Tag Archives: concussion

Natasha Richardson’s death and what you should know about brain injuries


This story about Natasha Richardson‘s death is from 2009 but relevant to understanding the nature of brain injuries. What appeared to be a fall in the snow on a bunny skiing slope ended up with Natasha’s untimely passing. Please scroll down to read more.

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Natasha Richardson’s death and what you should know about brain injuries

By Susan Perry | 03/19/09
Natasha Richardson

REUTERS/Lucas Jackson
Natasha Richardson at a Metropolitan Museum of
Art Costume Institute Gala in New York last year.

Initial reports of Natasha Richardson’s tragic skiing accident, which led to her death yesterday, offered two bits of information that had many people perplexed.

First, the actress’ fall had been onto the snow-covered ground. She hadn’t run into a hard upright object, like a tree, a building, or even another skier.

And second, Richardson had walked away from the accident seemingly unscathed. She was even heard joking about her fall. Not until an hour or so later, when she started having headaches, did the seriousness of the situation become apparent.

How can that be? How can someone tumble down a beginner’s ski slope, appear fine, and yet within hours be fighting for her life in a hospital’s ICU?”Natasha Richardson’s example sadly shows how devastating an innocuous brain injury can be,” says David King, executive director of the Brain Injury Association of Minnesota.

A major health problem
Many traumatic brain injuries (TBIs) — injuries severe enough to disrupt how the brain functions—have such harmless-appearing beginnings. Symptoms, such as headache, nausea, ringing in the ears, impaired vision, irritability and confusion, may take some time to develop. Or they may be ignored until they become severe — and life threatening.

TBIs are much more common than most people think. In the United States, one occurs every 15 seconds, and every five minutes someone dies from such an injury. Although people with TBIs can recover, particularly if they receive medical treatment early enough, many experience lasting and life-altering impairments.

Source: click to read more…

http://www.minnpost.com/politics-policy/2009/03/natasha-richardsons-death-and-what-you-should-know-about-brain-injuries

MacArthur ‘Genuis’ Tackles Concussions In Football


MacArthur ‘genius’ tackles concussions in football

By Melissa Healy / Los Angeles Times / For the Booster Shots blog
September 20, 2011, 5:30 a.m.
Kevin Guskiewicz, one of the winners of the MacArthur Foundation award  announced Tuesday, was long a thorn in the side of the National Football League.

Since 1999, he has wired the helmets of about 700 college football players with accelerometers to study what kinds of hits result in concussions, which kinds of players get them, and what the long-term consequences of those brain injuries can be. He was among the first to find a strong link between multiple concussions and later dementiadepression and memory and intellectual deficits that often lead to Alzheimer’s disease.

When a 2005 report prepared for the NFL asserted that a player who had sustained a concussion could safely be returned to play on the same day, Guskiewicz begged to differ. In an interview on National Public Radio, he suggested that those drafting the NFL report “are more interested in trying to protect the game or the league rather than taking a more responsible approach.”

But by 2010, a lot had changed. A mountain of research — much of it by Guskiewicz but also by Boston University’s Center for the Study of Traumatic Encephalopathy — had made clear even to the most hard-core football fans that concussions could not just be “shaken off.” The military’s experience with widespread trauma among troops in Iraq and Afghanistan, and numerous cases of suicides and dementia among recently retired football heroes, underscored that “getting your bell run” several times was likely to have long-term repercussions.

Read more:
http://www.latimes.com/health/boostershots/cancer/la-heb-macarthur-concussions-football-20110919,0,1604791.story

Quote

“Brain injury survivors …”


“Brain injury survivors need to laugh at the things that happen. Even some of the most difficult times can be funny…at least when you reflect on what happened. Communication difficulty of various degrees occur with brain injury. This situation is an unfortunate communication barrier. I give details surrounding the situation so others can better understand what happens in the lives of brain injured survivors.” Edie, author, Brain Injury Self Rehabilitation

Brain Injury Self Rehabilitation

One of the resources that I have recently discovered is the “Brain Injury Self Rehabilitation” blog on WordPress! The blog is owned by Edie, a  Registered Nurse and member of Sigma Theta Tau International Honor Society of Nurses from Ohio, who is now a Traumatic Brain Injury (TBI) survivor.

Edie’s Story

Edie is a Rehabilitation Nurse that was assaulted at work. She eventually got treatment after nearly 20 years following her injury. She documented her journey through the American health care, legal, insurance, and Workers’ Compensation System showing what an ordinary American mother, spouse, nurse, and family had to go through before she had proper treatment.

She discusses how she restored her life through her determination and self rehabilitation. She indicates that she lives just 20 miles from world renowned healthcare facilities. After many twists and turns in her cold and complex case, and an ordeal that lasted for nearly 20 years, she finally got proper treatment 200 miles away from home!

Edie now shares her experience and educates survivors of Chronic Traumatic Encephalopathy (CTE), “Mild Traumatic Brain Injury” (mTBI) and Traumatic Brain Injury (TBI) about “Brain Injury Self Rehabilitation“. She speaks out to protect other nurses and healthcare workers, and advocates for patients through education.

Humor is Sometimes the Best Medicine!

Edie uses humor to maintain a level head even in dire circumstances. In a recent blog post titled, “Laughter as brain injury medicine – Permanent Hairdo? A Day in My Life. Keep Smiling!” she states:

“Brain injury survivors need to laugh at the things that happen. Even some of the most difficult times can be funny…at least when you reflect on what happened. Communication difficulty of various degrees occur with brain injury. This situation is an unfortunate communication barrier. I give details surrounding the situation so others can better understand what happens in the lives of brain injured survivors.”

I am already learning a lot from Edie’s posts on her “Brain Injury Self Rehabilitation” blog. I highly recommend that CTE, mTBI, and TBI survivors visit her blog to learn more. I will be reading her blog judiciously!

Read more: 

http://braininjuryselfrehabilitation.com/

AP ENTERPRISE: Hall of Famer Tony Dorsett, other ex-players suing NFL, describe negligence


By Associated Press, Published: February 2

The helmet-to-helmet shot knocked Tony Dorsett out cold in the second quarter of a 1984 Cowboys-Eagles game, the hardest hit he ever took during his Hall of Fame NFL career.“It was like a freight train hitting a Volkswagen,” Dorsett says now.

( Martha Irvine / Associated Press ) – In this image take from video shot on Wednesday, Jan. 25, 2012, Tony Dorsett, a retired Hall of Fame running back for the Dallas Cowboys, listens to a reporters question in his home in suburban Dallas. Dorsett, 57, is one of at least 300 former players suing the National Football League, claiming the NFL pressured them to play with concussions and other injuries and then failed to help them pay for health care in retirement to deal with those injuries.

 “Did they know it was a concussion?” he asks rhetorically during an interview with The Associated Press. “They thought I was half-dead.”
And yet, he says, after being examined in the locker room — a light shined in his eyes; queries such as who sat next to him on the Cowboys’ bus ride to the stadium — Dorsett returned to the field and gained 99 yards in the second half. Mainly, he says, by running plays the wrong way, because he couldn’t remember what he was supposed to do.“That ain’t the first time I was knocked out or been dazed over the course of my career, and now I’m suffering for it,” the 57-year-old former tailback says. “And the NFL is trying to deny it.”Dorsett traces several health problems to concussions during a career that lasted from 1977-88, and he has joined more than 300 former players — including three other members of the Pro Football Hall of Fame, and at least 32 first- or second-team All-Pro selections — in suing the NFL, its teams and, in some cases, helmet maker Riddell. More should have been done in the past to warn about the dangers of concussions, their lawyers argue, and more can be done now and in the future to help retired players deal with mental and physical problems they attribute to their days in the NFL.In interviews conducted by the AP over the past two months with a dozen plaintiffs, what emerged was, at best, a depiction of a culture of indifference on the part of the league and its teams toward concussions and other injuries. At worst, there was a strong sense of a willful disregard for players’ well-being.“It’s not about whether players understood you could get a concussion playing football. It’s about the negligence of care, post-concussion, that occurred,” says Kyle Turley, an offensive lineman for the Saints, Rams and Chiefs who was the No. 7 overall pick in the 1998 draft and an All-Pro in 2000.

Players complain that they carried owners to their profits, in an industry that now has more than $9 billion in annual revenues, without the safety nets of guaranteed contracts or lifetime medical insurance.

“Yeah, I understand you paid me to do this, but still yet, I put my life on the line for you, I put my health on the line,” Dorsett says. “And yet when the time comes, you turn your back on me? That’s not right. That’s not the American way.”

Head injuries are a major topic of conversation every day of the NFL season. With the Super Bowl as a global stage, the NFL will air a one-minute TV commercial during Sunday’s game highlighting rules changes through the years that have made the sport safer.

The owners of the teams playing for the Lombardi Trophy in Indianapolis — Bob Kraft of the New England Patriots and John Mara of the New York Giants — acknowledge the issue’s significance.

Mild Brain Injury and Concussion


Definition
What happens in a mild brain injury
Diagnosis of Mild Brain Injury
What can I do if I have a mild brain injury
Mild Brain Injury Issues
Mild Brain Injury and Concussion
Additional Resources

Definition

The term “mild brain injury” can be misleading. The term “mild” is used in reference to the severity of the initial physical trauma that caused the injury. It does not indicate the severity of the consequences of the injury.

Read Anne’s story about a person who sustained a mild brain injury and the challenges she faced in understanding this injury.

The Centers for Disease Control as part of its Report to Congress on Mild Traumatic Brain Injury in the United States developed the following definition of mild brain injury:

A case of mild traumatic brain injury is an occurrence of injury to the head resulting from blunt trauma or acceleration or deceleration forces with one or more of the following conditions attributable to the head injury during the surveillance period:

  • Any period of observed or self-reported transient confusion, disorientation, or impaired consciousness;
  • Any period of observed or self-reported dysfunction of memory (amnesia) around the time of injury;
  • Observed signs of other neurological or neuropsychological dysfunction, such as—
    • Seizures acutely following head injury;
    • Among infants and very young children: irritability, lethargy, or vomiting following head injury;
    • Symptoms among older children and adults such as headache, dizziness, irritability, fatigue, or poor concentration, when identified soon after injury, can be used to support the diagnosis of mild TBI, but cannot be used to make the diagnosis in the absence of loss of consciousness or altered consciousness. Further research may provide additional guidance in this area.
  • Any period of observed or self-reported loss of consciousness lasting 30 minutes or less.

The definition focuses on the actual injury or symptoms, not the possible consequences. For many people, there are challenges in getting an accurate diagnosis and treatment, especially when there is no documented or observed loss of consciousness. There does not need to be a loss of consciousness for a brain injury to occur.

What happens in a mild brain injury?

The brain is not a hard, fixed substance. It is soft and jello-like in consistency, composed of millions of fine nerve fibers, and “floats” in cerebral-spinal fluid within the hard, bony skull. When the head is struck suddenly, strikes a stationary object, or is shaken violently, the mechanical force of this motion is transmitted to the brain.

When the head has a rotational movement during trauma, the brain moves, twists, and experiences forces that cause differential movement of brain matter. This sudden movement or direct force applied to the head can set the brain tissue in motion even though the brain is well protected in the skull and very resilient. This motion squeezes, stretches and sometimes tears the neural cells.  Neural cells require a precise balance and distance between cells to efficiently process and transmit messages between cells.  The stretching and squeezing of brain cells from these forces can change the precise balance, which can result in problems in how the brain processes information.
Closed Head Injury
Any time the brain suffers a violent force or movement, the soft, floating brain is slammed against the skull’s uneven and rough interior. The internal lower surface of the skull, pictured to the left, is a rough, bony structure that often damBase of Skullages the fragile tissues within the brain as it moves across the bone surface. The brain may even rotate during this process. This friction can also stretch and strain the brain’s threadlike nerve cells called axons.

Although the stretching and swelling of the axons may seem relatively minor or microscopic, the impact on the brain’s neurological circuits can be significant.  Even a “mild” injury can result in significant physiological damage and cognitive deficits.

A Single Neuron
Another mechanism of injury involves changes that occur in the neuron’s ability to produce energy for the cell’s vital functions in structures called mitochondria. An initial increase in energy production occurs followed by a dramatic decrease that affects the ability of the cell to produce structural proteins to preserve the diameter of the axon. This change occurs gradually after the time of impact and may be responsible for the delay in symptoms sometimes observed.

As a person recovers, the cells re-establish the precise balance needed to ensure effective information processing, but this may mean some compensation or adjustments to the neural cell’s original alignments. The more often neural cells must compensate or adjust to injury, the more likely the task takes longer and may not be as complete. For example, when a person sprains or fractures an ankle, professionals recommend cold/heat treatments, rest and supports (i.e., cast, brace) and specific exercises to help the ankle adjust to the injury and recover maximal function. Depending on the severity of the ankle injury (i.e., sprain, fracture) and what is required after recovery (i.e., long distance running, ballet), the injury to the ankle can disrupt a person’s life.

Obviously, a human brain is much more complicated than an ankle. Yet, similarly, rest, supports (i.e., compensations, modifications) and “exercises” (i.e., therapies, education) for the brain may be recommended to rehabilitate and restore useful function. Depending on the severity of the injury and what the person needs to do (i.e., care for a family, return to work or school, manage a large company), a mild brain injury can disrupt a person’s life for a short period of time or even longer.

Read more: http://www.biausa.org/mild-brain-injury.htm

Living With Traumatic Brain Injury


Senate Juciary Hearings on NFL Player Head Injuries


Bradshaw shares battle with concussions


Terry Bradshaw discusses how concussions have affected him.

Terry Bradshaw is a two-time Super Bowl MVP who led the Steelers to four Super Bowl championships during his pro career. He was inducted into the Pro Football Hall of Fame in 1989. Bradshaw joined FOX NFL SUNDAY in 1994.

Updated Apr 14, 2011 2:01 PM ET

Well, fans, I’m going out and buying a ping pong table. The doctors say that will help improve my hand/eye coordination. It’s definitely not what it used to be. And I’m also doing some brain puzzle tests that I download off the Internet. Basically, I’m rehabbing my brain.

CONCUSSIONS TAKE TOLL
Terry Bradshaw says the numerous concussions he’s sustained are affecting his health.

Today most athletes rehab after surgery from a knee or shoulder injury. Well, I’m learning how to prevent my brain from getting worse than it is after suffering a career worth of concussions playing football. When I played for the Steelers and I got my bell rung, I’d take smelling salts and go right back out there. All of us did that. We didn’t know any better. You don’t know how many times I was in the huddle, asking my teammates to help me call a play. After a few minutes, I’d be fine and I’d keep playing just like nothing had happened.

But lately I’ve really been struggling with my short-term memory. I was in Ruston, La., doing my annual fundraising golf tournament for my alma mater, Louisiana Tech, and I told a bunch of writers and TV folks back there what was going on with me. I was dead serious with them. It was definitely the first time I was back there that I didn’t crack a joke or smile. I think they knew I was serious because I was sweating so much, explaining what was going on with me.

Why did I go public? Well, I thought it would be good for a lot of players for this to get out, for me to tell my story because I was a quarterback. I know how much my late center Mike Webster suffered. I can only imagine what a lot of defensive players from my era are going through. I’ve talked with Howie Long about this. He understands what I’m going through. I just thought it would good for them to hear what I had to say. I also think other players should speak up and say what they’ve been experiencing. It’s good for the soul and your brain.

I spent a weekend at the Amen Clinic in Newport Beach, Calif., where I found out the cause of my short-term memory loss. I’ve had this horrible concentration problem for a while now — it took me 10 days to learn nine pages of a speech, something that would probably take you one or two days to learn. It’s obvious that my brain isn’t what it used to be. I’m taking memory power boost tablets to help me every day and doing the puzzles to help me stay focused.

Toward the end of last season on the FOX pregame show, maybe the last six weeks, I really started to forget things. That’s why I quit reciting statistics because I couldn’t remember them exactly and I stayed away from mentioning some players by name because I really wasn’t sure and I didn’t want to make a mistake. I’m on national TV in front of millions and I hate making mistakes. I told the people in Ruston that I suffered six concussions and numerous head injuries. I think that’s right, but I’m not really sure.

The memory loss made me jittery at times. It was driving me crazy that I couldn’t remember something that I studied the night before. All it did was trigger my anxiety and all of sudden everything would snowball on me. I know I have depression and it’s a horrible disease. This memory loss just made my depression worse.

By looking at the damage to my own brain, I can see now what I’m dealing with and what I have to do from making it worse. I definitely have issues, but I did pass most of the tests. I know what I have to do to maintain and do the FOX show and do my speeches without worrying all the time, making myself feel worse. It’s not the end of the world, but it’s something I have to stay on top of now.

I know the NFL has done a lot to help us and also to improve the conditions for today’s players in regards to helmets and head injuries. But it’s nowhere where it needs to be. Over 100 professional athletes have gone through the Amen Clinic. They are doing some amazing studies of the brain. But I really think it is important for players to talk about what they are going through after their playing days are over. The research, the talking is going to help someone else. I really believe that.

Source: http://msn.foxsports.com/nfl/story/Terry-Bradshaw-explains-concussions-short-term-memory-concerns-041211

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