The blog for editorial consideration of topics from "a" to "z" to stimulate your further investigation and to draw your comments.
Wednesday, October 20, 2010
Heads For Football
" ...during the minutes to few days after concussion injury, brain cells that are not irreversibly destroyed remain alive but exist in a vulnerable state. This concept of injury-induced vulnerability has been put forth to describe the fact that patients suffering from head injury are extremely vulnerable to the consequences of even minor changes in cerebral blood flow and/or increases in intracranial pressure and apnea....The American Orthopaedic Society for Sports Medicine
It is estimated that more than 3 million American youngsters play football at the youth level, and an additional 1.2 million suit up for their high school teams. Lately one football injury is coming under scrutiny -- concussion. No other contact sport gives rise to as many serious brain injuries as football does. High school football players alone suffer 43,000 to 67,000 concussions per year, though the true incidence is likely much higher, as more than 50% of concussed athletes are suspected of failing to report their symptoms.
Most believe a concussion is a bruise to the brain caused by hitting a hard surface. Concussions range in significance from minor to major, but they all share one common factor — they temporarily interfere with the way the brain works. Every concussion, no matter how mild, injures the brain to some extent since it is caused by a sudden blow to the head or to the body.
People normally lose consciousness. How long a person remains unconscious may indicate the severity of the concussion. And, often victims have no memory of events preceding the injury, or immediately after regaining consciousness. More severe head injuries can cause longer periods of memory loss (amnesia).
And, indeed, no physical swelling or bleeding is usually seen on radiological scans. The injury generally occurs when the head either accelerates rapidly and then is stopped, or is spun rapidly. This violent shaking causes the brain cells to become depolarized and fire all their neurotransmitters at once in an unhealthy cascade, flooding the brain with chemicals and deadening certain receptors linked to learning and memory. The results often include confusion, blurred vision, memory loss, nausea and, sometimes, unconsciousness.
Neurologists say once a person suffers a concussion, he/she is as much as four times more likely to sustain a second one. Moreover, after several concussions, it takes less of a blow to cause the injury and requires more time to recover. ("Concussions And Head Injuries in Football," The New York Times, October 20 2010)
Long Time Risks
While medical science is only beginning to understand the links between multiple concussions and increased risks for afflictions like Alzheimer's, depression, memory loss, cognitive loss and dementia, even a single concussion to a child's growing brain can impair his ability to reach his full cognitive potential, inhibiting his ability to learn and undermine his classroom performance, cause personality changes, behavioral, emotional and attention deficit disorders; and accelerate the natural process of brain degeneration that accompanies aging.
A 2000 study surveyed 1,090 former N.F.L. players and found more than 60 percent had suffered at least one concussion in their careers and 26 percent had had three or more. Those who had had concussions reported more problems with memory, concentration, speech impediments, headaches and other neurological problems than those who had not, the survey found. ("Head Injuries In Football," The New York Times, October 20 2010)
In 2005, scientists at the National Center for Catastrophic Sports Injury tested more than 2,500 retired professional football players. Those with three or more concussions were five times as likely to have cognitive declines classified as mild cognitive impairment, and three times as likely to have significant memory problems as retirees without a history of concussion. Although the researchers didn't find a definite association between recurrent concussion and Alzheimer's disease, keep in mind that the majority of patients with mild cognitive impairment eventually progress to full-blown Alzheimer's. (Robert Burton, "Should Johnny Play Linebacker?" www.salon.com, January 13 2009)
A 2007 study conducted by the University of North Carolina's Center for the Study of Retired Athletes found that of the 595 retired N.F.L. players who recalled sustaining three or more concussions on the football field, 20.2 percent said they had been found to have depression. That is three times the rate of players who have not sustained concussions.("Scientists Find Link Between ALS, Football Head Injuries," Detroit News, August 18 2010)
In 2009, a study commissioned by the National Football League reported that Alzheimer’s disease or similar memory-related diseases appear to have been diagnosed in the league’s former players vastly more often than in the national population — including a rate of 19 times the normal rate for men ages 30 through 49. (Alan Schwarz, "Dementia Risk Seen In Players of NFL Study," The New York Times, September 29, 2009)
Repeated blows to the head can have lifelong repercussions. A study commissioned by the NFL and operated by Dr. Ann McKee, a Boston University neurological researcher, found that ex–pro players over age 50 were five times as likely as the national population to receive a memory-related-disease diagnosis. Players 30 to 49 were 19 times as likely to be debilitated.
Dr. McKee has received a dozen brains donated from former NFL, college and high school players. In each one, it's simple to spot a protein called tau, which defines a debilitating disease known as chronic traumatic encephalopathy, or CTE. Common symptoms of CTE include sudden memory loss, paranoia and depression during middle age. The disease is also known as dementia pugilistica, or punch-drunk syndrome, because until recently the overwhelming majority of its victims were boxers. Not anymore. Researchers like McKee have found a deep and disturbing association between CTE and America's most popular sport (Sean Gregory, "The Problem with Football: how to Make It Safer," Time," January 28 2010)
McKee said she found toxic proteins in the spinal cords of three athletes who had suffered head injuries and were later diagnosed with Lou Gehrig's disease, or ALS. Those same proteins have been found in the brains of athletes with chronic traumatic encephalopathy, a disease linked to head injuries that causes cognitive decline, abnormal behavior and dementia. (Journal of Neuropathology and Experimental Neurology, September 2010). McKee noticed that a high number of football players seemed to be affected by ALS. The disease attacks nerve cells in the brain and spinal cord, and destroys the ability to move and speak.
Catastrophic head injuries, which include bleeding or swelling in the brain, can be fatal. Miranda Hitti of WebMD Health News reported that catastrophic football head injuries are rare, a new study shows they may be more than three times as common in high school football players than college athletes.("High School Football Head Injury List," WebMD Health News, July 6 2007)
A neuropathologist found that brain damage from repeated concussions suffered by former NFL star Andre Waters likely led to his depression and ultimate death by suicide in November 2006. Although youth athletes likely suffer far fewer concussions than pro football players like Waters (who told the Philadelphia Inquirer in 1994 that he lost count at 15), nearly half of all high school football players in one recent study admitted after the season to having experienced concussion symptoms at some point during the season. And, other studies suggest one in five athletes playing a contact sport will suffer a concussion. (Brooke De Lench, "Death of Ex-NFL Star Highlights Need for Vigilance on Concussions," www.momsteam.com, 2010)
* The National Football League on Dec. 3, 2009, announced that it would impose its most stringent rules to date on managing concussions, requiring players who exhibit any significant sign of concussion to be removed from a game or practice and be barred from returning the same day.
* For young players, Pennsylvania lawmakers recently took a smart step by approving a House bill that would put useful safeguards in place to shield more school athletes from brain injuries. With the urging of the Pennsylvania Medical Society, the Senate should concur.
* The University Interscholastic League approved rules by their legislative council that state athletes who suffer concussions in any sport cannot return to competition on the same day. Furthermore, they cannot resume competing until they have been cleared by a licensed healthcare professional. The changes will go into effect next fall.
* Congress has held hearings and is encouraging football leagues to develop safer helmets and modify their rules that now allow injured players to continue competing.
* NFL officials have finally acknowledged the long-term health risks from concussions, including depression, memory loss, and dementia. The league has taken positive steps by requiring that injured players be cleared for a return to play by independent doctors.
* Even if football head injuries aren't severe, players with head injuries should stay out of the game, note the researchers, who included Barry Boden, MD, of The Orthopedic Centre in Rockville, Md. "Coaches, athletes, parents, athletic trainers, and all medical personnel need to be educated to never allow an athlete to continue playing football with ongoing neurologic symptoms," write Boden and colleagues.(Miranda Hitti, "Severe Football Head Injuries 3 Times More Common in High School Players Than in College Players," WebMD Health News, July 6 2007)
* Since one study stated that athletic directors reported 286 concussions among their more than 22,800 varsity, junior, and freshman players during the 2001 football season, the survey results indicate that certified athletic trainers may be better than coaches in checking helmet fit.
Janice Lloyd of USA TODAY reports, "When high school athletes suffer concussions, as many as 40.5% return to action prematurely and set themselves up for more severe injuries, new research shows. The study from the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio, adds fuel to growing concerns about the long-term side effects of concussions. It also shines new light on inadequately trained personnel on the sidelines unprepared to make accurate diagnoses and informed decisions about sending players back on the field..
Dawn Comstock, the study's director of research, says that most troubling news is the following: "16% of football players reported returning to play the same day they lost consciousness. An athlete is advised not to return to play the same day after losing consciousness in guidelines created by an international panel of experts in 2004." Young athletes, whose brains and skulls are immature, risk death or additional concussions by going back too soon. (Janice Lloyd, "High School Athletes Face Serious Concussion Risks," USA TODAY, May 4 2009)
The most important thing to remember about concussion is that allowing players to return when their concussion symptoms subside puts players at risk. It is widely known that symptoms of a concussion can reappear hours or days after the injury, indicating that the player had not healed from the initial blow.
John Hamilton reports that coaches could learn a valuable lesson from the battlefield -- to identify military personnel who have suffered a concussion and force them to rest until their brains have a chance to heal. Even if the participant objects, players who suffer a concussion may need to be benched for a week or more. (John Hamilton, "Football's Brain Injury Lessons Head To Battlefield," NPR. October 12 2010)
Brain injury experts say mandatory rest and evaluation are even more important in combat because of new discoveries about the way energy from an explosion appears to reach the brain and cause damage. The goal is to prevent fighters who have already had one concussion from suffering another while their brain is still especially vulnerable to damage.
Brain scans show that for days or even weeks after an injury like this, the brain's metabolism slows down, which leaves some cells starved for energy, David Hovda, who directs the Brain Injury Research Center at UCLA, says. "During the time when this metabolism is altered," he continues, "the brain not only is dysfunctional, but it's also extremely vulnerable, so that if it's exposed to another mild injury, which normally you'd be able to tolerate really well, now there can be long-term devastating consequences."
It's the second hit or the third that often does the lasting damage, Hovda says. So Hovda and others have been urging the military to act more like the NFL and order troops off the field when they've had a head injury.
Kyle Turley is six feet five. He is thirty-four years old, with a square jaw and blue eyes. For nine years, before he retired, in 2007, he was an offensive lineman in the National Football League. From "Malcolm Gladwell, "Offensive Play: How Different Are Dogfighting and Football?" The New Yorker, October 19 2010)
“Lately, I’ve tried to break it down,” Turley said. “I remember, every season, multiple occasions where I’d hit someone so hard that my eyes went cross-eyed, and they wouldn’t come uncrossed for a full series of plays. You are just out there, trying to hit the guy in the middle, because there are three of them. You don’t remember much. There are the cases where you hit a guy and you’d get into a collision where everything goes off. You’re dazed. And there are the others where you are involved in a big, long drive. You start on your own five-yard line, and drive all the way down the field—fifteen, eighteen plays in a row sometimes. Every play: collision, collision, collision. By the time you get to the other end of the field, you’re seeing spots. You feel like you are going to black out. Literally, these white explosions—boom, boom, boom—lights getting dimmer and brighter, dimmer and brighter.