concussions

Discussion of Minnesota Girls High School Hockey

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goldy313
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Post by goldy313 » Sat Jul 07, 2018 6:12 am

Google Tyler Hilinski, Washington State QB who committed suicide in January, Tyler was a NFL prospect who also post mortem was diagnosed as having the highest stage of CTE by the Mayo Clinic. (Mayo has been among the latest to admit CTE is real)

Of course among the main bored moderators CTE is much like Bigfoot or the Loch Ness Monster, though science now puts CTE closer to Polio or cancer.

Karl saying he has no idea what I am talking about is as laughable as it comes. I hope that no responses to the Tyler Hilinski story have more to due that it is July......but have my doubts.....

greybeard58
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Joined: Sun Aug 22, 2004 5:40 am

CTE Researcher Reflects on Tyler Hilinski's Suicide

Post by greybeard58 » Sun Jul 08, 2018 10:58 pm

A CTE Researcher Reflects on Tyler Hilinski's Suicide, Concussions and the Future of Football

In the wake of SI's story and documentary on the late college QB Tyler Hilinski, the co-founder and CEO of the Concussion Legacy Foundation reacts and reflects.
By CHRIS NOWINSKI July 02, 2018

Chris Nowinski is the co-founder and CEO of the Concussion Legacy Foundation. Nowinksi, as told to SI senior writer Greg Bishop, reacts to SI’s story and documentary on Tyler Hilinski, a Washington State quarterback who committed suicide in January. Hilinski’s family later found out that Tyler had Stage I chronic traumatic encephalopathy or CTE.

I wish I was more surprised by the diagnosis. One thing I consistently struggle with is that nearly all of the college and professional football players whose brains we’ve looked at had the disease. And even if you factor in who the sample is coming from, families should not be right 95% of the time at guessing this.

This is the third active college football player that we know about that had CTE. We’ve seen CTE in football players who just played a few seasons. So we don’t know where the floor is. But it’s safe to assume that one season of football in theory could give you CTE. The risk is not zero after one season. It just goes up each additional year you play.

We’ve seen it in kids as young as 17. But now, we’re talking about the youngest when he stopped playing football was 14. We recently had a case of a young man who had post-concussion syndrome in eighth grade. He played five years of football, seven years of ice hockey, baseball. But had never really played a sport after the eighth grade. He never got better from his post-concussion syndrome and he also died by suicide at the age of 20. He had Stage 1 as well.


There’s two discussions after stories like this publish. We have to divide them. One is the discussion about whether his CTE was caused by playing football. And there’s less intelligent pushback on that these days. But it’s still strong because people see the game under threat, and there are a lot of people who are more focused on protecting this abstract concept of the game than the real concept of the people who play the game. It wasn’t that long ago that the NFL was in complete denial and just said CTE doesn’t exist and that was the stance of a lot of people until the last five years.

But where there’s a really fair debate is: did CTE play a role in the decisions that Tyler and others made that led to their suicide? And we can’t answer that. But it’s absolutely something we should discuss. Because there’s a known and incredibly strong relationship between concussions and increased risk of suicide. Most studies peg it as a three to four times greater risk of suicide, just from one concussion.

We don’t have to have this discussion around CTE. We can just talk about this as a concussion problem. There’s almost zero chance Tyler got out of all those years of football without concussions.

Ten years ago we had 10 cases of CTE with football players. Now we have hundreds. And we’re funding a young investigator who’s looking at the psychiatric symptoms of CTE. We talk about CTE as in the frontal cortex but really we’re also seeing lesions in Stage 1 in deep areas of the brain stem that are involved with regulation of anxiety and depression. And there’s more to Stage 1 CTE than we realize.

I’ve always hated the analogy that he had the brain of a 65-year-old man. It just confuses the hell out of people. What (the doctors) are referring is the tau pathology. It looks like a brain of somebody who’s elderly, because you just never see that sort of tau pathology in young people. But symptomatically they’re completely different. People need to understand: just the presence of the neurofibrillary tangles and those lesions, you would think, if you didn’t have the age of the person, this person must have been old. That’s what they’re saying. Because it’s just so rare.

• SI's Greg Bishop Reflects on His Story About Tyler Hilinski

We don’t want everybody who might have early stage CTE, which may include me, to think this is going to destroy my life. Because now that we have hundreds of case studies of football players, many are living what would be seen as normal lives, until they reach an age where they don’t live normal lives anymore. Sometimes it’s not until their 50s, 60s or 70s where they start having symptoms that appear to be related to the disease. That being said, we have dozens of young people who have died and had this disease and whose families say their personality completely changed. And there’s a very good chance that change was due to this disease spreading in their brain. So we also should not dismiss early stage pathology.

The focus should be on: what can we learn from this? If you follow the breadcrumbs on what we’re seeing with football and CTE and with changes in behavior and suicide, it’s fair to say, hey, let’s look at this. Because this is something that we can prevent, if it was caused by football. We could prevent it by having kids start playing tackle football later, which would lower their risk of CTE dramatically.

I get why Tyler’s brother, Ryan, (who has committed to South Carolina), still wants to play. I don’t know if you could have convinced me to stop playing when I was young. This is a problem they just can’t feel. It’s hard to walk away. I mean, the short-term costs, which are known—lose your friends, have to find something else to do, lose your identity, lose your path. The short-term costs, which are high. The long-term costs to them are completely unknown because, let’s face it, a high school athlete does not have the capacity to understand the risk. It’s the same reason they can’t go serve in the military or can’t sign a legal contract. We’re struggling to have medical doctors interpret this evidence in an appropriate manner.


A College QB's Suicide. A Family's Search for Answers.
I hear insurance rates are going up because people are starting to realize that there could be lawsuits that follow, that people actually win. I do think the moment we have an accurate diagnostic test will be a moment of reckoning for the game. Because you can imagine people seem to be comfortable and cool with at least one out of 10 NFL players having this disease, which is what we’ve seen over the last 10 years, that one out of 10 who died have had it. It’s actually a much higher percentage in the last five years. We’re comfortable with adults getting it. But we’re not going to be comfortable with more kids getting it. If you put a high school team through the test and you find out it’s more than one kid, who’s a minor, who has this disease already, people may not be able to sign their children up anymore. Who’s going to let them play?

I look at it this way. There’s still nearly one out of five Americans who smoke, despite the fact they know it’s got a good chance of accelerating their death. So there always will be people that are just going to ignore the science and say it’s worth it and it’s my choice. But I also get the sense that once we can diagnose this and get an idea of the scope there’s going to be a scramble. And there’s a decent chance that no one wants to go back on that field who doesn’t need the money, that isn’t being paid. And that would shut down all but the professional leagues.

We’re starting to build these interesting webs of teammates who all had this disease. You start to realize, like, you have lightning striking twice or three or four times on one starting lineup. We’re getting a brain almost every other day. We’re going to get 200 this year. There will be more stories to tell, more families like the Hilinskis.


https://www.si.com/college-football/201 ... s-football

greybeard58
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Post by greybeard58 » Fri Jul 20, 2018 4:11 pm

Is there a relationship between whiplash-associated disorders and concussion in hockey? A preliminary study.

Hynes LM1, Dickey JP.
Author information

Abstract
PRIMARY OBJECTIVE:
To examine the relationship between the occurrence of whiplash-associated disorders and concussion symptoms in hockey players.

RESEARCH DESIGN:
Prospective cohort observational study to examine the relationship between whiplash associated disorders and concussion in actual hockey play.

METHODS AND PROCEDURES:
Twenty hockey teams were followed prospectively for one season. Team therapists completed acute and 7-10 day follow-up evaluation questionnaires for all of the players who received either a whiplash mechanism or a concussion.

MAIN OUTCOMES AND RESULTS:
183 players were registered for this study; 13 received either a whiplash mechanistic injury or a concussion injury. Initial injuries ranged from WAD I to WAD III and all subjects reported concussion symptoms. Only three subjects reported full resolution of both WAD and concussion symptoms at the 7-10 day follow-up evaluation.

CONCLUSIONS:
There is a strong association between whiplash induced neck injuries and the symptoms of concussion in hockey injuries. Both should be evaluated when dealing with athletes/patients suffering from either injury.

https://www.ncbi.nlm.nih.gov/pubmed/164 ... t=Abstract

greybeard58
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Post by greybeard58 » Fri Jul 20, 2018 4:16 pm

Shona McCallin: Olympic gold medallist on effects of 'brutal' concussion
From the sectionHockey


Shona McCallin on her struggle with concussion
2018 Hockey Women's World Cup
Venue: Lee Valley Hockey and Tennis Centre, Queen Elizabeth Olympic Park, London Dates: 21 July-5 August
Coverage: Reports on England and Ireland matches on the BBC Sport website; BBC Radio 5 live sports extra commentary on selected matches - full details & fixtures here
"There have been times where I've been looking down a dark tunnel and there is no light at the end."


Like most elite athletes, Olympic gold medal-winning hockey player Shona McCallin has had her fair share of injuries. But concussion, she says, is "far and away the worst".

Playing for England against Argentina in February, the 26-year-old took an opponent's shoulder to her head. Headaches, sickness and a sensitivity to light and sound rapidly developed, and despite being initially told she would only be out for two to four weeks, she has still not returned to full-time training.

She is one of three players - along with England team-mate Nicola White and the Netherlands' Pien Sanders - who will miss the World Cup, which starts on Saturday, because of concussion.

"Concussion is like a game, but not a very fun game," McCallin told BBC Sport. "It takes over your whole life.

"It's a brain injury, so you can't mess around with it."

So is enough being done? Are athletes aware of its seriousness? And should the sport's governing bodies be considering more action to prevent such injuries by introducing headwear?

What is concussion?
Concussion is a temporary injury to the brain, usually caused by a bump, blow or jolt to the head.

Symptoms, like those experienced by McCallin, can include headaches, nausea, and balance issues, as well as dizziness, confusion, changes in vision and unusual behaviour.

McCallin's symptoms developed almost instantaneously, and when she was substituted she veered left and right as she ran off the pitch despite believing she was moving in a straight line.

"I got really angry when I was told I wasn't going back on, which I know now is a sign of concussion," says McCallin, who had headaches every day for four months as a result.

"I went to warm down with the girls and I couldn't run, my co-ordination had just gone. I found it hard to just talk. I couldn't think and engage my brain and get my words out.

"As soon as I heard the word concussion, I knew I wasn't playing any more on that trip."

'Like a hangover in handcuffs'

McCallin is yet to return to full-time training after she was concussed in February
McCallin missed April's Commonwealth Games - where England won a bronze medal - and will have to sit out the World Cup.

But while she admits missing such tournaments is "horrible", she says the "brutal" impact on her personal life has been just as great.

"They are huge tournaments and ones you want to go to as an athlete, but what is worse is the control concussion has over your life," she says.

"You don't know how it is going to affect you each day, how you're going to wake up or if it's going to be a good or bad day."

McCallin, who won European gold with England in 2015, does not yet know when, or indeed if, she will return to full-time training, but says the past five months have given her "more perspective on life".

"Concussion is overwhelming and relentless, you just can't get away from it sometimes. It feels like a hangover in handcuffs - you don't have the freedom to do what you want," she says.

"There have been times where I have thought, 'am I going to be able to live a normal life? Am I going to be able to get rid of this?'

"Hockey isn't everything, there are bigger things in life, and this has really cemented that in my mind."

'The onus is on the player'
During her recovery McCallin has met former rugby players who, after retiring, still experience side-effects from concussions they suffered during their playing careers.

It has led to her wanting to raise as much awareness about the injury as possible, admitting she was previously "naive" about it.

"All I want is to raise awareness of concussion and educate people more because the actual onus is probably on the player initially to tell medical teams," McCallin says.

"I could have hidden the fact I had a headache, so it's about educating people to understand the consequences of hiding it and the seriousness of it."

Luke Griggs, of brain injury association Headway, told BBC Sport incidents of concussion are often "unreported", meaning experts do not know the "extent of the problem" in sport.

"Either people don't understand it and the risks of continuing to play, or they choose not to take themselves off and be assessed," said Griggs, who experienced concussions himself as a hockey player.

"Hockey is progressive. It is trying to evolve and improve things and that is great, but is enough being done?"

'There will be concussions at this World Cup'

Players wear masks when defending penalty corners but remove them once the move has ended
While hockey goalkeepers wear head-to-toe protection including helmets during games, outfield players only put on masks for penalty corners.

There have been calls for players to wear head protection throughout games, but the International Hockey Federation (FIH) says there are "no imminent plans" to make changes - and McCallin thinks it would have made little difference in her case.

"I think if I had been wearing a headpiece, I still would have got a concussion," McCallin says.

English Institute of Sport physiotherapist Matthew Davies, who works with England Hockey, told BBC Sport playing hockey provides "no extra risk" of concussion than other sports.

He said: "Inevitably, if someone runs into you and hits you in the head, I'm not sure we can prevent concussion.

"There's not a lot of evidence that would support the use of helmets in preventing concussion."

At this summer's football World Cup in Russia, Morocco were criticised for playing winger Nordin Amrabat five days after he suffered a concussion.

Griggs says there will "undoubtedly" be concussions at the hockey World Cup in London, but hopes the sport will "set a better example" than football.

"Greater awareness is happening all the time, and you can't take every risk out of life and out of contact sport," he says.

"The information needs to be out there that if a concussion happens, people need to acknowledge it, act accordingly, and take the 'if in doubt, sit it out' approach."

https://www.bbc.com/sport/hockey/44869617

greybeard58
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Can you see how this applies to hockey?

Post by greybeard58 » Fri Jul 20, 2018 4:20 pm

Can you see how this applies to hockey? Substitute the word hockey for soccer and it reads the same...

For one, the risk of injury is high, due in part to many kids’ decision to focus intensely on one particular sport. In 2016, the American Academy of Pediatrics warned that “the increased emphasis on sports specialization has led to an increase in overuse injuries, overtraining, and burnout.” An analysis in the medical journal Pediatrics of soccer-related emergency-room visits among children aged 7 to 17 reveals a dramatic uptick in injuries: Researchers found that the annual rate of injuries for every 10,000 soccer players rose by 111.4 percent between 1990 and 2014; the annual rate of concussions and other “closed head injuries”—when the head is hit, but the skull isn’t penetrated—over the same period went up by 1,595.6 percent. Girls are injured more than boys. Knee injuries, including ACL tears, are nearly four times more likely to bedevil female soccer players than male. (The American Academy of Orthopaedic Surgeons reported that female soccer players have a higher rate of concussion than football players.)

...Part of the reason soccer has this incredibly demanding top tier, said Rick Eckstein, a professor of sociology at Villanova and author of How College Athletics Are Hurting Girls’ Sports, is that it’s one of the most commercialized of youth sports; it contains a flourishing industry of tournament directors, private club and travel teams, and assorted soccer-related businesses whose financial interest is served by the status quo. And unlike basketball, say, which also has a sturdy commercial presence, soccer has developed so that the top players are identified and nurtured only through clubs. While college-basketball coaches still scout players at gyms and high schools, their counterparts in soccer rely on “showcase” tournaments to fill out their teams. “Soccer is the poster child for hyper-commercialized youth sports because it is played across the country and across the world, it has extraordinarily high participation levels, and is equally commercialized for girls and boys,” Eckstein wrote in an email.

...Intense youth travel teams can also send unhealthy messages, to kids and adults alike, about a family’s priorities. Club soccer can require heroic measures on the part of adults—driving regularly to and from distant games, giving over sacred weekends to a child’s pursuit, and dividing up the family to deposit different kids at separate venues. One of the main jobs of parents, saidMadeline Levine, a psychologist and the author of The Price of Privilege: How Parental Pressure and Material Advantage Are Creating a Generation of Disconnected and Unhappy Kids, is modeling for children what adulthood should look like. Youth sports teams that require parents to devote huge amounts of time and income signal to children that grown-ups are an afterthought, and that being a parent is an exercise in passivity and boredom. “We have become so child-centered that what kids have to look forward to [when they become parents] is diddling with a cellphone and sitting passively, not being an active participant,” she said.

The Downsides of America’s Hyper-Competitive Youth-Soccer Industry
The sport’s top tier is organized around the goal of producing a tiny group of elite players, at the expense of kids’—and parents’—well-being.
Read more: https://www.theatlantic.com/family/arch ... ry/565109/

greybeard58
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Two surveys seeking information

Post by greybeard58 » Tue Jul 24, 2018 6:13 pm

Two surveys seeking information


Parent Concussion Survey

If you are over 18 years of age and are the parent of child who has experienced a concussion, please take the survey at:
http://concussionsurvey.blogspot.com/p/ ... urvey.html

Concussion Policy and Procedures Survey

If you are over 18 years of age, and are involved as a league administrator, manager, or coach, please take this survey about policies and procedures for concussion awareness and prevention in youth sport organizations:
http://concussionsurvey.blogspot.com/p/ ... nsent.html

Neuropsychologist Philip Schatz, Ph.D., a professor in the Department of Psychology at Saint Joseph's University in Philadelphia, PA is seeking parents of youth athletes to complete surveys on concussion treatment in youth athletes.

For more info: concussionsurvey.blogspot.com
To review his other research, visit: http://schatz.sju.edu/research1.php

greybeard58
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Joined: Sun Aug 22, 2004 5:40 am

Re: concussions

Post by greybeard58 » Mon Aug 20, 2018 10:46 pm

The simpler solution is to avoid concussions in the first place

“But while doctors and specialists at the symposium spoke of better ways to treat and diagnose head injuries, Dryden said the simpler solution is to avoid concussions in the first place.”

Eric Lindros suggests drastic rule change to save future NHLers from concussions: Ban body contact
Read more: https://nationalpost.com/sports/hockey/ ... dy-contact

greybeard58
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Re: concussions

Post by greybeard58 » Tue Aug 28, 2018 1:42 am

Treatment specific

Women suffer from concussions differently than men do, according to new research, and it could change the way they’re treated.

“For the first time, we’re seeing a difference in the response of chemicals due to injury because we’re now able to study women,” said Dr. Alex Lin of Brigham and Women’s Hospital.

...“We really need to view this in a different light, that women and men can’t be treated in the same way,” Lin said. “Going forward, those differences in gender need to be taken into consideration.”

Gender differences eyed in concussions
Study: Men, women react differently
http://www.bostonherald.com/lifestyle/h ... oncussions

greybeard58
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Joined: Sun Aug 22, 2004 5:40 am

Re: concussions

Post by greybeard58 » Tue Aug 28, 2018 1:48 am

"If you are a women’s ice hockey player, you are three times more likely to have a concussion than if you play football"

Concussion.

The word conjures up images of head-to-head collisions between football players, most likely in the NFL because that gets the most attention.

But you are at just as much risk of getting a concussion in other sports.

Football isn’t even the highest risk when it comes to athletes getting a concussion.

If you are a women’s ice hockey player, you are three times more likely to have a concussion than if you play football, Dr. Jayson Loeffert, a specialist in family medicine and primary care sports medicine with Penn State Hershey Medical Group, told a group of parents in the auditorium of Middletown Area Senior High school on Wednesday, Aug. 15.

“Everybody thinks football is the issue. Football gets the most talk, but football actually isn’t the highest risk in terms of sports,” said Loeffert, who is team physician for the Blue Raiders. He also treats athletes at Penn State Harrisburg and the Harrisburg Senators.

“Just because your son or daughter does not play football doesn’t necessarily mean they are immune from getting a concussion,” he added. “It can happen in any sport.”

District Athletic Director Cliff Smith arranged for Loeffert to give the talk, to educate parents on a topic that Smith noted is “constantly changing.”

That’s true, judging from what Loeffert had to say during his 25-minute long presentation before the group of about 20 people, including several district staff members.

One point Loeffert sought to drive home to the parents was the need for a student athlete to come to a team doctor or coach as soon as possible, if he or she is experiencing symptoms from a concussion.

Athletes are often reluctant to say they are experiencing symptoms because they don’t want to be out of the game. But this can lead to athletes being on the sidelines longer, and putting themselves at greater risk.

“When athletes are unwilling to come to me, it makes my job very difficult and it makes their rehab and their recovery difficult a lot of times, too,” Loeffert said. “What I like to promote is openness. We know that athletes who are treated quickly and treated in the right away, which is generally just rest and a progressive return to activities, get better far faster than the athletes that keep playing, get more hits, and can have progression of their symptoms. … Usually the athletes I take care of who have a long-term duration of symptoms didn’t come forward right away with their diagnosis and their symptoms.”

Categorizing

Loeffert grouped symptoms into four categories: physical, mental, emotional and sleep.

Physical symptoms include dizziness, trouble with light and sounds, and headaches.

Mental symptoms include trouble with memory, trouble staying focused or trouble paying attention in class — are they falling behind in their homework?

Emotional symptoms include anxiety, depression and anger — sadness, irritability or feeling worried or scared.

Loeffert emphasized that a concussion is “a very complicated thing” that can vary widely from person to person.

For example, someone can receive “a very, very hard hit” that doesn’t cause a concussion, and someone else can receive a fairly mild hit that does.

“We don’t really know why that happens,” Loeffert said. “There’s no real good prediction as to what is going to cause a concussion.”

The easy way to think of a concussion is, you have trauma to the brain that causes changes to cognitive function, and then can cause symptoms afterward.

Some athletes develop amnesia but this is “really rare,” occurring in fewer than 1 or 2 percent of athletes diagnosed with a concussion, Loeffert said.

Not all athletes who have a concussion report having headaches. They think that if they don’t have a headache, they could not have had a concussion. Not so.

“If you have all these other symptoms, you don’t have to have a headache,” Loeffert said. Headaches are “just part of the picture” involved in having a concussion.

Loss of consciousness is also rare, Loeffert said. An athlete suffering a concussion will say they were out, and their parents will say, “No, you got up really quick.”

Loeffert put up a graph showing a continuous rise in concussions in the United States since 2007.

Girls at risk

Until 2005, a concussion diagnosis had to include loss of consciousness. In 2005, the requirement that an athlete had to lose consciousness in order to be diagnosed with having a concussion was removed.

That change has led to the steady rise in athletes being diagnosed with concussions since 2005, Loeffert said, although “a lot more knowledge and a lot more openness for admitting symptoms” are also factors behind the increase.

Young girls are at greater risk of having a concussion than young boys, because young girls have weaker neck muscles and they jump differently, Loeffert noted.

Loeffert used a scenario about a hockey player to illustrate the state requirements in Pennsylvania for an athlete who has symptoms of a concussion, and what happens afterward.

The hockey player gets slammed into the boards. He complains of headache and dizziness, and has trouble with sounds.

He is removed from play and monitored on the bench. But his symptoms appear to clear up, and after 10 minutes he feels normal. Can he return to the game?

No.

“The rule is if you have concussion symptoms you are automatically removed from that game, and you can’t return to any physical activity until at minimum the next day,” Loeffert said, adding that this is a state rule in Pennsylvania intended to protect the athlete.

If diagnosed with a concussion, you can expect to be out of action for at least seven days. This is also a state-mandated rule, Loeffert said.

Returning to the field

Before an athlete can return to his or her sport, they have to be “asymptomatic” — lacking obvious signs or symptoms — without the aid of medication, he noted.

All medicines have side effects, Loeffert said. He tries as much as possible to avoid prescribing medicine to an athlete diagnosed with a concussion.

Loeffert said he doesn’t have to rely on medicine very often, “because I am getting my athletes treated really well, really fast. They are clearing up their symptoms quick and they are getting back to their sport, which is ultimately what they want to do.”

Loeffert also utilizes a “return to play progression” for getting an athlete diagnosed with a concussion back in action.

The athlete must first be symptom free for at least a day. Then each day the athlete undergoes steps that gradually become more intense, in terms of physical activity.

For example, in the first day after being symptom free you do light aerobic activity, such as a jog or a long walk.

If you don’t experience a return to symptoms, gradually over the next several days you progress to more intense “sport specific” exercises, Loeffert said.

If some or all symptoms return during this progression, the athlete doesn’t have to go back to the beginning of the process.

“They just stop for the day, and then the next day they try those sports specific activities again,” Loeffert said. “That’s a really important thing to tell the athlete, because if they think they are going to have to start over they are not going to tell you they are symptomatic. But if you say you are just losing a day, then usually they are more able and open to admit they are becoming symptomatic.”

Loeffert explained why it is critical that if an athlete does experience a return to symptoms during this return to play progression, that he or she tell their doctor or coach — in order to prevent “second impact syndrome.”

“Second impact syndrome is the idea where you get a concussion, you are still symptomatic and you suffer another head impact,” Loeffert said. “Nobody has ever died of a concussion … but there is what is believed to be some inflammation quality when you get a concussion. If you get a second hit, that inflammation can kind of skyrocket. You can get swelling on the brain which people have been reported to die from. All the protective stuff we are doing is to prevent this.”

Helmets can’t prevent them

Loeffert also had a word or two to say regarding equipment such as helmets.

Helmets don’t protect people from having concussions, Loeffert said, and he doesn’t expect they will “now or in the foreseeable future.”

“Our brains sit inside of our skull and it’s kind of surrounded by fluid. And it floats,” Loeffert added. “Everything in there shakes around. That’s what happens within our skull. You can’t prevent that no matter how much padding we use, no matter how much protective layer. That brain is still going to move. That’s what puts you at risk of a concussion.”

The Food and Drug Administration even forbids a helmet maker from saying that his or her product will prevent a concussion, as “nothing has been found to truly prevent concussion,” he said.

Moreover, the testing of helmets in a scientific lab does not adequately replicate what happens to an athlete in a real practice or game situation, he added.

Helmets can protect student athletes from skull fractures and scalp lacerations, he said.

Last year, Loeffert said he was asked about the value of putting a pad over the top of a helmet.

This won’t prevent a concussion, and the padding could make things worse by adding weight to the top of the helmet, putting extra force on the neck, he notes.

Head gear for soccer players has been investigated, but Loeffert noted one study suggests athletes who wear head gear may take risks they wouldn’t otherwise take while playing, because it gives them a false sense of security.

Are students educated?

During a brief question-and-answer period following Loeffert’s presentation, a parent asked Smith about whether the school district is providing this same information about concussions to the student athletes.

Smith said that typically, student athletes are not educated about a concussion unless they have one, and then “they are educated as the doctor is treating them.”

However, he seemed open to the possibility of the district being more pro-active about providing information about concussions to all student athletes.

As one parent noted, if student athletes know “ahead of time” that they might not have to sit out as long if they report symptoms quickly, “they might be more prone to come to you and say ‘this is what I am feeling’ and nip it in the bud.”

Smith urged district parents with questions about concussions email the questions to him, so he can forward the questions to Loeffert for answers.

You can reach Smith at cliffsmith@raiderweb.org.

Smith also encouraged parents contact him with ideas for other student athlete-related topics that can be the subject of future presentations.

Football isn’t highest-risk sport for athletes and concussions, doctor for Blue Raiders says
Read more: http://www.pressandjournal.com/stories/ ... says,38629

greybeard58
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Re: concussions

Post by greybeard58 » Tue Aug 28, 2018 1:48 am

Marissa Gedman: "I have endless anecdotes about players who got one or two or a series of concussions"

Marissa Gedman, 26, played for the Boston Pride in the National Women’s Hockey League for three years after graduating from Harvard in 2015. She was on the Harvard hockey team before that, where she suffered from a concussion — not unlike many of her teammates.

Gedman was inspired to go into the medical field by her experience as a professional athlete and is now working as a medical assistant in orthopedics at Brigham and Women’s Hospital while studying for her master’s degree in biomedical science at Tufts University.

Daughter of former Red Sox catcher Rich Gedman, she is now applying for medical school. She shared her story with the Herald’s Mary Markos:

There is a huge need for more research on female athletes and hockey players specifically.

I would say just from all my exposure through my own concussion and my teammates’ concussions and other orthopedic injuries, I definitely gained a huge respect for the medical field and owe so much to the doctors I worked with over my career. Now, being able to work in Brigham and Women’s orthopedics and hopefully be a physician in the future, it all stems from my experience as an athlete.

My biggest exposure was through teammates who had life-changing concussions that affected their life outside of hockey.

I have endless anecdotes about players who got one or two or a series of concussions and whether it’s due to coming back and playing too soon or not getting proper medical attention, they end up having far-reaching effects, whether it’s time off from school or symptoms lasting longer than a year or two. It becomes a real-life issue for them. ... This is a solvable issue, why can’t we figure out how to properly treat these athletes that need this medical attention?

She said most of the research is on men, a trend that has helped motivate her to keep up her studies on why women are not better represented.

Is it a case of them not reporting the injury because they’re nervous? There are tons of social effects. “Will I not play anymore? Will my teammates think I’m a baby?” Just looking at the attitudes of the coaches and players and why this issue has come to be something we’re now talking about.


Ex-athlete Marissa Gedman inspired by experience to go into medicine
Read more: http://www.bostonherald.com/lifestyle/h ... o_medicine

greybeard58
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Concussions loosen insulation around brain cells

Post by greybeard58 » Thu Sep 06, 2018 4:55 pm

First evidence of myelin sheath damage from hockey concussion, persisting after brain injury symptoms subside

Detailed scans of concussed hockey players found that the protective fatty tissue surrounding brain cell fibers was loosened two weeks after the injury -- even though the athletes felt fine and were deemed ready to return to the ice. A loosening of that insulation, called myelin, slows the transmission of electrical signals between neurons, and shows that passing a concussion test may not be a reliable indicator of whether the brain has truly healed.

..."These results show that there is some damage happening below the surface at least two weeks after a concussion," Weber says. "Passing a concussion test may not be a reliable indicator of whether their brain has truly healed. We might need to build in more waiting time to prevent any long-term damage."

Concussions loosen insulation around brain cells
Condition detected two weeks after concussion, when players said they felt ok
Read more: https://www.sciencedaily.com/releases/2 ... 101206.htm

greybeard58
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Studies uncover flaws in youth sports concussion laws

Post by greybeard58 » Fri Sep 07, 2018 5:14 pm

Studies uncover flaws in youth sports concussion laws
September 6, 2018, University of Minnesota

All 50 states have passed a youth sports concussion law to help athletes and parents. But two new studies from the University of Minnesota suggest these laws are not giving athletes and parents the information they need to make informed decisions.

The studies, led by Law School Professor Francis Shen and co-authored by research assistants Carly Rasmussen and Sydney Diekmann, were recently published in the Berkeley Journal of Entertainment & Sports Law and the Duquesne Law Review.

"The fundamental question we were asking is how can athletes make informed choices when they're never told what the actual risks are?" said Shen. "We have an ethical duty to be upfront with parents and athletes about the risks of sports concussions."
The researchers reviewed more than 100 peer-reviewed publications and found that both ends of the current concussion debate are problematic. On one hand, data clearly shows that the vast majority of youth athletes will not sustain a concussion. However, it also shows that there are elevated risks in collision sports and actual concussion incidence rates are likely underestimated.
The first study, titled "How Dangerous Are Youth Sports for the Brain?" identified a number of important data trends:
There is great variation from sport-to-sport in concussion rates.
Sports with the consistently highest concussion rates are football, wrestling, ice hockey, soccer and lacrosse.

Female athletes appear to experience almost double the rate of concussions as their male athlete counterparts in comparable sports (this finding, as well as additional demographic variation in concussion incidence, remains in need of further research). It is unclear if this increased rate directly translates to increased clinical impact in female athletes.

Despite significant improvements in return-to-play protocols, much remains unknown.
Although state concussion statutes are a step in the right direction, Shen's additional research, "Are Youth Sports Concussion Statutes Working?," shows that the laws are not yet living up to their full potential. The second study's findings revealed:
While most high schools have implemented a concussion protocol roughly consistent with state law, parents and athletes in non-school youth sports have been largely overlooked.
In a survey of hundreds of Minnesota athletes and parents, less than 50 percent of the respondents correctly understood the state's concussion law.
Shen, who is working with colleagues in the University of Minnesota Medical School, School of Public Health and others to improve Minnesota's concussion policy, hopes schools and youth teams will be able to provide more accurate information on health risks and benefits of particular sports and best-practice communication in the future (e.g. easy to understand language and appropriate presentation of statistics).
"The bottom line is that we need to do much more if we want to fully address the great challenge of brain injury in youth sports," said Shen. "Stakeholders should be working together to build better policy.”

Studies uncover flaws in youth sports concussion laws
https://medicalxpress.com/news/2018-09- ... ssion.html

greybeard58
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Monday, September 10 is World Suicide Prevention Day

Post by greybeard58 » Mon Sep 10, 2018 8:32 pm

Today Monday, September 10 is World Suicide Prevention Day

Taking a moment today to reflect on the families in our hockey community who have been impacted by suicide.

How to get help in Minnesota: Suicide prevention resources
Read more: https://www.mprnews.org/story/2018/06/0 ... resources-

WHO launches new toolkit for suicide prevention
The WHO just released a new suicide prevention toolkit to mark World Suicide Prevention Day today. Suicide is a critical public health problem: Nearly 800,000 people kill themselves each year and many more attempt suicide. The new toolkit is stocked with resources for community suicide prevention efforts, including resources specifically for refugees and migrants, older individuals, and young people. It also outlines how a community can create a tailored action plan that taps into its unique resources and addresses specific prevention priorities.
Free toolkit at: http://apps.who.int/iris/bitstream/hand ... 91-eng.pdf

greybeard58
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DID ONE HIT LEAD TO A 13-YEAR-OLD'S SUICIDE?

Post by greybeard58 » Thu Sep 13, 2018 5:12 pm

DID ONE HIT LEAD TO A 13-YEAR-OLD'S SUICIDE?
Three years ago, James Ransom suffered a concussion playing tackle football. Just over one year later, he took his own life.

More than a thousand people came to James Ransom's funeral. His parents, Greg and Courtney, and his sisters, Julia and Lillie, were in attendance, each one imbued with a sorrow that crashed like waves. James' buddies were there; some wore bright yellow sneakers and ties—an homage to James' love of SpongeBob SquarePants. His elementary and middle school teachers, his football teammates and coaches, his neighbors and other members of the community all came. Row by row, they packed the Church of Jesus Christ of Latter Day Saints in Mission Viejo, California, full of grief, full of love.
"He never knew how many lives he touched," Lillie says. "He never knew how many people loved him, how many people needed him.

Giant poster boards bearing James' face were sprinkled throughout the church. Greg made them. He had been too devastated to put them together at first, but Courtney nudged him to do it. He found joy in the process, however—combing through the albums, picking the photos he liked best, seeing his son's doughy cheeks. His son in his football uniform, swallowed by giant shoulder pads, proudly clutching a football. His son dressed up as Harry Potter for Halloween. His son and wife rolling their top lips over, making funny faces.

A pianist began to play, and Lillie took the podium to sing "For Good" from Wicked. She was scared, staring at the casket in front of her, but she loved to sing and James was her No. 1 supporter. He used to come to her plays and whisper to their mom: "Lillie's got the best voice in here! They shouldn't let anybody sing but her!"
Lillie took a deep breath and let the rhythm take her:
Like a comet pulled from orbit
As it passes a sun
Like a stream that meets a boulder
Halfway through the wood
Who can say
If I've been changed for the better?
Because I knew you
I have been changed
For good

More than a thousand people came to James Ransom's funeral. Those who knew James are still searching for answers as to the nature of his death.

There was not a dry eye in the church. A woman in the first row buried her head into the neck of the man next to her as tears streamed down her cheek. Greg and Courtney cried. They had seen their son go from a kid with a playful personality who loved what many young kids love—football, family, friends—to a kid who struggled with mental illness and ultimately took his life. The change was swift and drastic—it happened in just over a year's time. Those who knew James are still searching for answers.
________________________________________
The Ransoms live on a street full of kids. About 40 of them. The trees are green, and the lawns are immaculately trimmed. There are American flags and basketball hoops. Wide pavement to play in the hot sun. The cream-colored two-story houses start to look the same. A nearby cafe, Lola's, serves muffins that ooze fresh blueberries on first bite.

Ladera Ranch, about 10 miles east of Laguna Beach, is full of families with kids who play sports, and those families watch those kids play sports and become close with other families with kids who play sports. Both Greg and Courtney grew up around football—the former in Richland, Washington, and the latter Glendale, a suburb of Los Angeles. Greg played tackle football, beginning in the ninth grade. Courtney enjoyed watching youth football as a young girl. Her father played quarterback in high school and her high school boyfriend was a punter.
James loved football. He began playing tackle at age nine. (Kids are allowed to play tackle as young as five in Santa Margarita Pop Warner.) He was a natural lineman—big and strong and skilled. He started on offense and defense and liked blocking and being depended on. When he was 12, James joined the Stallions, and in a year's time he became known as one of the toughest kids on his team. Players went one-on-one in practice, and whoever knocked the other kid off stayed. He hit hard and he got hit hard, too.
"My son would often go head to head, repeatedly," Greg says. "Who knows how many times they were hitting each other like that?"

When he was 12, James joined the Stallions, and in a year's time he became known as one of the toughest kids on his team. "My son would often go head to head, repeatedly," his father, Greg, says.Photo courtesy of the Ransom family
September 12, 2015, was a normal Saturday by most measures. A weekend day on the gridiron at West Covina High School. The Stallions were playing the West Covina Bulldogs. Courtney was not at the game. Greg, the Stallions' team manager, was on the sideline monitoring substitutions.

He didn't see it when it happened. He only heard what happened from James after the game. The game had gotten chippy, and during one play an opposing player hit James on the side of his head. James later said the player was dirty—intentionally so. Parents in attendance couldn't say for sure. Either way, James shook it off and continued to play. He was not taken off the field—maybe because nothing seemed out of the ordinary. According to Pop Warner, America’s largest and oldest youth football organization, Santa Margarita officials “have no memory or record of an injury so they are unable to describe it.”

James didn't say anything about the hit to anyone during the game. His reasons for doing so the Ransoms can now only speculate. He may not have had the awareness, as a 12-year-old, in his moment of distress, to think that he might have had a concussion. He may not have even understood what a concussion was.
Even if he did register that he had a concussion, he had learned from his coaches that playing through pain was part of the game. "Toughness" was something his coaches preached. According to Greg, there was a "culture of yelling" that James' coaches adhered to—even if players cried. (Jason Wegis, the Stallions' head coach, did not return requests for comment. Stan Bennett, the line coach, declined to comment.) The culture was familiar to Greg from his playing days; he and his friends feared their coach, who was allegedly known to throw helmets at players.

After the game, on the way home, Greg noticed blood on James’ ear. The lobe was smashed and the skin had an abrasion. Later that night, James told Greg he had his "bell rung." He also told his father it wasn't the first time something like this had happened. "Oh, I've gotten my bell rung before," James said.
"What?" Greg asked. "What do you mean?"
"I've had my bell rung before," James replied, nonchalantly, as if it were as common as running a route or completing a pass. "I've been hit so hard I've seen stars before."
________________________________________
James practiced on Monday, but on Tuesday he began to feel nausea and dizziness during drills. His parents took him to a pediatrician, who diagnosed James with a concussion, clinically known as a traumatic brain injury (TBI). He was told to sit out for a week. A few days later, on Saturday, James and Greg went to see the Stallions play from the sidelines. Afterward, they watched the BYU-UCLA football game on television. But when James went to a concussion specialist the following week, he had no recollection of watching the Stallions or UCLA games.
Another specialist later on found James to have lost a substantial amount of his short-term visual geometric memory. During one test, he was shown rectangles and squares, which were then taken away. A few seconds later, he was asked to draw what he just saw. He couldn't remember the shapes.
There were other changes, like balance and vision. He couldn't stand on one foot without falling over. He had severe nausea within five to 10 minutes of attempting schoolwork, as his eyes struggled to track objects. His right eye and left eye struggled to work together; he was diagnosed with a third-nerve palsy and convergence issues. He was found to have lost a quarter of his visual spectrum and was given corrective glasses.

Within two to three weeks of his brain injury, James began exhibiting signs of intense obsessive-compulsive disorder. He was consumed with ensuring the battery on his phone was always 100 percent charged, with making sure the software on his tablet was always updated. He made sure doors were always locked. Courtney says James liked structure and had always been a perfectionist—he cried because he scored a 98 on a test at age eight—but after his brain injury, his behavior was different. "He was doing things he had never done before," Courtney says. "It was disturbing."
James wasn't just smart; he was curious. "He thought very deeply about things," says Paul Conover, the bishop at the family’s church. James knew two coding languages and was learning a third. He was interested in math and history, especially the Constitution. He took to philosophy. "He was brilliant," Meredith Ritner, an English instructor who taught James in the eighth grade, recalls.
Though James was accustomed to "A" grades, he struggled to complete schoolwork after the injury. His teachers allowed him to not turn in work while he was recovering—James had a doctor's note—but when "zeros" showed up on James' academic profile on School Loop, Ladera Ranch Middle School's online portal, he got frustrated. (The zeros were temporary.)
"He felt as though he were a failure," says Tom Bogiatzis, school counselor at Ladera Ranch Middle School. "He'd say, 'I'm not going to be successful. I'm not going to be good at anything.'"
James felt like he was falling behind and that his life was over. He became irritable, angry and aggressive, grabbing his father's neck on more than one occasion. He'd randomly chatter his teeth or throw himself on the ground and make strange noises. Sometimes his eyes rolled back uncontrollably. None of this was behavior he'd exhibited prior to his brain injury.

Before the concussion, he had been gentle. He was affectionate and had a sweet disposition. He rescued animals, like Rosie the beagle. One time, he found and returned a neighbor's lost dog. "He was the kind of brother that would give you a big bear hug," says Julia, 17.
But afterward, James grew meaner, shrewder. "This wasn't the gentle kid that I knew," Courtney says. He yearned for isolation, despite the fact that, previously, he had never really liked being alone. He told Lillie, with whom he used to spend hours playing Minecraft, to leave him alone.
The Ransoms were terrified. They couldn't understand what was happening to their child. Let alone understand how to help him. "As a parent, dealing with this, you have no idea what's going on," Greg says. They went from appointment to appointment, seeing neurologists, pediatricians, concussion specialists, psychologists, ophthalmologists, vision therapists, physical therapists, desperate for answers, for relief. But James was still suffering.

James (bottom middle) was affectionate and had a sweet disposition. But after his concussion his parents, Greg (top right) and Courtney (top middle), couldn't understand what was happening to him.Photo courtesy of the Ransom family
Once, he and Courtney were standing on the pavement outside their house, about to get in Courtney's car, when James just began to walk the other direction. "James. Where are you going?" she called after him. "James!" He didn't answer. His mother's words flew right past him. He kept walking down the sidewalk, his body looking like a silhouette under the Southern California sun.
________________________________________
Dr. Bennet Omalu published the first evidence of CTE, or Chronic Traumatic Encephalopathy, the degenerative brain disease found in people with a history of repetitive brain trauma, in football, in 2005. By the time of James' injury in 2015, the term "CTE" was only just starting to matriculate into the public lexicon. (The movie Concussion, detailing Dr. Omalu's story, was released that year.) Like many parents at the time, Greg and Courtney knew little about CTE. "We didn't even think of it," Greg says. "We didn't think of it at all."
The disease seemed to them like something that was diagnosed in older men, men who had played in the NFL. Former San Diego Chargers linebacker Junior Seau had been diagnosed with CTE in 2013, less than a year after he took his life.
A landmark study by Dr. Ann McKee, a neuropathologist, published by the American Medical Association in July 2017, found that the incidence of CTE was markedly higher in football players than the general population. Of 202 football players, 177 had CTE. (Of the 111 NFL players included in the study, 110 had CTE.) Since, the disease has been found in cases of football players as young as 17 and 14. Recently, Tyler Hilinski, the former quarterback at Washington State who died by suicide in January, was posthumously found to have had CTE.

The Ransoms never thought about CTE in relation to their eighth-grade son. There was no way to know whether James had it, because the disease can only be diagnosed after death through brain tissue analysis. But he had been diagnosed with a concussion—a traumatic brain injury—and his behavior was growing more worrisome by the day.

One afternoon in October 2015, about a month after James' brain injury, Courtney walked into his room. She saw him lying on his white comforter, head pressed against his white pillow, arms folded across his stomach, eyes staring at the ceiling. The family cat, Meg, lay at his feet.
"It's OK, Buddy. You are going to be OK," she said. "We are going to be able to work this out."
"I don't think so," he said, turning to her, looking her in the eye. Courtney felt a chill. She says she knew in that moment, in the way mothers know things, that her son wanted to take his life.
In late December, Courtney caught him trying to take his life. It wasn't the first time he had done so, however, he would later admit; he had tried on another occasion, unbeknownst to the family. More erratic behavior ensued. In early January, he bolted out of the house, running past six houses and up a hill at the end of the block. Lillie chased after him. When she caught him, he told her they should run away.

The next day, Greg and Courtney took James to nearby UC Irvine's emergency room, and he was admitted to its neuropsychiatric unit. He stayed there, sometimes with one-on-one supervision, for the duration of the month. When James was discharged, Greg and Courtney still worried. Each day they thought, Today, we have to keep him alive. We just have to keep him alive. Sometimes Courtney would fall asleep on the stairs, staying near his room to make sure she didn't lose sight of him.

They drove James to more appointments, more specialists. Determined, devastated, hopeful, afraid. All the time. At any moment they feared their son could try to take his life again, right then, wherever they were. They continued to try to find a treatment. They were willing to give anything—their eyes, their arms, their legs—if that meant it would keep him alive. "I was trying to get through to him," Greg says. "I was trying to tell him: 'We love you. You don't have to do this.'"
________________________________________
What, exactly, was going on inside James' head? Concussions are known to produce emotional distress. Common symptoms include anger, denial, depression, shock, guilt, paranoia and impaired judgment. A 2014 study found that adolescents who suffered concussions and other traumatic brain injuries are "significantly more likely" to try to kill themselves. In 2016, researchers found that concussions—among other brain injuries—significantly increased the long-term risk of suicide among adults. In 2017, a medical study from Boston University found that those who played youth tackle football before the age of 12 were twice as likely to develop mood and behavioral problems and three times more likely to develop depression in middle age.

The brain doesn't mature until the mid-20s in terms of its physiology and basic biology, as major changes continue to occur through puberty and late adolescence to early adulthood. Blows to the head during that time (and beyond) can alter physical, cognitive and emotional development, according to Dr. Erin D. Bigler, Professor Emeritus of Psychology and Neuroscience at BYU. He has studied concussions for over 40 years.

"You're putting the brain at risk every moment that you're on the field and in practice," Bigler says, "and that is ultimately damaging the brain." The amygdala and hippocampus, both parts of the temporal lobe, are critical for emotional processing and memory. Bigler says those two areas are extremely vulnerable to the effects of concussions.

What those effects are, and how they manifest, is different for each kid, given each kid's genetic background and medical history. James' changes included vision, balance, impulse control and suicidal ideation, but another kid might experience other changes, like depression or anxiety. Some may not even know they are experiencing changes at all—not until later in life. Or ever. Still, those changes may be happening.

But what about the smaller hits that James said he had also taken—the times in which he got his "bell rung" but there was no concussion diagnosis? How much do those undiagnosed—sometimes smaller—hits impact brain function?
"The problem is, is that we don't have real, good, quantitative, physiological evidence about what's happening (in the brain) with a 'bell rung,'" says Dr. James Hicks, a professor at UC Irvine who co-authored a pioneering study about concussions in water polo. "Those are the kind of hits you might take a lot of and not really think about them."
Whether it was a small hit, big hit, a culmination of hits or some other factor that resulted in James' mood swings is not easily discernible. All his parents knew was that the boy they raised—the one who used to hold his mother's hand, who used to scream "I LOOOOOVEEE YOUUUU" to Lillie in the hallway between classes—was suffering.
________________________________________
A few months after he was released from the neuropsychiatric ward, James seemed to be doing better. He was managing his OCD using techniques he had acquired. He liked his psychiatrist. He was enjoying his personal training sessions, which he had three times a week, feeling active again. He traveled to Washington with his dad. He still had moments of extreme impulsivity, anxiety and erratic behavior but seemed optimistic about the future.

In August, James returned to Ladera Ranch Middle School to start eighth grade. He did well academically. His third-eye palsy seemed to be healing, though his balance was still off. He had a lot of friends. He was 13 and sprouted a foot taller. Girls liked him. Ritner identified him as a potential Student of the Year award winner. "Everything's going to be fine," Lillie thought. "He's going to get through this."

James (left) was smart and curious. "He was brilliant," Meredith Ritner, an English instructor who taught James in the eighth grade, recalls.Photo courtesy of the Ransom family

But Greg and Courtney were still fearful. They could not let their guard down, not with life and death always in the back of their minds.
The family traveled to Hawaii for Thanksgiving vacation in November. Sometimes James was happy; he laughed, tried to learn how to surf. Other times, he exhibited worrisome behavior. Once, he walked out of the hotel to the balcony and stood there for a while, looking down, a few floors below, in a contemplative state. Courtney, distressed by her son's actions, couldn't help but wonder if he was thinking of jumping.
A few days after returning home, James was back at school, standing with a bunch of students at lunch. A boy in a special-needs class approached him and reached for his chest. But before the boy could make contact, James swatted him away and hit him. The two tussled before teachers stepped in. James was sent to the principal's office, so upset with himself because he was not a fighter. He had never been sent to the principal's office before.
He tried to dust it off, channel his energy. He went to taekwondo with his neighbor and good friend William the next night, as he had begun to engage in light physical activity. James was in good spirits, having received the paper he needed to test for his next belt, yellow. He and William laughed in the car, as they always did, on the way home while playing Bop It. James talked about wanting to surf again.
A few hours later, James was talking with his mother about the incident at school the day before. She told him the kid who approached him was probably jealous of him and that James should act with kindness toward him. James agreed: "He probably is jealous of me." Courtney asked him why. James said: "Because I am smart, funny and people like me."
Later that night, James came downstairs to talk to his mom again, asking about her work, her upcoming projects. He went upstairs to go to bed but then came down again pretty quickly. He said he needed a glass of water. Courtney reminded him to take his medication and his melatonin, so he could get his sleeping schedule back on track. He nodded his head, finishing his glass.
"Goodnight," she said. "I love you."
"I love you, too."
James went upstairs and never came back down.

________________________________________
When you walk into the Ransoms' house, past the green door with a wreath of lavender and green hydrangeas, a tiny angel in the middle, the first things you notice are photos of James. On the walls. On top of a cabinet. Downstairs. Upstairs. With his sisters. With his parents. With his friends. Smiling in all of them.
"I see him everywhere. I want him everywhere," says Courtney.
It's been nearly two years since James took his life on November 30, 2016. The pain does not lessen as each day passes. "He was just a little boy," Greg says. A tear drops down his cheek. "And now he's gone."
Sometimes, Greg and Courtney replay every moment in their heads, from the hit to everything that came after. They've talked to the parents of James' teammates about what happened on the field. They've spoken with the Stallions' coaches. They've combed through James' account of what happened, wondering what might have been.
It is unclear if any athletic trainers or board-certified physicians were present on that fateful day. "What we are told is that Santa Margarita has at least two CPR / First Aid certified coaches," Brian Heffron, a spokesperson for Pop Warner, wrote in an email. "No one has a memory of the specifics of that game."
Youth sports organizations are not required under state law to report games in which an athletic trainer or board-certified physician is present, so it is unknown how many are typically present at youth games. Two months before James' death, the California legislature passed AB 2007, which required mandatory concussion protocols be followed—including, among other things, the removal of players suspected to have a concussion and that coaches or administrators complete head injury training. (It went into effect January 2017.) And just days before James took his life, Pop Warner launched a "concussion education campaign" and implemented safety measures—such as reducing contact in practice to 25 percent and requiring any player who suffers a suspected head injury to receive medical clearance from a concussion specialist before returning to play. (It is unclear what 25 percent constitutes, or what "suspected" means, or how the protocol is enforced.)
The Ransoms have not brought legal action against the Stallions, Santa Margarita Pop Warner, Pop Warner or the player who hit James. (Pop Warner is currently being sued in a class-action lawsuit for failing to institute safety protocols. The lawsuit is not related to James' death.)
Greg and Courtney have not seen footage, nor have they been able to retrieve it. Pop Warner said "no" when asked, in a written request, if it had video footage to make available. In a statement, Pop Warner wrote: "The loss of a child is heartbreaking and it's hard to imagine the pain the Ransom family has experienced. Our hearts go out to them.
"While football is a very physical sport we have worked hard to make the game safer for young people by instituting major rule changes, including limiting contact in practice, better training for coaches and education for parents and players. Pop Warner's concussion rule, which has been in place since 2010, requires any participant removed from play due to a head injury or suspected concussion to be evaluated and cleared in writing by a currently licensed medical professional trained in the evaluation and management of concussions before they return to play. During games, the home team must provide medical coverage. In the absence of a physician or ambulance on site, the team is required to supply an individual who is EMT qualified or certified in Red Cross Community First Aid and Safety."

The Ransoms have hungered to understand the science behind their son's apparent behavioral changes. But they have not had James' brain studied since his death, so they do not know whether James had CTE. At the time of his death, they didn't think about having his brain studied. It wasn't on their radar. Whether the Ransoms could, years later, still find out if James had CTE is unclear. "It depends on a lot of factors," Chris Nowinski, Ph.D., the co-founder and CEO of the Concussion Legacy Foundation, explained in an email. "People have been exhumed months after burial for a successful diagnosis."
The knowledge, the Ransoms insist, wouldn't serve any purpose for them.
"Nothing is going to bring James back," Courtney says.


Instead, the Ransoms have taken steps to educate themselves. Courtney pored through articles on the internet, reading blogs of families whose teens died from taking their own life. "After he died, I could not stop searching for answers," she says. Greg learned more about CTE, which led him to consider the effects of other brain trauma that hadn't resulted in CTE.
From Courtney's internet research, a pattern emerged: In many of the cases in which a teen took his or her life, there was a concussion. Many of the accounts seemed to be about young people who were just like James—people who were well-liked, performed well academically, lived "normal" lives that then took a drastic turn that resulted in death. Courtney then talked to other parents about their teenage sons who weren't, as Courtney says, "right," after some sort of concussion in football. She started to wonder if all of these things were connected.
________________________________________
Researchers in recent years have found that concussions can lead to mental illness and exacerbate symptoms or episodes of mental illness. Sometimes, it only takes a single head injury for mental illness to occur. Among teens, untreated concussions can lead to mental disorders. Not all teens who have suffered concussions develop mental illnesses. Some studies have shown that, for many athletes, mental effects resolve themselves over the long term. But a situation like James' is not out of the realm of possibility.
Though James' behavior changed following the traumatic brain injury suffered on September 12, 2015, the Ransoms will never know for sure what led to James' mental illness, but they want to help other families by telling his story. They have created the James Henry Ransom Foundation to raise money for other teens and adolescents and families struggling with mental illness.
Greg says he understands why people love the game of football and sees how their identities are wrapped up in it. He gets how this game has saved other people's and other families' lives—how it has provided a way out of poverty for some or offered a social connection for others, and how deeply meaningful that can be.
"It's not about being anti-football. We loved football. My son loved football," Greg says.
It's just that, "Football wasn't worth it," he adds.
Ultimately, James' story can help make parents more aware of the risks, Greg says. "If people knew what was happening to their kids, if they saw the bruises that accumulated on their legs, they'd be disturbed by it," Greg says. "But you don't see what's accumulating inside of a skull. You don't see it. … It's an injury people can't see so they pretend it doesn't exist.
"Nobody thinks their son can die playing this game, which they can," Greg adds. "Even if my son hadn't died, we went through hell for a year. Just the awfulness of my son having to go through that. … He didn't have to die for this to be awful."

Mirin Fader is a Writer-At-Large for B/R Mag. She's written for the Orange County Register, espnW.com, SI.com and SLAM Magazine. Her work has been honored by the U.S. Basketball Writers Association. Follow her on Twitter: @MirinFader.
Editor's note: This piece mistakenly identified Dr. Omalu as having published the first evidence of CTE, though it first emerged in print in 1949 via British neurologist Macdonald Critchley. The article has since been amended to clarify Omalu's work as being specific to football. We regret the error.

DID ONE HIT LEAD TO A 13-YEAR-OLD'S SUICIDE?
https://bleacherreport.com/articles/2795305

greybeard58
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Re: concussions

Post by greybeard58 » Thu Sep 20, 2018 2:34 pm

Hayley never once formally diagnosed with a concussion yet says she's had a few

Got eaten alive on Facebook for just asking a parent to do research before putting their kid into hockey. We can’t ignore the science in the name of the almighty $$$ especially in education.

Further to this: the face of women’s hockey says she’s donating her brain to concussion research. —Educator Sarah Moore
https://twitter.com/SMooreBC/status/1029777653983637510


I donated my brain for research. You should too.
'The future can be better and healthier for those young girls who will come along after I’m gone’

In my entire career, I was never once formally diagnosed with a concussion.

Looking back, I’m pretty sure I likely suffered a few. After all, playing 32 years of hockey and contact sports, it’s hard to believe not one of those thousands of hits didn’t leave me spinning.

But there was one particular hit I took that I will never forget. It was in 2008. I was playing professional men’s hockey in Sweden.

The Swedish pro team was gracious enough to allow me to continue to play in tournaments with the Canadian women’s national team. In November of that year, during the Four Nations Cup in Lake Placid, N.Y., I collided with an American player and suffered a third-degree tear of the medial collateral ligament in my knee. It was the worst situation I could imagine: I was being paid to play pro hockey in Europe - a woman in a men’s league, no less - and now I was going back to the team injured.

I spent two weeks in Toronto doing everything I could to heal quickly, and returned to Sweden for another 10 days of rehab. Normally, a bad MCL tear means six weeks, minimum, before you can return to full-contact hockey. I got myself ready in four. My coach at the time, Matthias Karlin, pleaded with me to take more time. In any other case, I likely would have, but these were unique circumstances. I was the sole breadwinner in my family, my son loved his Swedish school and didn’t want to go back to Canada, I was the only woman playing at this level, and many people wanted me to fail. The pressure was enormous.

I chose to play.

'Bad idea’

The deal with Matthias was that I would watch the first period from the bench, and then he would ease me into the game. Bad idea. I knew it was, but I wanted to play so badly, I agreed. The second period started and I was chomping at the bit to get in the game, but I was cold. Matthias gave me the nod on right wing and out I went. The puck got dumped into our own end and I went back to receive an outlet pass from the D-man. Except he didn’t wait for me to get into position and threw it right up my back - a suicide pass as it’s called.

The funny thing is I knew what was coming next. I could feel the energy, the air change, I could sense that I was about to get hit by a train. I felt I had to take the hit and show I could handle it. What I didn’t anticipate was how much force was coming. The opposing player ran me from about 15 feet and hit me “Sidney Crosby” style with a rotational force that was so hard I actually ended up with an avulsion fracture in my neck, meaning a piece of my vertebrae was broken off, though I wouldn’t find this out until much later. I almost blacked out, but luckily I was near the bench and our trainer opened the door and picked me up by my pants and sat me down. I was in big trouble and I knew it: nauseous, headache, confused, memory issues, off balance - the list of symptoms went on and on.

But I finished the game.

I’m not proud that I finished the game. It was a matter of survival to me. It became a life-and-death choice for me in that moment. In fact, I didn’t even miss a beat. Coaches kept asking if I was OK. Everyone knew I had just gotten absolutely crushed. “Yup, all good,” I said. For the next three weeks I struggled to sleep, light bothered me and it was all I could do to get up in the morning, get my son to school, sit in the dark, quiet house, drink coffee and try to put myself together for the afternoon practices. I had to survive. So I hid. I found ways to avoid taking hits, do fewer reps in drills and save my energy. My brain needed it. Eventually, I was able to slowly recover and play with no obvious ill effects. I got lucky.

'Higher risk’

So when people ask me why I have donated my brain to the Concussion Legacy Foundation, that story is part of the answer. I don’t want athletes to suffer if we can help it. Female athletes have a higher risk of concussion and slower recovery time than male athletes. There are few professional female athletes in contact sports to study, and even fewer who have donated their brains to the cause. I hope this inspires more to do the same. After all, when you are gone, ya kinda don’t need it anymore!

Steve Montador is another motivation for me to donate my brain to science. Steve played 12 NHL seasons and his death was a tragedy. The post mortem showed chronic traumatic encephalopathy (CTE) in his brain, which can be directly attributed to the brain injuries he suffered playing hockey. Steve was one of my dearest friends and greatest people I knew in hockey. He was a beautiful soul. The day he passed away I made a promise never to pass up a chance to honour his legacy. I donated my brain in memory and honour of Steve, his deep care and concern for others and how much better he deserved in his time of suffering.

I’m currently studying medicine with aspirations to work in emergency trauma. I have always been fascinated with the workings of the human body. We know a lot, but there is so much still to learn. I believe in research, I believe in science and I believe we can do much better when it comes to educating the next generation about how important it is to protect the brain.

I believe that leadership at its best comes in the form of action. We need more concrete action in the area of concussion research. My life in sport inspired me to study medicine. It also compelled me to donate my brain, in the hope that it will inspire and promote more action, so that the future can be better and healthier for those young girls who will come along after I’m gone.

If you would like to further the research on concussions and donate your brain to science, join me by going to https://concussionfoundation.org.

I donated my brain for research. You should too.
'The future can be better and healthier for those young girls who will come along after I’m gone’
Read more: https://www.cbc.ca/playersvoice/entry/i ... should-too

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Re: concussions

Post by greybeard58 » Thu Sep 20, 2018 2:38 pm

Suicide risk nearly double for traumatic brain injury sufferers: Study


https://abcnews.go.com/Health/suicide-r ... dlines_hed

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When was your first concussion?

Post by greybeard58 » Thu Sep 20, 2018 8:41 pm

When was your first concussion?

New study of 5616 athletes finds the age at which an individual has their 1st concussion may be an important factor in determining long-lasting cognitive effects. Additional concussions linked to lower memory & impulse control scores.

Conclusion: On the basis of objective performance metrics for cognitive function, concussions had a more persistent effect on cognitive function than previously thought. The age at which an individual has his or her first concussion may be an important factor in determining long-lasting cognitive effects.

Concussion History and Cognitive Function in a Large Cohort of Adolescent Athletes
https://www.ncbi.nlm.nih.gov/pubmed/30230912

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"If you are a women’s ice hockey player

Post by greybeard58 » Sun Sep 23, 2018 12:33 am

"If you are a women’s ice hockey player, you are three times more likely to have a concussion than if you play football"


Concussion.

The word conjures up images of head-to-head collisions between football players, most likely in the NFL because that gets the most attention.

But you are at just as much risk of getting a concussion in other sports.

Football isn’t even the highest risk when it comes to athletes getting a concussion.

If you are a women’s ice hockey player, you are three times more likely to have a concussion than if you play football, Dr. Jayson Loeffert, a specialist in family medicine and primary care sports medicine with Penn State Hershey Medical Group, told a group of parents in the auditorium of Middletown Area Senior High school on Wednesday, Aug. 15.

“Everybody thinks football is the issue. Football gets the most talk, but football actually isn’t the highest risk in terms of sports,” said Loeffert, who is team physician for the Blue Raiders. He also treats athletes at Penn State Harrisburg and the Harrisburg Senators.

“Just because your son or daughter does not play football doesn’t necessarily mean they are immune from getting a concussion,” he added. “It can happen in any sport.”

District Athletic Director Cliff Smith arranged for Loeffert to give the talk, to educate parents on a topic that Smith noted is “constantly changing.”

That’s true, judging from what Loeffert had to say during his 25-minute long presentation before the group of about 20 people, including several district staff members.

One point Loeffert sought to drive home to the parents was the need for a student athlete to come to a team doctor or coach as soon as possible, if he or she is experiencing symptoms from a concussion.

Athletes are often reluctant to say they are experiencing symptoms because they don’t want to be out of the game. But this can lead to athletes being on the sidelines longer, and putting themselves at greater risk.

“When athletes are unwilling to come to me, it makes my job very difficult and it makes their rehab and their recovery difficult a lot of times, too,” Loeffert said. “What I like to promote is openness. We know that athletes who are treated quickly and treated in the right away, which is generally just rest and a progressive return to activities, get better far faster than the athletes that keep playing, get more hits, and can have progression of their symptoms. … Usually the athletes I take care of who have a long-term duration of symptoms didn’t come forward right away with their diagnosis and their symptoms.”

Categorizing

Loeffert grouped symptoms into four categories: physical, mental, emotional and sleep.

Physical symptoms include dizziness, trouble with light and sounds, and headaches.

Mental symptoms include trouble with memory, trouble staying focused or trouble paying attention in class — are they falling behind in their homework?

Emotional symptoms include anxiety, depression and anger — sadness, irritability or feeling worried or scared.

Loeffert emphasized that a concussion is “a very complicated thing” that can vary widely from person to person.

For example, someone can receive “a very, very hard hit” that doesn’t cause a concussion, and someone else can receive a fairly mild hit that does.

“We don’t really know why that happens,” Loeffert said. “There’s no real good prediction as to what is going to cause a concussion.”

The easy way to think of a concussion is, you have trauma to the brain that causes changes to cognitive function, and then can cause symptoms afterward.

Some athletes develop amnesia but this is “really rare,” occurring in fewer than 1 or 2 percent of athletes diagnosed with a concussion, Loeffert said.

Not all athletes who have a concussion report having headaches. They think that if they don’t have a headache, they could not have had a concussion. Not so.

“If you have all these other symptoms, you don’t have to have a headache,” Loeffert said. Headaches are “just part of the picture” involved in having a concussion.

Loss of consciousness is also rare, Loeffert said. An athlete suffering a concussion will say they were out, and their parents will say, “No, you got up really quick.”

Loeffert put up a graph showing a continuous rise in concussions in the United States since 2007.

Girls at risk

Until 2005, a concussion diagnosis had to include loss of consciousness. In 2005, the requirement that an athlete had to lose consciousness in order to be diagnosed with having a concussion was removed.

That change has led to the steady rise in athletes being diagnosed with concussions since 2005, Loeffert said, although “a lot more knowledge and a lot more openness for admitting symptoms” are also factors behind the increase.

Young girls are at greater risk of having a concussion than young boys, because young girls have weaker neck muscles and they jump differently, Loeffert noted.

Loeffert used a scenario about a hockey player to illustrate the state requirements in Pennsylvania for an athlete who has symptoms of a concussion, and what happens afterward.

The hockey player gets slammed into the boards. He complains of headache and dizziness, and has trouble with sounds.

He is removed from play and monitored on the bench. But his symptoms appear to clear up, and after 10 minutes he feels normal. Can he return to the game?

No.

“The rule is if you have concussion symptoms you are automatically removed from that game, and you can’t return to any physical activity until at minimum the next day,” Loeffert said, adding that this is a state rule in Pennsylvania intended to protect the athlete.

If diagnosed with a concussion, you can expect to be out of action for at least seven days. This is also a state-mandated rule, Loeffert said.

Returning to the field

Before an athlete can return to his or her sport, they have to be “asymptomatic” — lacking obvious signs or symptoms — without the aid of medication, he noted.

All medicines have side effects, Loeffert said. He tries as much as possible to avoid prescribing medicine to an athlete diagnosed with a concussion.

Loeffert said he doesn’t have to rely on medicine very often, “because I am getting my athletes treated really well, really fast. They are clearing up their symptoms quick and they are getting back to their sport, which is ultimately what they want to do.”

Loeffert also utilizes a “return to play progression” for getting an athlete diagnosed with a concussion back in action.

The athlete must first be symptom free for at least a day. Then each day the athlete undergoes steps that gradually become more intense, in terms of physical activity.

For example, in the first day after being symptom free you do light aerobic activity, such as a jog or a long walk.

If you don’t experience a return to symptoms, gradually over the next several days you progress to more intense “sport specific” exercises, Loeffert said.

If some or all symptoms return during this progression, the athlete doesn’t have to go back to the beginning of the process.

“They just stop for the day, and then the next day they try those sports specific activities again,” Loeffert said. “That’s a really important thing to tell the athlete, because if they think they are going to have to start over they are not going to tell you they are symptomatic. But if you say you are just losing a day, then usually they are more able and open to admit they are becoming symptomatic.”

Loeffert explained why it is critical that if an athlete does experience a return to symptoms during this return to play progression, that he or she tell their doctor or coach — in order to prevent “second impact syndrome.”

“Second impact syndrome is the idea where you get a concussion, you are still symptomatic and you suffer another head impact,” Loeffert said. “Nobody has ever died of a concussion … but there is what is believed to be some inflammation quality when you get a concussion. If you get a second hit, that inflammation can kind of skyrocket. You can get swelling on the brain which people have been reported to die from. All the protective stuff we are doing is to prevent this.”

Helmets can’t prevent them

Loeffert also had a word or two to say regarding equipment such as helmets.

Helmets don’t protect people from having concussions, Loeffert said, and he doesn’t expect they will “now or in the foreseeable future.”

“Our brains sit inside of our skull and it’s kind of surrounded by fluid. And it floats,” Loeffert added. “Everything in there shakes around. That’s what happens within our skull. You can’t prevent that no matter how much padding we use, no matter how much protective layer. That brain is still going to move. That’s what puts you at risk of a concussion.”

The Food and Drug Administration even forbids a helmet maker from saying that his or her product will prevent a concussion, as “nothing has been found to truly prevent concussion,” he said.

Moreover, the testing of helmets in a scientific lab does not adequately replicate what happens to an athlete in a real practice or game situation, he added.

Helmets can protect student athletes from skull fractures and scalp lacerations, he said.

Last year, Loeffert said he was asked about the value of putting a pad over the top of a helmet.

This won’t prevent a concussion, and the padding could make things worse by adding weight to the top of the helmet, putting extra force on the neck, he notes.

Head gear for soccer players has been investigated, but Loeffert noted one study suggests athletes who wear head gear may take risks they wouldn’t otherwise take while playing, because it gives them a false sense of security.

Are students educated?

During a brief question-and-answer period following Loeffert’s presentation, a parent asked Smith about whether the school district is providing this same information about concussions to the student athletes.

Smith said that typically, student athletes are not educated about a concussion unless they have one, and then “they are educated as the doctor is treating them.”

However, he seemed open to the possibility of the district being more pro-active about providing information about concussions to all student athletes.

As one parent noted, if student athletes know “ahead of time” that they might not have to sit out as long if they report symptoms quickly, “they might be more prone to come to you and say ‘this is what I am feeling’ and nip it in the bud.”

Smith urged district parents with questions about concussions email the questions to him, so he can forward the questions to Loeffert for answers.

You can reach Smith at cliffsmith@raiderweb.org.

Smith also encouraged parents contact him with ideas for other student athlete-related topics that can be the subject of future presentations.

Football isn’t highest-risk sport for athletes and concussions, doctor for Blue Raiders says
Read more: http://www.pressandjournal.com/stories/ ... says,38629

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STATE CONCUSSION LAWS

Post by greybeard58 » Wed Oct 03, 2018 12:31 am

STATE CONCUSSION LAWS
Five years ago (2010), only 10 states had laws addressing traumatic brain injuries in youth sports. Since Washington state enacted the Zackery Lystedt law in 2009, every state and the District of Columbia has enacted some form of “When In Doubt, Sit Them Out” law (Wyoming enacted a law, although it is so weak it is not counted in this table).

The laws by themselves are not the solution. For instance, most states require some form of education of student athletes and their parents, but in almost every state this takes the form of nothing more than a piece of paper that must be signed by the athlete and parent before participation. Given the significant number of permission slips and other documentation that students and parents must sign, it is hard to imagine this step succeeds in providing anything approaching comprehensive education. Very few states require parents be notified of their child’s traumatic brain injury, and even fewer mandate medical personnel be present at games involving collisions.

Some states go further than others.
Rhode Island, for example, not only has a return to play protocol, coach training, and athlete and parent education, it also encourages the use of baseline testing and the attendance of medical trainers at all athletic events.

Tennessee has a brain trauma registry to study incidence information, and disseminates a list of public and private agencies which can provide services to people with TBIs.

Vermont requires training for referees as well as coaches, requires schools have a concussion management plan, and requires health care providers to be present at all collision sports, and for visiting team’s athletic directors to be notified of any concussions within 48 hours of a game.

Colorado and Idaho extends their concussion laws all the way down to middle school (though Colorado is one of the few states that does not require athlete and parent education).


State Requires clearing health professional to be licensed physician or trained in TBI management Requires training for coaches Requires athlete education Requires parent education Requires parent notification of suspected or diagnosed TBI
Alabama ✔ ✔ ✔ ✔
Alaska ✔ ✔ ✔
Arizona ✔ ✔ ✔
Arkansas ✔ ✔ ✔ ✔
California ✔ ✔ ✔
Colorado ✔ ✔
Connecticut ✔ ✔ ✔ ✔ ✔
Delaware ✔ ✔ ✔ ✔
DC ✔ ✔ ✔ ✔
Florida ✔ ✔ ✔ ✔
Georgia ✔ ✔
Hawaii ✔ ✔ ✔
Idaho ✔ ✔ ✔
Iowa ✔ ✔ ✔
Illinois ✔ ✔ ✔ ✔
Indiana ✔ ✔ ✔ ✔
Kansas ✔ ✔
Kentucky ✔ ✔ ✔ ✔
Louisiana ✔ ✔ ✔ ✔ ✔
Maine ✔ ✔ ✔ ✔
Maryland ✔ ✔ ✔
Massachusetts ✔ ✔ ✔ ✔ ✔
Michigan ✔ ✔
Minnesota ✔ ✔ ✔ * ✔ *
Missouri ✔ ✔ * ✔
Mississippi ✔
Montana ✔ ✔ ✔ ✔
Nebraska ✔ * ✔ ✔ ✔
Nevada ✔ ✔ ✔
New Hampshire ✔ * *
New Jersey ✔ ✔ ✔ ✔
New Mexico ✔ ✔ ✔
New York ✔ ✔ ✔ ✔
North Carolina * * ✔
North Dakota ✔ ✔ ✔ ✔
Ohio ✔ ✔ ✔ *
Oklahoma ✔ ✔ ✔
Oregon ✔ ✔ ✔
Pennsylvania ✔ ✔ ✔
Rhode Island ✔ ✔ ✔ ✔
South Carolina ✔ ✔
South Dakota ✔ ✔ ✔ ✔
Tennessee ✔ ✔ ✔ ✔
Texas ✔ ✔ ✔
Utah ✔ ✔
Vermont ✔ ✔ ✔ ✔ ✔
Virginia ✔ ✔
Washington ✔ ✔ ✔
Wisconsin ✔ ✔
West Virginia ✔ ✔ ✔ ✔
Wyoming ✔ ✔ ✔ *

Connecticut added parental notification in May 2015 through Public Act 14-66: An Act Concerning Youth Athletics and Concussions.

Minnesota only requires student/parent education if a consent form is already required, in which case, concussion information is on that form.
Missouri’s information sheet must only be signed by the parent, not the athlete themselves.

Nebraska requires that training for coaches be “made available,” but does not require coaches to be so trained.

New Hampshire requires materials be distributed, but does not require any confirmation of receipt or other steps.

North Carolina requires coaches and athletes receive a concussion information sheet, but does not require acknowledgement of receipt or specific coach training.

Pennsylvania, which mandates suspensions of coaches found in violation of concussion protocols, is the only state to include an enforcement mechanism with its return-to-play law.

Wyoming calls for school districts to develop concussion protocols, but specifically states that no school district is required to adopt the protocols.

State Concussion Laws | The American Association For Justice


https://www.justice.org/state-concussion-laws

greybeard58
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Re: concussions

Post by greybeard58 » Wed Oct 03, 2018 12:36 am

Anne Hunt

"Women’s ice hockey needs to show more leadership in concussion prevention. Consistent enforcement of rules & development of policies similar to GTHLHockey might help. I’m seeing too many injuries in my daughters league.”
https://mobile.twitter.com/drannewhunt/ ... 7133564928

greybeard58
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Re: concussions

Post by greybeard58 » Wed Oct 03, 2018 12:37 am

Katie Lachak
comes home from hockey practice with a black eye
mom starts freaking out trying to see if I have a concussion
dad takes picture, ohh that’s a good one
https://mobile.twitter.com/katiedmlacha ... 0964462593

greybeard58
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Re: concussions

Post by greybeard58 » Wed Oct 03, 2018 12:38 am

Devil’s Ben Lovejoy who pledge his brain for concussion research
“This is strictly about science. This is strictly about finding a cure and making the game of ice hockey safer down the line for future generations. When my daughters want to play hockey, I want the game to be even safer than it is now,” Lovejoy said.
http://www.sportingnews.com/ca/nhl/news ... 7e0t5el409

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Maeve Lee concussion

Post by greybeard58 » Wed Oct 03, 2018 12:44 am

Maeve Lee concussion

Maeve Lee

Hingham played three lines and three extra forwards, and Findley relished the chance to get lots of kids some ice time.

“It was Senior Night for us, so we played all the seniors a lot tonight,” Findley noted. “I think our kids played well, and overall, we’re on an upswing. It is funny that our leading scorer is a defenseman -- Lizzy Jacobson -- but as we saw tonight she is a talented player. Our second-leading scorer is Julia Salvucci, another defenseman, so they’ve been big contributors.”

“We’ve won some games we shouldn’t have won, and lost some games we should’ve won,” Findley said of his team’s record. “But they’re all on the same page, and we have a very good nucleus.

“I thought Julia Forbes had a very good game tonight. And Maeve Lee, just getting back from a concussion, came back strong and had a couple very good scoring chances. So, we’re getting people back, and we have good depth. We end our year with two tough games, Andover and Reading, but we feel like we can make the tournament and continue to improve.”

H.S. GIRLS HOCKEY: Hingham blanks Norwell
Read more: http://www.patriotledger.com/sports/201 ... ks-norwell

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Re: concussions

Post by greybeard58 » Sun Oct 07, 2018 4:23 pm

For Your Patients-Traumatic Brain Injury: TBI Is Associated with Nearly Two-Time Risk for Suicide Better Interventions Are Needed, Experts Say
Collins, Thomas R.

Neurology Today: October 4, 2018 - Volume 18 - Issue 19 - p 27–28
doi: 10.1097/01.NT.0000547364.96917.03
For Your Patients
• Article Outline
Back to Top | Article Outline

ARTICLE IN BRIEF


In a retrospective study, people with traumatic brain injury (TBI) who had different kinds of medical contacts — inpatient treatment, outpatient visits, and visits to emergency units — had an increased risk for suicide compared with those in the general population without TBI.

A new study on traumatic brain injury (TBI) and suicide risk — notable for its size and the level of detail of its analysis — has found that those who've experienced a TBI are almost twice as likely to commit suicide as those who have not had such an injury, with the highest risk seen among those who developed a psychological illness or engaged in non-fatal self-harm after their TBI.

Independent experts say that while the results, published in the August 14 JAMA, might not be groundbreaking — this increased risk has been seen in prior studies — the study provides a new and persuasive impetus for clinicians to include a psychiatric or psychological component into the treatment of these patients and to screen for suicide risk among people with brain injuries.

The study's lead author, Trine Madsen, PhD, a post-doctoral fellow at the Danish Research Institute for Suicide Prevention, said she hopes the main takeaway is that it is important to take steps to avoid TBIs altogether.

“First and foremost, we would recommend a focus on preventing TBI, such as promoting use of protective helmets in workplaces where risk of falls or head injury are higher, [such as] construction sites, and in contact sports like boxing and American football,” she said. “If head trauma has occurred, an individual who experiences post-TBI emotional problems or psychiatric symptoms should be advised to seek help or treatment for this in order to prevent a detour towards suicidal ideation or behavior.”

She said the findings also suggest it's important to schedule regular follow-up visits after discharge for a TBI.
Back to Top | Article Outline

STUDY DETAILS

Investigators analyzed data from 1980 to 2014 on more than 7.4 million people living in Denmark. They pulled information from the Danish Civil Registration System, the Database for Integrated Labor Market Research, the National Hospital Register, the Psychiatric Central Research Register, and the Cause of Death Register, all of which contain continuously updated data.

TBI data have been kept for inpatient treatment in Denmark since 1977. TBI information for outpatient visits and emergency room visits were not added until 1995, which could mean, the authors said, that the estimates for TBI-associated suicide risk is likely on the conservative side.

The suicide risk for those with one or more TBIs was 90 percent higher than those without a TBI, with an incidence rate ratio (IRR) of 1.90 after adjustments for 12 factors, including sex, age, socioeconomic status, marital status, fractures not involving the skull or spine, epilepsy, and psychiatric diagnosis or deliberate self-harm before the TBI (p<.001).

The more severe the TBI, the higher the risk, researchers found. For mild TBI, the IRR was 1.81; for skull fracture, 2.01; and for severe TBI, 2.38 (p<.001 for all).
People who were diagnosed with a psychological illness after their TBI were almost five times as likely to commit suicide as those with a TBI only (IRR, 4.90), and those who engaged in deliberate self-harm after TBI were more than seven times as likely (IRR, 7.54) to commit suicide.
Researchers found that the risk was highest in the six months immediately following the TBI and when patients had spent three or more days in treatment for TBI. Younger patients — those who were 16 to 20 at the time of their first contact with health care for TBI — had the highest suicide risk of all the age groups, investigators found.

Those who had a diagnosis of a psychological illness before TBI (IRR, 2.32) and those who had engaged in deliberate self-harm beforehand (IRR, 2.85) were at an increased suicide risk compared those with TBI only.
Further investigation on how to avoid steps leading to suicide after TBI would be valuable, Dr. Madsen said.
“It is important to look into how to optimize the treatment of serious head injuries to minimize the many possible consequences — psychiatric, cognitive, physical, and social — that can tragically lead to suicidal behavior,” she said. “It would be interesting to carry out a large register-based study examining how TBI might be associated with more social consequences such as employment status in the years following the TBI incident.”
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EXPERT COMMENTARY

Amy J. Starosta, PhD, assistant clinical professor in the department of rehabilitation at the University of Washington, said: “I think this type of research is really important because it just shows that we're not looking at one specific type of population, like veterans,” she said. “This is a problem for all of our rehab patients, and it's something that we need to be thinking about across the board in primary care settings, in rehab medicine clinics, in inpatient rehab settings, and in neurology clinics.”

In an accompanying editorial, Lee Goldstein, MD, PhD, associate professor of psychiatry and neurology at Boston University and Ramon Diaz-Arrastia, MD, PhD, director of the Traumatic Brain Injury Clinical Research Center at the University of Pennsylvania, wrote that the study was particularly notable for its adjustments for so many relevant factors, distinguishing it from past research.

“The results reported by Madsen, et al, point to an important clinical triad — TBI history, recent injury (especially with long hospital stays), and more numerous post-injury medical contacts [for example, inpatient and outpatient hospitalization] for TBI — that serves as ‘red flags’ for increased suicide risk,” they wrote. They also noted that suicide risk is relevant across all TBI severity levels, including the “far more common mild injuries,” for which the incidence rate ratio, compared to no TBI, was 1.81.
While the results are clinically relevant, they said, they are also “mechanistically indeterminate.”

“Among the main questions stimulated by this research is the mechanism,” they wrote. “How exactly do TBIs increase suicide risk? What are the substrates and processes that causally link TBI, a highly heterogeneous condition, to a singular catastrophic outcome? The answers are undoubtedly multifactorial and complex.”
Dr. Starosta said she was struck by the stark difference in suicide risk by gender among those with a TBI — 27.5 suicides per 100,000 person years for women and 49.3 for men — because some literature has suggested that there is much less of a difference by gender in TBI populations compared to the general population.
She said it was also telling that those with a pre-existing psychological illness actually had a lower suicide risk after they had a TBI.

“These patients have more of a touch-point with providers and I think that just really speaks to the intervention piece,” she said. “Having more touch points with a broad range of providers is going to be a really critical piece for actually making a change in suicide risk.”

She said that evaluating suicide risk among those who've had a traumatic brain injury is similar to the assessment in the general population, involving questions about depression, anxiety, hopelessness and other signs. But among those with a TBI, the conversation might be shaded a bit toward attention to patterns of impulsivity, which can be elevated among those who have had a TBI.
She said that more centers have integrated psychiatric and psychological components into their care, but outside of academic medical centers and some primary-care settings it has been a bit slow in coming, mainly because of limited resources.
“Once the screening — the initial questioning — has happened, you need to get a more fine-grained assessment, and that's really where having mental health available to medical providers is a really important key,” Dr. Starosta said. “It's reasonable for clinics, and providers and nurses to be screening for suicide either through standardized measures such as the Patient Health Questionnaires 2 and 9. But then at that point once we need to do a more though risk-assessment it's really helpful to have psychology, mental-health providers, or social work to be on board so that we have people who have that training.”
Craig Bryan, PsyD, assistant professor of clinical psychology at the University of Utah, said greater adoption of scientifically-supported suicide prevention treatments is needed. “I would argue that the treatment of suicide risk among all populations, even those without TBI, has been lacking,” Dr. Bryan said.
Both dialectical behavior therapy — which involves individual and/or group therapy that focuses on psychosocial issues — and brief cognitive behavior therapy — which addresses thoughts, beliefs, and attitudes and the development of personal coping strategies that target current problems — have been shown in many studies to reduce suicidal behaviors by 50 percent or more, he said. A 2015 study on which he worked found that cognitive behavior therapy was effective in a military population, a group with high rates of TBI.
“Although TBI was not an explicit focus of that study, the fact that a treatment was so effective in a population with high rates of TBI suggests brief cognitive behavior therapy may be a useful method for addressing suicide risk among TBI patients,” Dr. Bryan said.
He said that because similar results have been found in other studies, he doubted these latest findings would “change anything dramatically.”
But, he said, “it provides further evidence for the TBI-suicide link and may help to call attention to the need for clinicians to better implement empirically-supported treatments for suicide prevention. The aforementioned treatments — dialectical cognitive therapy and brief cognitive behavior therapy — seem to work because they help individuals to manage their emotions more effectively, take perspective, and improve decision-making in the midst of intense emotional distress. These are common problems that TBI patients report, so there may be some implications for the value of those treatments with this population.”
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LINK UP FOR MORE INFORMATION:
•. Madsen T, Erlangsen A, Orlovska S, et al. Association between traumatic brain injury and risk of suicide https://jamanetwork.com/journals/jama/f ... le/2697009. JAMA 2018; 320(6):580–588.
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Re: concussions

Post by greybeard58 » Sun Oct 07, 2018 4:26 pm

Grace Fahey
Just back from an injury (concussion) junior forward Grace Fahey sealed the Cards’ scoring with 4:38 remaining, finishing a feed from Kelly.

“It’s great to be back, I missed the team, so it’t nice to be back out there,” Fahey said. “We’re all putting in a lot of effort and getting better and better as a team.”

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