Tag Archives: football

Why Are We “Suddenly” Hearing About Brain Injuries

Brain injuries are a hot topic in today’s media.  Whether it be football players with lasting damage due to concussions, soldiers suffering from brain injuries due to overseas conflicts or the latest youth sports concussion protocols, it seems that there are suddenly many news stories on brain injury that simply were not around just five or ten years ago.  Some individuals may be cynical and wonder whether brain injuries are simply the “diagnosis of the moment”, one of the many diagnoses that are suddenly “hot” but will disappear over time.  To those individuals, I would like to offer several rational reasons why brain injury stories have become more prominent over the last few years.

First, many people are now living with brain injuries who would have died from their injuries in previous eras.  The medical world has advanced significantly over the years and now doctors are able to save the lives of people who would have otherwise died. However, just because their lives were saved does not mean they emerged from their health emergency unscathed.  These survivors often have brain injuries which require treatment.  Please allow me to give an example of this change over time.  I once was talking over lunch with an older rabbi about Transitional Learning Center.  He relayed a story about his time at a synagogue many decades ago in Indiana.  A young man in his community had a serious motorcycle accident and as his rabbi, he visited the young man in the hospital.  After conversing for a while and finishing his visit, the rabbi exited the room.  As he left, the doctor pulled him aside and said “You know he will be dead in three days”.  The rabbi was shocked, having just had a full conversation with the young man.  But the doctor was correct.  The hospital had no means to manage his brain injury.  Due to either brain swelling, bleeding or both (the rabbi did not know the details), the young man passed three days later.  Today, a person with a similar motorcycle accident would have a surgery and other potential procedures to manage his injury and would stand a good chance of living, albeit with a brain injury.  Similarly, improvements in military field medicine are allowing many soldiers to survive blasts and other dangers that would have killed them in previous battles.  Thankfully, these soldiers still have their lives, but often struggle with long-lasting brain injuries suffered in their military service.

Second, it is important to acknowledge the active suppression of information regarding brain injuries in certain circles that is only recently coming to light.  Most famously, the NFL actively denied and hid data on the long-term brain injury effects of concussions to former football players.  Through a series of lawsuits, the NFL opened up about brain injuries and is now acknowledging the long-term injuries that many former players have suffered.  This has led to a complex $1 billion settlement for players with long-term effects of brain injuries.  Following these court cases, many other lawsuits have been filed against other professional and amateur sports, leading to further agreements and new safety protocols.  The suppression in the past contributed to an artificial perception that brain injuries were less common than they actually were.

Third, we are in an age of information so it is much easier to learn about what is happening to people across the country, and even across the world.  Just think about how often you hear or read stories about a robbery or kidnapping occurring hundreds of miles from where you live.  Until the age of the internet, most of those stories would be confined to local media.  Now, stories can go “viral” and suddenly everyone knows the details.  This phenomenon is equally true in the realm of brain injuries.  A simple keyword search of “brain injury” will bring up a plethora of local stories that prior to the age of the internet would have been hidden from most of the world.  These local stories existed in the past but only now d0 we have so much access to them.

Fourth, we are now having a more honest conversation about brain injuries.  In the past, people generally did not talk about brain injuries.  Athletes and soldiers rarely mentioned their deficits due to fear of sounding “weak”.  Individuals with brain injury deficits from car accidents, strokes or other methods were often afraid of negative views and discrimination if others knew about their deficits.  We are now coming to an age of sharing without fear.  It may be hard to believe but the Americans With Disabilities Act (ADA), the civil rights legislation that has allowed for a greater involvement of people with disabilities in the workplace without fear of discrimination, was only passed in 1990.  In comparison, the Civil Rights Act, which blocked discrimination due to issues such as race, gender, and religion, was passed in 1964.

Fifth, we are much more able to diagnose and treat brain injuries than in the past.  Technology such as MRI and CT exams to scan the brain and locate injuries are relatively new.  Moreover until fairly recently many people, even health professionals, did not even know the right questions to ask to identify a potential brain injury.  For instance, if a high school athlete is concussed in a game today, the coach and athletic trainer often have a protocol to follow to ensure proper health management.  Twenty years ago, the player would likely have been just given smelling salts, asked if he or she felt “okay” and sent back into the game.  In fact, many states now have mandatory concussion training for coaches and athletic trainers.  This was unheard of just a few years ago.  In the past, people with brain injuries were forced to suffer in the silence of unrecognized deficits.  Now, these brain injuries and their concomitant deficits are more likely to be accurately diagnosed.

Overall, there are many rational reasons why we are “suddenly” hearing about brain injuries in the media, despite these injuries having been an issue in the past.

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

 

 

Doing It Best

Jahvid Best appeared to be on the road to football stardom.  Drafted in the first round by the Detroit Lions, Best possessed blazing speed that was the envy of other running backs.  Unfortunately, his professional football career met a premature end during it’s second year due to the effects of concussions.  Best put forth great effort to get back into the NFL but ultimately doctors ruled against his return.  For many people, this would be the end of the story.  For Jahvid Best though it was the start of something new.

One of the key tasks that brain injury survivors must navigate is assessing their retained abilities so as to identify what they can still do best in spite of their injuries.  Best understood that though his body was not ready to be tackled by 300 lb linemen, he still had his speed.  Best worked tirelessly at his skills on the track.  The hard word paid off.  Best qualified for the 2016 Olympics in Rio, where he will be representing the island nation of St. Lucia.  Best demonstrated how to thrive and succeed in spite of an injury!  Though he was not a TLC patient, we certainly think he is a true hero for the brain injury community.  Identifying a survivor’s skills and choosing activities that match those skills is a key part of the rehabilitation process.  For more reading on Jahvid Best’s journey, click on the link below:

 

http://olympics.nbcsports.com/2016/07/16/jahvid-best-olympics-detroit-lions-nfl-football-track-and-field-st-lucia/

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

 

 

 

Bubba Smith and CTE

The phrase “larger than life personality” could have been invented to describe Bubba Smith.  Looming at 6’7″ and almost 300 pounds, he was the first pick of the 1967 NFL draft and earned his ring at Superbowl V with the Baltimore Colts.  His extraordinary defensive skills on the football field left many a shell-shocked quarterback lying prostate in his wake.  Following his nine year professional football career, he parlayed his fame into a second career in film and television.  He is best known in the acting world as Captain Moses Hightower in the Police Academy movies and for his appearances in Miller Lite commercials.  After he passed in 2011, his estate allowed researchers to study his brain for evidence of Chronic Traumatic Encephalopathy (CTE).  It was discovered that he had been living under the effects of level three CTE (the scale runs from one to four).  Follow the link below to read more about these findings.

http://www.nytimes.com/2016/05/25/sports/football/bubba-smith-cte-nfl-concussion.html?_r=1

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

 

 

 

Return to Play is Important But Return to Learn is Vital

With a rise in awareness in the world of sports regarding the strikingly prevalent danger of brain injury and its deleterious effects, there has been a corresponding increase in the development of various concussion protocols for returning to active participation in sports following an injury.  These protocols are now the norm in the major sports leagues such as the NFL, NHL, MLB and NBA.  These “Return to Play” protocols are important for ensuring that athletes do not suffer a second concussion that can compound the damage of a not yet fully healed first one, causing an even more serious injury.  Schools around the country are following suit, pushing for more training on concussions.  In many school districts, concussion training for school athletic trainers and/or coaches is mandatory.  There is also a considerable amount of discussion in the media about return to play policies at the school-age level.  Just as professional athletes do, student athletes need to avoid the effects of compounding brain injuries.  However, there is a subject that seems to be garnering less public conversation but is even more important than when a student may be “ready to play”.  There is far too little discussion about an immensely more important topic, namely when a student is “ready to learn”.

School-age youth universally have one primary “job” in their lives, and that is to perform at their best in school classes.  Though sports are enjoyable and often quite meaningful to students, only a tiny few will go on to earn a sports scholarship to college and just a small fraction of those will ever play professional sports.  And even of this small fraction, only a handful will play more than a few years in professional sports.  Sports are not likely to be any particular student’s full time future job.  However, almost every single student’s future is tied in some way to his or her ability to learn information in a school setting. Most every job, and adult life in general, will require extensive dependence upon skills learned in the classroom such as writing and math.

School is similar to an adult’s full-time job as it encompasses the majority of daytime activities and requires a significant expenditure of cognitive energies on a daily basis to ensure performance at optimal levels.  Pushing a child back to school too quickly post-injury can engender an inability to learn effectively which can lead to a downward spiral of emotional distress and academic failure.  Schools need to work with parents and health professionals in order to create a plan for return to school after a brain injury, whether that injury be suffered on the playing field, in a car accident or by any other means.  Not every child will be able to return quickly or to a full load of classes.  Adjustments may be necessary to the schedule, format or setting of classes and school material.  The child may require special assistance from aids, tutors and note-takers.  The child may also benefit from breaks in the day to when he or she has crossed a threshold of cognitive overload.  If injuries are particularly serious and long-lasting, a Section 504 plan may be necessary.  The Brain Injury Association of Vermont has a sample return to learn protocol that can help guide parents, educators and health professionals as to when a child would likely be ready to healthily engage in different school tasks.

 

http://biavt.org/concussion-kit-documents/Section%207%20-%20RTL%20Protocol-pub%20final_5-9-13.pdf

http://biavt.org/concussion-kit-documents/Section%207%20-%20RTL%20Protocol-pub%20final_5-9-13.pdf

A healthy return to play protocol following a brain injury is important, but we need to remember that a child ultimately does not need to play a sport.  However, every child most assuredly does need to learn in school. So let’s increase the discussion on “ready to learn” plans and needs!

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

New Big 12 Concussion Policy

The Big 12 Conference, one of the most important conferences in Division I college athletics, has instituted a new concussion policy.  The Big 12 Conference includes college athletics powerhouses such as the University of Texas, the University of Oklahoma and Baylor University.  There are two pieces to the policy which strike as particularly important.  First, the new policy affords university medical staff position to make the sole and incontrovertible decision as to whether or not an injured player should be allowed to return to play while also removing from the teams’ coaches purview any form of employer’s authority over the medical staff.  This allows medical staff to make important medical decisions in an environment absent any fear of retribution from coaches.  Second, it states that any player diagnosed with a concussion cannot return to play or practice the day that that concussion is suffered.  This will hopefully eliminate dangers presented by the previous practice of returning concussed players back into games where they then face risk of suffering a more serious subsequent brain injury.  Remember, concussion is just another word for brain injury.  This truly is a step in the right direction when it comes to the reduction of brain injuries experienced in the world of college athletics and the improved treatment of those injuries suffered.  The link below will take you to the Big 12 press release covering this new concussion policy:

http://www.big12sports.com/ViewArticle.dbml?DB_OEM_ID=10410&ATCLID=209895746

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

NFL Settlement Battle

Lawyers representing the vast majority of National Football League retirees seeking legal recourse due to the deleterious effect upon their lives resulting from brain injuries suffered throughout the course of their careers will be in court on Wednesday to argue over the terms of the settlements between the NFL and those former players.  This may be the final settlement between the NFL and the former players, though some players have opted out of the settlement in order to pursue individual lawsuits.

http://www.reuters.com/article/2014/11/17/us-nfl-concussions-idUSKCN0J123S20141117

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

English Premier League Concussion Protocol

The English Premier League, one of the top leagues in professional soccer, recently enacted new protocols designed to help manage the effects of concussions suffered by its players.  Under the new rules, all players will be given baseline neuropsychological testing for later comparison prior to each season, in much the same way that the NFL, the NHL and NASCAR already do.  Any player who has received a concussion  (or is even sufficiently suspected of having received a concussion) will be automatically removed from the remainder of a given game.  The decision whether or not the player has received a concussion will be solely up to the team doctor, rather than allowing coaches or players themselves to make that all too crucial call.
These new rules follow on the heels of the World Cup, at which Alvaro Pereira of Uruguay and Christoph Kramer of Germany both continued to play after receiving concussions.  Former United States National Team member and current television analyst Taylor Twellman brings up the concern that a neutral doctor would be a better choice to make these evaluations than a team doctor, as the team doctor may feel pressure from the organization under which he’s employed to allow a star player to return.  Though his point is valid, this nonetheless still doubtlessly represents a much-needed step in the right direction as concerns the health and well-being of professional soccer players.  Moreover, as the English Premier League tends to be a trendsetter for other leagues, this likely bodes well for the further implementation of concussion protocols in leagues around the world.  After all, a concussion is just another word for brain injury and the better that these injured players are cared for, the less likely it is that their injuries will lead to permanent brain damage.

http://www.nytimes.com/2014/08/07/sports/soccer/premier-league-concussion-protocol-could-force-injured-players-from-games.html?_r=0

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

NCAA and Brain Injury

The National Collegiate Athletic Association (NCAA) has agreed to pay a $70 million settlement which provides for testing in order to assess whether past and current college athletes have suffered brain injuries throughout the course of their participation in a wide range of sports.  Athletes with brain injuries can individually sue for damages due to their brain injuries on the basis of the results from this testing, but the settlement amount itself does not specifically involve any dedicated sum to pay athletes with injuries.

http://espn.go.com/college-sports/story/_/id/11279710/ncaa-settles-head-injury-lawsuit-create-70-million-fund

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

 

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

Tony Dorsett

Tony Dorsett was one of the greatest players in football history.  Over the years he began to experience memory loss, mood swings and thoughts of suicide.  He took the initiative to be tested for Chronic Traumatic Encephalopathy (CTE), which is a brain damage experienced secondary to multiple traumas to the brain.  In Dorsett’s case, these traumas occurred as a result of the thousands upon thousands of hits he endured  over the course of his playing career.  Dorsett was found to have signs of CTE.  The link below will bring you to a video in which he discusses his experience learning to cope with the symptoms of brain injury. In addition to providing further detail on Dorsett’s story, the article beneath the video relates the similar experiences of Hall of Fame lineman Joe DeLamielleure and All Pro linebacker Leonard Marshall as they also have experienced brain injury symptoms and received the CTE diagnosis.

http://espn.go.com/espn/otl/story/_/id/9931754/former-nfl-stars-tony-dorsett-leonard-marshall-joe-delameilleure-show-indicators-cte-resulting-football-concussions

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