HBO’s Real Sports Features Concussion Crisis in Youth Football Players

Over the past three years, 17 high school football players have died after sustaining head injuries while playing. A similar situation in the NFL would have caused a national uproar, so how has this been allowed to happen to our youth?

Take a look at trailer for this riveting episode of HBO’s series Real Sports with Bryant Gumbel, which is airing several times on HBO through mid-December 2016, as well as On Demand. The episode as a whole explores why there are such inconsistencies in protecting professional athletes versus the youngest players.

Significant Head Trauma Can Occur with Repeated Hits, Not Just Concussions

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

CTE’s connection to football has been in the news for five years now, with a debate centered around whether the number of concussions will affect long-term health and well-being of those playing the sport. Likewise, I’m constantly asked by patients and parents what the future effect of this or future concussions will be on their health. A recent study released by researchers at the Boston University School of Medicine (such as Dr. Robert Cantu, Dr. Ann McKee, Chris Nowinski and others) will probably give moms and dads across America a moment of pause before starting a collision sport like football or hockey.

An answer may lie in a concept developed by these researchers called the Cumulative Head Impact Index (CHII). They found individuals who had more hits to their heads—regardless of whether they had a concussion or not, were significantly (i.e., not even close…a large statistic margin) more likely to experience later-life cognitive problems, apathy and depression. The caution here is that the sample size was only 93 individuals and the exposure was only to football.

Helmet-Warning-Label

A football helmet’s health warning sticker is pictured between a U.S. flag and the number 55, in memory of former NFL player Junior Seau; new research suggests that the accumulation of subconcussive hits may have more significant long-term effects than concussions. (© Mike Blake / Reuters/REUTERS)

The next step is for medical providers and concussion specialists to help families begin to connect the dots throughout the developmental hurdles of a child’s life. For example, the health outcomes for two 7th grade beginning hockey players if they have a different history. One student may have fallen off a changing table as an infant and suffered a skull fracture, have been in a motor vehicle accident, and have fallen multiple times during winter sports, while the other 7th grader may not have suffered any head injuries or significant head trauma. Baseline neurocognitive testing like the ImPACT® test might look different on these two young students, and the outcome and recovery time of any current injuries sustained by each of them could be considerably different.

I’ve often said that kids can’t live in a bubble as much as parents are sometimes inclined to want to wrap their kids in bubble wrap. Young people—really, people of all ages—are going to be in car accidents, bike accidents, and slip and fall just going through life. Parents need to make their own unique, informed decision about how much additional risk of physical injury to which they want to expose their child, given his or her medical history and athletic abilities.

The Connection Between Concussions and Suicide

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

The topic of mild traumatic brain injury and/or concussion has been in the news for several years. The release of a major motion picture, a concussion sustained by a professional sports star, or the passage of a law tends to rekindle interest in the topic. Recently, another issue was linked to concussion — the concern of suicide. But, I am optimistic. Why? By nature, I’m an optimist, but I’m also hopeful that parents, community leaders and politicians will pay attention to the epidemic of suicide in our country.

When I worked in the U.S. Navy, one of my careers was serving as their Suicide Prevention Program Coordinator. Every death by suicide crossed my desk. The number of Marines and Sailors who attempted and completed suicide staggered me.

In our country, the number of people — servicemembers or civilian — who die by suicide is almost too much to comprehend. Compared to 16,000 homicides each year in the U.S., the number of suicides is nearly double that at almost 32,000 a year, most due to untreated depression of some form.

Let’s put those numbers in another perspective: In the last decade of our troops fighting in Afghanistan and Iraq, just over 7,000 Americans have made the ultimate sacrifice and almost 50,000 have been wounded. During that same time, more than 300,000 have died by suicide and more than 50,000 have been children between the ages of 14 and 24. The number of suicide attempts is in the millions.

Researchers are also finding out that some of the consequences of concussion are linked to depression and suicide. Untreated brain injuries can lead to devastating consequences.

My optimism lies in the hope that coaches, parents, athletes, and community leaders understand that the physiology of a concussion caused by a blow to the head or body prompts the neurons to function ineffectively due to a disruption of their normal chemical process.

I’m optimistic that these same parents, coaches, athletes, and community leaders will make the connection that the neurological process of a concussion is to depression. That these neurons which govern our emotions and self-esteem for a variety of different reasons — the death of a loved one, loss of a job, bankruptcy, medical conditions — can lead to a disruption of the neurons and cause depression leading to suicide.

I’m optimistic that the people who form every individual’s support system, from parents and teachers to friends and fellow athletes, will ACT if something seems amiss:
A — ask an individual if he or she is thinking about suicide
C — let him or her know you care about them
T — get the individual to treatment with someone who specializes in suicide evaluations: a counselor, pastor or chaplain, family doctor or pediatrician, psychologist, or psychiatrist or local emergency room

Concussion-Suicide-Risk-March-2016-900x900I’m optimistic that people will realize that depression can be considered the “common cold” of psychiatric conditions and has a variety of effective treatment options.

I’m optimistic that people will pass on the suicide prevention hotline number and website to those in crisis: 1-800-273-TALK and www.suicidepreventionlifeline.org.

And finally, I’m optimistic that people will pass this blog and information onto at least FIVE other people and in doing so, might just save a life.

“Concussion” Movie is Just the Beginning of the Brain Injury Conversation

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director
and Ann-Marie Sedor, HeadFirst Concussion Care Marketing

The much-anticipated movie “Concussion” is scheduled for release this year on Christmas Day, and already there is Oscar Award talk for Will Smith, who plays the role of Dr. Bennet Omalu. It was Dr. Omalu who discovered the tragic progressive degenerative effects of years of multiple concussions in NFL players, which he named CTE (chronic traumatic encephalopathy).

US-ENTERTAINMENT-SCREENING-CONCUSSION

Bennet Omalu, M.D., (L) and actor Will Smith attend the screening of the major motion film, “Concussion,” on November 23, 2015. (VALERIE MACON/AFP/Getty Images)

The film highlights the NFL’s initial response of anger and denial. Indeed, since Dr. Omalu’s discovery in 2002, the NFL has experienced lawsuits, exposés, and finger-pointing in general. Now, 13 years later, bystanders have watched the NFL’s reaction to this scientific research unfold in a manner not unlike many stages of grief – first denial, then anger, on to bargaining and, finally, acceptance. (Although, the League is still working on fully coming to terms with this last step.)

For their part, the NFL hasn’t had much reaction to the movie, preferring to keep the controversy at arm’s length. While Dr. Omalu has vocalized his opposition to children playing football until they are legally and emotionally old enough to understand the danger of putting their brains at risk, the NFL can’t afford to lose any of their reported $7+ billion in annual revenue.

Yet, while the debate rages on, two points are patently clear from years of scientific research: that children repeatedly hitting their heads during developmental years is potentially very harmful, and that college and professional football players can face significant health consequences from playing the sport.

But just how serious are families going to be about keeping their children from playing football? Indeed, this is just the beginning of the conversation about brain injuries.

As a community-based concussion clinic that has treated more than 30,000 traumatic brain injury patients over the past three years, HeadFirst Concussion Care has seen multiple reasons for why people sustain concussions. And while football is a violent sport, soccer, lacrosse and hockey also put our youth at risk for head trauma.

And again, this is just half of the dialogue. HeadFirst’s data shows that traumatic brain injuries sustained while playing organized sports with a concussion protocol in place (high school or college sports) account for a relatively small percentage of our patients. In fact, in as many as 80 percent of our patients, concussions are sustained by other mechanisms of injury. These include non-organized sports-related injuries (bike riding, skateboarding, trampolining, skiing, pick-up or other informal recreational games), slips and falls, motor vehicle accidents, and assaults.

The key message is that the people must understand that traumatic brain injuries can happen to anyone, anywhere, at any time. Not just kids. Not just athletes. And certainly, not just NFL players. And since anyone is at risk, everyone must understand the proper protocols for healing an injured brain.

On a final note to end the year, my holiday wish is that families, schools, and employers begin to talk about head injuries and follow traumatic brain injury protocols to keep all children and adults safe.

How Many Concussions Are Too Many?

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

Football is just a phenomenal sport.

I’m a season ticket holder of Navy football and also a huge fan of Army and Air Force football. These kids stand for a bit more than just playing football…and if I’m going to spend money I’d rather support the Brigade of Midshipmen and Air Force and West Point Cadets. But that’s a blog post for another day.

The bottom line is that I’m a huge football fan. The lessons that come from football often can’t be taught in a classroom.

NFL wide receiver Wes Welker has incredible numbers for the New England Patriots and now for the Denver Broncos. But for Wes, the most troubling concern is his three concussions in the last nine months. And watching the game last Sunday he looked as though he got clobbered and never saw the hit coming late in the fourth quarter.

Baltimore Ravens v Denver Broncos

Sometimes, parents will ask me “How many concussions are too many and when should I start looking for another sport for my little one?”

Presently there is no definitive number of concussions published in the literature. But three tends to be my number as a provider. If an athlete has had three significant neurological events — a concussion or mild traumatic brain injury —and there was a change in their mental status, that’s worthy of a discussion with the parents.

Clinicians will look at a number of factors such as mechanism of injury, intensity of symptoms, and length of time until complete recovery. I’ve had a patient who had a single mTBI and I had to talk to the parents about potentially choosing another sport after their child took 14 months to recover. Conversely, I’ve worked with parents after their child has had her sixth concussion but recovered in a week.

Wes Welker appears to have just had his fourth concussion in 10 months and I’m sure he’s having talks with his coaches and family about his health and recovery.

Here at HeadFirst Concussion Care, we have thousands of visits to treat head traumas. And, in many of those visits, I am often asked if sports are worth it.

My answer everytime? Absolutely. Kids learn leadership, companionship, competition, exercise, emotional balance, and many other values and benefits of sports.

The primary danger with a head injury is returning too soon before the injury has had a chance to heal itself. Play it safe. When in doubt, sit it out. In almost every case, the brain will heal and the child can return to his or her love of sports.

Student Athletes Just Want to Get Back to Playing

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

Parents beware… kids want to get back in the game. Injured or not, playing their sport is, after all, their passion. Who can blame them?

Often in the event of a concussion, the course of treatment is fairly straightforward.  Kids experience a traumatic brain injury and they go through a sequential recovery. After an initial period of rest the patient gradually returns to normal functioning.

Some of latest new research may indicate that the metabolic process of recovery normalizes for most mild head traumas around 30 to 40 days after the initial injury, which coincides with the timeframe of when many youth athletes are recovering from their concussion. However, with spring sports playoffs coming up, some athletes will try to push through their recovery faster to get back onto the field.

HeadFirst-Catcher

Even with all our advances in science and medicine, it still generally takes six to eight weeks for a human bone to heal. And, whether you’re 5 or 65 years, that’s just how long it takes for a bone to heal. When my patients have broken bones, I put brain injuries in perspective by asking if they’d go back onto the field with a break that hadn’t healed.  Inevitably, they answer, “Of course not, because I might do permanent damage.” At this point, I have to draw the parallel to having a traumatic brain injury and that returning to play too soon also could lead to lasting permanent brain damage.

I once treated a 15-year-old elite-level lacrosse player with a traumatic brain injury whose recovery was moving along nicely in the right direction. After 24 days, he had no symptoms and was completely back in school. When I performed a follow-up exam, everything looked great except his ocular-motor functioning, fine motor speed and neurocognitive test reaction time was a bit slow compared to other athletes at his level. He excused his slow performance by saying that he wasn’t trying as hard as he could have, but I saw that there were too many data points and subtle findings to indicate the young man was still recovering.

My patient, like so many athletes, was obviously anxious to get back to the game. He knew his teammates were counting on him but I had to remind him that protecting his brain was of the utmost importance.

Emotional Symptoms of a Concussion Last Longer than Physical Problems, Study Finds

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

An interesting new study has recently been released from Children’s Hospital in Boston, which finds that the emotional symptoms of a concussion often longer than the physical repercussions like headache, blurred vision, fatigue and difficulty concentrating.

Researchers found that, while symptoms such as headaches and dizziness show up initially after a concussion, emotional symptoms show up a bit later and can last much longer.

Image

The study tracked 235 children aged 11 to 22 with diagnosed concussions for three months. Among the findings: most children recovered within two weeks after the injury, but 25 percent still had headache a month after their injury. Additionally, more than 20 percent suffered from fatigue, and nearly 20 percent reported taking longer to think for a month after their concussion.

Although the word is getting out, parents and caregivers should expect that recovery from a head trauma that caused a significant neurological event — a change in cognitive, emotional or behavioral processing — will take weeks of treatment to reach recovery. In addition to brain rest and a gradual return to full activity, medical providers use a host of treatments to help individuals fully recover from a traumatic brain injury.