as at home, and I’ve been branching out into new areas of my life, meeting new people, doing new things. And enjoying myself. During halftime last night, I was on the phone with a friend who’s going into the hospital for surgery today, and they remarked at how much better I’ve been doing. Noticeably. I told them it was kind of hard for me to remember how things were before, but they echoed my sense that going back and dredging up past evidence of impairment was not the best use of time.

“Just enjoy it,” they told me. “You’ve earned it.”

And earned it, I have.  It’s kind of amazing to me, but I really have made good progress. I’m clearer now, I’m more confident, more focused, more settled. I’m also a lot more stable. The emotions have either chilled out a good deal, or I’ve figured out how to manage my responses to them. I still have my moments, of course, but all in all, I’ve really managed to get my act together in some fundamental ways. There are still times when I don’t recognize myself or people around me — there are times when people who obviously know me come up to me and start talking, and I have no idea who they are. But I hang in there and interact with them as though I know them, and in a few minutes, I figure out who they are. So long as I don’t let things throw me, and I just hang in there, I can make progress — good progress.

Well, speaking of progress, it’s time to get on with my day.

This is better. Much, much better.

 

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

Cheap – and dumb – shots on the ice

This past Sunday, the Boston Bruins’ Marc Savard was blindsided by Matt Cooke. Watch it here:

All the YouTube comments about “If you can’t take a hit, you’re a pussy” and “Canucks are friggin’ animals” notwithstanding, getting hit like this in hockey, as well as other sports, is often part and parcel of the game.

Consider also Mike Richards’ hit on David Booth:

I watched both of these videos last night (which is one of the reasons I didn’t get to sleep at the time I was planning), and I had to wonder — if Cooke and Booth actually knew what they were doing when they drove their shoulders into the unprotected heads of their opponents, would they have done it?

If they’d known that repeat concussions can lead to dementia and Alzheimers… memory loss… broken marriages… domestic violence… lasting loss of balance… and more — sometimes ending in unemployment, homelessness, and suicide… would they have done it? If they’d known that “destroying” someone like that isn’t like breaking their finger — it’s more like cutting it off and mangling the other fingers around it — would they have thought twice? And if their coaches and managers and team owners had the right information and any sense, would they have let them get away with it? Furthermore, would the refs have overlooked it?

I’m not sure people’s brains are working well enough to let them make smart choices, here. I’m not sure, given the culture of hockey, and the tough-guy mystique, there’s any chance for anything other than dumb choices, when it comes to these kinds of sports.

I’m not being down on contact/collision sports players. I was one, myself, once. And I loved it. If I could still do it, I probably would. But there’s a logistical issue here, that has to do with how we’re physically constructed, not how mentally and physically tough we are.

One of the problems I see with contact/collision sports is that traumatic brain injury (which is what a concussion is) can lead to reduced appreciation of risk, poor judgment, lousy planning, increased aggression, and a whole host of other cognitive/behavioral issues which can impair anyone. It’s not only pedestrians walking around in the everyday world after car accidents, assaults, falls, and brain viruses, who suffer the ill-effects. Professional athletes do, too.

And when you play a rough-and-tumble sport that involves repeated impacts, including grade 2 concussions,  as just part of the game, the cumulative effects can be dramatic and quite serious.

Imagine the long-term effects on kids who are taught/allowed to brawl on the ice or on the field, season after season, year after year, from the time they’re old enough to handle a stick or a ball. We don’t know nearly enough about what concussion does to young brains, but it strikes me (so to speak) that engaging in repeated intense shaking of the brain, which severs fragile axons which are essential for clear thinking and responsible functioning, would ultimately produce the kinds of aggressive and downright stupid behaviors we see in the Cookes and Richardses of the sporting world. It’s not their character I’m questioning (though some might). It’s their neurology.

Add to that the fact that players are getting bigger and faster each decade, and the pressures of money and success, that we’re living in a culture of shoot-first-ask-questions-later and bigger-and-badder-is-better, and you’ve got a recipe for a whole lot more Booths and Savards being laid out on the ice — or on the grassy field/floorboards.

Ultimately, what these kinds of incidents tell me, is that the NHL is not doing its job in enforcing rules that keep play from degenerating to a series of full-on assaults over possession of a little round black puck. It’s also doing a piss-poor job of educating its players about the long-term effects of the concussions they dole out to each other. Either that, or it’s breeding numb (if not hateful and bloodthirsty) assailants who don’t give a crap about the long-term consequences of their chosen actions.

According to some definitions, that would qualify as sociopathic behavior.

One of the reasons I’m so pissed off about this is that Richards and Cooke are professionals. They should know better. They can do better. But they didn’t. And somehow, that’s okay. It’s just part of the game. Never mind skills. Never mind sportsmanship. That’s for pussies. It’s much quicker and easier to knock your opponent out with a blindside hit than have to actually play against them. Screw the game. All that matters is the win.

I have to wonder if folks who resort to violence instead of athletic skill are too impaired from their own repeat head traumas to fully grasp the seriousness of what they’re doing.

If that’s the case, then the NHL is really the ultimate culprit in producing what amounts to little more than (briefly) premeditated assault in the name of a “game”.

And the league can thank themselves — in refusing to penalize these kinds of hits — for promoting this kind of behavior in young players, who are too young to know better — and aren’t being taught any different.

Best wishes to Marc Savard and David Booth for full recoveries. Good luck, guys.

The difference between concussion and mild traumatic brain injury

Follow these links for more writing (and thinking) about concussion vs. traumatic brain injury, including the reasons why I believe concussion and brain injury are two separate parts of an ongoing process. I also believe we should stop calling the whole process “concussion” and refer to it as Concussive Brain Injury, or CBI.

I’ve been reading up on University at Buffalo’s work with concussion rehabilitation, using regulated exercise to deal with post-concussive syndrome (or post-concussion syndrome).

I have to say, it’s probably the most exciting news I’ve come across in a while. With all the talk about the NFL’s new post-concussion guidelines (which may or may not make a difference), and the increasing awareness about head injuries, expecially mild traumatic brain injuries (MTBI), it gets a little depressing, thinking about all the people who are getting hit in the head and suffering for years as a result.

A lot of folks are talking about it being an epidemic, that concussions are no joking matter, and lots of people are getting on the helmet bandwagon (especially since Natasha Richardson died from a brain injury while skiing). Prevention is great. But concussion is all but unavoidable in sports — especially student athletics. It happens. All the time. Yet nobody seems to have come up with a reliable way of addressing it when it does happen. Aside from bed rest and taking it easy, suggests for howto deal with concussions/brain injury are few and far between.

We know concussions happen. We know head injuries are common. We know they can have serious long-term consequences. You can try to prevent them, but you can’t be successful 100% of the time. And if you do have a head injury, you have to be sidelined from your life/sport, with no guarantee that the “treatment” will actually work.

I was starting to get seriously depressed.

Then, suddenly, I was looking around the other day and I found that the University at Buffalo has been working with regulated exercise to treat — even heal — the after-effects of concussion. Post-concussive syndrome is, according to the definitions of Willer and Leddy (at UB),  “persistent symptoms of concussion past the period when the individual should have recovered (3 weeks)”. According to them, post-concussive syndrome “qualifies as mTBI.”

This is interesting. I have heard a lot of people say that concussion is an mTBI, and the two are interchangeable. I am not a doctor, and I don’t have medical training, so I can’t throw my hat in the ring on that debate. But it is interesting to me, that people distinguish between the two.

At the UB web page on concussion research, there are some interesting papers, and they do talk about the difference between concussion and mild TBI.

Here’s what they have to say in the paper Retest Reliability in Adolescents of a Computerized Neuropsychological Battery used to Assess Recovery from Concussion (bold is mine)

A recent review … of concussion and post concussion  syndrome provided a model for distinguishing concussion from mild traumatic brain injury (mTBI) and post concussion syndrome (PCS). The model uses the most commonly accepted definition of mTBI and the one proposed by the American Congress of Rehabilitation Medicine and the Centers for Disease Control: loss of consciousness for no more than 30 minutes or amnesia as a result of a mechanical force to the head, and a Glasgow Coma Score (GCS) of 13 to 15 …. The model also uses the most commonly accepted definition of concussion as established by the American Academy of Neurology (AAN): a trauma induced alteration of mental status that may or may not involve loss of consciousness …. Although not explicitly stated in the AAN definition, concussion is generally viewed as a transient state from which the individual will recover fully in a relatively short period of time …. In contrast, mTBI is viewed as a permanent alteration of brain function even though the individual with mTBI may appear asymptomatic. Post concussion syndrome was defined in the Willer and Leddy … model as persistent symptoms of concussion past the period when the individual should have recovered (3 weeks) and therefore qualifies as mTBI. Neuropsychological testing is often used to describe the impairment associated with mTBI and PCS and have done so with relative success ….

So, basically,

  • mTBI = a loss of consciousness for no more than 30 minutes or amnesia as a result of a mechanical force to the head, and a Glasgow Coma Score (GCS) of 13 to 15
  • Concussion = a trauma induced alteration of mental status that may or may not involve loss of consciousness; it’s a transient state from which the individual will recover fully in a relatively short period of time
  • Post concussion syndrome (PCS) = persistent symptoms of concussion past the period when the individual should have recovered (3 weeks)
  • PCS, due to its enduring nature, qualifies as mTBI

(Note: I think someone needs to fill in the gap about how PCS satisfies the criteria for mTBI,  if they require that there be some loss of consciousness or amnesia involved. How lasting effects qualifies based on these criteria puzzles me. But for the purposes of this discussion, I’ll let this slide.)

I find this really compelling information, and it helps me make more sense of the whole “concussion thing”. I know I’ve sustained a bunch of concussions in the course of my life, and I also know that I have been diagnosed with “Late effect of intracranial injury.” But I could never really distinguish between the mTBI vs. concussion. I actually thought — and had been told — that they’re the same thing.

But that never made much sense to me, because when I look around at me, and I read that “An estimated ten percent of all athletes participating in contact sports suffer a concussion each season” And that’s just athletes. Plenty of people fall down, too, or are in car accidents. I’m not entirely sure what to make of it. Apparently, hundreds of thousands of people sustain concussions each year, yet the general population doesn’t appear to be completely crippled by TBI (though some people I know would debate that 😉 ) How is it possible, that so many people are sustaining concussions, especially in their youth and/or in sports, yet we’re not all running around impaired?

Making the distinction between a concussion that is transient, and a concussion that turns into an mTBI makes all the sense in the world to me. It makes it possible distinguish between someone who’s experiencing short-term issues, and someone who needs to deal with a broader-spectrum and deeper set of challenges. And in doing so, it de-stigmatizes concussion (at least in my mind), by steering clear of the “concussion = brain injury = brain damage” concept, which could be quite debilitating to a youth who has hit their head while playing a sport they love.

There are tons of potential ramifications and implications from being able to state that concussion is not necessarily an enduring brain injury. I may write more about this later, but it requires more thought.

The other very hopeful piece of this is that, by saying concussion is not always followed by brain injury, you’re opening a window to addressing concussions promptly so they do not turn into mild traumatic brain injuries. This, to me, is key. It not only makes sense of the two different kinds of injuries, but it also establishes that it may in fact be possible to treat the concussion to prevent it from becoming a more serious, long-term injury — the “gift” that keeps on giving. And by understanding concussion and brain injury this way, you also up the ante and really infuse the topic of prompt treatment with urgency. If acting promptly to address concussion makes it possible to avoid a lasting brain injury, then it’s in everyone’s best interest to become familiar with and properly trained in the recognition and treatment of concussion.

In this case, if mTBI is only present if concussion symptoms persist, and there’s no guarantee that concussion will result in a lasting brain injury, then prompt recognition and action may save the day.

Now, I’m still noodling over the idea that subconcussive impacts can seriously affect the brain over the long term, which Malcom Gladwell talked about in his article “Offensive Play“. But I am still hopeful. Because while subconcussive impacts may affect the brain, it could be that the damage takes place when no action is taken to address the injuries when they happen. Again, I’m not a doctor or a qualified medical professional, but it seems to me that if actively treating concussion helps with the really obvious issues — as the University at Buffalo has shown it does (albeit on a fairly limited scale) — then it might just help repair lesser damage done.

It might. I only wish I had the medical and scientific background and credentials to be able to speak as an expert on this. But apparently expertise is no guarantee of being able to help out, when it comes to TBI. The vast majority of experts haven’t had the wherewithall to state definitively what can actually be done about brain injuries, let alone recommend specific action that works, and there are thousands upon thousands, if not millions, of people suffering, day in and day out (along with their loved ones and co-workers) with the after-effects of concussion and mild traumatic brain injury.

So, somebody’s got to take the lead in finding a solution… Or at the very least think about finding one. The folks in Buffalo are up to wonderful work, and I can only hope that more folks have the gumption to take their lead and do something about this wretched hidden epidemic of ours.

Now, I’m off to address my own issues of the day.

New NFL concussion guidelines

The NFL has recently released new stricter concussion guidelines.

The new policy states, in part: “Once removed for the duration of a practice or game, the player should not be considered for return-to-football activities until he is fully asymptotic, both at rest and after exertion, has a normal neurological examination, normal neuropsychological testing, and has been cleared to return by both his team physician(s) and the independent neurological consultant.”

This could be a really good thing.

I hope.

After creating memories, will NFL stars recall them?

The Minneapolis Star Tribune recently ran this story:

By RACHEL BLOUNT, Star Tribune

New evidence discovered by the Sports Legacy Institute shows that the repetitive head trauma suffered by football players often results in a brain disease called CTE.

Sunday’s Super Bowl created some of the most indelible memories in the game’s recent history. Years from now, fans will be recalling Santonio Holmes’ balletic touchdown catch and James Harrison’s roaring 100-yard interception return.

Whether the players will remember is a different story. Early last week, while the Super Bowl hype machine cranked out its usual merriment, the Sports Legacy Institute held a small press conference in a quieter corner of Tampa, Fla. The group, dedicated to studying head injuries in sports, unveiled new evidence that NFL players are at risk of developing serious brain damage from the effects of repeated head trauma.

In one sense, this hardly seems like news. With ever bigger, faster players crashing into each other Sunday after Sunday, with fans clamoring for tooth-rattling hits they can replay on YouTube, semi-regulated violence remains the cornerstone of football’s allure. But as we learn more about the alarming toll the game takes on its players, the NFL has been slow to act — leaving it to guys like Chris Nowinski to ferret out the truth.

“People are not taking this seriously enough by a long shot,” said Nowinski, president of the Sports Legacy Institute. “Active players don’t want to talk about it. They have a short window of time to make money in the game, and they don’t want to think what happens to the brain when they run into a 300-pound man at 20 miles per hour. And the NFL’s research is borderline pathetic.

“Our ultimate goal would be for nobody to develop [the brain disease] CTE, to figure out how to prevent and treat it. Our initial goal is just to give people a choice. Nobody knew that multiple concussions would lead to this.”

CTE stands for chronic traumatic encephalopathy. It used to be called dementia pugilistica, because it was primarily seen in boxers who had taken too many blows to the head.

Continue reading the article here…

I’m really happy to see people talking about this so frankly. I, myself, was one of those “jocks” in my youth who took a lot of hits and got up slowly afterwards… felt punchy and dull and foggy and “off”… but still had to get back in the game.

Now, years later, after lots of re-injury — thanks at least in part to my diminished risk-assessment skills — my life is harder going than it probably needs to be.

Everyone has problems, certainly, and I cannot use my injuries as an excuse to avoid living life to the best of my ability. But if you walk out in the rain without an umbrella, you can expect to get wet. And if the weather is cold and it’s flu season and you’re in the habit of shaking hands with sick people and then rubbing your eyes, getting sick is something you can reasonably expect to happen.

You can’t avoid every mishap on the face of the planet, but if you know that something has inherent dangers, it’s not unreasonable to seek to avoid it — or at least plan for what to do, in the event of a mishap.