Category Archives: Bennett Omalu

There is Help for Battered Athletes and TBI patients!


A CT of the head years after a traumatic brain...

A CT of the head years after a traumatic brain injury

One of the doctors that has been at the forefront of the battle against traumatic brain injury (TBI) and chronic traumatic encephalopathy (CTE) is Dr. Daniel Amen. He has been working with athletes, military servicemen, and other brain trauma patients to provide a treatment regimen to help them to better cope with living with the effects of CTE and TBI — memory loss, dementia and depression. As Dr. Amen said recently, “My hope is that through increased awareness and education we can help these athletes before it’s too late.”

Since people with the CTE and TBI condition often do not have visible scars, it is hard for most people, including some physicians and other medical providers, to understand the extent to which short-term memory loss affects one’s ability to cope with daily living. Things that other people take for granted just takes much longer to do. Unless one is very organized, one can spend an inordinate amount of time looking for things that one needs on a daily basis. Just getting ready to leave the house for work or an appointment becomes a stressful  ordeal unless one has a routine that is not disturbed in any fashion.

Realization of the Consequences of Brain Trauma

It takes a while — maybe years for person with a CTE or TBI condition to fully understand that their brain no longer functions properly. Those that are lucky enough to have proper treatment may come to the realization sooner that those who do not receive treatment or worse still have to contend with skeptical or uncaring physicians and medical providers.

For instance, I have never had any neurological treatment or rehabilitation for the brain trauma that I sustained while working at Ameriprise Financial in July 2004. It took a number of years for me to realize that I had to take care of my own health rather than succumb to despair. I used my skills as a research analyst to search for articles on traumatic brain injuries so I could better understand what had happened to my brain and why I was experiencing short-term memory problems while my long-term memory was so crystal clear. In fact, I believe my creativity even increased as a result of the brain trauma resulting in a deluge of new and often very brilliant ideas. The only problem is that if I don’t write them down immediately,I would not be able to recall the  ideas after a short time. As I now sometimes joke that — my long-term memory is probably near genius level while my short term memory is significantly impaired. For someone that is particularly cerebral, with a background as a money market portfolio manager and an investment research analyst, one can only imagine my frustration with the situation. What I have essentially had to do is my own “self rehabilitation” using nutrition, naturopathic solutions, and coping mechanisms and systems that I have developed by myself which may not be the most efficient methods but nevertheless do work for me. Now I have the daunting task of going through an administrative hearing regarding the State of Washington‘s Department of Labor & Industries (L&I)‘s  premature termination of my medical benefits and I have to do it by myself, if I don’t get any legal help! A tall order for me but I am determined to go the distance to ensure that the State of Washington‘s Department of Labor & Industries (L&I) ensures compliance with workplace safety standards and more importantly, that L&I changes the way it treats workplace traumatic brain injury cases. A traumatic brain injury is not tantamount to a broken limb and should not be treated as such!

Coping with the Effects of Brain Trauma

Ultimately, one has to come to terms with the fact that the brain trauma has caused a fundamental change in one’s brain function. The best way to deal with the effects of the trauma is to accept it, the same way that one would accept the loss of a limb, and then find the best way to cope and live with it. It is not an easy journey coming to terms with the loss of brain function. High performance super athletes,  military servicemen, and intellectuals always like to perform at or above  a certain level of excellence.  It is very difficult and frightening for super-achievers that suffer a brain trauma to come to terms with the loss of a part or most of their  brain function. It is even more frustrating when one has to contend with all the pseudo-brain specialists that have never read a single pamphlet or sheet on brain science nor have any clue about the effects of CTE or TBI but think they know more than the brain specialists. Anabel Maya, a psychologist who is an expert on memory wrote an article titled “A Closer Look Into Memory” and she admits that she is fascinated by memory because of the amount of information that the human brain is able to store; however, she states that she does not completely understand memory — she is still learning about it!

Support of Family and Friends!

It is really important that people that have sustained brain trauma have support from their families and friends. Support also means understanding how the trauma affects the brain and how to help the person cope with the effects of the brain trauma. I am lucky to have the support of my family and close  friends and I will forever  be grateful to them. I would not have survived without their love and support! I have information on this blog that can help families to understand TBI and CTE and what role they can play to help their loved ones to cope and live with the condition.

You are not alone — there is lots of help!

Some people with a CTE or TBI condition receive treatment; however, there are a significant number of people like me that  receive little or no treatment and have to find ways to cope and live with the condition. The result of no treatment is despair and depression that eventually leads some to suicide! Some insurers like Zurich advise their clients to take precautionary steps to minimize workplace injuries, report injuries in a timely manner in order to start treatment soon after the injury occurs so that to that the employee recovers and returns to work resulting in lower worker compensation costs to the employer. Some employers don’t even bother to follow state mandated safety guidelines, do not report injury claims and time to ensure proper and timely treatment of their employees, and do not care what happens to the employee that has been injured due to their own negligence.  The only thing that matters to such employers is return to shareholders and management bonuses. The injured employee and their family be damned!They are much more interested in covering their tracks and paying the lowest premiums they can muster than doing the right thing!

However, there is help available.  Dave Duerson, Junior Seau and Ray Easterling did not need to take their own lives out of frustration, fear and despair! Most likely they could have been saved, if they had been under the care of physicians and other providers that specialize in the treatment of patients with CTE and TBI conditions.

Resources Available for Brain Injury Treatment

Amen Clinic: Dr. Daniel Amen of the Amen Clinic has a practice that focuses on helping former athletes,  servicemen and others that have sustained brain trauma. He has posted the article below on his blog to let people know that they need not commit suicide when there is lot of help available for them. You can visit his website to learn more and also for the contact information.

Brain Injury Research Institute (BIRI): Dr. Bennett I. Omalu, the forensic pathologist that discovered the presence of “Tau Proteins” in the brains of Mike Webster and other dead athletes and who coined the term “chronic traumatic encephalopathy” (CTE), and his partner Dr. Julian E. Bailes established the Brain Injury Research Institute (BIRI)  to continue their research on CTE and also to treat people that have sustained brain trauma and brain injury from multiple concussions.You can contact them by visiting their website.

Federal Agencies: The Federal Government has established  a dedicated section on its HRSA website to provide information and guidance to doctors, patients, and schools on dealing with Traumatic Brain Injury . The Center for Diseases Control (CDC) also has a section on its website that is dedicated to traumatic brain injury.

Military servicemen and veterans are returning from war with high incident rates of brain trauma which used to be generally diagnosed as post-traumatic stress syndrome. Now the Federal Government is on top of it game and military servicemen and veterans are receiving state of the art diagnosis and treatment for traumatic brain injuries. The Defense Departments’ Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (CDoE) was established in November 2007 to integrate knowledge and identify, evaluate and disseminate evidence based practices and standards for the treatment of psychological health and TBI within the Defense Department. The Defense and Veterans Brain Injury Center (DVBIC) serves active duty military, their beneficiaries, and veterans with traumatic brain injuries (TBIs) through state-of-the-art clinical care, innovative clinical research initiatives and educational programs.

State Agencies: Your best bet is to start with your State’s Brain Injury Association  of  America(BIAA). You can contact your State BIA‘s office by visiting the Brain Injury Association  of  America(BIAA)‘s website and then click on the map to select your own State.

Web: The internet abounds with information on brain injuries. You can do your own research using Google to type in keywords. Please see the tags on this page for examples of keywords that you can use for your search..

Brain Health Resources Blog: This blog has lots of information and links to help you to quickly find the resources that are available. If you have a question for me, kindly leave a comment and I will revert to you to guide you to find the information that you need.

Disclaimer: Please consult your own doctor first for guidance on your brain injury condition and treatment options.

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There is Help for These Battered Athletes

Shock, dismay and grief descended upon family, friends, and fans when news broke that former 12-time pro bowl NFL linebacker, Junior Seau had taken his own life.  The news came as shock to all, even those that were close to him, but this tragic story is becoming far too common.

Just two weeks ago, former Atlanta Falcons safety Ray Easterling, 62, shot himself in Richmond, Va.  His wife, Mary Ann Easterling, told news reporters that her husband suffered from depression, insomnia and dementia after his football career.  Another ex-NFL player Dave Duerson, a former Chicago Bears Pro Bowl safety, committed suicide nearly 15 months ago by shooting himself in the chest.  Duerson, 50, thought he suffered from dementia that fueled his depression. His suicide note included the request: “Please, see that my brain is given to the NFL’s brain bank.”

Post-death exams of Duerson’s brain showed he suffered moderately advanced evidence of chronic traumatic encephalopathy — a progressive degenerative disease related to repeated concussive blows. The disease has been linked to at least 18 deceased NFL players.

I just wrote about how serious a problem CTE is for athletes in contact sports and returning soldiers in last week’s newsletter and here we are again dealing with another heartbreaking story.  Junior Seau was a legend, but even legends cannot escape the ravages of chronic brain damage.  There is help for these athletes and anyone suffering from chronic traumatic brain injuries, depression, and irritability and memory problems.

I began studying the effects of football on brain health in 1999 when Brent Boyd, a former NFL player, came to the Amen Clinics.  After Anthony Davis came to the clinic in 2007 our work with active and former NFL players really took off when we partnered with the Los Angeles Chapter of the Retired NFL Players Association to perform the world’s largest brain imaging/brain rehabilitation study.

As part of the rehabilitation study we scanned the brains of 116 NFL players and found that 113 suffered brain damage and the level of brain damage was just awful.  People who have chronic, traumatic brain injuries, which almost all football players have because they get hit in the head thousands of times in their careers; have a much higher incident of depression and suicidal ideas and suicidal behavior.  Thirty percent of the players we studied had issues with severe depression.  That is four times the rate of depression among the general population!  Even worse, linebackers, like Junior Seau, who lead with their heads on the field, suffer the most significant damage.  The study showed patterns in damage to the front part of the brain and temporal lobes, under the temples and behind the eyes, which manage memory, mood stability and impulse and temper control.

The good news is the brains of contact-sport players and soldiers can be rehabilitated.  We have conducted three clinical studies with 116 active and former players from the National Football League here at the Amen Clinics and each study shows that it’s not only possible, it’s likely, that with a brain-directed health protocol, significant improvement can be experienced in decision-making, reasoning, depression, mood and memory.

Our studies found significant evidence that, fortunately, there are treatment protocols that can often reverse many of the symptoms caused by brain damage and improve brain function.

The studies include:

  1. Effects of Elevated Body Mass in Professional American Football Players on rCBF and Cognitive Function, Transl Psychiatry (2012) 2, eK, doi:10.1038/tp.2011.67.
  2. Impact of Playing Professional American Football on Long Term Brain Function. Journal of Neuropsychiatry and Clinical Neurosciences, J Neuropsychiatry Clin Neurosci 23:1, Winter 2011, 98-106.
  3. Reversing Brain Damage in Former NFL Players: Implications for TBI and Substance Abuse Rehabilitation. Journal of Psychoactive Drugs, 43 (1), 2011 Online publication date: 08 April 2011.

Junior may have damaged his pre-frontal cortex, which is responsible for decision-making.  Brain trauma symptoms can appear decades after the playing days and can include dementia, memory loss, violent behavior, obesity, mental illness and depression. And unfortunately, suicide is more common in people who have experienced brain trauma.

Playing football is a brain damaging sport and for those that are going to play it, my message would be to get your brain examined before you play and after you stop as well as any time you get a concussion.  The best way to prevent tragedies like these from happening aside from avoiding the things that are harmful to the brain, are early detection and treatment.  My hope is that through increased awareness and education we can help these athletes before it’s too late.

Source: http://70.32.73.82/blog/5758/there-is-help-for-these-battered-athletes/

World-Famous Doctor Helps With Junior Seau’s Autopsy


Dr. Bennet Omalu, co-founder of the Brain Injury Research Institute, was in San Diego to assist medical examiner

By Paul Krueger
|  Friday, May 4, 2012  |  Updated 6:33 PM PDT
World-Famous Doctor Helps With Junior Seau's Autopsy

Junior Seau looks on during a press conference to announce his retirement from the NFL on August 14, 2006 at the Chargers Training Camp in San Diego, California.

A world-famous doctor has been in San Diego to help with Junior Seau’s autopsy, NBC San Diego has confirmed.

That autopsy was performed Thursday at the county medical examiner’s office.

It will hopefully provide answers about why the veteran linebacker died of an apparent suicide on Wednesday.

The county medical examiner was assisted by Dr. Bennet Omalu, a forensic pathologist and co-founder of the Brain Injury Research Institute, which studies the impact of concussions on health.

Omalu’s participation in the Seau autopsy was confirmed today by a spokesperson for the Research Institute.

Omalu is also the chief medical officer for San Joaquin County, California.

The Seau autopsy won’t be completed for weeks, but right now, doctors know important new details about the condition of Seau’s brain because they were able to examine it during the autopsy.

One expert tells NBC San Diego that a pathologist can immediately see if the brain has been damaged by the impact of repeated concussions.

“Typically, the frontal lobes and the temporal lobes take most of the damage, so I would expect those areas will be looked at with some scrutiny,” says Dr. Jerome Stenehjem, of Sharp Memorial Rehabilitation in Kearny Mesa.

Stenehjem says cross-sections of a brain damaged by concussions will show shrunken lobes, compared to those in a healthy brain.

“It’s almost like a raisin shrinking down,” Stenehjem said, in describing the appearance of the damaged brain matter.

Stenehjem and other experts say repeated concussions can cause brain damage, including dementia and depression, which can lead to suicide.

Gary Plummer, a former NFL linebacker who played on the San Diego Chargers during the Seau years, tells NBC San Diego that a good NFL linebacker will suffer several “grade one,” or minor concussions, in every game.

“I can guarantee that in 20 years, he had easily over 1,000 concussions,” Plummer says.

Source: World-Famous Doctor Helps With Junior Seau’s Autopsy | NBC San Diego

Read more:

http://espn.go.com/nfl/story/_/id/7888497/sources-forensic-pathologist-credited-identifying-cte-involved-junior-seau-autopsy

Culled Comment from the ESPN link above:

#1: “I have had 13 concussions myself. While my friends, family and co-workers are all well aware of the memory loss, that is all that they are aware of. The depression, the headaches, the sensitivity to light at times all come with the territory as well but nobody is willing to admit it to friends. Long term concussion side effects are not a joke and something I have to live with everyday. I am only 25. I was once dumb and took pride in getting right back after having my “bell rung”. Now, I regret it everyday. Don’t just look at football. Wrestling and Boxing have it too.”

#2: “As an engineer I can guarantee you that both helmets and mouth-guards can be further optimized to reduce vibrations in the skull after a collision. To say that they will 100% prevent concussions is obviously far-reaching, but we could easily prevent 60% of the current concussions with better protection. The Brain will always bounce around in the skull, but creating damping mechanisms inside the helmet and with a mouthguard can prevent a huge percentage of the damage cause by these “Brain vibrations”.”

#3: “The Culture, behavior and technique is the answer. The only reason the helmet is used as a weapon is because it is glorified and even sometimes encouraged. Some have complained that we are creating a watered down game. But, i say they miss the point of football to begin with. The object is to move the ball down the field and score with strategy. Not see how many people you can Spear which IS ILLEGAL! Maybe all of this with Junior, Dave and Ray will make us do some soul searching and find a way to make them proud of the evolution of the game! Look I have coached 20+ years. I have won 4 championships and have NEVER had one of my players carted off or taken away in an ambulance. Why cause I teach proper technique. I teach them how to defend themselves!”

Dementia of football the next major public health issue.


June 14th, 2007

On September 24, 2002, Pro Football Hall of Fame center Michael Lewis Webster died in Allegheny General Hospital’s coronary care unit at age 50. Known as “Iron Mike” during his playing years, Webster’s discipline and overachieving nature helped propel the Pittsburgh Steelers to four Super Bowl championships. But soon after retiring in 1990, Webster’s life became plagued by debt, depression, family turmoil, and eventually homelessness.

Through an entirely serendipitous set of circumstances, forensic pathologist and neuropathologist Dr. Bennet Omalu had an opportunity to conduct an extensive examination of Mike Webster’s brain shortly after his death. What Dr. Omalu found was astonishing. While Mike Webster’s brain did not show any outward physical signs of dementia, at a cellular level his brain resembled that of an 80-year-old advanced dementia patient.

Over the next 5 years, Dr. Omalu conducted post-mortem tests on additional former pro football players, and he began to notice an emerging pattern which seemed to indicate an entirely different form of progressive chronic traumatic encephalopathy. Termed “Dementia of Football,” this syndrome was very different from dementia pugilistica, or the boxers’ “punch-drunk syndrome.” In contrast, “Dementia of Football” tended to occur without the presence of any motor symptoms – which would explain why it would often be misdiagnosed or completely overlooked.

Join us in this fascinating conversation with Dr. Omalu where we discuss this newly emerging syndrome in detail and ponder what could very well be one of the next major public health issues to affect athletes – both amateur and professional – worldwide.

Click to listen to the Podcast.

Source: http://intrepidinsights.com/2007/06/14/dementia-of-football-the-next-major-public-health-issue/

Game Brain


Game Brain
Let’s say you run a multibillion-dollar football league. And let’s say the scientific community—starting with one young pathologist in Pittsburgh and growing into a chorus of neuroscientists across the country—comes to you and says concussions are making your players crazy, crazy enough to kill themselves, and here, in these slices of brain tissue, is the proof. Do you join these scientists and try to solve the problem, or do you use your power to discredit them?

By Jeanne Marie Laskas
GQ Magazine
X-ray image by Nick Veasay
October 2009

On a foggy, steel gray Saturday in September 2002, Bennet Omalu arrived at the Allegheny County coroner’s office and got his assignment for the day: Perform an autopsy on the body of Mike Webster, a professional football player. Omalu did not, unlike most 34-year-old men living in a place like Pittsburgh, have an appreciation for American football. He was born in the jungles of Biafra during a Nigerian air raid, and certain aspects of American life puzzled him. From what he could tell, football was rather a pointless game, a lot of big fat guys bashing into each other. In fact, had he not been watching the news that morning, he may not have suspected anything unusual at all about the body on the slab.

The coverage that week had been bracing and disturbing and exciting. Dead at 50. Mike Webster! Nine-time Pro Bowler. Hall of Famer. “Iron Mike,” legendary Steelers center for fifteen seasons. His life after football had been mysterious and tragic, and on the news they were going on and on about it. What had happened to him? How does a guy go from four Super Bowl rings to…pissing in his own oven and squirting Super Glue on his rotting teeth? Mike Webster bought himself a Taser gun, used that on himself to treat his back pain, would zap himself into unconsciousness just to get some sleep. Mike Webster lost all his money, or maybe gave it away. He forgot. A lot of lawsuits. Mike Webster forgot how to eat, too. Soon Mike Webster was homeless, living in a truck, one of its windows replaced with a garbage bag and tape.

It bothered Omalu to hear this kind of chatter—especially about a dead guy. But Omalu had always fancied himself an advocate for the dead. That’s how he viewed his job: a calling. A forensic pathologist was charged with defending and speaking for the departed—a translator for those still here. A corpse held a story, told in tissue, patterns of trauma, and secrets in cells.

In the autopsy room, Omalu snapped on his gloves and approached the slab. He noted that Mike Webster’s body was sixty-nine inches long and weighed 244 pounds. He propped up the head and picked up his scalpel and sliced open the chest and cracked open the ribs. He took out the heart and found everything he expected of a man who was believed to have died of a heart attack, as was the case with Webster. Then he made a cut from behind the right ear, across the forehead, to the other ear and around. He peeled the scalp away from the skull in two flaps. With the electric saw he carefully cut a cap out of the skull, pulled off the cap, and gently, like approaching a baby in the birth canal, he reached for the brain.

Omalu loved the brain. Of all the organs in the body, it was easily his favorite. He thought of it sort of like Miss America. Such a diva! So high-maintenance: It requires more energy to operate than any other organ. The brain! That was his love and that was his joy, and that’s why his specialty was neuropathology.

Omalu stared at Mike Webster’s brain. He kept thinking, How did this big athletic man end up so crazy in the head? He was thinking about football and brain trauma. The leap in logic was hardly extreme. He was thinking, Dementia pugilistica? “Punch-drunk syndrome,” they called it in boxers. The clinical picture was somewhat like Mike Webster’s: severe dementia—delusion, paranoia, explosive behavior, loss of memory—caused by repeated blows to the head. Omalu figured if chronic bashing of the head could destroy a boxer’s brain, couldn’t it also destroy a football player’s brain? Could that be what made Mike Webster crazy?

Of course, football players wear helmets, good protection for the skull. But the brain? Floating around inside that skull and, upon impact, sloshing into its walls. Omalu thought: I’ve seen so many cases of people like motorcyclists wearing helmets. On the surface is nothing, but you open the skull and the brain is mush.

So Omalu carried Mike Webster’s brain to the cutting board and turned it upside down and on its side and then over again. It appeared utterly normal. Regular folds of gray matter. No mush. No obvious contusions, like in dementia pugilistica. No shrinkage like you would see in Alzheimer’s disease. He reviewed the CT and MRI scans. Normal. That might have been the end of it. He already had a cause of death. But Omalu couldn’t let it go. He wanted to know more about the brain. There had to be an answer. People don’t go crazy for no reason.

He went to his boss, pathologist Cyril Wecht, and asked if he could study the brain, run special tests, a microscopic analysis of the brain tissue, where there might be a hidden story.

There was nothing routine about this request. Another boss might have said, “Stick with the protocol,” especially to a rookie such as Omalu, who had not yet earned a track record, who was acting only on a hunch. But Wecht was famously never one to shy away from a high-profile case—he had examined JFK, Elvis, JonBenét Ramsey—and he said, “Fine.” He said, “Do what you need to do.”

A deeply religious man, Omalu regarded Wecht’s permission as a kind of blessing.

*****

It was late, maybe midnight, when Bob Fitzsimmons, a lawyer working in a renovated firehouse in Wheeling, West Virginia, got a call from the Pittsburgh coroner’s office. It was not unusual for him to be at the office that late; he was having a bad week. He struggled to understand the man’s accent on the phone.

Read Morehttp://www.gq.com/sports/profiles/200909/nfl-players-brain-dementia-study-memory-concussions#ixzz1KiJHRyIP

Brain Injury Research Institute (BIRI) Experts at WVU Discuss Chronic Traumatic Encephalopathy (CTE)


Uploaded by WestVirginiaU on Jun 28, 2010

For the first time, doctors have found evidence of Chronic Traumatic Encephalopathy in a young athlete who was an active NFL player at the time of Chris Henry‘s death. Full story: http://health.wvu.edu/newsreleases/news-details.aspx?ID=1515

Experts at the Brain Injury Research Institute (BIRI) at West Virginia University said that an examination of Chris Henry’s brain tissue revealed the same kind of damage found previously in older, retired players who had histories of concussion.

WVU Chairman of Neurosurgery Dr. Julian Bailes

Uploaded by InDepthCrew on Oct 20, 2009

Dr. Julian Bailes, talks about the severity of head injuries in football. Dr. Bailes is working closely with the National Football League Players Association on head injuries. He has been quoted in national publications including the New York Times, USA Today and The Washington Post and appeared on NBCs The Today Show, CBSs The Early Show, CNN. He was most recently featured in a GQ article title Game Brain by Jeanne Laskas.

WVUs Dr. Julian Bailes on ABCs Nightline program: Long-term Impact of Concussions

Uploaded by WVUHealthcare on Oct 19, 2009

Dr. Julian Bailes, Chair of the WVU School of Medicine Department of Neurosurgery, appeared on ABC’s Nightline program (with guest host Martin Bashir) on October 16, 2009 to discuss the long-term impact of concussions to NFL football players.

Dr. Daniel Amen on the NFL Dementia Debate


Senate Juciary Hearings on NFL Player Head Injuries


Health Special: Kids and Concussions


Head hits are causing a concussion crisis for America‘s kids. How science is helping diagnosis

Headbanger Nation

By Jeffrey Kluger Thursday, Feb. 03, 2011

Gregg Segal for TIME

I didn’t get a good look at the little boy who injured my daughter in the science museum in Mexico City. He seemed to be about 7, my daughter Elisa was not yet 3, and the two of them were part of a scrum of kids playing on an indoor patio. At precisely the wrong moment, she turned left, he turned right, and they collided. Physics being physics, the smaller mass yielded to the larger one, and my daughter fell down. She landed first on her bottom, then tipped backward and hit her head on the floor.

The sound was one that parents dread: the singular clunk of skull striking cement. I winced, Elisa wailed, and I gathered her up. Soon she stopped crying and went off to play, but even as she did, a dangerous process had begun to unfold inside her skull. (Read Dr. Mehmet Oz’s column about concussions.)

When Elisa’s head hit the floor, the deceleration was sudden, but — physics again — her brain stayed in motion for an instant, moving through the small intracranial space until it collided with the back of the inside of her skull. Concussive energy radiated through the tissue. As it did, channels in the neurons opened wide, allowing calcium ions to flow into the cells, depressing their ability to metabolize energy. Brain tissue began swelling, but with nowhere to go, it squeezed up against the skull wall. Shearing forces tore axons connecting the cells, damaging their myelin sheathing, which can disrupt nerve signals. All of that was the best-case scenario. The worst case was a brain bleed, which could be fatal without immediate surgery.

Within 20 minutes, Elisa grew withdrawn. An hour later, back in our hotel, she vomited and then began thrashing convulsively. We rushed her to a hospital, where doctors struggled to get a line into one of the tiny veins in her arm, shouting at her to stay awake.

“Open your eyes!” I shouted at her in English. “Abre tus ojitos!” my wife echoed. Elisa understood both languages; she answered in neither.

Finally, the doctors got her into a CT scanner, then administered an EEG. There was no bleeding, but there was swelling. Elisa spent three days in the hospital taking antiseizure and antiswelling medication and finally was released. On the flight home, she was a terror — but only in the way a toddler is supposed to be. (See a graphic on the physics behind concussions.)

For us, that was a first-time — and, we dearly hoped, last-time — experience, but we’re hardly alone in having gone through it. In the U.S., concussions are an alarmingly commonplace injury, particularly among kids and most particularly among active, athletic ones. Up to 3.8 million Americans are getting concussed per year, according to the Centers for Disease Control and Prevention, and even that big a figure is a moving target. In 2005, the number of children who visited emergency rooms for treatment of concussions was more than twice what it had been in 1997, according to a new study in the journal Pediatrics. High school football players alone sustain 100,000 full-blown, diagnosed concussions per year. Flying under the radar are injuries mild enough to get passed off by coaches as a mere ding or ignored by players anxious to get back on the field.

According to a study by neuroscientist Kevin Guskiewicz of the University of North Carolina, the average college football player sustains a breathtaking 950 to 1,100 subconcussive blows per season — hits that are enough to do cumulative damage to young brain tissue but not enough to cause immediate symptoms. “There’s what we call a dose response,” Guskiewicz says. “After a certain number of hits, the damage starts to show.”

But while football is responsible for more than half the concussions kids suffer playing team sports, there’s a lot more blame to go around. The success of Title IX, which forbids gender discrimination in scholastic athletics, has led to a 900% increase in girls’ sports teams since the law’s passage in 1972. But guaranteeing girls equal access to sports also guarantees them equal access to injuries. Girls’ soccer accounts for nearly 12% of total team-sports concussions, compared with just 6.6% for boys’ soccer. Girls’ basketball causes 7%. Even volleyball weighs in at 1.1%. (See a special report on women and health.)

What’s more, a third of all concussions among kids are caused by nonteam activities such as ice skating, bicycling and playground recreation. Gaining fast too are newer head-cracking activities like snowboarding and extreme skateboarding. Kids may be the first group to fall in love with such sports, but they’re the last group — neurologically speaking — that should engage in them.

“The immature brain is still developing,” says Julian Bailes, a neurologist at West Virginia University and the medical director for the Pop Warner Youth Football program. “That makes it more susceptible to damage and more likely to suffer repetitive injury.” How this shapes overall development is unknown. A child’s brain is like a ship en route to somewhere: a concussion can blow it off course.

The severity of the damage — both acute and chronic — is what researchers are now trying to understand and what legislators and the sports-equipment industry are trying to control. Even as scientists look deeper into the physics, neurochemistry and genetics of brain injury, lawmakers are imposing new rules governing how kids should be assessed for concussions and when they should and should not be eligible to play. Equipment manufacturers, particularly those who make football helmets, are being pushed to redesign their product lines and reform the testing standards that essentially allow the industry to police itself. Pro teams too are feeling the heat for selling an elbow-throwing, stick-swinging, head-butting ethos that may be fine for millionaire athletes who know what they’re getting into but is hurting, and in some cases killing, the kids who emulate them.

“I keep telling kids, Your brain is not your knee. It’s not your shoulder. It’s your future,” says neuropsychologist Gerard Gioia, chief of pediatric neuropsychology at Children’s National Medical Center in Washington. “We have to protect it better than we are.” (See TIME’s special report “How to Live 100 Years.”)

The Science of a Hit
If it’s football that receives most of the attention in conversations about concussions, it’s partly because the hits inflicted in the game can be so shocking. In soccer, basketball or even hockey, violence is typically a by-product of aggressive play. In football, it is the play. Guskiewicz conducts his studies by placing accelerometers in players’ helmets and recording not just how often they get hit but also how hard. The unit of measure he uses is g-force. Liftoff of a Saturn V moon rocket exposed its crew to a maximum of four g’s. A roller coaster may exceed six g’s. College football players, by contrast, collide with each other with an impact of nearly 23 g’s — and that’s the average. Higher-end blows range from 85 to 100 g’s. “The highest we ever recorded was 180 g’s,” says Guskiewicz.

Worse, it’s not necessary to be hit in the head for that kind of impact to do concussive damage. A player struck in the chest can suffer whiplash just like a passenger in a car accident, and when the head snaps back and forth, the brain sloshes around with it. “One sign,” says Gioia, “is when a player complains of neck pain. That’s often an indicator that the head has moved around hard.”

Many of those blows don’t necessarily lead to a concussion, and in a way, that’s unfortunate. Only about 10% of concussions lead to loss of consciousness, but the other signs are hard to miss, including headache, vomiting, dizziness, balance problems, sensitivity to light or noise, confusion, irritability and amnesia. A player with any of those symptoms is likely to be sent to the bench — at least for a while. A player whose brain has been jolted at a subconcussive level is much likelier to stay on the field and return there week after week with no recuperation time. The damage that does can be deadly. (Read Dr. Mehmet Oz’s column about concussions.)

In April 2010, University of Pennsylvania football star Owen Thomas committed suicide in his off-campus apartment, having never before exhibited any sign of mental illness. When researchers at Boston University examined his brain, they found it flecked with what are called tau proteins, telltale signs of a condition known as chronic traumatic encephalopathy (CTE), which is often seen among dementia patients and NFL players with a lifetime of concussions behind them. Thomas had never sustained a concussion, but that might not have mattered.

“He’d been playing since he was 9,” says neuropsychologist Robert Stern, part of the team that conducted the analysis. “That suggests he had a great deal of exposure to repeated subconcussive blows.”

The link between tau and brain damage is straightforward. The protein is one of the major structural materials of nerve tissues. When the brain is shaken too hard, nerve fibers are torn and the tau is released. The brain tries to clean up the mess, and given enough time, it could. If the hits keep coming, however, the proteins just accumulate. “I describe [the tau deposits] as a form of sludge,” says Bailes.

It’s not unusual for players like Thomas suffering from CTE to die in violent or otherwise dramatic ways. Bailes was part of a team that found tau protein in the brain of Chris Henry, a player for the Cincinnati Bengals who was killed in 2009 when he got into an argument with his fiancée and jumped on the back of her pickup truck as she drove away — taking a fatal tumble onto the road. In 2007 wrestler Chris Benoit murdered his wife and son and then hanged himself. In 2004 former Pittsburgh Steeler Justin Strzelczyk, who suffered from hallucinations, died when he drove his car into a tractor trailer while fleeing police. Both Benoit and Strzelczyk had CTE. “This disease starts young and progresses through life,” says Stern.

Until recently, doctors didn’t know just how young, but they’re getting an idea. Michael (not his real name) is a ninth-grade football player visiting an outpatient concussion clinic Gioia runs in Rockville, Md. Michael got clobbered in a game in mid-September, suffered many of the immediate concussion symptoms and four months later is still not well. Recovery time varies for all patients, though three months is a good benchmark; four months suggests trouble. Michael’s sleep remains disturbed, his temper remains erratic, and his school performance has cratered. An honor-roll student in eighth grade, he has gotten mostly D’s and F’s this year. “The change,” says his mother, “it’s shocking.”

It’s not possible to diagnose anything like CTE from just those symptoms, particularly because Michael’s recent academic problems began before his concussion. But he already had a history of what he calls stingers, or head blows — none of which kept him off the field. What’s more, his coach allowed him to return to play only a month or so after his recent concussion, a game in which he took another blow to the head, then lost his temper and got ejected.

Michael is hardly the only student athlete playing roulette with his brain, and his coach is hardly alone in abetting such recklessness. One study has shown that up to 40% of players who experience a concussion are back on the field before their brains have fully healed. That, Gioia says, is especially worrisome since sometimes two mild injuries can do more damage than one severe one. In some cases — mercifully rare — players who return to the field before they’re fully recovered may even suffer what is known as malignant brain edema, or second-impact syndrome, in which another blow to the head leads to a fatal brain bleed. About half a dozen kids per year die from second impact. (Read Dr. Mehmet Oz’s column about concussions.)

It’s easy enough to make the case that any person who has suffered a brain injury needs a long period of recuperation before returning to vigorous physical activity. But what about vigorous intellectual activity? The brain is a cognitive machine, and it requires an enormous amount of energy to keep its gears moving. That’s a fact concussed kids often confront when they resume their classwork after an injury and find that their symptoms return the moment they crack a book. “Cognitive exertion requires a high degree of metabolic activity,” says Gioia. “If you have a brain that’s already impaired, that ability is going to be reduced.”

Mary, a high school junior and another patient at Gioia’s clinic, has suffered three concussions over the past three years as a goalie for her soccer team. Surprisingly, it is not heading the ball that leads to most concussions in soccer — though the limited studies that have been done have looked only at young adults, and none have explored subconcussive injury. Rather, the damage is done mostly by collisions with other players or, as in Mary’s case, with equipment. Her third concussion came last November, when she hit her head against the frame of the goal. She remains an honors student in the International Baccalaureate program in her high school, but the struggle to keep up that level of academic excellence has been grueling.

“I didn’t have any exams until two months after the injury,” she says. “But when I did, the headaches and fatigue came back immediately. I lost focus during one test and had no idea what I’d just written.” She got through all the same and has gone back to school full time, but every day is a battle with pain, exhaustion and sensitivity to noise and light. She has also accepted that soccer — which was a passion — is just not an option anymore. “I can’t afford another concussion,” she says. (See a graphic on the physics behind concussions.)

Digging Deep
The fact that no two concussions follow the same recovery arc is one of the things that makes them so challenging to diagnose and treat. But that same particularity of injury also provides scientists insights into which people are at the greatest concussive risk.

Gender, for one thing, seems to play a role. Mary may be recovering faster from her injury than Michael is, but on the whole, females are both more susceptible to concussions than males are and suffer more-severe symptoms. So far, the reason for that gap is unclear. There is some thought that a girl’s comparatively weaker neck muscles may leave her head more susceptible to violent shock. Hormones too may play a role. Among epileptic girls and women, rising and falling estrogen levels are known to make the brain more or less vulnerable to seizures. The thinking is that this may apply to concussion symptoms as well — though it’s unclear whether a girl’s hormonal makeup leaves her more concussion-prone throughout the month or just during menstruation. (See a special report on women and health.)

Genes may also be involved. The fact is, plenty of athletes make it through their careers battered and scarred but cerebrally intact, while others who may not get hit with any greater frequency suffer all manner of brain damage. Researchers at the Children’s National Medical Center are studying the genomes of both concussed and nonconcussed kids, looking for markers that may explain the difference.

“There could be a genetic predisposition that affects metabolic activity,” says geneticist Susan Knoblach. “People always assume that there’s a genetic component in degenerative conditions but not acute ones, but of course there can be.”

Maryland’s Fairfax County has instituted a program in which student athletes spit into cups so their genetic profiles can be taken. The genomes of the ones who come down with concussions can then be compared for key similarities. Early attention is focusing on a gene that codes for a protein called ApoE, which has been implicated in Alzheimer’s disease. In the long run, teasing out concussion genes could lead to better drugs or gene therapy to treat or prevent the injury. In the short run, it could help parents and coaches determine in advance which sports kids are best suited to play. Says Gioia: “We may actually find out, ‘You know what? You’re not set up to be a football player. You might be a better tennis player.'”

Newer brain-scanning technology is also making a difference, helping doctors diagnose concussions and track recovery. The microscopic size of tau proteins and nerve fibers makes them impossible to see without a postmortem exam, but three noninvasive techniques can help sidestep that problem. Magnetic resonance spectroscopy measures not direct damage to the brain but its metabolic activity — a good way to evaluate the very system that breaks down first when a brain is concussed. Diffusion tensor imaging can observe transmission along nerve-fiber tracks, providing a sense of the integrity of the neural wiring. And resting fMRI allows physicians to watch the brain when it’s not performing a task, providing a look at basic function. (See TIME’s special report “How to Live 100 Years.”)

Changing the Rules
Smart medicine, of course, can do only so much to reverse the number of concussions. Smart policy must do the rest. To keep kids from hurting themselves — and to prevent coaches from enabling them — 10 states, including New Jersey, Oregon, Virginia and football-mad Oklahoma, have passed return-to-play laws requiring kids who have sustained even a suspected concussion in any sport to be pulled from play and not returned until a doctor or certified athletic trainer declares them fit. A handful of other states are considering similar legislation, and last year two separate bills along the same lines were introduced in the House of Representatives. Both will have to be resubmitted under the new GOP majority. Still, the national trend is clear: “When in doubt, sit them out” is how the advocates put it.

Most major professional sports leagues in the U.S., as well as most large universities and 4,000 high schools, now also use a computer program known as ImPACT (for Immediate Post-Concussion Assessment and Cognitive Testing) that measures such basic skills as memory, word recognition and pattern recognition. Players are required to take a baseline test at the beginning of the season and are periodically retested, especially postconcussion, to determine if there’s been any erosion of skills. “I used to sit across from athletes doing paper-and-pencil memory tests,” says ImPACT developer Mark Lovell, a neuropsychologist at the University of Pittsburgh Medical Center. “That would never work with large groups of kids. There aren’t that many neuropsychologists alive.”

Reform is also coming — slowly — to the major manufacturers of football helmets, driven mostly by the NFL, which has imposed much stricter concussion and tackling rules in the past season. The NFL is anxious both to protect its players and to shake its image as a weekly tutorial for student athletes learning all the wrong safety lessons from pros who should know better. Currently, the group that certifies helmets is the National Operating Committee on Standards for Athletic Equipment (NOCSAE), which sounds reassuringly official except for the fact that it’s essentially funded by the manufacturers themselves. NOCSAE has come under fire not only for this seeming conflict of interest but also for what critics consider unreliable testing. The larger problem, though, is that the standard football helmet was designed to prevent only lacerations and fractures — a job it does very well — and to do little or nothing to prevent concussions. “The science just isn’t there today,” says Dr. Robert Cantu, a neurosurgeon at Boston University and a member of NOCSAE’s board. (See a graphic on the physics behind concussions.)

That’s not NOCSAE’s or the NFL’s fault, but they’re trying to do something about it. In December the league and the helmet manufacturers convened a sort of head-injury summit in New York — a gathering that also included officials from NASCAR and the military — to consider helmet modifications that could reduce the concussive carnage. For football, those modifications could include better padding, stronger chin straps and redesigned face masks that distribute shock differently. Kids’ helmets must also be more than simply smaller versions of those used by adults. The padding inside all helmets is designed to compress at the forces generated by colliding adult bodies. With the smaller forces kids produce, the padding stays rigid, essentially becoming one more hard surface for the head to strike. Innovations introduced in football could ripple out to other sports’ playing fields, to say nothing of battlefields.

Athletics will never be stripped of all danger, and terrible as the blown knee or wrecked elbow may be, there is always an assumption of those risks when you elect to play the game. But the brain is more than a joint or a limb. It’s the seat of the self. We overlook that fact at our peril and — much worse — at our children’s.

View the full list for “Health Special: Kids and Concussions”

Source: http://www.time.com/time/specials/packages/article/0,28804,2043395_2043506_2043494-1,00.html

Brain Injury Awareness Month


March is Brain Injury Awareness Month, a critical time when we can all help to  raise awareness about this important public health problem. Please scroll down to read the entire page and then visit the Center for Diseases Control (CDC)’s Brian Injury website.

Traumatic Brain Injury (TBI) is a debilitating and often degenerative condition. People that have suffered TBI often appear normal outwardly while they are facing tremendous turmoil, and mental and physical challenges due to the effects of TBI.

Veterans are returning from Iraq and Afghanistan with TBI sustained from bomb and other attacks. This has tremendously increased the TBI epidemic in the US.

New Frontier: Neuroscience or brain science and brain function is still very much a new frontier. Doctors and scientists are still learning and making new discoveries about the human brain and how it functions. Researchers at Allen Institute for Brain Science, Brain Injury Research Institute (BIRI)Stanford University, John Hopkins University,  and other universities and research institutions are working hard to map the human brain so they can more thoroughly understand how the human brain functions.

Research undertaken by Dr. Bennet Omalu, the renowned neurology forensic pathologist,  led to diagnosis of Chronic Traumatic Encephalopathy (CTE) arising from excessive levels of tau protein in the brains of NFL players that had sustained multiple concussions. This discovery led to a US House of Representatives Judiciary Committee hearing in February 2010; and literally forced the NFL to change its policy and protocol on assessment of concussions and the return of football players to play following concussions, and compensation of players that had suffered multiple concussions and TBI.

Dr. Omalu, now the pathologist for San Joaquin County, CA,  and Dr. Julian Bailes, the chairman of the neurosurgery department at West Virginia University and a leading concussion researcher. co-founded the Brain Injury Research Institute (BIRI), and have published the results of the examination of the autopsy of the brain tissues of fourteen professional athletes and three high school football players after unexpected deaths in the February 2011 edition of Neurosurgery. Dr. Omalu is also collaborating with neurologist  Dr. Daniel Amen on further study and treatment of NFL players.

Recent research on TBI has also led the CDC to focus more attention on TBI. CDC now provides information on TBI through its website. CDC has also developed guidelines for medical practitioners; coaches, athletes, and parents;  and school administrators, teachers and nurses on proper handling of concussion and TBI cases.

If you know someone that has suffered a traumatic brain injury, please reach out to support and help them by sharing this blog and information with them.  Don’t assume that you have all the answers because even top scientists and doctors are still learning.The best gift that you can give a person suffering from TBI is compassion and understanding.

Also, you can help by sharing this blog with your doctor, your children’s school teachers, nurses and administrators, and friends and family members. You will never know when TBI may impact you or someone close to you.

Learn TBI Signs, Symptoms and How to Respond

Bringing Attention to Brain Injury:

Photo: MRI filmHave you ever hit your head as a result of a fall, a car crash, or other type of activity that left you feeling “just not right” afterwards? After a few days you returned to your normal activities, however, you kept getting a headache, were sensitive to noise, and had more trouble than usual concentrating or remembering things. Does this sound familiar? If so, you may be one of the millions of people who sustain a traumatic brain injury (TBI) each year.

This March, in recognition of Brain Injury Awareness Month, CDC and our partners are working together to spread the word and raise awareness about TBI prevention, recognition, and response to help address this important public health problem.

CDC estimates that 1.7 million Americans sustain a TBI, including concussions, each year. Of those individuals, 52,000 die, 275,000 are hospitalized, and 1.4 million are treated and released from an emergency department.

Photo: A mother fastening a helmet on her son.

Understanding Traumatic Brain Injury (TBI):

A traumatic brain injury (TBI) is caused by a bump, blow, or jolt to the head or body that causes the head and brain to move quickly back and forth. This sudden movement can literally cause the brain to bounce around or twist in the skull, damaging brain cells and creating chemical changes in the brain.

Learning the Signs and Symptoms:

Most people with a TBI recover quickly and fully. But for some people, symptoms can last for days, weeks, or longer. And in severe cases, a TBI can lead to coma and even death. In general, recovery may be slower among older adults, young children, and teens. Those who have had a TBI in the past are also at risk of having another one and may find that it takes longer to recover if they have another TBI.

Symptoms of TBI usually fall into four categories:

TBI symptoms thinking icon.gif Thinking/
Remembering
TBI symptoms physical icon.gifPhysical TBI symptoms emotional icon.gifEmotional/
Mood
TBI symptoms sleep icon.gifSleep
Difficulty thinking clearly Headache
Fuzzy or blurry vision
Irritability Sleeping more than usual
Feeling slowed down Nausea or vomiting
(early on)
Dizziness
Sadness Sleep less than usual
Difficulty concentrating Sensitivity to noise or light
Balance problems
More emotional Trouble falling asleep
Difficulty remembering new information Feeling tired, having no energy Nervousness or anxiety

Some of these symptoms may appear right away, while others may not be noticed for days or months after the injury, or until the person starts resuming their everyday life and more demands are placed upon them.

See When to Seek Immediate Medical Attention, to learn about dangers signs to watch for in adults and children.

Getting Help:

People with a TBI need to be seen by a health care professional. If you think you or someone you know has a TBI, contact your health care professional. Your health care professional can refer you to a neurologist, neuropsychologist, neurosurgeon, or specialist in rehabilitation (such as a speech pathologist). Getting help soon after the injury by trained specialists may speed recovery.

Getting Better:

Rest is very important after a TBI because it helps the brain to heal. Ignoring your symptoms and trying to “tough it out” often makes symptoms worse. Be patient because healing takes time. Only when your symptoms have reduced significantly, in consultation with your health care professional, should you slowly and gradually return to your daily activities, such as work or school. If your symptoms come back or you get new symptoms as you become more active, this is a sign that you are pushing yourself too hard. Stop these activities and take more time to rest and recover. As the days go by, you can expect to gradually feel better.

See Getting Better, for tips to help aid recovery from a TBI.

Reaching Out:

Several groups help people and their families deal with concussion and more serious TBIs. They provide information and put people in touch with local resources, such as support groups, rehabilitation services, and a variety of health care professionals.

See Finding Support for more information, including contacting support groups in your area.

Learn more information about TBI in the militaryExternal Web Site Icon, including an interactive website for service members, veterans, and families and caregivers.

The annual celebration of National Public Health WeekExternal Web Site Icon is scheduled for April 4-10, 2011.  This year, the American Public Health Association (APHA) will continue its broad vision to make America the healthiest nation in one generation by raising awareness of the importance of preventing violence and injuries, such as TBI, through the theme Safety is No Accident: Live Injury-free.

Improving Research:

Research and data are critical to understand traumatic brain injury as an important public health problem. CDC collects and reports TBI data to help inform prevention strategies, identify research and education priorities, and support the need for services among those living with a TBI.

See TBI statistics and who is at risk to download reports, get national and state TBI estimates, and learn about the leading causes of TBI in the United States.

Helping Spread the Word:

To help improve prevention, recognition, and response to TBI, including concussions, CDC developed the “Heads Up” educational initiatives to offer information to health care professionals, school professionals, sports coaches, parents, athletes, and others.

See “Heads Up” educational initiatives to download or order the “Heads Up” resources and to learn how you can get involved.

Source: http://www.cdc.gov/Features/BrainInjury/