This is a story about athletes and concussions.

When you read that sentence, what picture popped into your mind:  250-pound football players… or 10-year-old girls with ponytails?  According to research published in The American Journal of Sports Medicine, the severity of symptoms after a concussion is–in part–dependent on the age and gender of the patient. Girls and young women suffer worse symptoms than men, and young people suffer more than older people.

The study tested young athletes for balance and verbal and visual memory. Researchers tracked the athletes for two years. In that time, about 300 of the athletes received a concussion and were tested again. Results showed that high school athletes performed worse for their age than college-aged athletes, and that female athletes with concussion had more symptoms and worse visual memory than male athletes with concussion. In addition, symptoms lasted longer in younger athletes than in older athletes.

According to an article in The New York Times:

The findings suggest that because of anatomical differences that make them more vulnerable, female athletes, and younger athletes in particular, may need to be managed more cautiously after a concussion, said Tracey Covassin, an associate professor of kinesiology at Michigan State University and the lead author of the report.

“Parents need to understand that if their daughter has a concussion, that they may potentially take longer to recover from that concussion than their son who is a football player,” she said.

Experts think that younger brains suffer greater damage from concussion because they haven’t fully developed…and because we tend to treat them as miniature adults when it comes to sports and expectations. According to Mark Hyman, author of “Until It Hurts: America’s Obsession With Youth Sports and How It Harms Our Kids” (Beacon Press, 2009):

“The brain and head of a small child are disproportionately large for the rest of the body,” he said. “The result is that their heads are not as steady on their shoulders. When they take a big hit in a football game or are slammed with an elbow in a soccer game, their brains move inside their skulls. That’s when concussions occur.”

RESOURCES

To read an abstract of the article in The American Journal of Sports Medicine, click here:  The role of age and sex in symptoms after concussion

To read the full article in The New York Times, click here:  Concussions May Be More Severe in Girls and Young Athletes

New Orleans Saints coach Payton with quarterback Drew Brees; REUTERS/Robert Galbraith

About 18 months ago, we wrote with great excitement about the National Football League (NFL) and the new attention they were bringing to the crisis of concussion. The 2010 football season began with new concussion awareness posters in the locker rooms. As quoted in The New York Times, the Baltimore Ravens’ center, Matt Birk, said:

“To put it out there in writing in locker rooms, at least it’s publicly acknowledging that, ‘Hey, this is real.’ There’s risks in everything you do, and this one is real. You can’t sweep it under the rug anymore.

Unfortunately, there didn’t seem to be much change in the culture of the sport: Players were not removed from play after either giving or receiving hard head hits—the kind that are likely to cause concussion. The concussion prevention program was little more than words on a page, talk with no back-up action.

Now, a new scandal has rocked the NFL, and this one is difficult to understand, under any circumstance.

An investigation has revealed a “Pay for Pain” bounty program in the New Orleans Saints. Head coach Sean Payton and general manager Micky Loomis have taken full responsibility. According to a Reuters news article, under the bounty program, players were reported with payments of thousands of dollars for hard hits that knocked opponents out of games. Supposedly, players were paid $1,000 for a “knockout hit” and another $1,000 if a player were to be carried off the field.

The program was administered by former Saints defensive coordinator Gregg Williams, who issued a statement acknowledging his involvement:

“It was a terrible mistake, and we knew it was wrong while we were doing it. Instead of getting caught up in it, I should have stopped it,” said Williams. “I take full responsibility for my role. I am truly sorry. I have learned a hard lesson and I guarantee that I will never participate in or allow this kind of activity to happen again.”

This seems like quite a cold-blooded apology for such a heinous and injurious program. Oops, sorry, won’t do it again. Perhaps he and everyone else who actively or passively condoned this program shouldn’t be allowed a chance to do it again…perhaps they should lose their jobs…perhaps they should pay restitution of some sort to the players who were seriously injured by this program.

As Charles P. Pierce wrote on the website Grantland.com:

“What we shave here now is the face of organized savagery, plain and simple…. These events were not incidental to the playing of the game. They were an essential part of it. The players who participated in the program did not do so accidentally. The coaches who designed the program did not do it without knowing full well what it entailed, including the possibility of retaliation if the story ever got out, and a subsequent football arms race that would end up with someone dead on the field.

How much violence and physical damage is too much before we start to realize that our national pastime needs to change the unwritten rules of the game? We have a crisis of concussion… players dying young due to chronic traumatic encephalopathy (CTE) and dementia… players committing suicide as they experience catastrophic declines in their physical and mental health… and now aggression bounties. As Mr. Pierce wrote:

Gradually, football has seen its appeal slip at the most basic levels. Pediatricians are advising parents not to let young children play organized football too early in life. Local high schools are looking at skyrocketing insurance rates and wondering, in a time when school budgets are being squeezed to a pulp all over the country, whether this particular game is worth the candle. Major college programs have all the economic problems present in the high schools combined with all the workplace-safety issues with which the NFL is grappling. Football may be losing some of what once appeared to be its unbreakable purchase on the country’s soul.

I’ve always been one of those people who cringe and look away when aggressive football hits are replayed in slow motion, so maybe I’m out of touch with what football fans are willing to bear. But I’ll never again be able to enjoy the pure sport of football without wondering exactly what nefarious plays are being planned in the huddle or the locker room. And I’ll never be able to assume that any on-the-field injury was due to an accident, rather than a calculated hit.

And maybe it’s time for the New Orleans team to change its name. “The Saints” just doesn’t seem to fit anymore.

RESOURCES

To read the full Reuters article, click here:  Saints coach and GM take blame for bounties

To read the full article on Grantland.com, click here: The Saints, Head-hunting, and (Another) Disaster for the NFL

To read more about the scandal on ESPN, click here:  Saints coach, GM sorry for bounties

What survives of a marriage when a spouse suffers brain injury?

According to an article in The New York Times, that’s the question being investigated by Dr. Jeffrey S. Kreutzer and other psychologists at Virginia Commonwealth University (V.C.U.) in Richmond. In addition, the psychologists are working to develop marriage counseling techniques for affected couples.

According to a 2007 article published in the journal NeuroRehabilitation, when a spouse suffers a brain injury, the risk of divorce is surprisingly low—approximately 17 percent. Well below the national average for uninjured couples. But the statistic may not be an accurate reflection of the health of the marriages—the couples aren’t necessarily happy. According to Dr. Kreutzer: “While people may technically be married, the quality of their relationship has been seriously diminished.” According to The New York Times:

Dr. Kreutzer and other psychologists at V.C.U. are among the few therapists in the country trying to develop marriage counseling techniques tailored to couples dealing with brain injuries. Traditional marriage counselors often hope to restore people and their relationships to their original luster. For Dr. Kreutzer and his team, recovery often means teaching uninjured spouses to forge a relationship with a profoundly changed person — and helping injured spouses to accept that they are changed people.

“Changed” doesn’t begin to describe what some spouses experience.

Depending on the severity of the brain injury, an individual may be considerably changed by the injury…so much so that he or she may seem like an entirely different person. Injured people often have difficulties with attention, concentration, memory, reading, writing, and speaking. They may appear confused, have trouble with physical coordination, and become impulsive—buying expensive items they can’t afford, take off on trips without notification, or other potentially damaging behaviors. And then there are the possible personality changes:  aggressiveness, irritability, mood swings, depression, lack of motivation, and poor judgment. While every person experiences a different constellation of symptoms, even a small number of these symptoms can make the spouse of a brain-injured individual wonder what happened to the person they married.

The article in The New York Times talks about the experiences of Terry Curtis—who suffered brain injury from a tumor and the surgery needed to remove it—and his wife Vicky:

Mrs. Curtis, 60, was once drawn to her husband’s “sparkle,” she said. After the injury, he “flat-lined” emotionally, and he suffers from depression, anxiety and a lack of motivation. Her husband sometimes makes erratic decisions, she added, like the time he decided to take a do-it-yourself approach to the plumbing at their home in Coralville, Iowa. “Not a good picture when I got home,” Mrs. Curtis said. “And you can yell at him like a little kid, but he didn’t know any better.”

Once a software programming analyst, Mr. Curtis, 57, has “a lot fewer interests” than he did before the injury, and he estimates he has lost 90 percent of his friends.

“It’s a new you,” he said, “and they just can’t cope with that.”

It’s worse for a spouse, who lives with the changed person. According to the psychologists, the factor that seems to keep marriages from falling apart is guilt. It’s hard to be the kind of person who gets a divorce from a brain-injured person. The goal in therapy is to help the couple see that the person will not ever be exactly the same…that they will have to deal with a “new normal” in their lives…but that it may be possible to rediscover a new facet to the old relationship.

That may be the real definition of hope.

To read the full article in The New York Times, click here:  When Injuries to the Brain Tear at Hearts

To learn more about traumatic brain injuries, visit our dedicated webpage here:  HensonFuerst TBI page

The post-game video review was especially difficult at John C. Birdlebough High School. Administrators and coaches examined every frame of what will forever be known as “THE game.” The game when 16-year-old Ridge Barden died.

According to an article in The New York Times, the coroner ruled that Barden’s death was due to a brain bleed, also known as a subdural hematoma. But while the reason for his death is known, the actual cause is still a mystery.

“There’s nothing here; there’s still nothing there; there’s nothing there; there’s nothing there — and now he’s laying on his stomach,” Jeff Charles, the head coach, said while watching the sequence frame by frame.

Apparently, Barden had no preexisting condition, no history of head trauma, and no symptoms of concussion during the game. He had a state-of-the-art Riddell Revolution helmet. On hand at the game were two certified athletic trainers, and emergency medical technicians arrived with an ambulance within minutes. And yet, a catastrophic injury resulted in an untimely death.

“You can have the perfect plan in place but if all of these things happen, it can still result in a catastrophic injury and death,” said Kevin Guskiewicz, the chairman of the department of exercise and sports science at the University of North Carolina and a leading researcher on sports concussions.

During the game, Barden told his coach that he had a helmet-to-helmet hit, and that his head hurt. When he tried to stand up, he collapsed. He went into cardiac arrest in the ambulance. Two hours after the injury, he had died.

This is a tragic story all around. The coach is considering not returning for another season, despite the fact that everyone agrees he did nothing wrong. No doubt, his teammates—and their parents—will also be reconsidering whether to continue playing football.

The lesson seems to be that any head injury is dangerous, and you can’t predict the outcome of any one hit. Barden never had a chance to say “Yeah, I already had one concussions…I think that’s enough. Time to quit.” His first hit was his final hit. The fatal hit.

All we can say is stay safe. Protect your head. Barden’s death was a fluke. Nothing could have been done differently or better. Sometimes, life is dangerous.

To read the full article in The New York Times, click here:  An ordinary football game

To learn more about legal options in the event of a traumatic brain injury, visit our website at www.lawmed.com.  If you have questions, HensonFuerst has answers.

According to an article in The New York Times, the National Football League (NFL) is not sticking to their new policy of protecting players from concussion and head injury.

One player was tackled square in the face with the helmet of an onrushing opponent. Another, fighting for one last yard, took a polyurethane bash to the head. Still another player spent 10 minutes mostly motionless among dozens of praying players before medics carried him away on a stretcher after a helmet-to-helmet hit. [from The New York Times]

No flags were thrown for these controversial hits…all hits were deemed legal…and all of the hits probably caused traumatic brain injury to the players involved.

But the N.F.L.’s recent movement toward eliminating particularly dangerous tackles suggests that some of the collisions like those seen Sunday night could be forbidden as early as next season. Given how youth and high school football tend to follow the N.F.L.’s lead, the changes could affect more than just professionals.

Football is a violent sport, and players of all ages are encourage to “hit hard.”  Any serious move toward protecting players’ brains would require pulling back from the level of violence, and it’s not clear that anyone is willing to do that. It’s a $9 billion business, and fans live for televised clashes. Still, research has shown that multiple concussions (also known as mild traumatic brain injury, or MTBI) can lead to neurologic dysfunction, early dementia, and even death.

We’ve seen the outcome of head trauma, and we firmly believe that no game…no sport…no job should encourage—tacitly or explicitly—the kinds of activities that regularly cause concussion or more serious brain injuries. The NFL created pretty posters about concussion and vowed to take a tougher stance on head-hits. Thus far, this has all been nothing but “wah-wah-wah” background noise that everyone is ignoring.

According to Dr. Thom Mayer, medical director for the players union:

“Anything that can be done to improve the safety of our players really should be done, short of stopping playing the game.”

We agree. Hey…what if there were a fine against the team owners every time a player got a concussion during the course of a game? Hitting the big guys in their wallets wouldn’t be as painful as a head-hit, but it might at least start a serious discussion of how to stop the injuries.

Just food for thought.

To read the full article in The New York Times, click here: Big Hits, No Flags

At the end of the summer, the National Football League (NFL) decided to take action to reduce the number and potential effects of concussions. It created a poster that outlined the organization’s position on concussion, including the fact that players should know the symptoms, report them, get checked out, and basically start taking concussions seriously. After all, recent research suggests that repeated concussions may be more than just a passing pain–they may cause early dementia and neurologic wasting similar to Lou Gehrig’s disease.

As the football season started, health officials watched to see how the NFL would really respond to head-hits. The first few weeks weren’t good. Players were put back in the game after only a cursory examination…including Stewart Bradley, a Philadelphia Eagles player who staggered and and then collapsed on the field after attempting a tackle. He was put back into play after 3 minutes (but taken out at halftime).

But finally it looks like the NFL is putting money where its mouth is…its players’ money, that is.

According to an article in The New York Times,

A day after saying it would consider suspending players for helmet-to-helmet hits, the N.F.L. decided Tuesday to fine three players involved in a string of injurious collisions last Sunday.

The N.F.L. wants to give players and teams fair warning that it plans to ratchet up discipline for violations of players’ safety rules, the league spokesman Greg Aiello said. Players, coaches and teams will be told Wednesday that future disciplinary actions will be harsher, setting the stage for possible suspensions.

Two players received fines of $50,000. The worst fine was for a serial trouble-maker, linebacker James Harrison of the Pittsburgh Steelers, who was fined $75,000.

It’s probably going to take a while for players and teams to fully embrace the new rules. From the time they first pick up a football in Pop Warner games, players learn to hit hard, and they learn how to take body hits. After a lifetime of learning to tough it out and walk off pain, this new culture of caring about concussions is going to take some getting used to. It’s about time. How many brains and lives have been put at risk for the sake of a sport? Now that everyone knows better, we applaud these fines as a good start. We’re not sure where the fines are going, but it would be great if the money could be donated to brain injury research.

Hey, NFL! We have a list of worthy research groups, if you need some ideas.

(For a list of great brain injury support and research organizations, see our website: HensonFuerst Brain Injury page)

Information Sources (click titles for direct link)

The New York Times: “N.F.L. Fines Players for Hits to Head”

Previous HensonFuerst blog: “NFL is All Talk, No Proper Action”

Previous HensonFuerst blog: “Brain Trauma May Mimic Lou Gehrig’s Disease“

You know that feeling of dragging your body around in a North Carolina heatwave? Feeling sluggish and fatigued and just plain drained? (Yes, I’m happy it’s finally autumn.) But what if that feeling didn’t go away when the weather broke?

That’s what happened to Marilyn Berger, a contributor to The New York Times. As she describes in a fascinating article, Ms. Berger’s story started May with a fall from her bike. She landed on grass, but her helmet got crunched. By July, during the worst of the summer’s heat wave (and about two months after the fall), Ms. Berger was dragging along like the rest of us. Well, not quite like the rest of us. Her symptoms didn’t stop when the temperature dropped.

To make her awful and riveting story much shorter than it deserves, it turns out that the bike fall caused more than just a damaged helmet–her brain was injured, too. The diagnosis was a subdural hematoma, the type of blood clot thought to have killed actress Natasha Richardson last year.  She nearly died, and was saved only by the fact that a house guest was around to discover her in bed, incoherent.  She had brain surgery; she lived to tell the story.

Ms. Berger tells the story much better, with poignancy and clarity. There are two morals to this story. The first, which Ms. Berger leaves unspoken, is that all head injuries should be taken seriously. The second is that when a brain is injured, a brain can’t recognize the injury. Ms. Berger’s foot had been dragging, she weaved when she walked, she felt tired–the brain can concoct all kinds of reasons for the physical changes. Like extreme summer heat.

Which brings us back to moral number one: All falls need to be taken seriously. Especially because we may not always recognize the most serious of symptoms.

Please read the entire article. You’ll never look at a simple fall the same way again. Click this link:  The New York Times: “The Calm Before the Brain Injury Was Discovered”

To learn more about the effects of traumatic brain injury, see our website:  HensonFuerst Brain Injury page

The National Football League (NFL) has a pretty, new poster that boasts a tagline that reads: Let’s Take Brain Injuries Out of Play. Turns out it was all a lot of hot air.

In Sunday’s game, Philadelphia Eagles player Stewart Bradley attempted a tackle that left him stumbling before he collapsed on the field. To an average fan, he appeared obviously hurt and impaired. But the team’s medical staff took him out of play for less than 3 minutes before allowing him back in the game.

It wasn’t until halftime, when he was officially diagnosed with a concussion, that Bradley’s brain and body were given a chance to rest.

According to an article in The New York Times, Eagles Coach Andy Reid and the Eagles’ medical staff all stated that they had not seen Bradley stagger and fall. (Makes you wonder exactly who is watching the players, other than the fans, of course.)

Interestingly, one of the excuses the medical staff gave was that:

…they were apparently tending to quarterback Kevin Kolb — who also was suspected of having a concussion, returned during the quarter, and then was found during halftime to have sustained a concussion.

So they didn’t catch Bradley’s concussion because they were treating Kolb…but Kolb was also returned to play because his concussion wasn’t diagnosed until halftime.

To an outside observer, it seems that the doctor who is able to diagnose concussion so easily during halftime should be made available throughout the game. There’s no safe amount of time a player can “play hurt” when the injury involves the brain. The NFL’s concussion poster ends with these lines: Work smart. Use your head, don’t lead with it. Help make our game safer. Other athletes are watching…

Hey, NFL:  You’re right…we’re watching…and we don’t like what we saw on Sunday. Brain damage is forever.

To read the full New York Times article, click here: The Return of a Stumbling Eagle Raises Concerns

The evolution of the “meaning” of concussion has just taken another step…and it’s a frightening step.

Back in the day, concussion was viewed as a mild bump on the head, getting your “bell rung.” No one paid it much mind; take the hit and get back in the game.

Recently, doctors have warned that concussion is more dangerous than that. In fact, pediatricians have been lobbying to have it renamed, from concussion to the more accurately descriptive “mild traumatic brain injury” (MTBI).

Earlier this year, scientists made the disturbing discovery that people who suffer repeated head injury (such as football players and soldiers) develop a type of brain damage that mimics amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease. This was the discovery of a new disease syndrome that causes brain damage, central nervous system damage, dementia, and eventually death. It is called Chronic Traumatic Encephalopathy, or CTE, and it is only caused by repetitive brain trauma.

Today, The New York Times reports that the autopsy of a 21-year-old college football player who died of suicide revealed that he had the early stages of CTE. This young man, Owen Thomas, had no history of depression, but suffered what was called a “sudden and uncharacteristic emotional collapse” before taking his life in April 2010. Thomas is the youngest football player, and first amateur football player, to be found with clear CTE. If he hadn’t killed himself, the brain injury wouldn’t have been discovered for years, if ever. But the circumstances of his death demanded autopsy.

Although there is no way to definitively link his suicide to the brain damage, the connection is certainly possible, if not probable:

“It’s not unreasonable that aspects of his behavior were related to the underlying brain disease that was detected,” said Dr. Perl [Daniel Perl, professor of pathology at Uniformed Services University of the Health Sciences], adding that he was speaking as an experienced neuropathologist and not on behalf of his organization. “This is real.”

Dr. Perl added that this finding showed that CTE is possible earlier, and at impact levels lower than those experienced by professional football players.

Right now, no one knows how many hits…how frequent the hits…or how hard the hits have to be before “several concussions” becomes “irreversible brain damage.”  The only thing that is clear is that we need to do more to protect the brains of young athletes. If CTE was found in the brain of an otherwise healthy 21-year-old man, when did it start? In high school? Junior high? Pop Warner Youth Football?

Just last month, we reported about the virtual explosion in the number of head injuries experienced by children while playing sports: In just 10 years, kids ages 8-13 had double the number of concussion-related hospital emergency visits. Kids ages 14-19 had quadruple the number. Unless we take action now, some of these children may end up with permanent, debilitating brain injury.

What can we do? We wrote about that, too…just last week. (Click here to read that entry: The Head Game of Youth Sports.)  And you know what? We’ll continue to write about concussion and brain injury until there is nothing left to write about. Football season is here…let’s keep all players safe.

If you want to read the full article from The New York Times, click here: Penn Football Player Had Brain Disease, Autopsy Shows

“Tuesdays with Morrie” is the heartbreaking story of the final life lessons imparted by a beloved teacher dying of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. Today, the New York Times reports on an astonishing bit of science that expands the tragedy:  Some people diagnosed with ALS may not have the disease. Concussions and other brain trauma may cause neurological decline and death in a way that mimics ALS.

“Doctors at the Veterans Affairs Medical Center in Bedford, Mass., and the Boston University School of Medicine, the primary researchers of brain damage among deceased National Football League players, said that markings in the spinal cords of two players and one boxer who also received a diagnosis of A.L.S. indicated that those men did not have A.L.S. at all. They had a different fatal disease, doctors said, caused by concussionlike trauma, that erodes the central nervous system in similar ways.” [from the New York Times article]

This is not to say that ALS does not exist…it simply highlights a new syndrome, a cascade of damage to the brain an nervous system that begins with trauma.

The researchers (in an article to be published tomorrow on the website for the Journal of Neuropathology & Experimental Neurology) refer specifically to athletes and men in combat, who suffer repeated head injury during their training and careers. Although Lou Gehrig is not specifically mentioned, the study raises questions about whether his eponymous disease actually caused his death. It may have been caused by his multiple head injuries. As recounted in the New York Times:

In 1924, during a postgame brawl with the Detroit Tigers, Gehrig swung at Ty Cobb and fell, hit his head on concrete, and was briefly knocked out. While playing first base against the Tigers in September 1930, Gehrig was hit in the face and knocked unconscious by a ground ball. He was knocked out again by an oncoming runner in 1935.

Those are the four incidents in which Gehrig’s being knocked unconscious was notable enough to be reported in newspapers. He most likely sustained other concussions that were never noticed or considered meaningful — for example, when he was hit in the head with a pitch during a 1933 game against Washington but continued playing — either in baseball or while serving as a halfback for Commerce High School in New York and later Columbia University.

This sure makes helmets look like a brilliant invention.

We’ve been writing a lot lately about the importance of recognizing concussion and allowing athletes–especially young athletes–time to heal. Playing through injury is no longer a sign of strength…now, it’s smarter to value brain over brawn.