Monthly Archives: June 2014

World Cup Error

As the top athletes in soccer gather to play in the World Cup, we’ve seen both good decisions and poor decisions made in relation to brain injury and its effects.  Let’s start with a remarkably poor decision.  During the Uruguay-England match, Uruguayan midfielder Alvaro Pereira was knocked unconscious after accidentally being hit in the head by the knee of an English player.  Once Pereira regained consciousness, he argued with the doctor against being substituted out and was allowed to finish the game.  This is problematic on a number of levels.  First, a player should never be allowed to overrule a doctor regarding medical issues.  Players are not medical  experts, they are experts at playing the game.  Moreover, with adrenaline flowing the athlete is unlikely to give sufficient consideration to potential health risks.  Second, a player with a concussion should always undergo testing in order to properly evaluate the seriousness of the injury.  Since the brain is inside the skull, it is difficult to assess the level of severity of such an injury or determine if swelling of the brain is beginning to occur.  Third, this is a terrible example to provide for young players as to the care one should afford oneself after receiving an injury.
In contrast, Netherlands player Bruno Martins Indi’s Word Cup concussion was handled very differently.  Martins Indi suffered a concussion while playing Australia.  He was immediately taken off the field and sent to the hospital for testing.  He was allowed the entirety of the next week to slowly recover and his coach even insisted that he miss his team’s next game against Chile.  Both Martins Indi and Pereira are world-class players who play in top European leagues yet the quality of treatment each received was light years apart.
In reaction to Pereira’s injury, the international soccer player’s union FIFPro wants to have all players suspected of having a concussion be temporarily substituted out in order to have an evaluation.  Perhaps a better idea would be to follow a protocol similar to that which is followed by Major League Soccer (MLS) here in the United States.  League protocols include:
“Any player suspected of having sustained a concussion shall be removed from play immediately and evaluated by team medical staff. If the initial evaluation results in a concussion diagnosis, he will not be returned to play in the same game or practice…Every MLS club has a designated Team Consulting Neuropsychologist, one of whom will conduct the post-concussion neuropsychological evaluation when an injured player is symptom-free at rest, prior to his return to play. Any player diagnosed with a concussion will be free of somatic and cognitive symptoms for at least 24 hours before starting an individualized, graded return-to-play progression under the supervision of the team physician.”
Moreover, MLS mandates that players have baseline neuropsycological testing performed so as to have those results on hand for later comparison with post-injury results.  The MLS protocol is very similar to protocols used by the NBA to evaluate basketball players suspected of having suffered a concussion.
Competing in the World Cup is an exciting opportunity, but nothing justifies any level of disregard for player safety.  Any game is, after all, ultimately just a temporary set of circumstances.   A poorly managed injury however, can leave its mark for a lifetime.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

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Free Family Caregiver Kit

Families of brain injury survivors face a great deal of stress in many areas of life.  Often significant among these new stressors encountered in the post-injury landscape is the sudden need to manage a loved one’s personal life. In many cases a brain injury survivor will no longer be capable of managing his or her own finances or of making important medical decisions unassisted.  Columnist Dear Abby and the United States government have teamed together to offer a free Family Caregiver Kit.  This kit contains nine publications addressing a wide range of important issues such as effectively managing finances, the implications of power of attorney and enacting proper medicine safety strategy.  The kit can be ordered for free (or alternatively, the publications can be downloaded for free) via this link:

http://promotions.usa.gov/dearabby.html

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

Mood and Awareness

It can be scary when a brain injury survivor lacks sufficient awareness of the full effect an injury has had upon his or her life.   It can be all too easy for a survivor in such a circumstance to engage in what could potentially be extremely risky behavior. For instance, if a survivor does not realize that he can no longer walk, he may attempt to get up from his wheelchair anyway to walk to the bathroom. This could lead to a terrible fall. Similarly, a survivor who is not aware that she now suffers from severe memory deficits may turn on a curling iron for her hair and forget to turn it off. This could lead to a fire. When survivors gain in awareness of their situations post-injury, families understandably feel much more at ease as these risky behaviors can only decline.

However, there is one downside to such improved awareness. When a survivor first becomes significantly aware of his or her deficits, he or she often experiences a marked decline in mood. The survivor is suddenly aware of the severity and implications of the injury. It is depressing to realize that life has changed, in some cases irrevocably, and that success over these new challenges can only come after many trials and tribulations. It is important that the loved ones of brain injury survivors understand that this decline in mood is natural and expected. This is the time when a psychologist, counselor or psychotherapist can step in and help the survivor adjust to his or her new situation. With therapy and support, most brain injury survivors will see an improvement in mood after this initial decline due to increased situational awareness.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org