The U.S. Centers for Disease Control and Prevention (CDC) released the latest surveillance report about traumatic brain injury (TBI) deaths. The information, collected from 1997 to 2007, is compiled to help provide insights to help doctors, public health officials, and other professionals assess the impact of brain-related injuries.

There is some good news in the report:  The death rate from TBI-related injuries decreased by 8.2% compared to the previous 10 years. However, the bad news far outweighs the good. According to the CDC:

• About one-third of all injury-related deaths—or about 53,000 cases—involve traumatic brain injury.
• Despite the overall decreased death rate, the rate of TBI-related death increased for people age 75 and older.
• TBI deaths are three times higher among men than women.
• The top three causes of TBI-related deaths are firearms, automobile wrecks, and falls. Compared to the previous 10 years, the incidence of deaths related to falls is the only one to have increased.

To read a full copy of the report, click here:  CDC report on TBI

What do you call an activity requires strength, stamina, flexibility, agility, planning, and coordination with team members?  What if the participants were required to train with weight-training and aerobic exercises?  And what if that activity was performed in gymnasiums, in stadiums, and on outdoor fields?  And what if teams competed regionally and nationally?

That sure sounds like a sport to me. What would you call it?

Well, officially, cheer is not a sport. (And by the way, advocates now prefer the term “cheer” to “cheerleading,” mainly because the nature of the activity has changed almost to the point of being unrecognizable since the early days of pom-poms and calls of S-U-C-C-E-S-S.)  But in July 2010, U.S. District Judge Stefan Underhill ruled that cheer is not a sport because it is “too underdeveloped and disorganized.” I’m not sure what he looked at to make his decision, but cheer is one of the most organized activities around–there are cheer squads in nearly every middle school, high school, and college…participants are taught and coached in standard moves…and the competition circuit is big business.

Why definitions are important

Whether cheer is defined as a sport or as merely an athletic activity has repercussions that go beyond ego. Sometimes it’s a question of available funding from colleges or sponsors, and sometimes it’s about reputation and respect–cheerleaders are admired, but rarely honored for their combination of brains and athleticism.

But even more important is how defining cheer as a sport would affect safety of the participants. A true sport requires coaches to have a certain level of training and certification; a “sport” puts limits on the risks required of the participants; and a “sport” makes training and safety an integral part of practice and performance. Unfortunately, in most schools, cheering lacks safety, limits, and trained coaches. That’s why cheer accounts for more than 65% of of all high school catastrophic injuries, and more than 70% of all collegiate catastrophic injuries. (For the record, “catastrophic injuries” are life changing events, including traumatic brain injury, paralysis, and death.)  Less severe injuries are also common–each year, this sport sends more than 25,000 female students to hospital emergency rooms.

A Cheer Advocate Speaks Out

In June 2010, we posted a blog that listed guidelines to help prevent cheer injuries, as recommended by Frederick O. Mueller, Ph.D., Director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill (UNC-CH). It’s a long list, so we won’t repeat it now, but you can read the full blog here: When Is a Sport Not a Sport?

After it was posted, we heard from one of the all-time great cheer coaches, Rusty McKinley. In his career, McKinley was Spirit Director at the University of Southern Mississippi, followed by eight years as Cheer Advisor/Coach at the University of Memphis. He authored two books:  The Complete Partner Stunt Book and NCA Pyramids. Currently, he is a nationally known and respected expert in the area of cheer safety. (I know he’s going to be embarrassed that I put it that way.) He was even one of the featured interviews in the cheer safety episode of the Emmy-nominated television show Penn & Teller: Bullshit! (season 8, episode 1: Cheerleading).

McKinley reports that the state of cheer safety is worse than most people think. He recently obtained the AACCA Certification–a safety certification from the American Association of Cheerleading Coaches and Administrators. Sounds impressive, right? As McKinley said:

The entire course, 2.5 hours, is dedicated to walking you through the AACCA Manual and highlighting the areas that will be on the Open Book test that follows. No “hands on” experiences are required or tested in any fashion.  The periodic update requires 20 minutes online, again without hands on training or demonstrations.

McKinley has given us a wealth of information about the state of cheer safety, as well as some solid suggestions for how parents, schools, coaches and all the rest of us can help keep these athletes safe from traumatic brain injury and other catastrophes.

This is the first of a 3-part series we’re writing on cheer safety. Part 2 will be posted May 2, 2011 and Part 3 will be posted on May 9, 2011.

Meanwhile, if you have questions about cheer safety, please send them to our researcher, carol@lawmed.com. We’ll do our best to answer them online.

If someone you know has a cheer injury…

To report a cheerleading injury to make statistical reporting more accurate, go to www.cheerinjuryreport.com, sponsored by the National Cheer Safety Foundation. For more information about traumatic brain injury, or to request a legal consultation for a cheer injury, visit our dedicated web page.

If you have questions, HensonFuerst has answers.

The goal of Brain Injury Awareness Month is to help the public learn more about brain injury, and to improve the lives of everyone affected–those who are living with brain injury, and their families and caregivers. To play our part, we have created our own quiz to help test your level of awareness.

1. According to the U.S. Centers for Disease Control and Prevention (CDC), how many people in the United States receive treatment for brain injury every year?

• (a)  1,700
• (b)  17,000
• (c)  170,000
• (d)  1,700,000

ANSWER: (d) And that doesn’t even include all the people who receive a head injury but don’t seek treatment.

2. Is a concussion considered a brain injury?

• (a)  yes
• (b)  no

ANSWER: (a) Anyone who reads this blog knows that concussion is definitely a form of brain injury. In fact, some experts are trying to have concussion called by a more accurately descriptive name: mild traumatic brain injury, or MTBI.

3. Which of the following is NOT a possible symptom of brain injury?

• (a)  moodiness
• (b)  loss of sexual interest
• (c)  slurred speech
• (d)  hallucination
• (e)  difficulty doing math
• (f)  inability to multitask
• (g)  not recognizing your own arm
• (h)  color blindness
• (i)  insomnia

ANSWER: This was a trick question…they are all possible symptoms of brain injury.

4. Which of the following is NOT an appropriate member of a brain injury treatment team?

• (a)  neurologist
• (b)  psychologist
• (c)  physical therapist
• (d)  job coach
• (e)  attorney

ANSWER: Another trick question…all of these professionals are important for improving the medical, psychological, and financial situation of a person with brain injury.

5. According to the National Center for Catastrophic Sports Injury Research, which sport is the number-one cause of brain injury among high school and college female athletes?

• (a)  Gymnastics
• (b)  Field Hockey
• (c)  Cheerleading
• (d)  Soccer

ANSWER: (c) It’s not even close. Cheerleading injuries accounts for about 65% of serious catastrophic injuries.

6. What is the leading cause of traumatic brain injury among all age groups?

• (a)  Motor vehicle wrecks
• (b)  Falls
• (c)  Sports injuries
• (d)  Assault

ANSWER: (b) Falls are the cause of about 35% of all brain injuries for all age groups. Motor vehicle wrecks are the second leading cause of traumatic brain injury.

7. According to the National Institute of Neurological Disorders and Stroke (NINDS), about how much is the lifetime cost for one person surviving a severe traumatic brain injury?

• (a)  about $1 million
• (b)  about $2 million
• (c)  about $3 million
• (d)  about $4 million
• (e)  more than $4 million

ANSWER: (e) The great cost of taking care of a person with severe brain injury is one reason why it is so important to talk with a lawyer who is experienced in handling brain injury cases. You want to make sure the injured person gets all the compensation he or she is entitled to. Covering the costs is next to impossible without financial help. injury.

8. Which of the following are good ways to prevent head and brain injury?

• (a)  Wearing a helmet while riding a bicycle
• (b)  Wearing a helmet while riding a motorcycle
• (c)  Wearing a seatbelt while driving or riding in a motor vehicle
• (d)  Removing or securing throw-rugs in a house
• (e)  Removing snow and ice from walkways, driveways, and outdoor steps
• (f)  all of the above

ANSWER: (f) You knew that would be the answer! Preventing brain injury means being aware of potential trouble areas, taking an abundance of care to keep areas free from fall hazards, and protecting your head while engaging in high-risk activities.

So, how did you do?

If you want more information, feel free to visit our traumatic brain injury page on the HensonFuerst website at http://www.lawmed.com/. Stay safe!

In Minnesota, where winter seems to last forever and icy walkways are everywhere, falls have become the number one cause of traumatic brain injury. Here in North Carolina, where winters are relatively warm and mercifully short, slippery surfaces can still be dangerous.

The three main slip-and-fall problems in North Carolina are that:

1. We don’t expect frozen surfaces! We keep shorts and sandals available all year ’round because temperatures in the 70s are possible at any point…but down coats are a rare sight, anytime.
2. Because of meteorologic factors, parts of North Carolina are prone to flash freezing, when any moisture on the ground turns to a thin layer ice.
3. Ice on stairs and walkways is often invisible. (On black-top road surfaces, the thin layer of flash-freeze is called “black ice.”) If there is snow on the ground, you can see it and you automatically take safety precautions (including putting on boots with traction). But if you don’t see ice…and you don’t expect ice…then you can step out on a stairway and have your feet slip out from under you.

And the potential outcome of an icy fall is much worse than a nasty bruise or broken bone. Serious and permanent brain injuries are all too common. In fact, in 2007 the legendary writer Kurt Vonnegut suffered brain injury and died after an icy slip-and-fall. To protect your brain, learn to take safety precautions in winter:

• In the event of a snow or ice storm, apply a layer of sand or salt to sidewalks, driveways, and outdoor stairways. The rock salt (not table salt) will melt the ice, and the sand will provide traction. (NOTE: De-icing rock salt can damage concrete. To prevent damage, spread sand instead, but understand that sand will not get rid of the ice…it will only improve traction. According to “Ask the Builder” newsletter, another alternative that will let you use salt safely is to treat your concrete driveway with clear coatings of silane/siloxane.)
• Invest in a good pair of flat-soled boots or shoes with treads, and wear them if roads seem slick.
• If the weather is cold, dress appropriately. If you are cold, shivering, and distracted, you have a greater risk of losing your balance.
• In cold weather, test walkway conditions before stepping out of a car or walking down steps. If your foot slides at all, make sure you have something solid to hold onto before continuing.

Stay safe this winter season!

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

I just read a fantastic editorial about head injury and concussion in youth sports, written by someone who knows and cares: Neurologist Richard C. Senelick, M.D., Medical Director of the Rehabilitation Institute of San Antonio. He is also a father and a grandfather, so this topic is more than just an abstract medical exercise to him.

We have written extensively about the dangers of concussion–what doctors now refer to as “mild traumatic brain injury” or MTBI. So far, this has been a watershed year in how concussions are viewed. This year, we learned that a person who receives multiple concussions is at risk for developing Chronic Traumatic Encephalopathy (CTE), which leads to early dementia, depression, personality changes, and death.

We also learned this year that some cases of amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s Disease) may be due to head trauma, not disease process.

This is also the year that we found out that the number of head injuries in children’s sports have doubled or even quadrupled in the past 10 years. MTBI awareness has even reached that most hard-headed group, the National Football League, which has mandated that an educational poster about concussion be hung in every pro locker room.

As Dr. Senelick states:

Although the population of NFL players is important, there are only 1,900 active NFL players each season. There are more than 3 million children playing football at the youth level and 1.2 million more playing high school football. This doesn’t even begin to count the number of kids playing soccer (heading the ball) and hockey (body checking). We have to ask whether we are taking adequate steps to protect our children – to change not just the equipment but the rules so that we reduce the chances of the players experiencing traumatic brain injuries.

What does he suggest? The same things experts and investigators have been suggesting for years:

1. Change the rules of the games to make head injury less likely.
2. Change the equipment, helmets and the equipment that makes dangerous projectiles of balls and pucks.
3. Mandate certified trainers in schools and for all organized sports activities.
4. Change the culture, so that we value health over winning a game…especially when our children are young, their brains are developing, and the games will be forgotten by morning.

None of that will be easy. Think how difficult it is just to get people to use a seat belt in a car, or to wear a helmet while cycling. Dr. Senelick notes that in Idaho…

We have an increasing number of bear attacks because people foolishly approach a bear, thinking it is safe to get that close-up picture. I recently read the following analogy:  If people are in the ocean and hear someone yell “shark” they race out of the water. If someone yells “bear” in Yellowstone, everyone races to get a close-up photograph. They have not been properly educated on the dangers of close encounters with a bear.

The same is true for youth sports and brain injuries. There is a bear out there and people need to be educated and the rules need to be changed.

He ends his editorial with this sentence:  ”Our children are getting injured and dying — it is time to wake up.”  Given the traumatic head injuries we have seen, we agree.  The only thing more heartbreaking than seeing a child with a head injury is watching the agony of that child’s parents. No one gets over it…not the child, not the parents, not the grandparents, not the community. We owe it to…well, everyone to help protect our children from head injury.

If you want to learn more about concussion and other traumatic brain injuries, visit our website at www.lawmed.com. If you have questions, HensonFuerst has answers.

Our previous blogs on concussion:

Football Concussion Poster

Youth Concussion Rates Skyrocket

Metal Bat Controversy in Youth Baseball

Head Injury and Lou Gehrig’s Disease

To read Dr. Senelick’s full article, click here: Head Games and Youth Sports: Have We Gone Too Far?

To read a great Time magazine article, which has a link to a video of what football can do to the brain, click here:  The problem with football:  How to make it safer

It may seem like we keep banging the concussion drum, but this story doesn’t go away.  According to new information published online today, the number of concussion-related hospital emergency visits for children ages 8-13 doubled between 1997 and 2007 (a 100% increase). For youth age 14-19, the increase was 200%, a 4-fold increase.

The cause of this increase isn’t clear, but the researchers note that most of the concussions happened as a result of sports, even though fewer kids participate in organized team sports. So…if fewer kids play organized team sports, but there are more concussions due to sports, what exactly is going on?

According to the experts, there are a few potential explanations:

• while there are fewer organized team sports, there are more sports activities available;
• organized sports today are even more competitive today than they were in 1997, which puts kids at higher risk;
• practice and play times have become more intense.

There is also the possibility that parents and coaches are more aware of the symptoms of concussion, and are therefore more likely to take an injured child to the hospital.

No matter the reason(s) for the increase, everyone agrees that action needs to be taken to bring these rates down. For example, there need to be clear, comprehensive, and age-appropriate return-to-play guidelines for all young athletes. In the future, we may also see use of MRI scans, balance tests, and neuropsychological testing to take the guesswork out of concussion diagnoses. Helmet use should be required in sports that currently have no helmet rules (such as for skiing)…and other equipment could be modified to reduce injury risk (for example, padding goalposts, or decreasing mass and air pressure of soccer balls).

For more information, see this story posted by NPR: http://www.npr.org/templates/story/story.php?storyId=129519808

The original medical journal article is available online: Pediatrics

The reference is:

“Emergency Department Visits for Concussion in Young Child Athletes,” by Lisa L. Bakhos, Gregory R. Lockhart, Richard Myers, and James G. Linakis. Pediatrics, online publication August 30, 2010.

“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.

About four years ago, Texan Dianne Helms drove home after a night of partying and drinking. She crashed her Toyota Tundra into a culvert. Her body was tossed around in the car…her head went through the driver’s side window and smashed onto the pavement.

That’s how her year-long coma began.

That’s how she ended up in a wheelchair, unable to use her left arm or leg, unable to speak or even to pucker her lips enough to kiss her now 10-year-old daughter. Helms had “locked-in syndrome,” a condition in which a person can think, but can’t move or speak–nightmare of fear and frustration. She is now relearning the most basic of physical tasks, like how to eat and swallow, and how to go to the bathroom by herself.

The Houston Chronicle reports that with the help of a computer and a voice synthesizer, Helms is finally able to tell her story. And she doesn’t want anyone to end up in the same position she is in.

Over the past few months, Helms has continued giving her speech to teenagers, to adults – to anyone who will listen. She says warning others is her mission in life now. ”Maybe I was saved so I could save others,” she recently typed out on her laptop.  [from The Houston Chronicle]

Helms feels tremendous guilt, for many things. For being a burden to her parents, who take care of her every need…and for not being fully there for her daughter.

Most people know that they shouldn’t drink and drive, but they never think that anything bad will happen to them. It’s the other guy, the one who isn’t “a good driver,” or who “can’t hold his liquor.” But impaired is impaired, and those who are most likely to get in a wreck are often those who think they are most capable.

Everyday, the lawyers of HensonFuerst see the victims of drunk drivers. These people end up in a wreck because they got in the way of an impaired driver–they had no choice in the matter, and they did everything right.

Broken bones can heal…cut skin can close and scar…but an injured brain is permanent. The brain doesn’t give second chances. Here’s hoping everyone hears Helms’ story and makes the smart choice: Don’t Drink and Drive.

Finally, finally, finally!  Professional locker rooms across the country will be undergoing minor redecoration, with players’ health in mind.

The National Football League (NFL) has released its official, new poster, which clearly lists symptoms of concussion and potential long-term effects. In one section, the poster says that traumatic brain injury (TBI) can lead to “…problems with memory and communication, personality changes, as well as depression and the early onset of dementia.”  This is the most honest and blunt statement of the hazards of football by the NFL since, well…ever.

According to an article in the New York Times, players welcome the posters:

“That poster is shocking,” said Domonique Foxworth, a cornerback for the Baltimore Ravens. “It gives people facts before they take risks. But it’s not exactly a new revelation.”

Matt Birk, the Ravens’ center, 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.”

On the poster (which may or may not be different from what is said on the field), players are told that “playing through” a concussion could cause permanent brain damage. The advice is to report symptoms, get checked out by medical staff, and then take time to recover.

Although this is a great and long over-due first step, the New York Times reports that a lawyer for the NFL wrote a memo discrediting connections between football head trauma and long-term cognitive decline. The article continues:

The letter, obtained by The New York Times, explained, “We can point to the current state of uncertainty in scientific and medical understanding” on the subject to deny players’ claims that their neurological impairments are related to football.

Sadly, that adds credence to the football league’s “chew ‘em up and spit ‘em out” reputation when it comes to players’ health. The problem is that if a player wrecks his knee, he loses his job…but if he wrecks his brain, he could lose his memory, his family, his entire sense of self. We’re glad to see that the posters provide solid medical information. Maybe, eventually, the message will sink in. The next step is to make sure players are respected for taking it slow after concussion.

To read the full New York Times story, click here: NFL Concussion Poster