According to an article in Bike World News, two major cycling organizations have jointly released recommendations for how to treat cyclists who have sustained head trauma.

Medicine of Cycling, an independent group of physicians and psychologists working to improve processes that can have a meaningful impact on the way care is delivered to cycling athletes, recently formed the Medicine of Cycling Concussion Task Force which aims to increase awareness of concussion and improve safety for cycling athletes. The guidelines pertain to adult athletes only, as younger riders are even more vulnerable to brain injury. These guidelines are intended to educate cycling team managers, coaches and athletes on the symptoms and management of concussion in athletes. The guidelines are not a surrogate for evaluations by appropriately trained medical professionals.

The guidelines include actions to take in the pre-season, how to evaluate for concussion after a head injury, and considerations for returning to cycling after a concussion.

If you are a serious cyclist—especially if you are a member of a cycling team—you need to read these concussion guidelines so that you, team coaches, and teammates are all on the same page when it comes to head injury.

Ride like the wind… but stay safe!

P.S.  If you would like to join the HensonFuerst Cycling Team, we are adding new riders to our group. We ride for fun, and for community support, fundraising for health organizations, and disease awareness. Cyclists of all skill levels are welcome.

RESOURCES

To read the full article in Bike World News, click here:  Medicine of Cycling releases concussion guidelines

To read the concussion guidelines, click here:  Concussions in Cyclists

Can motherhood cause brain injury?   Yes… indirectly.

An article in the Deseret News recounts the experience of mom Erin Stewart, whose preschooler gave her a concussion:

Motherhood is rough. I’m not talking about emotions here. I’m talking physically rough. I’m talking just-got-back-from-the-doctor-with-a-minor-concussion rough. Seriously. My preschooler gave me a concussion.

In what will forever be known in our family as the day mom officially became a wimp, my 4-year-old daughter slammed her head into the back of mine. She was fine; I screamed in pain. A week of headaches later, I went to the doctor (despite my husband’s mockery) and was told I likely have a concussion.

This article is humorously written, but also educational. Concussions don’t just happen to football or hockey players, skateboarders, or daredevils. Concussions also happen to moms… or grandpas… or anyone who has a brain. All it takes is a blow to the head, even if the blow is delivered by a little girl.

Where Erin was mistaken—and where the article fails—was when she waited a week to seek treatment for her constant headaches. (All the worse if she really delayed her visit to the doctor for fear of more mockery from her husband.)

A concussion is also known as mild traumatic brain injury (MTBI). While the symptoms are often mild and temporary, some concussions are serious. Depending on the exact nature of the injury, the symptoms of concussion can last many long months.  After multiple concussions, some people can develop permanent, debilitating neurologic symptoms that mimic Lou Gehrig’s disease.

So, read this article for the humor Ms. Stewart intends, but keep in mind it’s lesson, also:  Concussions can happen to anyone, and often occur when we least expect it. And sometimes they are caused by cute little girls.

At about 2:00 pm, second grade student Michael Rodriguez slipped on some water at school and hit his head. By 6:00 pm, his mom was rushing him to the hospital. The basic story is simple, but the lessons are in the details.

According to a Texas-based news source, VictoriaAdvocate.com, by the time 7-year-old Michael got proper medical care, he was screaming “My brain hurts…I’m going to throw up.” After a CT scan, he was diagnosed with a skull fracture and contusion.

Michael’s mom, Michelle Robinson, who also has three other children reported that she had had previous difficulty communicating with the school nurse about her kids’ medical problems. According to VictoriaAdvocate.com:

“I personally went to the office and told her, ‘I don’t care if it’s something as little as a cut on his knee, I want to know,’” Robinson said. “At that time, she pulled all my kids’ emergency medical cards and wrote on there in red pen, ‘Call mom for anything.’ She led me to believe that communication was going to be better.”

Robinson did not receive a phone call about her son’s afternoon head bump.

The issues raised involved the nurse’s qualifications (the school said that the nurse was certified as a “licensed vocational nurse” who was in her first year with the school); the nurse’s treatment of Michael (the nurse’s clinic notes indicate he was treated for about a minute, and the child was sent back to class with just an ice pack); and protocol for head injury (standard protocol involves monitoring a student for 20 minutes to watch for symptoms of slurred speech, blurred vision, headache, etc.).

“What if it happens again? What if it happens to another child, and it’s worse next time? I will be more than happy to use my son as an example and do something to reprimand this nurse, or it can happen again,” Robinson said.

It is frightening to think how easily a slip can change from a “bump” to a skull fracture.

While there is no way to prevent all accidents, there are some tips provided by Dr. Jeffrey Lehman, Director of the Huff & Puff Allergy and Asthma program at St. John’s Children’s Hospital (on FoxIllinois.com) about how to ensure that your child receives the best care possible in school:

• If your child needs specialized treatment, make sure the school’s staff knows how to administer medications and other treatments;
• For chronic medical problems, provide the school with a personalized management plan to take the place of the school’s standard plan;
• Give the school a recent photo of your child to include in the child’s medical file, as well as up-to-the minute contact information for you and any other emergency contacts.
• Ask about the school’s protocol for dealing with common injuries, including falls and head bumps. Make sure you understand exactly what will happen if your child is injured.
• And even though it didn’t work for Michael’s mom, ask to have the school contact you anytime your child visits the school nurse.

To read the full story on VictoriaAdvocate.com, click here:   7-year-old Suffers Skull Fracture

This feels like a win for everyone in North Carolina, and for everyone who loves an individual with traumatic brain injury (TBI):

Kevin Guskiewicz, Ph.D., works at the University of North Carolina, Chapel Hill in the UNC Injury Prevention Research Center. Through is research, he has made strides in the diagnosis, treatment and prevention of sports-related concussions. According to an article in the News & Observer, Dr. Guskiewicz, 45, said he wants to use some of the grant money to develop rehabilitation plans for athletes and soldiers who suffer concussions. The foundation noted Guskiewicz’s combination of laboratory and in-the-field investigations to further his research.

Based on the idea that balance and posture can help to evaluate concussions objectively, his diagnosis and rehabilitation system uses a symptom checklist as well as an inexpensive device made of foam and a stopwatch. According to an article in The New York Times:

Acknowledging that his work has the potential to save lives, Mr. Guskiewicz said he was still “floored, surprised and honored, all at the same time,” by the MacArthur grant.

Congratulations, Dr. Guskiewicz!
To read the full article in The New York Times, click here:  MacArthur Foundation Selects 22 ‘Geniuses’

To read the full article in the News & Observer, click here:  http://www.newsobserver.com/2011/09/20/1503230/macarthur-foundation-reveals-2011.html#ixzz1YVMuEd1h

In Canada, kids pick up an ice hockey stick about the same time American kids pick up a Wiffle ball bat. They get their first pair of ice skates not long after they start walking. From Vancouver to Nova Scotia, Winnipeg to Yellowknife, hockey is the national sport of our northern neighbor.

So you can only imagine the guts it took for Jack Todd, the famous sports columnist writing in the Montreal Gazette, to suggest an outright ban on fighting in the National Hockey League (NHL). In his own words:

Enough is enough. It’s time to outlaw fighting in hockey, to put an end to the game’s goon culture for once and for all…. The toll fighting takes on the fighters is too great. The stress is too much, the constant pain, the accumulated affects of too many punches, too many painkillers, too much alcohol mixed with the painkillers.

The article comes on the heels of the death of 35-year-old Wade Belak, a former hockey enforcer who just retired in March. He committed suicide August 31, 2011, in a hotel room in Toronto, where he was preparing for a TV reality show called “Battle of the Blades.” Belak’s death has raised more questions about the possible effects of chronic traumatic encephalopathy (CTE)—a degenerative brain disease linked with repeated hard hits. According to an article on MercuryNews.com:

“We’ll never know with any certainty when someone commits suicide whether CTE played a role,” said Dr. Robert Cantu, a prominent neurosurgeon who is co-director of the Center for the Study of Traumatic Encephalopathy at Boston University’s School of Medicine. “We do know CTE attacks the portion of the brain that controls functions of memory, emotion, addictive behavior and impulse control, the latter associated with suicide. And so we’re clear, in some cases the people involved may well have had emotional issues before its onset. But every time I read or hear about these tragedies, my first question is, ‘Did CTE play a role?’ “

Belak’s death was the third in this recent post-season. About two weeks earlier, 27-year-old Rick Rypien was found dead in his home. And four months before Belak killed himself, 28-year-old hockey player Derek Boogaard died from an accidental overdose of the narcotic painkiller oxycodone and alcohol. Dr. Cantu’s group is now studying Boogaard’s brain.

“There’s no way to know how much was damage caused by fighting as opposed to hits to the head sustained in the normal course of playing the game. Personally, though, I suspect it’s caused more by fighting,” Cantu said. “In my practice, when I’ve studied ‘enforcer-type’ guys and we discuss fights, they say roughly one in four times they get concussed. But they never bring it to the trainer’s attention. They just go to the box and try to recover enough to make it back to the bench when the penalty’s over. It’s the code. They’re afraid if they admit it, they’ll be out of a job.”

There are a growing number of people who believe that the deaths of these three young men should be a call to arms…or rather, a call to lay down arms. To remove fights from the hockey equation. To get rid of the goon squads.

On the other side of the proverbial table are the fight proponents, who believe that the passion of hockey requires that the passion be expressed in battle, and battering. But, as Jack Todd says, Football is also fast, passionate, and violent, but fighting is not allowed on the gridiron. And he continues:

As long as the NHL permits fighting, it will be a bit bushleague, with one skate in the big-time and the other firmly planted in roller derby. The league is growing up in the way it is beginning to deal in a meaningful way with concussions and the awful toll they take on its talent. (You need look no further than the probable end of Marc Savard’s career to know how serious the concussion issue is.)

Now it’s time to move on and to put an end to fighting. Call it the Wade Belak Rule if you like. If his death can help bring about an end to fighting in the NHL, then something good might come of what is otherwise a senseless, heartbending tragedy, the death of a father of two young girls at a time that should have been the prime of his life.

Here’s to the Wade Belak Rule. Let’s hope the owners, fans, and players find a way to make this happen.

RESOURCES

To read the full article in the Gazette, click here:  The NHL must ban fighting

To read the full article on the MercuryNews.com, click here:  Questions linger over recent deaths of three NHL enforcers

To read the article about Wade Belak, click here:  Wade Belak Found Dead

One of the most common and persistent symptoms of traumatic brain injury (TBI) is fatigue. While the debilitating nature of the fatigue may lessen over time, some fatigue can be expected for years…if not a lifetime. Now, Australian researchers report that sitting in front of a light box for 45 minutes a day may help to reduce fatigue in patients with TBI.

According to the Traumatic Brain Injury Survival Guide, by Dr. Glen Johnson, the fatigue after TBI can affect both mental and physical performance. Physical fatigue is most pronounced immediately after the brain injury—it takes effort to relearn how to coordinate muscles and build up strength after such a devastating injury. Worse is the mental fatigue, the type that can wipe you out after an hour of balancing the checkbook. It tends to go on for long periods of time.

Think of owning a car that you can only fill with half a tank of gas. You can now only go half as far as you used to. When you run out of gas, the engine stops. With mental fatigue, it’s as if the brain runs out of chemicals and just shuts down.

That’s why this preliminary study is so exciting.

Light therapy has been used for decades to treat depression caused by seasonal affective disorder (SAD). When sitting in front of a light box (using special light bulbs, not the usual lamp bulbs), the light can stimulate changes to hormones in the brain, resetting the body’s circadian rhythms.

According to an article in the Brisbane Times, people with fatigue from head injuries felt more alert and performed daily tasks more easily after using short-wavelength light therapy. In addition, tests showed that patients had better sleep patterns, shorter reaction times, and lower levels of depression and anxiety. The treatment consisted of sitting in front of a light box for 45 minutes, within 90 minutes of waking up.

Professor Jennie Ponsford [professor of neuropsychology at Monash University] said one participant, an academic with a mild head injury who had been struggling to function in a high-powered job, found the treatment had transformed his ability to work.

”People getting the [short wavelength light] therapy are coming back and saying, ‘I want one of these boxes’. I must say I was very sceptical about the whole thing, it sounds a bit out there, but I really think it works,” she said.

The full results of the study are not in—in fact, only 30 of a total of 90 patients have been tested—but the initial results are exciting, indeed. It is a simple treatment that anyone could have, without a prescription and without great expense.

We will keep you informed of all developments, including the full report once the study has been completed.

To read the full article in the Brisbane Times, click here:  http://www.brisbanetimes.com.au/world/science/light-box-could-be-breakthrough-in-treatment-of-brain-injury-fatigue-20110807-1ihj8.html#ixzz1VVbDK7NV

On July 28, 2011, Northwestern Medicine in Chicago hosted a concussion symposium called “Playing It Safe: Changing the Mindset Around Concussion Safety.”  And a few top-notch physicians were on hand to talk about the effects of concussion.

Concussions are in the news every week these days. Former pro football players are suing the NFL, claiming that they were never warned of the dangerous, sometimes life-threatening effects of concussion. New helmets are being developed to protect brains better after hard hits. And coaches and players alike are receiving training in how to recognize and treat head injuries.

Concussions can happen anytime there is a blow to the head, causing a jarring or shaking that disturbs brain function.

“The brain is like jello, when jello is impacted it’s going to move within the bowl. The same thing applies for a brain; even if it’s the slightest impact the brain is affected,” said Carrie Jaworski, MD, head team physician for Northwestern University Athletics.

It’s easy to see why prevention and protection are so important—imagine trying to use a helmet to protect a bowl of Jell-O. Even the best helmet won’t keep the Jell-O from getting shaken up. And without a helmet, impacts can do even greater damage. Football players’ heads have at least some protection from those giant helmets; gymnasts’ and cheerleaders’ heads do not.

“Concussions aren’t discriminatory; they affect people of all ages and all activities, even in non-contact sports such as gymnastics or cheerleading,” said Hunt Batjer, MD, chair of the department of neurological surgery at Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine. “In fact, young girls may be at a higher risk than boys when it comes to concussions.”

Tips From the Concussion Symposium

Along with the usual academic discussions, the symposium provided some useful tips, too. Some of the information you may find helpful:

• Black outs. You don’t have to black out to have a serious concussion. In fact, most concussions don’t result in any black out, of any length.
• Game-specific signs of concussion. We know the general symptoms of dizziness, confusion, etc. But doctors at the symposium gave specific signs to watch for, which include appearing dazed or stunned; confusion about an assignment or position; forgetting a play; uncertainty of game, score, or opponent; moving clumsily; answering questions slowly; losing consciousness (even briefly); behavior or personality changes; and the inability to recall events before or after a hit or fall.

“If an outgoing and boisterous athlete on your team suddenly becomes quiet or withdrawn, this is a cue that the player needs to be taken out and evaluated. The signs can be very subtle, but if you feel like something is wrong, you need to assume it is,” said Adam Bennett, MD, sports medicine physician at Northwestern Memorial and assistant professor of family and community medicine at the Feinberg School.

• Second Impact Syndrome. Athletes who resume playing too soon after a concussion are at a greater risk for second impact syndrome, which can cause the brain to swell rapidly—a serious medical emergency. This occurs when a second head injury happens before the child recovers from the first concussion. Because the second hit happens when the brain is still injured, it is more vulnerable to additional injury…perhaps permanent, serious, irreversible injury.
• Encourage open dialog. Players need to know that talking about their symptoms is “safe”—that they will be respected for being open about their injury, and rewarded for taking time to heal. According to Dr. Batier:  “Players can shake off pain in the leg, but they should understand that they should never shake off a head injury.”
• Sidelining players. All players need to be sidelined until all symptoms have disappeared—that means not only the obvious physical symptoms of headache or blurred vision, but also normal concentration and resuming normal patterns of eating and sleeping. This could take three weeks…it could take three months or longer. For coaches and parents of youth athletes, this translates to a simple rule:  When in doubt, sit them out.

Also highlighted at the symposium were concussion war stories, such as this one from former football great Dan Hampton, from his years playing professional sports:

“I played during what I call the ‘crash-test for dummies’ period. Players would get hit so hard they wouldn’t even know how to walk off the field,” said Hampton. “I wish these discussions happened back when I played. Today most people are aware of the effects of a concussion, that wasn’t the case when I played.”

We have been writing a lot about how sports participation can increase the risk of traumatic brain injury (TBI).  Now, new research sheds some light on the causes of  TBI in the workplace.

ScienceDaily reports on an article published in the American Journal of Preventive Medicine about the causes and trends of fatal TBI in the United States between 2003 and 2008. The goal of the research is to identify the areas that could benefit from preventive efforts.

“While TBI is an important topic for public health researchers, there has been a lack of attention paid to the investigation of brain injuries occurring in the workplace,” commented lead investigator Hope M. Tiesman, PhD…. “With limited resources available for occupational safety and health programs, the identification and targeting of high-risk populations, including older workers, should be a priority for industry.”

The analysis showed that some jobs are definitely more hazardous than others. Nearly half of all fatal traumatic brain injuries occurred in a handful of industries: construction, transportation, agriculture, forestry (including logging), and fishing. The fatalities happened as the result of motor vehicle accidents (31%), falls (29%), assaults and violent acts (20%), and contact with objects or equipment (18%).

While motor vehicle wrecks still account for the most cases of TBI, that is actually changing. According to ScienceDaily:

The authors also found that the leading cause of fatalities has recently shifted from motor vehicle to falls. This change mirrored changes seen in overall TBI fatality rates. This effect may also be related to the “graying” of the American workforce, with employment of workers 65 and over increased by 101% from 1977 and 2007. These older workers are more susceptible to falls.

And one bit of good news in the data also appeared: Over the course of the 6-year study, occupational deaths from TBI declined by 23%.  That dry statistic equates to lives saved…and that’s always good news!

His career is not well known here in the United States, but his pain may someday have an effect on the treatment of sports head injuries. Last Friday (July 8, 2011) Canadian Football Hall of Famer Matt Dunigan gave an emotional televised interview about his personal fight with post-concussion syndrome. The story was reported on the Canadian television station TSN.

Fifteen years after retiring from the Canadian Football League (CFL), Dunigan is still waiting for the clouds to lift from the 12 diagnosed concussions that he sustained over the course of his career as a superstar quarterback.

“He forgot how to laugh.  He didn’t think anything was funny anymore,” explains Kathy [his partner of nearly 30 years]. “Physically he had really bad headaches and he had ghost spots over his eyes.”

Dunigan’s concussions also deeply affected the life of his youngest son, Dolan. At age 14, Dolan was a promising quarterback himself. But after the child’s third sports-related concussion, Dunigan pulled him out of football. It was a difficult decision, affecting the boy’s future career and well-being.

“Just watching him and hearing stories about how good he was in the CFL, I wanted to be just like him,” says Dolan about his father. “It was almost impossible to give [football] up but it was probably the best decision he made for me.”

And, like many American football players, Dunigan has made arrangements to donate his brain to concussion research, with the hope of advancing science and treatment of brain injuries.

This is the kind of story no one wants to report. We believe and defend everyone’s right to free speech and beliefs. This story is nothing but tragic. But sometimes, out of tragedy and sadness, lessons can be learned.

On July 4, 2011, ABC World News reported that Philip A. Contos, 55, died while participating in a ride with 550 other motorcyclists to protest the state’s mandatory helmet law. With so many witnesses, the details are clear: Contos hit the brakes, and his Harley Davidson motorcycle fishtailed. He was thrown over the handlebars, hit his head on the pavement, and was pronounced dead at the hospital. According to a State Trooper interviewed by ABC News:

“The medical expert we discussed the case with who pronounced him [Contos] deceased stated that he would’ve no doubt survived the accident had he been wearing a helmet,” state Trooper Jack Keller told ABC News 9 in Syracuse. [ABC World News]

The rally rid was sponsored by ABATE–American Bikers Aimed Toward Education. Their goal is to promote motorcycle awareness and freedom. Despite the death, ABATE still supports the repeal of helmet laws. According to the ABATE of New York website:

“Mandatory helmet laws do nothing to prevent accidents. The decision on when to wear a helmet while operating a motorcycle should remain with each responsible adult rider.”

It is true that wearing a helmet does nothing to prevent accidents. However, it is also true that in the event of an accident, a biker wearing a helmet is more likely to survive a head injury, and will have less brain injury than a biker not wearing a helmet. It’s like saying steel-toed shoes won’t prevent warehouse accidents–true, but they will protect your toes should something fall on your foot.

According to a recent report by the Insurance Journal, Delaware (the only state included in the report) saw deaths from motorcycle crashes increase by more than 300% in the past year, compared with the previous year. Of those deaths, 80% occurred when riders were not wearing helmets.

At HensonFuerst, we have seen the aftermath of severe head and brain injury caused by auto and motorcycle wrecks, and we have represented and consoled many families grieving the loss of a loved one. From our perspective, helmet laws are in place to protect people who might be too short-sighted to recognize the physical damage that can occur after just a split second of poor judgment…or after another motorist causes an accident…or when road conditions become treacherous.

We’re not saying motorcyclists are unsafe–some of the bikers we know are better and safer on the road than many car drivers. We’re saying that protections are needed so that everyone stays as healthy and intact as possible should the worst occur.

To read more about motor vehicle safety, please feel free to visit our website at http://www.lawmed.com/.  If you have questions, HensonFuerst has answers.