Part 1: These young female athletes died by suicide. They all had head injuries in common
Kelly Catlin and Ellie Soutter never met, but they had a lot in common.
Both were commanding athletes: Catlin, a US track cyclist, was a three-times world champion and Olympic silver medalist, and Soutter, a snowboarder, was tipped to be one of Team Great Britain's strongest contenders for the 2022 Winter Olympics, having already won a bronze medal at the 2017 European Youth Olympic Festival.
Both were incredibly smart -- Catlin was studying for a master's degree in computational and mathematical engineering at Stanford University, while Soutter learned to speak French in about six months, according to her father.
At times they almost seemed superhuman. In 2013, after only three weeks of formal training and having broken her wrist, Soutter became British Champion with her arm in a cast. Meanwhile, Catlin, who had a tenderness for children, once rode 80 miles through sleet and snow to speak to a grade school about her Olympic experience
Yet these two women's lives were tragically cut short after they sustained serious head injuries in their pursuit of sporting greatness and then took their own lives. Catlin was 23, while Soutter died by suicide on her 18th birthday.
Females may be more susceptible to concussion, and they also have worse and prolonged symptoms after their injury than men, according to a review of 25 studies of sport-related concussion published in the Orthopaedic Journal of Sports Medicine.
However, women remain significantly underrepresented within sport and exercise science research. This, leading experts warn, means they often do not get the treatment or aftercare they need following a head injury.
Women's sports have historically not received the same attention or funding as men's sports, Dr. Ann McKee, Director of the Boston University Chronic Traumatic Encephalopathy (CTE) Center told CNN.
"It's been shown that women athletes are more likely to get a concussion, they tend to have longer recovery periods," McKee added.
"We do not have enough information about what happens in the female brain. We don't know if women are biologically more susceptible to these injuries," she said, adding that some research suggests the size and musculature of women's necks could play a part.
Kelly
Before becoming a track cyclist, Catlin, a triplet, was a national champion road cyclist and time trial national champion, her father Mark, told CNN. After winning a Canadian international race at 17 she was invited to an Olympic training camp for a try out, where, impressed by her performance numbers, coaches immediately offered her a position on the track pursuit team.
Catlin's father, Mark, told CNN, that his daughter was "intense" and "ambitious," attributes she channeled into her sporting life.
Her life changed irrevocably in January 2019. Practicing fast downhill descents in the hills near Los Angeles, she crashed and went skidding down the road. Despite suffering road rash, Catlin got back on her bike, and finished the ride. It wasn't her first crash -- she had experienced 4 or 5 hard crashes before this, her father said, and after the latest, she didn't have any symptoms at the time.
But soon after, at a World Cup track event in Berlin, Catlin was gripped by a sudden and severe headache.
"She couldn't compete," her father said. "Kelly is kind of this stoical individual. And if she's rolling around on the ground, clutching her head, it has to be a severe thing.”
On closer inspection, Catlin's helmet from LA had dents in it. Her father told CNN that this, coupled with her symptoms, caused her family to become aware she had suffered a concussion, which was later confirmed with a diagnosis from Stanford's Health Centre.
A concussion is a brain injury which happens after a hit to the head or body causes the brain to move back and forth inside the skull, according to the CDC.
When Catlin returned to the US, her father says she was examined by the track training center in Colorado. It was confirmed she suffered a concussion, and a return to training protocol was advised, but not implemented or communicated to her coach, he said.
"There wasn't any follow-up from Colorado after this. I believe they assumed she would seek care at Stanford," he told CNN.
CNN has reached out to Stanford and USA Cycling for comment.
Catlin's symptoms didn't improve, and in weekly phone calls with her parents, she admitted she was struggling with schoolwork and was unable to concentrate.
Stanford Health Center, having diagnosed Catlin with concussion with ongoing symptoms, recommended that she decrease her training for 2 weeks and then gradually build back up and start sessions with an athletic trainer, medical documents sent to CNN by her father show. She was referred to a concussion specialist, the document adds.
She tried to train, but "she would have to stop because she got a severe headache just from walking," according to her father. Her heart rate would also accelerate rapidly from even the smallest exertion, leaving her with "no exercise tolerance whatsoever," he added.
"Wherever she turned she could not find help.” — Mark Catlin
Her injury had other consequences.
"As far as we knew she was never a person that suffered from depression. She had an interesting sense of humor. She was always upbeat and bubbly about things," her father told CNN.
"She basically thought her life was over. She was no longer able to be the athlete that she was, she was failing her teammates. And she wasn't able to succeed in school now. And I think ultimately, that's why she took her life, because she thought her life was over," he added.
At the end of January, Catlin made a serious but non-fatal suicide attempt, and was involuntarily admitted to the locked psychiatric ward at Stanford, her father told CNN.
A month after that attempt, she took her own life.
Ellie
Soutter's father Tony said there were many dimensions to his young daughter -- not only was she an "adrenaline junkie," but she was "very conscientious" and excelled in school, even after moving from England to France.
Aged 12, Soutter took up snowboarding at school -- and just months later, she was spotted in her hometown resort of Les Gets and trialed by Team Great Britain in February 2013.
"It was quite obvious why she kept winning competitions because she just made it easy," her father said. "She just made it look graceful and beautiful.”
But training took its toll -- Soutter told CNN that his daughter suffered seven major concussions in five years, between 2013 and 2018.
"I was being advised by doctors "Oh, don't worry, she's young enough she'll bounce back. As she progressed, becoming an elite athlete starting on the World Cup circuit, every time she had another concussion, they got worse, and they took longer to recover from," he told CNN.
"With every concussion, with the exception of a few minor knocks, Ellie saw a doctor in person," he added. "I was always told that she was young enough to bounce back to full health after each case and therefore never consulted with the doctors that I met, about any previous concussions.”
But Soutter's final concussion was so "huge" that she spent two nights in the hospital.
"When I got there, she didn't even know who I was or where she was," her father said.
Soutter was then selected for the Junior Snowboard World Championships in New Zealand August 2018. But a month before the competition, she died by suicide.
"I truly believe today that my daughter would be alive had I had...even the smallest bit of information.” — Tony Soutter
Her father said a neurologist conducted a CT scan of her brain and reaction tests three months after her final concussion, but said she was "absolutely fine" and could continue competing.
Like Catlin, Soutter had issues with studying and concentrating, becoming more insular as she suffered from crippling headaches. She also started suffering from insomnia.
"She would literally sit with the tutor a good month after a concussion, and suddenly, she'd go blind. She'd not be able to see -- everything would go black and dark," her father said.
After missing a flight to snowboard training, Soutter died by suicide on her 18th birthday.
Team GB referred CNN to GB Snowsport when approached for comment, adding that Ellie only competed for Team GB at one event.
In order to represent Britain in international competitions, GB Snowsport says athletes or their coaches are required to demonstrate that the athlete has reached established performance criteria, is of the relevant technical ability to compete, and has appropriate medical clearance to compete. A large number of athletes can represent Britain at different levels of international competition but are not part of a programme delivered and overseen by GB Snowsport.
"As Ellie was not part of the GB Snowsport programme, we were unable to implement a personalized recovery and management programme for Ellie," a spokesperson for GB Snowsport told CNN in an email.
"She was, however, covered by national policies and protocols around fitness to compete, and would not have been cleared for any activity -- training or competition -- overseen by GB Snowsport without being able to demonstrate appropriate medical sign-off," they added.
The spokesperson for GB Snowsport told CNN: "We take concussions and head injuries incredibly seriously, and in reviewing contemporaneous records from the time that Ellie was involved in snowsport we are confident that GB Snowsport staff applied and followed every appropriate process.”
Catlin and Soutter aren't the only young sporting women whose lives have been cut short in this way.
After 29-year-old Australian rules football player Jacinda Barclay took her life in 2020, post-mortem research by scientists found that she had degradation to her cerebral white matter unusual for someone her age.
"For someone her age, you would expect to see lovely pristine white matter, and hers looked like she was an old woman in that it was basically degraded," Michael Buckland, founder and Executive Director of the Australian Sports Brain Bank, who studied Barclay's brain, told CNN.
"We haven't gone back and done specific white matter studies on our donors," he told CNN, adding that the bank hasn't done peer reviewed research on this. "But what struck me, just as someone that sees a lot of brains -- this is not normal for someone of that age.”
Damage to white matter has been associated with dementia, according to research published in the Journal of the American Medical Association.
Opportunities missed
Suicide after concussion is rare. However patients diagnosed with concussion or mild traumatic brain injury had double the risk of suicide and a higher risk of suicide attempts and suicidal thoughts than people without brain injuries, a 2018 study from researchers at the University of Harvard published in JAMA Neurology found.
Dr. Robert Cantu, clinical professor of neurology at the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine told CNN that there are several theories as to why incidence of suicide is higher in people who have suffered concussion.
One theory, he explained, is that those suffering from persistent post-concussion symptoms may have structural or functional brain damage and could be experiencing "behavioral dysregulation: short fuse, irritability, [and] can't suppress impulses the way you normally could.”
With these emotional problems, "they would be more prone to perhaps do something impulsive, like commit suicide," Cantu, medical director of the Concussion Legacy Foundation, told CNN.
A second theory, Cantu noted, is that post-concussive symptoms prevent people from getting back into their sport and stop them "from being the person that they were before their injury.”
Neither theory is proven to the exclusion of the other, Cantu said, adding he thinks increased suicidality was "a combined factor involving both in many, if not most cases.”
There are also differences in the way brain injuries affect women.
A study of female soccer players across US high schools found they are nearly twice as likely to suffer concussion as their male counterparts, according to research that looked at over 80,000 adolescent athletes, published in the journal JAMA Network Open.
Girls twice as likely to suffer concussions as boys in soccer
While concussions are rare, female soccer players in US schools are nearly twice as likely to suffer them (2.4% of athletes) as their male counterparts (1.3%), a recent study found. (See chart)
Women remain significantly underrepresented within sport and exercise science research: a 2021 study examining papers from some of the most influential sports medical journals found that only 6% of the studies were solely focused on women, compared with 31% of studies that included just men.
Other researchers have pointed to female sex hormones, with risk of concussion changing with hormone levels during a menstrual cycle.
McKee said all athletes can also experience "non-concussive" injuries: "hits to the head that can be of the same magnitude as concussion, but they don't rise to the level of symptoms for whatever reason, so a player tends to play right through it.”
Cumulative exposure to repetitive head impacts -- including concussion and non- concussive injuries -- increases the risk for the neurodegenerative brain disease chronic traumatic encephalopathy, known as CTE, McKee said.
The disease, which can only be formally diagnosed with an autopsy, has mostly been seen in either veterans or people who played contact sports, particularly American football, say researchers. The disease occurs when the brain starts to degenerate likely due to repeated head traumas, according to the Mayo Clinic, which notes CTE is "associated with recurrent concussions.”
But scientists aren't only concerned about concussions.
Previous studies have shown subconcussive head impacts -- repetitive hits to the head and body that do not cause symptoms -- can still result in long-term neurological disease.
According to The Concussion Legacy Foundation, "the best available evidence suggests that subconcussive impacts, not concussions, are the driving force behind CTE.”
There have been cases of CTE discovered in athletes who have never been diagnosed with a concussion, according to the Concussion Legacy Foundation.
And other changes in the brain after repetitive head impacts aside from CTE are likely "equally important," McKee said.
"We also see damage to the white matter. And that appears to be mostly in the frontal lobe, but also in the temporal lobes," she said.
"We're trying to understand the relationship of those white matter changes to behavioral and mood symptoms, perhaps even suicidality," she said. McKee stressed that concussion management is important, but physicians and athletes should also be aware of other injuries.
"The problem is the subclinical hits -- the non-concussive injuries that aren't detected, you don't pull the player off the field -- and they can be in the hundreds or even the 1000s in a single season," she explained.
Lack of research
Though a growing body of data suggests women in sport are more likely to sustain a concussion, have more severe symptoms, and to take longer to recover, most sports-related concussions protocols are based on data from men.
In a review in the British Journal of Sports Medicine, researchers looked at 171 concussion studies written since 1967 which are used to inform the most influential consensus and position statements in treating sports-related concussions.
Clinicians rely on these documents to guide their medical practice when treating athletes -- but most of the studies are focused on men. Only 1% of them was looking exclusively at concussions in women and 40% of them didn't have any women in a sample of participants at all.
Only 1% of research focuses solely on concussion in women athletes. Studies guiding clinical care for athletes with concussions rely on samples that are overall male, according to recent analysis of more than 170 papers. (See chart)
There is another risk factor for women in sport when they sustain head injuries, Katherine Snedaker, founder and executive director of PINK Concussions, a non-profit dedicated to women's health and brain injury, told CNN.
There is a gulf of millions of dollars separating women and men when it comes to average annual salaries in most professional sports.
Outside of elite sport, Snedaker says, female athletes often don't have access to the same medical care as men, meaning head injuries aren't spotted as routinely.
"They tend to push really hard through the injury," she said.
And many women can't afford to take time out to recover: even professional athletes will supplement their sports income with other jobs, she added, and many are caregivers.
"When they really crater, it's a couple of days or weeks later." Snedaker said female athletes often weren't aware they had suffered a head injury.
If they were, she said, there were no appropriate medical or sporting staff to inform.
Not enough support
The families of Catlin and Soutter feel the young women didn't get enough support after their injuries.
After Catlin's first suicide attempt, she was released from an involuntary admission to the psychiatric ward after threatening legal action, and a conference between psychiatrists, her coach and her parents.
She attended therapy sessions, which she agreed to attend during the conference, but found "they were geared toward suicidal freshman with a whole set of different issues than an elite Olympic athlete," her father told CNN.
She got a referral to a sports psychologist that worked with the Stanford athletic department, but the department forbade the psychologist from seeing Catlin because she was not a varsity athlete, her father added.
She contacted the office of a sports psychologist with whom she had developed a rapport while in the hospital -- but, his appointment secretary said he had no openings for six months, her father told CNN.
"Wherever she turned she could not find help," he said, adding that his daughter tried a suicide hotline several times: she was once put on hold and once received no answer.
Catlin described his daughter as a "stoic, female warrior type person that isn't going to admit that she's struggling.”
"She needed a sports psychiatrist that really could understand what she was going through and understand the rigors of her life in terms of preparation for competitions and the athletic side of it and what it could potentially do to you.”
Her father said a major factor in his daughter's death was "a lack of communication between the facilities that were involved in Kelly's care. No one was in charge and they assumed the other institutions were following up when they weren't," he added.
In a statement sent to CNN, Luisa Rapport, director of emergency communications and media relations at Stanford University did not address any of the specific allegations made by Catlin's family. She said while the university does not discuss in the media the details of individual students' experiences, "supporting the mental and emotional health of students is a critical priority for Stanford.”
"Students in need of mental health crisis assistance -- including students having suicidal thoughts -- and those who are concerned about students in need of assistance, can contact the University's Counseling and Psychological Services (CAPS) 24 hours-a-day, seven days-a-week," she added.
Rapport said that in addition to this, "there are multiple places where psychological services may be provided for students depending on individualized need and treatment recommendations, including, for example, affiliated hospital services and clinics through Stanford's Department of Psychiatry and Behavioral Sciences, and mental health programs and clinicians in the community.”
In a statement sent to CNN, USA Cycling said it was "devastated" by Catlin's death, adding: "She brought focus and determination to everything she did, and served as an inspiration to everyone who knew her.
"As the National Governing Body for the sport of cycling, USA Cycling prioritizes the holistic wellbeing of the riders on the U.S. National Team and has a longstanding commitment to providing both physical and mental health resources to members of the team," a representative for USA Cycling added.
After his daughter Ellie's death, Soutter was contacted by the UNITE Brain Bank, who wanted to study her brain as part of their research into CTE.
But even in that facility -- the biggest of its kind in the world -- of some 1,300 brains, only 3% belonged to women, Ann McKee, Director of the Boston University Chronic Traumatic Encephalopathy (CTE) Center told CNN.
"When I actually started looking into CTE -- all of the work that they've done with the footballers in America, she had every single symptom and more," Soutter told CNN.
"It was quite obvious to me that there was a definite link in her starting to get into dark places and feeling bad and anxious and not sleeping properly. All of those symptoms ... Every one that's involved in CTE was part of Ellie's life," he added.
"I truly believe today that my daughter would be alive had I had any inkling, you know, even the smallest bit of information.”
These young female athletes died by suicide. They all had head injuries in common.
Read more: https://www.cnn.com/2023/02/05/sport/he ... index.html
Editor's Note: If you are in the US and you or a loved one have contemplated suicide, call The National Suicide and Crisis Lifeline at 988 or 1-800-273-TALK (8255) to connect with a trained counselor.
For support outside of the US, a worldwide directory of resources and international hotlines is provided by the International Association for Suicide Prevention. You can also turn to Befrienders Worldwide.
The National Suicide and Crisis Lifeline
https://988lifeline.org/
International Association for Suicide Prevention
https://www.iasp.info/
Befrienders Worldwide
https://www.befrienders.org/
concussions
Moderators: Mitch Hawker, east hockey, karl(east)
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greybeard58
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greybeard58
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Part 2: Diagnosing head injuries, mental health -- especially for female athletes -- is crucial
Part 2: Diagnosing head injuries, mental health -- especially for female athletes -- is crucial
Not every battle is waged in plain sight.
The most internal are more times than not the most difficult.
Tragically at times, those battles end with unimaginable outcomes.
A recent CNN piece profiled two world-class female athletes: Kelly Catlin, an Olympic track cyclist, and Ellie Soutter, a teenage British snowboarder who was tipped to potentially compete in the 2024 Winter Olympics.
Both athletes suffered head injuries. Both had lingering effects. Both sought assistance.
Both ultimately died by suicide.
Without repeating too much of the CNN profile out of respect to its reporting, the sorrow of their parents sharing their daughters' journeys would make anyone feel their heartache. Some of the connected facts that went into these journeys are devastating as well.
According to a study from the Orthopaedic Journal of Sports Medicine, female athletes are "more susceptible" to concussion and have "worse and prolonged symptoms" than their male counterparts.
Clinical data of female athletes is severely underrepresented vs. males.
A study of 80,000 female high school soccer players found they are nearly twice as likely to suffer concussions as boys while playing the sport.
Repeated head injury, including concussion, can lead to increased risk of chronic traumatic encephalopathy, commonly known as CTE.
As noted last week in my opinion piece about the incident with the Oregon social-media influencer and allegations of inappropriate behavior, even broaching the subject of female vs. male sports is tricky.
When you discuss disparity, whatever that means, there will inevitably be those who aggressively push back.
It'll be some form of "I don't care about female sports and no one else does either," as if that should be justification for the heinous nature and extent to which those sports and athletes are attacked in some circles.
But even if you are someone who views it strictly as a issue of spotlight or lack thereof.
Even if you are someone who finds female sports "lesser than," however that may be defined.
Even if you are one of those vile "stay in the kitchen" types.
Perhaps we can all agree a female athlete should receive the same care, attention and diagnosis for their health as any male athlete.
That includes diagnosis of concussions and long-term care for mental health.
Part of the issue we have in this day and age — one improving incrementally — is the perception of toughness in sports.
To an extent, toughness was defined in part by the ability to compete through injury.
Basically, if you could stand upright, you could continue.
We have gotten much better with that — obviously, with responsible athletic trainers embedded at all sporting events today, it's not 1960. If you're hurt, you're not going back out there.
But it's not just "shaking it off" in and of itself.
There is pressure to return from injury. It may jeopardize a team's goals or briefly derail the quest for a college scholarship. It may impede a competitive advantage over an opponent.
It may be unspoken. It may be unnecessary. But it is there.
The soccer trend mentioned above about girls high school players being more likely to be concussed than boys is one that hits close to home, given my long involvement with the sport.
Without citing specific names and schools for all the obvious reasons, I think back to one Saturday afternoon girls soccer match many years ago. Two players went up for a 50-50 header and made head contact with one another. We had a photographer covering the match, who captured the moment of collision.
At the time, all parties involved marveled at the quality of the picture. The reason, though, was more because it defined competitive nature — i.e. both student-athletes being willing to do "whatever it takes" to win.
Retrospect is a powerful thing. If, in passing, I come across that picture today, I cringe — and I don't doubt the other principals involved that day would arrive at the same conclusion, knowing what we know now.
In the fall, we need to have a real conversation in high school soccer. If we're not going to outlaw headers altogether, which we're not, we probably need to at least consider making protective headbands mandatory. That data and impact is all too clear.
Competitive nature and competitive edge is not more important than mental health and general wellbeing.
At every juncture, we need to have proper resources available to athletes to manage head injuries and their aftereffects.
We've made great strides in high school sports with caring for those types of situations, not permitting student-athletes back into a competitive avenue until stated protocols have been met.
In soccer, we're incorporating more trapping if applicable in technical skill.
In hockey, we've instituted head-contact penalties to discourage its use. And so on.
But we still have a ways to go.
Clinical data and studies should be more prevalent.
Access to health care and, if needed, mental health professionals shouldn't be impeded.
Certainly not on a basis of gender.
Say what you want about female sports — and some people will.
No one should ever endure what Catlin's and Soutter's families have.
After his daughter's suicide, Tony Soutter was asked by the UNITE Brain Bank to study Ellie's brain.
Of that brain bank's collection of more than 12,000, 3% belonged to females.
"It was quite obvious to me that there was a definite link in her starting to get into dark places and feeling bad and anxious and not sleeping properly," Tony Soutter told CNN. "All of those symptoms ... Every one that's involved in CTE was part of Ellie's life.
"I truly believe today that my daughter would be alive had I had any inkling, you know, even the smallest bit of information.”
No, not every case ends as tragically as Catlin's or Soutter's did.
But every internal battle like theirs has significance and consequence.
Taking smart, proactive and equal action every step of the way, as Tony Soutter so heartbreakingly described, does as well.
Diagnosing head injuries, mental health -- especially for female athletes -- is crucial | Opinion
Read more: https://news.yahoo.com/diagnosing-head- ... 00406.html
Not every battle is waged in plain sight.
The most internal are more times than not the most difficult.
Tragically at times, those battles end with unimaginable outcomes.
A recent CNN piece profiled two world-class female athletes: Kelly Catlin, an Olympic track cyclist, and Ellie Soutter, a teenage British snowboarder who was tipped to potentially compete in the 2024 Winter Olympics.
Both athletes suffered head injuries. Both had lingering effects. Both sought assistance.
Both ultimately died by suicide.
Without repeating too much of the CNN profile out of respect to its reporting, the sorrow of their parents sharing their daughters' journeys would make anyone feel their heartache. Some of the connected facts that went into these journeys are devastating as well.
According to a study from the Orthopaedic Journal of Sports Medicine, female athletes are "more susceptible" to concussion and have "worse and prolonged symptoms" than their male counterparts.
Clinical data of female athletes is severely underrepresented vs. males.
A study of 80,000 female high school soccer players found they are nearly twice as likely to suffer concussions as boys while playing the sport.
Repeated head injury, including concussion, can lead to increased risk of chronic traumatic encephalopathy, commonly known as CTE.
As noted last week in my opinion piece about the incident with the Oregon social-media influencer and allegations of inappropriate behavior, even broaching the subject of female vs. male sports is tricky.
When you discuss disparity, whatever that means, there will inevitably be those who aggressively push back.
It'll be some form of "I don't care about female sports and no one else does either," as if that should be justification for the heinous nature and extent to which those sports and athletes are attacked in some circles.
But even if you are someone who views it strictly as a issue of spotlight or lack thereof.
Even if you are someone who finds female sports "lesser than," however that may be defined.
Even if you are one of those vile "stay in the kitchen" types.
Perhaps we can all agree a female athlete should receive the same care, attention and diagnosis for their health as any male athlete.
That includes diagnosis of concussions and long-term care for mental health.
Part of the issue we have in this day and age — one improving incrementally — is the perception of toughness in sports.
To an extent, toughness was defined in part by the ability to compete through injury.
Basically, if you could stand upright, you could continue.
We have gotten much better with that — obviously, with responsible athletic trainers embedded at all sporting events today, it's not 1960. If you're hurt, you're not going back out there.
But it's not just "shaking it off" in and of itself.
There is pressure to return from injury. It may jeopardize a team's goals or briefly derail the quest for a college scholarship. It may impede a competitive advantage over an opponent.
It may be unspoken. It may be unnecessary. But it is there.
The soccer trend mentioned above about girls high school players being more likely to be concussed than boys is one that hits close to home, given my long involvement with the sport.
Without citing specific names and schools for all the obvious reasons, I think back to one Saturday afternoon girls soccer match many years ago. Two players went up for a 50-50 header and made head contact with one another. We had a photographer covering the match, who captured the moment of collision.
At the time, all parties involved marveled at the quality of the picture. The reason, though, was more because it defined competitive nature — i.e. both student-athletes being willing to do "whatever it takes" to win.
Retrospect is a powerful thing. If, in passing, I come across that picture today, I cringe — and I don't doubt the other principals involved that day would arrive at the same conclusion, knowing what we know now.
In the fall, we need to have a real conversation in high school soccer. If we're not going to outlaw headers altogether, which we're not, we probably need to at least consider making protective headbands mandatory. That data and impact is all too clear.
Competitive nature and competitive edge is not more important than mental health and general wellbeing.
At every juncture, we need to have proper resources available to athletes to manage head injuries and their aftereffects.
We've made great strides in high school sports with caring for those types of situations, not permitting student-athletes back into a competitive avenue until stated protocols have been met.
In soccer, we're incorporating more trapping if applicable in technical skill.
In hockey, we've instituted head-contact penalties to discourage its use. And so on.
But we still have a ways to go.
Clinical data and studies should be more prevalent.
Access to health care and, if needed, mental health professionals shouldn't be impeded.
Certainly not on a basis of gender.
Say what you want about female sports — and some people will.
No one should ever endure what Catlin's and Soutter's families have.
After his daughter's suicide, Tony Soutter was asked by the UNITE Brain Bank to study Ellie's brain.
Of that brain bank's collection of more than 12,000, 3% belonged to females.
"It was quite obvious to me that there was a definite link in her starting to get into dark places and feeling bad and anxious and not sleeping properly," Tony Soutter told CNN. "All of those symptoms ... Every one that's involved in CTE was part of Ellie's life.
"I truly believe today that my daughter would be alive had I had any inkling, you know, even the smallest bit of information.”
No, not every case ends as tragically as Catlin's or Soutter's did.
But every internal battle like theirs has significance and consequence.
Taking smart, proactive and equal action every step of the way, as Tony Soutter so heartbreakingly described, does as well.
Diagnosing head injuries, mental health -- especially for female athletes -- is crucial | Opinion
Read more: https://news.yahoo.com/diagnosing-head- ... 00406.html
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greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
USA Hockey collaborating on study to evaluate blood and saliva biomarkers for concussion in elite high school hockey pla
USA Hockey collaborating on study to evaluate blood and saliva biomarkers for concussion in elite high school hockey players
BrainBox Solutions and Dr. Michael Stuart, chief medical officer of USA Hockey, on Friday announced their collaboration on a study evaluating blood and saliva biomarkers for concussion in elite high school hockey players.
The project, which is funded by the USA Hockey Foundation, will use BrainBox Solutions’ patented biomarkers to better understand the effect of both acute concussion and subclinical head trauma in athletes participating in high-endurance contact sports.
"We're hoping this study provides objective evidence of neurocognitive changes due to head impacts and will benchmark the efficacy of potential interventions," Dr. Stuart said in a statement. "We seek to advance our understanding of concussion and improve prevention, diagnosis and management of this common condition.”
The data from this project will also be used to inform BrainBox’s upcoming clinical trial of its artificial intelligence (AI)-enabled, multimodal BrainBox TBI concussion diagnostic and prognostic test. BrainBox is currently completing its pilot study in conjunction with Children’s National Medical Center in Washington, DC with a general population of 10- to 18-year-old participants.
BrainBox Solutions, USA Hockey announce collaboration on concussion biomarker study
Read more: https://www.labpulse.com/diseases/healt ... rker-study
BrainBox Solutions and Dr. Michael Stuart, chief medical officer of USA Hockey, on Friday announced their collaboration on a study evaluating blood and saliva biomarkers for concussion in elite high school hockey players.
The project, which is funded by the USA Hockey Foundation, will use BrainBox Solutions’ patented biomarkers to better understand the effect of both acute concussion and subclinical head trauma in athletes participating in high-endurance contact sports.
"We're hoping this study provides objective evidence of neurocognitive changes due to head impacts and will benchmark the efficacy of potential interventions," Dr. Stuart said in a statement. "We seek to advance our understanding of concussion and improve prevention, diagnosis and management of this common condition.”
The data from this project will also be used to inform BrainBox’s upcoming clinical trial of its artificial intelligence (AI)-enabled, multimodal BrainBox TBI concussion diagnostic and prognostic test. BrainBox is currently completing its pilot study in conjunction with Children’s National Medical Center in Washington, DC with a general population of 10- to 18-year-old participants.
BrainBox Solutions, USA Hockey announce collaboration on concussion biomarker study
Read more: https://www.labpulse.com/diseases/healt ... rker-study
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greybeard58
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Sex-specific differences in resting-state functional brain activity in pediatric concussion
Sex-specific differences in resting-state functional brain activity in pediatric concussion
Introduction
Concussion is a mild form of traumatic brain injury (TBI) that results in altered neurological function after biomechanical impact. In pediatric populations, concussion is of particular concern given that it is one of the most common injuries among children and adolescents and has a rapidly rising incidence in those aged 10–19. While the injury is transient for the majority of pediatric patients, between 14 and 29% experience persistent concussion symptoms (PCS; also referred to as post-concussion syndrome, marked by symptoms which last in excess of four weeks1). PCS can include somatic, cognitive, emotional, and sleep-related features that negatively impact academic outcomes and health-related quality of life.
Brain function in pediatric concussion has been studied to understand the nature and extent of its impairment post-injury, as well as its potential etiological role with respect to concussion symptoms. Studies have measured brain function using resting-state functional magnetic resonance imaging (rs-fMRI), which maps regions of brain activity (by proxy of the blood-oxygen-level-dependent, or BOLD, response) and the relative associations between them in a task-independent manner. Pediatric rs-fMRI studies have shown increased functional connectivity in comparison to healthy controls in widely-studied brain networks within the first-week of injury. At one-month post-injury (the expected time of recovery1), results of rs-fMRI studies are mixed. With respect to studies of children diagnosed with PCS, one study found that within-network functional connectivity across seven validated brain networks did not differ between children with PCS (n = 110) vs. healthy peers (n = 20), although select PCS symptoms, sleep impairment, and poorer cognition were associated with connectivity in the concussed cohort.
A notable limitation common to many pediatric concussion rs-fMRI studies are the imbalanced samples with respect to sex. Some studies involved male only cohorts whereas others had less than 25% female representation in their samples; in some cases, data on sex were not reported. Only a few studies had samples that approached balance (40–45% female) with respect to sex distribution, though these studies did not stratify their results by sex, instead providing group-level data comparing mixed-sex cohorts of children with concussion to their healthy peers. The most direct data on sex-specific rs-fMRI differences come from a recent study involving adults with PCS. More specifically, in this study, three commonly studied networks were examined through seed-based analyses, namely the default mode network (DMN), salience network, and fronto-parietal network; the authors reported reduced connectivity between the fronto-parietal network and nodes of the salience network in females with PCS.
The lack of a sex-specific understanding of rs-fMRI differences in pediatric concussion is a considerable knowledge gap, given that sex, as a biological variable, has been recognized as an understudied yet important consideration in neuroscience. Further, a growing body of research demonstrates that concussion presents differently in boys vs. girls. For example, a recent cohort study (n = 986) found that female adolescents with concussion endorse more symptoms on the 22-item and widely used SCAT530 than concussed males, and are more likely to have a higher total symptom score. Two large-scale, multi-center cohort studies have shown that females have a protracted recovery in comparison to males, which align with other clinical data on disparate sex effects in concussion summarized in two recent systematic reviews. Furthermore, differences in mechanism of injury between males and females, as well as factors that influence neurodevelopment (such as pubertal and hormonal status and genetics) can increase vulnerability to brain injury-induced pathologies in a sex specific manner (which are reviewed in detail by Arambula et al.). Therefore, we studied sex-specific rs-fMRI differences in pediatric concussion to address an important knowledge gap, and advance our understanding of how the functional neuropathology of concussion differs between males and females.
Participants
Children (aged 9–17) experiencing concussion symptoms were recruited by the clinical study team from sites at or affiliated with McMaster University, including the McMaster Children’s Hospital and associated rehabilitation and sports medicine clinics, as well as through direct referral from community physicians. Children diagnosed with a concussion, and their families, were recruited for an intake assessment. Neuroimaging data were then collected as soon after recruitment as scheduling permitted. For the present study, exclusion criteria included: (i) more severe forms of head injury that required surgery, resuscitation, or admission to the critical care unit, (ii) complex injuries involving multiple organ systems, and (iii) diagnosed neurological disorder or developmental delay.
Imaging data on healthy children were acquired from the multi-site, internationally compiled, open-source Autism Brain Imaging Data Exchange II (ABIDE-II) database. The ABIDE-II database is comprised of over one-thousand anonymized brains (including 557 healthy controls across age in our current study) collected from 19 sites, primarily in North America and continental Europe, yielding nearly 75 publications to date. Both anatomical and functional scans from the ABIDE-II database were pulled to serve as ~ 12:1 age- and sex-matched typically developing controls for our participants with concussion. Specific matching criteria were not applied when selecting controls. Rather, all children within the age range of interest (9–17) were retrieved as potential controls. While the hardware (with respect to make of the scanners, and the type of head coil used, although all scanners were 3.0 T) varied slightly between sites that participated in the ABIDE initiative, quality control data are indicative of homogeneity in data (with respect to signal-to-noise ratio, data smoothness, number of outlier scans) across sites. Imaging parameters and scanner make and models can be found in Supplemental Table 1.
Results
Demographic and injury data of the 29 children with concussion and 361 controls are summarized in Table 1. Age and sex distribution did significantly differ between cohorts; however, we controlled for age in all analyses and performed both mixed-sex cohort analyses as well as single-sex (i.e., healthy female vs. female with concussion) analyses. Within the concussion group, males and females had similar PCSS scores (47.8 vs. 41.6, p = 0.511) at time of imaging per an independent samples t-test. Patients with concussion were, on average, approximately one-month post-injury (28.8 ± 14.5 days) at time of imaging, and had no history of anxiety, depression, sleep disorder, or psychiatric diagnosis.
The following figures depict the five clusters of greatest change (as per TFCE scores and associated p-values), per network and per analysis. A full list of significant clusters can be found in Supplemental Table 2.
Healthy females vs. females with concussion
In females, with respect to the DMN, there was increased connectivity between the DMN seed and parts of the cuneal cortex (right), caudate, and thalamus, and reduced connectivity between said seed and primarily the paracingulate gyrus (right), occipital pole (right), hippocampus (right), and precentral gyrus (right). Hypoconnectivity was observed between the SMN seed and the cerebellum, parahippocampal gyrus (left), and vermis. The seed region of the SA had reduced connectivity with regions including the thalamus, cingulate gyrus, and cerebellum. Further, the FPN R was associated with increased functional connectivity with the precentral gyrus, and the FPN L was associated with reduced connectivity in the temporal pole (left), paracingulate gyrus (bilaterally) and superior frontal gyrus (bilaterally); see Fig. 5.
In females, groupwise ROI-to-ROI analyses showed that there was increased connectivity between ROIs in the cuneal cortex and cerebellum, as well as between the cuneal cortex and default mode network. There was also reduced connectivity between temporal brain structures and those in the occipital region in females with concussion compared to healthy females (Fig. 6).
Conclusions
This is the first study to explicitly study and report on sex-specific rs-fMRI differences in pediatric concussion. At one-month post-injury, we report on differences in females with concussion (in comparison to their healthy peers) that are not apparent in males. This research further speaks to the need for more sex-specific analyses in concussion research.
Sex-specific differences in resting-state functional brain activity in pediatric concussion
Read the entire study at: https://www.nature.com/articles/s41598-023-30195-w
Introduction
Concussion is a mild form of traumatic brain injury (TBI) that results in altered neurological function after biomechanical impact. In pediatric populations, concussion is of particular concern given that it is one of the most common injuries among children and adolescents and has a rapidly rising incidence in those aged 10–19. While the injury is transient for the majority of pediatric patients, between 14 and 29% experience persistent concussion symptoms (PCS; also referred to as post-concussion syndrome, marked by symptoms which last in excess of four weeks1). PCS can include somatic, cognitive, emotional, and sleep-related features that negatively impact academic outcomes and health-related quality of life.
Brain function in pediatric concussion has been studied to understand the nature and extent of its impairment post-injury, as well as its potential etiological role with respect to concussion symptoms. Studies have measured brain function using resting-state functional magnetic resonance imaging (rs-fMRI), which maps regions of brain activity (by proxy of the blood-oxygen-level-dependent, or BOLD, response) and the relative associations between them in a task-independent manner. Pediatric rs-fMRI studies have shown increased functional connectivity in comparison to healthy controls in widely-studied brain networks within the first-week of injury. At one-month post-injury (the expected time of recovery1), results of rs-fMRI studies are mixed. With respect to studies of children diagnosed with PCS, one study found that within-network functional connectivity across seven validated brain networks did not differ between children with PCS (n = 110) vs. healthy peers (n = 20), although select PCS symptoms, sleep impairment, and poorer cognition were associated with connectivity in the concussed cohort.
A notable limitation common to many pediatric concussion rs-fMRI studies are the imbalanced samples with respect to sex. Some studies involved male only cohorts whereas others had less than 25% female representation in their samples; in some cases, data on sex were not reported. Only a few studies had samples that approached balance (40–45% female) with respect to sex distribution, though these studies did not stratify their results by sex, instead providing group-level data comparing mixed-sex cohorts of children with concussion to their healthy peers. The most direct data on sex-specific rs-fMRI differences come from a recent study involving adults with PCS. More specifically, in this study, three commonly studied networks were examined through seed-based analyses, namely the default mode network (DMN), salience network, and fronto-parietal network; the authors reported reduced connectivity between the fronto-parietal network and nodes of the salience network in females with PCS.
The lack of a sex-specific understanding of rs-fMRI differences in pediatric concussion is a considerable knowledge gap, given that sex, as a biological variable, has been recognized as an understudied yet important consideration in neuroscience. Further, a growing body of research demonstrates that concussion presents differently in boys vs. girls. For example, a recent cohort study (n = 986) found that female adolescents with concussion endorse more symptoms on the 22-item and widely used SCAT530 than concussed males, and are more likely to have a higher total symptom score. Two large-scale, multi-center cohort studies have shown that females have a protracted recovery in comparison to males, which align with other clinical data on disparate sex effects in concussion summarized in two recent systematic reviews. Furthermore, differences in mechanism of injury between males and females, as well as factors that influence neurodevelopment (such as pubertal and hormonal status and genetics) can increase vulnerability to brain injury-induced pathologies in a sex specific manner (which are reviewed in detail by Arambula et al.). Therefore, we studied sex-specific rs-fMRI differences in pediatric concussion to address an important knowledge gap, and advance our understanding of how the functional neuropathology of concussion differs between males and females.
Participants
Children (aged 9–17) experiencing concussion symptoms were recruited by the clinical study team from sites at or affiliated with McMaster University, including the McMaster Children’s Hospital and associated rehabilitation and sports medicine clinics, as well as through direct referral from community physicians. Children diagnosed with a concussion, and their families, were recruited for an intake assessment. Neuroimaging data were then collected as soon after recruitment as scheduling permitted. For the present study, exclusion criteria included: (i) more severe forms of head injury that required surgery, resuscitation, or admission to the critical care unit, (ii) complex injuries involving multiple organ systems, and (iii) diagnosed neurological disorder or developmental delay.
Imaging data on healthy children were acquired from the multi-site, internationally compiled, open-source Autism Brain Imaging Data Exchange II (ABIDE-II) database. The ABIDE-II database is comprised of over one-thousand anonymized brains (including 557 healthy controls across age in our current study) collected from 19 sites, primarily in North America and continental Europe, yielding nearly 75 publications to date. Both anatomical and functional scans from the ABIDE-II database were pulled to serve as ~ 12:1 age- and sex-matched typically developing controls for our participants with concussion. Specific matching criteria were not applied when selecting controls. Rather, all children within the age range of interest (9–17) were retrieved as potential controls. While the hardware (with respect to make of the scanners, and the type of head coil used, although all scanners were 3.0 T) varied slightly between sites that participated in the ABIDE initiative, quality control data are indicative of homogeneity in data (with respect to signal-to-noise ratio, data smoothness, number of outlier scans) across sites. Imaging parameters and scanner make and models can be found in Supplemental Table 1.
Results
Demographic and injury data of the 29 children with concussion and 361 controls are summarized in Table 1. Age and sex distribution did significantly differ between cohorts; however, we controlled for age in all analyses and performed both mixed-sex cohort analyses as well as single-sex (i.e., healthy female vs. female with concussion) analyses. Within the concussion group, males and females had similar PCSS scores (47.8 vs. 41.6, p = 0.511) at time of imaging per an independent samples t-test. Patients with concussion were, on average, approximately one-month post-injury (28.8 ± 14.5 days) at time of imaging, and had no history of anxiety, depression, sleep disorder, or psychiatric diagnosis.
The following figures depict the five clusters of greatest change (as per TFCE scores and associated p-values), per network and per analysis. A full list of significant clusters can be found in Supplemental Table 2.
Healthy females vs. females with concussion
In females, with respect to the DMN, there was increased connectivity between the DMN seed and parts of the cuneal cortex (right), caudate, and thalamus, and reduced connectivity between said seed and primarily the paracingulate gyrus (right), occipital pole (right), hippocampus (right), and precentral gyrus (right). Hypoconnectivity was observed between the SMN seed and the cerebellum, parahippocampal gyrus (left), and vermis. The seed region of the SA had reduced connectivity with regions including the thalamus, cingulate gyrus, and cerebellum. Further, the FPN R was associated with increased functional connectivity with the precentral gyrus, and the FPN L was associated with reduced connectivity in the temporal pole (left), paracingulate gyrus (bilaterally) and superior frontal gyrus (bilaterally); see Fig. 5.
In females, groupwise ROI-to-ROI analyses showed that there was increased connectivity between ROIs in the cuneal cortex and cerebellum, as well as between the cuneal cortex and default mode network. There was also reduced connectivity between temporal brain structures and those in the occipital region in females with concussion compared to healthy females (Fig. 6).
Conclusions
This is the first study to explicitly study and report on sex-specific rs-fMRI differences in pediatric concussion. At one-month post-injury, we report on differences in females with concussion (in comparison to their healthy peers) that are not apparent in males. This research further speaks to the need for more sex-specific analyses in concussion research.
Sex-specific differences in resting-state functional brain activity in pediatric concussion
Read the entire study at: https://www.nature.com/articles/s41598-023-30195-w
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
MN High school hockey player urges concussion survivors to pay attention to mental health
MN High school hockey player urges concussion survivors to pay attention to mental health
When the Lakeville South hockey team’s forward Zander Billins suffered a concussion more than a year ago, it ironically didn’t come from a hockey game.
"I’m lightheaded, I’m dizzy, and I’m just out of it," recalled Billins moments before he collapsed and crashed to his kitchen floor. "All I remember is my vision just slowly, slowly going away.”
His parents, standing just a few feet away, didn’t see him fall, but they sure heard it.
"The noise when a six-foot-five person hits the ground, I mean, it was just a loud scary sound," said his mother Christine Billins. His parents rushed him to the emergency room at Children’s Minnesota Hospital in Minneapolis where doctors believed Zander had passed out from a severe case of the flu. He went home and rested for a week, but the headaches never went away.
"We went back, and they put me through more tests," recalled Zander of returning to Children’s Minnesota. "And they’re like, ‘He’s got a concussion.’”
Traumatic brain injuries are more common than many would believe. According to the Minnesota Brain Injury Alliance, there are roughly 100,000 Minnesotans living with a TBI. In a review of Minnesota hospital records, the Brain Injury Alliance’s Brad Donaldson says data shows an average of 20,000 concussions a year.
Zander immediately entered the concussion program at Children’s Minnesota that takes a clinical team approach to recovery and paired him with a physical therapist, an occupational therapist, and a psychologist. Every brain injury is different, but often times the rehabilitation is incredibly difficult, even for a highly skilled athlete.
"It was not easy for me at the start because everything I couldn’t do, I used to be able to do," said Zander of the physical and occupational therapy that required him to balance on one foot. "That’s easy for me, right? But I couldn’t do it. And walking backwards with my eyes closed got me all dizzy.”
The loss of his physical coordination was especially worrisome because it was a set of skills that made him a high-performing hockey player. "That was what made me so angry, as it seemed so easy like I would be able to do that if I didn’t have the concussion," said Zander.
That anger and frustration became just as much of a hurdle to overcome as regaining his strength and coordination.
"No one thinks of the mental side of it," said Zander. "And that was the hardest thing for me to come around to, is I’m not right in my head, like I need help.”
That struggle is why his Children’s Minnesota care team included psychologist Kevin Coleman. Dr. Coleman works with patients to help them focus on the immediacy of their recovery and the daily achievements and tasks—not the long-term missed opportunities and setbacks that concussions can create.
"I don’t know that everybody sees it probably quite as clearly as Zander has been able to," said Dr. Coleman on Zander’s resolve to ask for help with his mental health. Johnson says high school survivors of a TBI, particularly student-athletes, are vulnerable to physical and emotional setbacks.
"The schooling doesn't necessarily stop when you get a concussion," said Dr. Coleman.
"Everybody else kind of proceeds with their lessons, with their social lives. Seasons carry on. And I think that presents some unique challenges for a student and especially student-athletes within the context of a recovery from a concussion.”
That’s where the clinical team approach and especially the mental health counseling can help get adolescent concussion survivors back on their feet faster.
"I think that's a huge part of somebody like me and my role in our team is to be able to kind of emphasize a sense of hope," emphasized Dr. Coleman. "We know that there's in general, a predictable course of a recovery for concussion and that if we do take our time and really focus on doing each of the steps carefully, that we see good outcomes.”
Zander’s parents shared the same concerns as their son, but say they were reassured from the moment they met Zander’s care team.
"I will not forget when we sat down that very first appointment and she told us we're going to be we're going to get him back," recalled Christine. "That was like the biggest relief because we didn't know.”
After a year of rehab and work, Zander’s story, which began on his kitchen floor, recently achieved success when he skated with Lakeville South hockey team in the state tournament in St. Paul. The team lost in the first round, but Zander takes stock of what he won—his ability to come back and skate again. And with it, a solid list of advice for any other student-athlete who faces a comeback from a brain injury.
"First off, it's not easy," said Zander. "You can't just act like you're fine, and you're going to go back because you're going to realize you're not the same player I used to be. It's okay. You're going to get through it. You're going to have to put in your work. It's not just going to come back super easily and just be patient with yourself."
High school hockey player urges concussion survivors to pay attention to mental health
Watch the video at: https://www.fox9.com/news/high-school-h ... tal-health
When the Lakeville South hockey team’s forward Zander Billins suffered a concussion more than a year ago, it ironically didn’t come from a hockey game.
"I’m lightheaded, I’m dizzy, and I’m just out of it," recalled Billins moments before he collapsed and crashed to his kitchen floor. "All I remember is my vision just slowly, slowly going away.”
His parents, standing just a few feet away, didn’t see him fall, but they sure heard it.
"The noise when a six-foot-five person hits the ground, I mean, it was just a loud scary sound," said his mother Christine Billins. His parents rushed him to the emergency room at Children’s Minnesota Hospital in Minneapolis where doctors believed Zander had passed out from a severe case of the flu. He went home and rested for a week, but the headaches never went away.
"We went back, and they put me through more tests," recalled Zander of returning to Children’s Minnesota. "And they’re like, ‘He’s got a concussion.’”
Traumatic brain injuries are more common than many would believe. According to the Minnesota Brain Injury Alliance, there are roughly 100,000 Minnesotans living with a TBI. In a review of Minnesota hospital records, the Brain Injury Alliance’s Brad Donaldson says data shows an average of 20,000 concussions a year.
Zander immediately entered the concussion program at Children’s Minnesota that takes a clinical team approach to recovery and paired him with a physical therapist, an occupational therapist, and a psychologist. Every brain injury is different, but often times the rehabilitation is incredibly difficult, even for a highly skilled athlete.
"It was not easy for me at the start because everything I couldn’t do, I used to be able to do," said Zander of the physical and occupational therapy that required him to balance on one foot. "That’s easy for me, right? But I couldn’t do it. And walking backwards with my eyes closed got me all dizzy.”
The loss of his physical coordination was especially worrisome because it was a set of skills that made him a high-performing hockey player. "That was what made me so angry, as it seemed so easy like I would be able to do that if I didn’t have the concussion," said Zander.
That anger and frustration became just as much of a hurdle to overcome as regaining his strength and coordination.
"No one thinks of the mental side of it," said Zander. "And that was the hardest thing for me to come around to, is I’m not right in my head, like I need help.”
That struggle is why his Children’s Minnesota care team included psychologist Kevin Coleman. Dr. Coleman works with patients to help them focus on the immediacy of their recovery and the daily achievements and tasks—not the long-term missed opportunities and setbacks that concussions can create.
"I don’t know that everybody sees it probably quite as clearly as Zander has been able to," said Dr. Coleman on Zander’s resolve to ask for help with his mental health. Johnson says high school survivors of a TBI, particularly student-athletes, are vulnerable to physical and emotional setbacks.
"The schooling doesn't necessarily stop when you get a concussion," said Dr. Coleman.
"Everybody else kind of proceeds with their lessons, with their social lives. Seasons carry on. And I think that presents some unique challenges for a student and especially student-athletes within the context of a recovery from a concussion.”
That’s where the clinical team approach and especially the mental health counseling can help get adolescent concussion survivors back on their feet faster.
"I think that's a huge part of somebody like me and my role in our team is to be able to kind of emphasize a sense of hope," emphasized Dr. Coleman. "We know that there's in general, a predictable course of a recovery for concussion and that if we do take our time and really focus on doing each of the steps carefully, that we see good outcomes.”
Zander’s parents shared the same concerns as their son, but say they were reassured from the moment they met Zander’s care team.
"I will not forget when we sat down that very first appointment and she told us we're going to be we're going to get him back," recalled Christine. "That was like the biggest relief because we didn't know.”
After a year of rehab and work, Zander’s story, which began on his kitchen floor, recently achieved success when he skated with Lakeville South hockey team in the state tournament in St. Paul. The team lost in the first round, but Zander takes stock of what he won—his ability to come back and skate again. And with it, a solid list of advice for any other student-athlete who faces a comeback from a brain injury.
"First off, it's not easy," said Zander. "You can't just act like you're fine, and you're going to go back because you're going to realize you're not the same player I used to be. It's okay. You're going to get through it. You're going to have to put in your work. It's not just going to come back super easily and just be patient with yourself."
High school hockey player urges concussion survivors to pay attention to mental health
Watch the video at: https://www.fox9.com/news/high-school-h ... tal-health
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Why The Female Brain Is More Susceptible To Lasting Damage From A Head Injury
Why The Female Brain Is More Susceptible To Lasting Damage From A Head Injury
It was the middle of the night when Karen Murray’s daughter called out for her. Karen jumped out of bed. The next thing she remembers is her legs giving way from under her. She fell, hitting her head on the bedside table on her way down. “I blacked out,” the 45-year-old mum of two says. “A few seconds later, I came to and got up, but I felt wobbly and nauseous.” Her husband went to check on their daughter and Karen spent the next 20 minutes feeling as if she was going to throw up. When the nausea passed, she drifted back to sleep.
But the next morning, Karen woke with a pounding headache. The rest of that day – and the next – she had bouts of nausea and dizziness. Her mother, a nurse, urged Karen to go to the hospital, worried that she had suffered a concussion. “I’d thought that only happened to [footy] players or after a serious accident such as a car crash,” she admits. And yet, when she went to the hospital, the doctor ordered a CT scan. Sure enough, Karen was diagnosed with a mild concussion.
Dr Abigail Bretzin, a post-doctoral research fellow in the Penn Injury Science Center at the University of Pennsylvania, researches sex differences in concussion outcomes. She isn’t surprised Karen didn’t realise her head injury might be serious. “It hasn’t been recognised that concussion and traumatic brain injury happen as often as they do in women,” she says. “In general, the focus has been on men. While men do have higher rates of concussion than women overall, we also know that women’s brains may be more vulnerable.”
Fiber Optics
The word ‘concussion’ comes from a Latin word that means ‘to shake violently’, says Bretzin. “When you hit your head, the impact imparts forces to the brain and those forces lead to a cascade of events that can cause a range of symptoms,” she adds. Dr Douglas H Smith, director of the Penn Center for Brain Injury and Repair, studies the mechanics of concussion. “You can think of your brain as being like an electric grid, with a network of fibers coursing through it,” he explains. “The impulse starts in the grey matter, on the outside of the brain, and moves through to the white matter on the inside, which is filled with axons – fibers so small and delicate that you’d need to put 100 of them side by side to equal the thickness of one human hair.”
The axons are like the brain’s wires in this electric grid, Smith continues, transporting information from neuron to neuron so you can do everything from breathe and talk to read and move your muscles. The axons do this using the sodium channels that run through them; a flapper valve lets just the right amount of sodium into the axon to generate a spark that creates electricity, which then gets passed down the axon. When the axon has enough sodium for that spark, the valve shuts.
But if you bang your head, the impact can stretch these axons so abruptly that parts of them break, which, in turn, disrupts the valve. The result: too much sodium rushes into the axons, prompting an electric ‘brownout’ that may cause you to feel dazed and confused, have a slower reaction time and even lose consciousness. Since it takes a while for your brain to pump out all that excess sodium, the typical symptoms of head injury – headache, confusion, dizziness – persist. And as your brain tries to regulate itself, you are even more susceptible to another injury.
While about 80 per cent of those who experience a concussion recover fully, researchers are working to understand why the other 20 per cent don’t fare as well. Still, seeking medical attention after a head injury is crucial – even if you’re starting to feel better. “The reason we take head injuries so seriously and almost always order a CT scan is so we can check for bleeding in the brain, which, if not addressed, can cause early death in rare cases,” warns Smith. Early care can also help target treatment. “Not everyone with a concussion presents with the same symptoms, which can make it tricky to diagnose and treat,” says Bretzin. “If we can monitor your symptoms, we can better direct you to treatments to help prevent a long-term effect.”
Gender Grey Gap
A CT scan of Karen’s brain showed no internal bleeding. But her symptoms persisted for about three months. She had frequent headaches and found that looking at her computer or the TV for more than an hour led to intense head pain. These symptoms may have had something to do with biological differences, which can cause women to have more severe symptoms than men and take longer to recover from concussion, says Dr Angela Colantonio, a professor at the Rehabilitation Sciences Institute at the University of Toronto, who researches traumatic brain injuries.
Women tend to have smaller and weaker necks than men, which means they are more vulnerable to the rotational forces that can injure the brain. In a study of US soccer players, published in JAMA Network Open, women were nearly twice as likely to suffer concussions as their male counterparts. Researchers also found that women had a significantly greater head and neck ‘angular acceleration’, a measure of head impact that’s thought to be a cause of brain injury. Women’s axons also tend to be finer than men’s, with narrower diameters. “When we take human neurons and micropattern them into a human ‘mini-brain’ and induce the same kind of rapid stretching of those axons that happens in concussion, we find that there’s far less swelling and sodium influx in males’ axons compared with females,” says Smith. Researchers think its larger axon size makes the male brain better able to sustain impact.
Research has also shown a clear correlation between a woman’s recovery and her menstrual cycle phase at the time of injury. One 2014 study in the Journal of Head Trauma Rehabilitation found that women who suffered a concussion during the two weeks after ovulation, when progesterone levels are highest, had worse outcomes a month later than those whose injuries happened during the two weeks following menstruation, when levels of this hormone are low. Women taking oral contraceptives also fared better. A blow to the head may suppress the pituitary gland, the control center for the brain’s hormones. If the pituitary gland slows down when progesterone is high, a rapid decline in this hormone leads to worse symptoms that linger.
How to Protect Your Brain from Concussion
Seek help, stat
Treating a head injury quickly is vital, says Bretzin. Phone 911 or go to the emergency room if you’ve had a head injury and fall unconscious, even if for a second, or have a seizure; if bleeding won’t stop; if you’ve vomited; if blood or fluid is leaking from the nose or ears; or if you have other symptoms such as confusion, blurred vision or persistent headache.
Soften the Potential Lasting Effects
If you experience long-term effects, speak up, advises Dretzin. “Talk to your doctor about your understanding that women are at greater risk of persistent symptoms after concussion. Your symptoms may require continued care and management, and there are specialists who can help.”
Minimize Your Risk of a Fall
Preventing concussions can be as simple as eliminating risky behaviors or using protective equipment, such as a properly fitting helmet when you ride a bike. Colantonio notes that older adults are more likely to suffer concussions, so it’s key to assess your risk of falls as you age. “Exercising to build balance and strength, getting enough sleep, not rushing when you stand up and wearing well-fitting shoes can go a long way,” she says.
Concussion: Why The Female Brain Is More Susceptible To Lasting Damage From A Head Injury
Read more: https://www.womenshealth.com.au/concuss ... -in-women/
It was the middle of the night when Karen Murray’s daughter called out for her. Karen jumped out of bed. The next thing she remembers is her legs giving way from under her. She fell, hitting her head on the bedside table on her way down. “I blacked out,” the 45-year-old mum of two says. “A few seconds later, I came to and got up, but I felt wobbly and nauseous.” Her husband went to check on their daughter and Karen spent the next 20 minutes feeling as if she was going to throw up. When the nausea passed, she drifted back to sleep.
But the next morning, Karen woke with a pounding headache. The rest of that day – and the next – she had bouts of nausea and dizziness. Her mother, a nurse, urged Karen to go to the hospital, worried that she had suffered a concussion. “I’d thought that only happened to [footy] players or after a serious accident such as a car crash,” she admits. And yet, when she went to the hospital, the doctor ordered a CT scan. Sure enough, Karen was diagnosed with a mild concussion.
Dr Abigail Bretzin, a post-doctoral research fellow in the Penn Injury Science Center at the University of Pennsylvania, researches sex differences in concussion outcomes. She isn’t surprised Karen didn’t realise her head injury might be serious. “It hasn’t been recognised that concussion and traumatic brain injury happen as often as they do in women,” she says. “In general, the focus has been on men. While men do have higher rates of concussion than women overall, we also know that women’s brains may be more vulnerable.”
Fiber Optics
The word ‘concussion’ comes from a Latin word that means ‘to shake violently’, says Bretzin. “When you hit your head, the impact imparts forces to the brain and those forces lead to a cascade of events that can cause a range of symptoms,” she adds. Dr Douglas H Smith, director of the Penn Center for Brain Injury and Repair, studies the mechanics of concussion. “You can think of your brain as being like an electric grid, with a network of fibers coursing through it,” he explains. “The impulse starts in the grey matter, on the outside of the brain, and moves through to the white matter on the inside, which is filled with axons – fibers so small and delicate that you’d need to put 100 of them side by side to equal the thickness of one human hair.”
The axons are like the brain’s wires in this electric grid, Smith continues, transporting information from neuron to neuron so you can do everything from breathe and talk to read and move your muscles. The axons do this using the sodium channels that run through them; a flapper valve lets just the right amount of sodium into the axon to generate a spark that creates electricity, which then gets passed down the axon. When the axon has enough sodium for that spark, the valve shuts.
But if you bang your head, the impact can stretch these axons so abruptly that parts of them break, which, in turn, disrupts the valve. The result: too much sodium rushes into the axons, prompting an electric ‘brownout’ that may cause you to feel dazed and confused, have a slower reaction time and even lose consciousness. Since it takes a while for your brain to pump out all that excess sodium, the typical symptoms of head injury – headache, confusion, dizziness – persist. And as your brain tries to regulate itself, you are even more susceptible to another injury.
While about 80 per cent of those who experience a concussion recover fully, researchers are working to understand why the other 20 per cent don’t fare as well. Still, seeking medical attention after a head injury is crucial – even if you’re starting to feel better. “The reason we take head injuries so seriously and almost always order a CT scan is so we can check for bleeding in the brain, which, if not addressed, can cause early death in rare cases,” warns Smith. Early care can also help target treatment. “Not everyone with a concussion presents with the same symptoms, which can make it tricky to diagnose and treat,” says Bretzin. “If we can monitor your symptoms, we can better direct you to treatments to help prevent a long-term effect.”
Gender Grey Gap
A CT scan of Karen’s brain showed no internal bleeding. But her symptoms persisted for about three months. She had frequent headaches and found that looking at her computer or the TV for more than an hour led to intense head pain. These symptoms may have had something to do with biological differences, which can cause women to have more severe symptoms than men and take longer to recover from concussion, says Dr Angela Colantonio, a professor at the Rehabilitation Sciences Institute at the University of Toronto, who researches traumatic brain injuries.
Women tend to have smaller and weaker necks than men, which means they are more vulnerable to the rotational forces that can injure the brain. In a study of US soccer players, published in JAMA Network Open, women were nearly twice as likely to suffer concussions as their male counterparts. Researchers also found that women had a significantly greater head and neck ‘angular acceleration’, a measure of head impact that’s thought to be a cause of brain injury. Women’s axons also tend to be finer than men’s, with narrower diameters. “When we take human neurons and micropattern them into a human ‘mini-brain’ and induce the same kind of rapid stretching of those axons that happens in concussion, we find that there’s far less swelling and sodium influx in males’ axons compared with females,” says Smith. Researchers think its larger axon size makes the male brain better able to sustain impact.
Research has also shown a clear correlation between a woman’s recovery and her menstrual cycle phase at the time of injury. One 2014 study in the Journal of Head Trauma Rehabilitation found that women who suffered a concussion during the two weeks after ovulation, when progesterone levels are highest, had worse outcomes a month later than those whose injuries happened during the two weeks following menstruation, when levels of this hormone are low. Women taking oral contraceptives also fared better. A blow to the head may suppress the pituitary gland, the control center for the brain’s hormones. If the pituitary gland slows down when progesterone is high, a rapid decline in this hormone leads to worse symptoms that linger.
How to Protect Your Brain from Concussion
Seek help, stat
Treating a head injury quickly is vital, says Bretzin. Phone 911 or go to the emergency room if you’ve had a head injury and fall unconscious, even if for a second, or have a seizure; if bleeding won’t stop; if you’ve vomited; if blood or fluid is leaking from the nose or ears; or if you have other symptoms such as confusion, blurred vision or persistent headache.
Soften the Potential Lasting Effects
If you experience long-term effects, speak up, advises Dretzin. “Talk to your doctor about your understanding that women are at greater risk of persistent symptoms after concussion. Your symptoms may require continued care and management, and there are specialists who can help.”
Minimize Your Risk of a Fall
Preventing concussions can be as simple as eliminating risky behaviors or using protective equipment, such as a properly fitting helmet when you ride a bike. Colantonio notes that older adults are more likely to suffer concussions, so it’s key to assess your risk of falls as you age. “Exercising to build balance and strength, getting enough sleep, not rushing when you stand up and wearing well-fitting shoes can go a long way,” she says.
Concussion: Why The Female Brain Is More Susceptible To Lasting Damage From A Head Injury
Read more: https://www.womenshealth.com.au/concuss ... -in-women/
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Not Just for Men: Meeting the Needs of Women With Concussion
Not Just for Men: Meeting the Needs of Women With Concussion
Jacqueline Theis, a Virginia-based optometrist, was an avid soccer player during her teens. In the course of her athletic career, she had several concussions that triggered severe headaches when she tried to read.
“I was told that I had migraines and I’d ‘get over them’ and that I was ‘complaining too much’ – comments that are unfortunately all too common for women to hear,” she says.
“After 6 years, I saw an optometrist who noticed that my eyes weren’t coordinating and thought this was due to the concussions,” she recounts. “She prescribed glasses and vision therapy, and my headaches went away.”
Theis was angry that her headaches had been minimized and her visual issues overlooked. “I had 20/20 vision, so it didn’t occur to anyone that I could be having eye problems,” she says.
‘Invisible’ and Neglected
Katherine Snedaker, a licensed clinical social worker, agrees that women’s concussions are often minimized or overlooked. She created and leads PINK Concussions, a nonprofit group focused on concussions in women.
She says almost all of the previous concussion research has used male lab animals and men as subjects, although concussions are common in women too. And while people think of concussions in women as being sports-related injuries, PINK Concussions’ mission includes shining a spotlight on accidents, military service injuries, and domestic violence.
Over the past 5 years, “we’ve been able to raise awareness of brain injuries in female athletes and women veterans, but the far greater number of repetitive brain injuries are still hidden and endured by the invisible women who suffer intimate partner violence in every social and economic group of society,” she says.
“Concussions affect women and men differently, so it’s important for clinicians, parents, and others to be aware of how concussions might present in females as well as males,” says Snedaker, who has had multiple concussions, two of which came from car accidents.
Hormonal Connection?
David Wang, MD, head team doctor at Quinnipiac University in Hamden, CT, says that when women and men compete in the same sports, women get concussions at higher rates than men. Their symptoms also tend to be more severe, and they often have more prolonged symptoms.
There are several theories as to why women are more vulnerable to concussions and often have more severe symptoms or poorer outcomes, says Wang, who is the director of Comprehensive Sports Medicine in Connecticut.
Some studies suggest that female hormones may play a role. For example, one study found that women at certain phases of their menstrual cycle had worse symptoms after their concussion. And women often notice changes in their menstrual patterns after a concussion.
But Wang believes the story is more complex. “Concussions shake the pituitary gland, which is located in the head,” he says. “The pituitary is responsible for regulating aspects of women’s hormones.
Stress to the pituitary – whether due to the mechanical injury of the concussion or to emotional stress that can follow a concussion – may affect the menstrual cycle.”
This is supported by a new study. The researchers screened for hypopituitarism (low hormonal production by the pituitary) in 133 female athletes with a history of traumatic brain injury. The researchers found that the majority of women (66.2%) had abnormal pituitary screening blood test results. Certain hormones were too high, while others that were too low. Younger athletes and those with more symptoms had more pituitary hormone abnormalities.
Neck, Eyes, and Brain
Wang shared several other theories regarding women’s vulnerability to concussions.
“Women in general have weaker necks; and since the neck is weaker, the head accelerates more when it’s hit because the impact is more severe and violent,” he explains. Although this “isn’t the whole story, it is a contributing factor.”
Theis, who is affiliated with the Concussion Care Centre of Virginia, says there’s an “intimate relationship between eye movements, the brainstem, and the neck; and since women have weaker necks, compared to men, their eye movements are going to be more vulnerable to neck-related injuries.”
She says eye problems are also a little-known complication of whiplash as well. “The connection is in the brainstem and the neck.”
She says that the neck may not necessarily be painful, but eye pain or headaches can be “referred” pain from the neck.
Other theories include that women also may have different levels of inflammation, compared to men, Wang says. And concussions often target an area of the brain called the corpus callosum, which connects the right and left hemispheres. “This area receives the majority of the strain from a concussive blow, and that area is more robustly used by women than by men because females tend to use both hemispheres in process more than males do.”
Myths About Women
All the experts agree that there are common myths about the greater frequency of concussions in women and their more severe symptoms.
“Some people think women have more concussions because they complain more about symptoms, so they’re more likely to be diagnosed,” Wang says. “I don’t like to hear that, because it suggests that women are ‘complainers’ and also that female athletes are less competitive than male athletes, which simply isn’t true.”
Wang and his colleagues studied athletes and found that females were at least as likely as males to hide symptoms so as not to be taken out of the game. “In fact, some of the most driven people I’ve ever met are female athletes,” he says.
Snedaker recommends that women take their symptoms seriously. “I’ve spoken to countless women who said their concussion symptoms were dismissed by doctors or were told that they’re simply anxious.” she says.
So if you’ve had a blow to the head and your health care provider doesn’t do a thorough concussion workup, “it’s time to look for a different provider,” Snedaker advises.
Different Symptoms, Different Treatments?
Most of the symptoms of concussion – other than menstrual dysfunction – don’t differ between the sexes, according to Wang. “It’s not like a heart attack, where often, women actually have different symptoms than men – like nausea rather than chest or jaw pain,” he says.
Typical symptoms of concussion in both men and women include headaches, dizziness, blurry vision or other visual disturbances, agitation or cognitive changes, light and sound sensitivity, disorientation, nausea or vomiting, or feeling dazed.
Because concussions can affect the menstrual cycle, Snedaker encourages health care professionals to ask women who have had a concussion about their periods. “If there’s an issue, follow up with endocrine testing,” she recommends. And if you’ve had a concussion and notice changes in your periods, be sure to bring this up to your provider.
Men and women have similar “landmarks” and “rules” for returning to play or to any other activity, such as employment or academics. “We expect them to be without symptoms, and we put them through a graded return to activity,” Wang states.
But since women’s symptoms tend to last longer than those of men, “women need to be supported throughout that time,” Snedaker emphasizes. All too often “women are called ‘malingering’ or ‘mentally ill’ when they don’t recover as fast as men.”
Not Just for Men: Meeting the Needs of Women With Concussion
Read more: https://www.webmd.com/brain/news/202303 ... concussion
Jacqueline Theis, a Virginia-based optometrist, was an avid soccer player during her teens. In the course of her athletic career, she had several concussions that triggered severe headaches when she tried to read.
“I was told that I had migraines and I’d ‘get over them’ and that I was ‘complaining too much’ – comments that are unfortunately all too common for women to hear,” she says.
“After 6 years, I saw an optometrist who noticed that my eyes weren’t coordinating and thought this was due to the concussions,” she recounts. “She prescribed glasses and vision therapy, and my headaches went away.”
Theis was angry that her headaches had been minimized and her visual issues overlooked. “I had 20/20 vision, so it didn’t occur to anyone that I could be having eye problems,” she says.
‘Invisible’ and Neglected
Katherine Snedaker, a licensed clinical social worker, agrees that women’s concussions are often minimized or overlooked. She created and leads PINK Concussions, a nonprofit group focused on concussions in women.
She says almost all of the previous concussion research has used male lab animals and men as subjects, although concussions are common in women too. And while people think of concussions in women as being sports-related injuries, PINK Concussions’ mission includes shining a spotlight on accidents, military service injuries, and domestic violence.
Over the past 5 years, “we’ve been able to raise awareness of brain injuries in female athletes and women veterans, but the far greater number of repetitive brain injuries are still hidden and endured by the invisible women who suffer intimate partner violence in every social and economic group of society,” she says.
“Concussions affect women and men differently, so it’s important for clinicians, parents, and others to be aware of how concussions might present in females as well as males,” says Snedaker, who has had multiple concussions, two of which came from car accidents.
Hormonal Connection?
David Wang, MD, head team doctor at Quinnipiac University in Hamden, CT, says that when women and men compete in the same sports, women get concussions at higher rates than men. Their symptoms also tend to be more severe, and they often have more prolonged symptoms.
There are several theories as to why women are more vulnerable to concussions and often have more severe symptoms or poorer outcomes, says Wang, who is the director of Comprehensive Sports Medicine in Connecticut.
Some studies suggest that female hormones may play a role. For example, one study found that women at certain phases of their menstrual cycle had worse symptoms after their concussion. And women often notice changes in their menstrual patterns after a concussion.
But Wang believes the story is more complex. “Concussions shake the pituitary gland, which is located in the head,” he says. “The pituitary is responsible for regulating aspects of women’s hormones.
Stress to the pituitary – whether due to the mechanical injury of the concussion or to emotional stress that can follow a concussion – may affect the menstrual cycle.”
This is supported by a new study. The researchers screened for hypopituitarism (low hormonal production by the pituitary) in 133 female athletes with a history of traumatic brain injury. The researchers found that the majority of women (66.2%) had abnormal pituitary screening blood test results. Certain hormones were too high, while others that were too low. Younger athletes and those with more symptoms had more pituitary hormone abnormalities.
Neck, Eyes, and Brain
Wang shared several other theories regarding women’s vulnerability to concussions.
“Women in general have weaker necks; and since the neck is weaker, the head accelerates more when it’s hit because the impact is more severe and violent,” he explains. Although this “isn’t the whole story, it is a contributing factor.”
Theis, who is affiliated with the Concussion Care Centre of Virginia, says there’s an “intimate relationship between eye movements, the brainstem, and the neck; and since women have weaker necks, compared to men, their eye movements are going to be more vulnerable to neck-related injuries.”
She says eye problems are also a little-known complication of whiplash as well. “The connection is in the brainstem and the neck.”
She says that the neck may not necessarily be painful, but eye pain or headaches can be “referred” pain from the neck.
Other theories include that women also may have different levels of inflammation, compared to men, Wang says. And concussions often target an area of the brain called the corpus callosum, which connects the right and left hemispheres. “This area receives the majority of the strain from a concussive blow, and that area is more robustly used by women than by men because females tend to use both hemispheres in process more than males do.”
Myths About Women
All the experts agree that there are common myths about the greater frequency of concussions in women and their more severe symptoms.
“Some people think women have more concussions because they complain more about symptoms, so they’re more likely to be diagnosed,” Wang says. “I don’t like to hear that, because it suggests that women are ‘complainers’ and also that female athletes are less competitive than male athletes, which simply isn’t true.”
Wang and his colleagues studied athletes and found that females were at least as likely as males to hide symptoms so as not to be taken out of the game. “In fact, some of the most driven people I’ve ever met are female athletes,” he says.
Snedaker recommends that women take their symptoms seriously. “I’ve spoken to countless women who said their concussion symptoms were dismissed by doctors or were told that they’re simply anxious.” she says.
So if you’ve had a blow to the head and your health care provider doesn’t do a thorough concussion workup, “it’s time to look for a different provider,” Snedaker advises.
Different Symptoms, Different Treatments?
Most of the symptoms of concussion – other than menstrual dysfunction – don’t differ between the sexes, according to Wang. “It’s not like a heart attack, where often, women actually have different symptoms than men – like nausea rather than chest or jaw pain,” he says.
Typical symptoms of concussion in both men and women include headaches, dizziness, blurry vision or other visual disturbances, agitation or cognitive changes, light and sound sensitivity, disorientation, nausea or vomiting, or feeling dazed.
Because concussions can affect the menstrual cycle, Snedaker encourages health care professionals to ask women who have had a concussion about their periods. “If there’s an issue, follow up with endocrine testing,” she recommends. And if you’ve had a concussion and notice changes in your periods, be sure to bring this up to your provider.
Men and women have similar “landmarks” and “rules” for returning to play or to any other activity, such as employment or academics. “We expect them to be without symptoms, and we put them through a graded return to activity,” Wang states.
But since women’s symptoms tend to last longer than those of men, “women need to be supported throughout that time,” Snedaker emphasizes. All too often “women are called ‘malingering’ or ‘mentally ill’ when they don’t recover as fast as men.”
Not Just for Men: Meeting the Needs of Women With Concussion
Read more: https://www.webmd.com/brain/news/202303 ... concussion
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Emma Wells sustained "a major concussion" in her second year
Emma Wells sustained "a major concussion" in her second year
For the past 16 years of my life, I have been privileged enough to be immersed in the world of hockey without facing discrimination or injustices.
Sadly, many children do not have that same opportunity.
Throughout my life, on and off the ice, I have been an advocate for equity and inclusion in sports and believe that no matter one's gender, race, religion, or sexuality, they deserve equal opportunity to play the game. In that spirit, I’m honored and proud to be the coach of the African Hockey Association Program.
The goal of the African Canadian Association of Ottawa’s new program is to help break down barriers faced by many children and families in sports, such as racial discrimination and socio-economic challenges. We want to make the world of hockey more diverse and show that anyone can play.
In my final years in the sport, I played on the Carleton Ravens’ women’s varsity hockey team before sustaining a major concussion in my second year. I’m now a third-year student pursuing journalism with a minor in community engagement.
Back in October 2021, I was assigned a news story from my professor, and I reached out to the African Canadian Association of Ottawa in hopes of an interview to support the story. From there, I was put into contact with Godlove Ngwafusi, the co-founder of the African Hockey Association, along with Steve Leon.
One day after a team practice, I was sitting in the dressing room at the Carleton Ice House awaiting Ngwafusi on a Zoom call. While interviewing Ngwafusi, he asked where I was located during the interview, and we then started to talk hockey. The next day, I got a call from Leon asking me to volunteer with the new program. I was beyond excited to get involved in such an amazing initiative.
It goes without saying that hockey is one of the most expensive sports to participate in, and most children that play are predominantly white. In August 2019, Scotiabank and FlipGive surveyed more than 1,000 Canadian and American hockey parents. Nearly 60 percent of respondents stated they spend over $5,000 a year on hockey fees for one child to play, with only three percent of respondents claiming they spend less than $1,200. How is that cost feasible for middle- and lower-income families?
That said, to eliminate the fees, the weekly ice slots for the African Hockey Association are donated by Hockey Eastern Ontario and David Loehr, president of the Ottawa Centre Minor Hockey Association. In addition, all of the players' equipment is donated by Next Shift Canada – a Canadian non-profit aiming to “make hockey accessible to every child possible.”
After the call from Leon, I began to attend practice sessions at the Jim Durrell Arena in the Herongate community every Sunday morning. As members of the coaching staff, we taught the players the fundamentals of the sport while engaging in games throughout the session.
Amarkai Laryea, Ngwafusi and I ignited the program for the second season in a row in November 2022 after a fantastic season of smiles and development from over 30 kids.
As many coaches were unable to return this season, I decided to take on a larger role within the group as the head coach. That said, I am very lucky to coach alongside coach Laryea and coach Abbas Kwofie this year. We have 37 kids signed up, both girls and boys, between the ages of four to 15 with a range of skill levels. Due to the various levels, the coaches and parent volunteers divide the ice into sections and teach kids appropriately based on their experience and level of skill/understanding.
The kids itch to get on that ice every Sunday at noon. We structure practices as so: foundational skills for 25 minutes, following a game of the kids' choice, and ending with a scrimmage to introduce positions and rules and to simply let them play “Timbits hockey.” Conversations on the ice before we start drills normally become comical debates about which variation of tag we’ll play on that day at the end of the practice – it's the highlight for many of the kids.
Most recently, our team has collaborated with Black History Ottawa and the Ottawa Senators for a development session, commemorative game and the Senators Black History Month Awareness Game.
Jean-Marie Guerrier, vice-president of BHO, arranged for our group to practice with several Ottawa Senators alumni on Feb. 7, followed by the opportunity to watch a commemorative game in honor of Black History Month and the Coloured Hockey League of the Maritimes established in 1895.
The kids were ecstatic to be on the ice with the alumni players – they loved it! It was an opportunity for them to be on the “big stage” at the Canadian Tire Centre and visually see what they can do in their futures after being coached by Ottawa Senators alumni Llew Ncwana. Ncwana, who’s from Ottawa, played NCAA hockey at Bowling Green University in the early 1990s and attended the Sens’ training camp in 1992 before going on to play in the ECHL and low minors.
“Representation matters,” said parent Melissa Pierre-Sossoyan. “The fact that the kids see other kids that look like them makes them understand that they are capable and they have their place as much as anyone.”
On Feb. 13, the team was also invited to watch an Ottawa Senators contest against the Calgary Flames in the Black History Month Awareness Game. Two of our players, Christabel Bih and Jayden Mforteh, took part in the ceremonial puck drop prior to the game.
Being a part of this program has opened my eyes to the true meaning of sport. To come to the rink on Sundays and watch these kids skate, fall, and get back up 10 times over and still see their faces beaming with joy is the highlight of my week. Their faces light up as soon as they hit that ice – and that is what this sport is truly all about.
Everyone deserves the opportunity to have fun and learn in a safe atmosphere, and that is exactly why the African Hockey Association program exists.
My name is Emma Weller, and I’m a third-year journalism student at Carleton University in Ottawa and a former player on their women’s varsity hockey team. After “retiring” from U Sports, I’m now the coach of the African Hockey Association program – a program which strives to break down racial and socio-economic barriers in hockey for youth in the Ottawa area. I coach alongside Amarkai Laryea, Abbas Kwofie and GM Godlove Ngwafusi.
BREAKING DOWN BARRIERS ONE PRACTICE AT A TIME
First-person perspective: It’s been an eye-opening experience serving as a coach for the African Hockey Association in Ottawa.
Read more: https://thehockeynews.com/news/breaking ... -at-a-time
For the past 16 years of my life, I have been privileged enough to be immersed in the world of hockey without facing discrimination or injustices.
Sadly, many children do not have that same opportunity.
Throughout my life, on and off the ice, I have been an advocate for equity and inclusion in sports and believe that no matter one's gender, race, religion, or sexuality, they deserve equal opportunity to play the game. In that spirit, I’m honored and proud to be the coach of the African Hockey Association Program.
The goal of the African Canadian Association of Ottawa’s new program is to help break down barriers faced by many children and families in sports, such as racial discrimination and socio-economic challenges. We want to make the world of hockey more diverse and show that anyone can play.
In my final years in the sport, I played on the Carleton Ravens’ women’s varsity hockey team before sustaining a major concussion in my second year. I’m now a third-year student pursuing journalism with a minor in community engagement.
Back in October 2021, I was assigned a news story from my professor, and I reached out to the African Canadian Association of Ottawa in hopes of an interview to support the story. From there, I was put into contact with Godlove Ngwafusi, the co-founder of the African Hockey Association, along with Steve Leon.
One day after a team practice, I was sitting in the dressing room at the Carleton Ice House awaiting Ngwafusi on a Zoom call. While interviewing Ngwafusi, he asked where I was located during the interview, and we then started to talk hockey. The next day, I got a call from Leon asking me to volunteer with the new program. I was beyond excited to get involved in such an amazing initiative.
It goes without saying that hockey is one of the most expensive sports to participate in, and most children that play are predominantly white. In August 2019, Scotiabank and FlipGive surveyed more than 1,000 Canadian and American hockey parents. Nearly 60 percent of respondents stated they spend over $5,000 a year on hockey fees for one child to play, with only three percent of respondents claiming they spend less than $1,200. How is that cost feasible for middle- and lower-income families?
That said, to eliminate the fees, the weekly ice slots for the African Hockey Association are donated by Hockey Eastern Ontario and David Loehr, president of the Ottawa Centre Minor Hockey Association. In addition, all of the players' equipment is donated by Next Shift Canada – a Canadian non-profit aiming to “make hockey accessible to every child possible.”
After the call from Leon, I began to attend practice sessions at the Jim Durrell Arena in the Herongate community every Sunday morning. As members of the coaching staff, we taught the players the fundamentals of the sport while engaging in games throughout the session.
Amarkai Laryea, Ngwafusi and I ignited the program for the second season in a row in November 2022 after a fantastic season of smiles and development from over 30 kids.
As many coaches were unable to return this season, I decided to take on a larger role within the group as the head coach. That said, I am very lucky to coach alongside coach Laryea and coach Abbas Kwofie this year. We have 37 kids signed up, both girls and boys, between the ages of four to 15 with a range of skill levels. Due to the various levels, the coaches and parent volunteers divide the ice into sections and teach kids appropriately based on their experience and level of skill/understanding.
The kids itch to get on that ice every Sunday at noon. We structure practices as so: foundational skills for 25 minutes, following a game of the kids' choice, and ending with a scrimmage to introduce positions and rules and to simply let them play “Timbits hockey.” Conversations on the ice before we start drills normally become comical debates about which variation of tag we’ll play on that day at the end of the practice – it's the highlight for many of the kids.
Most recently, our team has collaborated with Black History Ottawa and the Ottawa Senators for a development session, commemorative game and the Senators Black History Month Awareness Game.
Jean-Marie Guerrier, vice-president of BHO, arranged for our group to practice with several Ottawa Senators alumni on Feb. 7, followed by the opportunity to watch a commemorative game in honor of Black History Month and the Coloured Hockey League of the Maritimes established in 1895.
The kids were ecstatic to be on the ice with the alumni players – they loved it! It was an opportunity for them to be on the “big stage” at the Canadian Tire Centre and visually see what they can do in their futures after being coached by Ottawa Senators alumni Llew Ncwana. Ncwana, who’s from Ottawa, played NCAA hockey at Bowling Green University in the early 1990s and attended the Sens’ training camp in 1992 before going on to play in the ECHL and low minors.
“Representation matters,” said parent Melissa Pierre-Sossoyan. “The fact that the kids see other kids that look like them makes them understand that they are capable and they have their place as much as anyone.”
On Feb. 13, the team was also invited to watch an Ottawa Senators contest against the Calgary Flames in the Black History Month Awareness Game. Two of our players, Christabel Bih and Jayden Mforteh, took part in the ceremonial puck drop prior to the game.
Being a part of this program has opened my eyes to the true meaning of sport. To come to the rink on Sundays and watch these kids skate, fall, and get back up 10 times over and still see their faces beaming with joy is the highlight of my week. Their faces light up as soon as they hit that ice – and that is what this sport is truly all about.
Everyone deserves the opportunity to have fun and learn in a safe atmosphere, and that is exactly why the African Hockey Association program exists.
My name is Emma Weller, and I’m a third-year journalism student at Carleton University in Ottawa and a former player on their women’s varsity hockey team. After “retiring” from U Sports, I’m now the coach of the African Hockey Association program – a program which strives to break down racial and socio-economic barriers in hockey for youth in the Ottawa area. I coach alongside Amarkai Laryea, Abbas Kwofie and GM Godlove Ngwafusi.
BREAKING DOWN BARRIERS ONE PRACTICE AT A TIME
First-person perspective: It’s been an eye-opening experience serving as a coach for the African Hockey Association in Ottawa.
Read more: https://thehockeynews.com/news/breaking ... -at-a-time
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Higher rates of concussion following COVID-19 infection in high school athletes
Higher rates of concussion following COVID-19 infection in high school athletes
Abstract
Objective To compare concussion rates (CRs) over one academic year in high school athletes with and without a COVID-19 infection prior to concussion.
Methods
Illness and concussion were prospectively reported for male and female high school athletes across six states over one academic year in the Players Health Rehab surveillance system. Concussion was truncated to 60 days following recovery and return to sport from COVID-19. CRs were estimated per 1000 athletes per academic year and stratified by those who tested positive for COVID-19 infection (with COVID-19) and those who did not (no COVID-19). Poisson regression analyses estimated rate ratio (RR) of concussion controlling for state, gender and an offset of the log athlete participation (with COVID-19 and no COVID-19).
Results
Of 72 522 athletes, 430 COVID-19 infections and 1273 concussions were reported. The CR was greater in athletes who reported COVID-19 (CR=74.4/1000 athletes/year, 95% CI 49.6 to 99.3) compared with those who did not (CR=17.2, 95% CI 16.3 to 18.2). Athletes with recent COVID-19 had a threefold higher rate of concussion (RR=3.1, 95% CI 2.0 to 4.7).
Conclusion
Athletes returning from COVID-19 had higher CRs than those who did not experience COVID-19. This may be related to ongoing COVID-19 sequelae or deconditioning related to reduced training and competition load during the illness and when returning to sport. Further research is needed to understand the association of recent COVID-19 infection and concussion in order to inform preventive strategies.
Higher rates of concussion following COVID-19 infection in high school athletes
Read more: https://bjsm.bmj.com/content/early/2023 ... 022-106436
Abstract
Objective To compare concussion rates (CRs) over one academic year in high school athletes with and without a COVID-19 infection prior to concussion.
Methods
Illness and concussion were prospectively reported for male and female high school athletes across six states over one academic year in the Players Health Rehab surveillance system. Concussion was truncated to 60 days following recovery and return to sport from COVID-19. CRs were estimated per 1000 athletes per academic year and stratified by those who tested positive for COVID-19 infection (with COVID-19) and those who did not (no COVID-19). Poisson regression analyses estimated rate ratio (RR) of concussion controlling for state, gender and an offset of the log athlete participation (with COVID-19 and no COVID-19).
Results
Of 72 522 athletes, 430 COVID-19 infections and 1273 concussions were reported. The CR was greater in athletes who reported COVID-19 (CR=74.4/1000 athletes/year, 95% CI 49.6 to 99.3) compared with those who did not (CR=17.2, 95% CI 16.3 to 18.2). Athletes with recent COVID-19 had a threefold higher rate of concussion (RR=3.1, 95% CI 2.0 to 4.7).
Conclusion
Athletes returning from COVID-19 had higher CRs than those who did not experience COVID-19. This may be related to ongoing COVID-19 sequelae or deconditioning related to reduced training and competition load during the illness and when returning to sport. Further research is needed to understand the association of recent COVID-19 infection and concussion in order to inform preventive strategies.
Higher rates of concussion following COVID-19 infection in high school athletes
Read more: https://bjsm.bmj.com/content/early/2023 ... 022-106436
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Coping with concussions: long road to recovery for some
Coping with concussions: long road to recovery for some
Vivienne Gray doesn’t fit the same profile as former or current professional athletes forced to live with the ongoing effects of concussions.
The 33-year-old cardiac care nurse has been attempting to cope with the side effects of a concussion sustained during a collision with an opposing player in an inline hockey game nearly two years ago.
She fell and hit her head on concrete and doesn’t remember being knocked out from the collision -- although a video showed she was unconscious. A day later she started feeling nauseous and had “weird” and incapacitating headaches that wouldn’t go away.
Five days later she saw her doctor, and that’s when potential brain damage from the hockey collision became apparent.
As a nurse, she often witnessed patients doing so-called higher cognitive tests, like counting backwards from 100 in multiples of seven or reciting the months of the year backwards.
As a healthy nurse, she had always done the tests along with the patients, and passed with flying colors.“But I knew something was amiss when my doctor asked me to do the same,” Gray said in an interview with The Associated Press. “I didn’t fare well at all. I didn’t even make it back to October.”
Gray’s doctor is Nicole Higgins, who is also president of the Royal Australian College of General Practitioners. This week her group warned government and sporting bodies in Australia that they must do more to limit the long-term impacts of concussions and repeated head trauma.
The group has submitted a report to an Australian Senate inquiry into concussions and head trauma in contact sports. It’s more aimed at the grass-roots level that GPs often have to deal with, like Gray’s case.
Funding for more research is a key part of the report.
“We are learning more and more about the management of prolonged concussion symptoms, such as post-concussion syndrome and suspected chronic traumatic encephalopathy which many people may recognize from an increasing number of concerning media reports,” Higgins said.
In Australia, those reports included the death of star Australian rules football player and coach Danny Frawley. Last year, a Victoria state coroner recommended that Australian Football League players be encouraged to donate their brains post-mortem to science to help further the understanding of CTE, a degenerative brain disease found in people with a history of repetitive brain trauma.
Frawley, who’d been suffering from anxiety and depression, died at the age of 56 in a car crash in 2019 and a post-mortem examination revealed he had CTE, which can only be diagnosed by autopsy.
“CTE must be taken extremely seriously, and it isn’t just something that we need to worry about in adult sport, damage to the brain can happen at an early age whenever there are repeated knocks to the head,” Higgins says.
The effects of concussions on athletes in professional contact sports is well-documented. Boston University CTE Center has done studies which show that more than 300 National Football League players have developed chronic traumatic encephalopathy.
“My job as a GP is to prevent and pick up any more complicated issues down the track,” Higgins says in an interview with the AP. “There is no such thing as ‘it’s just a little knock.’” She said someone with even an apparent minor injury can have more complex reactions in the future.
Many professional sporting codes have allocated resources to illustrate the dangers of concussions and their long-term effects, including the NFL, World Rugby and England Rugby.
Higgins has a son and two daughters who play Australian rules football and netball and a husband who coaches and has played Aussie rules. So she’s spent many afternoons and evenings on the sidelines watching young athletes in action.
“As a GP and a parent of children who loves contact sport, I can tell you that we certainly don’t want kids and adults walking away from contact sport and sitting on the couch,” Higgins says. “This must be taken seriously.”
Gray, who lives in the Queensland state regional city of Mackay, where Higgins is also based, is still struggling with her illness.
She still has difficulty multitasking — walking and talking, eating and conversing, singing and reading music. She has what she calls “fatigue and malaise” and “decreased lack of executive functions — self control, emotional control, task initiation, working memory . . . planning and time management.”
“It’s affected my ability to work, run errands, participate in hobbies, socialize and my relationships with friends and family — who are very supportive and caring,” Gray adds.
She began a graduated return to work in January 2022 but the six hours she had planned to work every day “broke my brain” and she realized she had pushed too hard to return to work.
“I got to the stage where I realized I was burning out, and I had overdone it,” she said.
Now she works three days a week for four hours a day and has what she calls a “multi-disciplinary approach” with her treatment.
“GP-directed care, psychiatrist, physiotherapy, massage, chiropractor, behavioral optometrist . . . and regular psychology reviews,” she says. She formerly saw a neurologist and occupational therapist.
More research, like the GP group is recommending, will help determine what works and what doesn’t.
“More light is being shed on it because with everyone being so different, there is no gold standard for treatment,” Gray says. “My doctors have said I’m doing all the right things to aid my recovery. The length of recovery time is uncertain . . . it will be slow and will be seen with time.”
Coping with concussions: long road to recovery for some
Read more: https://apnews.com/article/sports-head- ... 97b0aaea58
Vivienne Gray doesn’t fit the same profile as former or current professional athletes forced to live with the ongoing effects of concussions.
The 33-year-old cardiac care nurse has been attempting to cope with the side effects of a concussion sustained during a collision with an opposing player in an inline hockey game nearly two years ago.
She fell and hit her head on concrete and doesn’t remember being knocked out from the collision -- although a video showed she was unconscious. A day later she started feeling nauseous and had “weird” and incapacitating headaches that wouldn’t go away.
Five days later she saw her doctor, and that’s when potential brain damage from the hockey collision became apparent.
As a nurse, she often witnessed patients doing so-called higher cognitive tests, like counting backwards from 100 in multiples of seven or reciting the months of the year backwards.
As a healthy nurse, she had always done the tests along with the patients, and passed with flying colors.“But I knew something was amiss when my doctor asked me to do the same,” Gray said in an interview with The Associated Press. “I didn’t fare well at all. I didn’t even make it back to October.”
Gray’s doctor is Nicole Higgins, who is also president of the Royal Australian College of General Practitioners. This week her group warned government and sporting bodies in Australia that they must do more to limit the long-term impacts of concussions and repeated head trauma.
The group has submitted a report to an Australian Senate inquiry into concussions and head trauma in contact sports. It’s more aimed at the grass-roots level that GPs often have to deal with, like Gray’s case.
Funding for more research is a key part of the report.
“We are learning more and more about the management of prolonged concussion symptoms, such as post-concussion syndrome and suspected chronic traumatic encephalopathy which many people may recognize from an increasing number of concerning media reports,” Higgins said.
In Australia, those reports included the death of star Australian rules football player and coach Danny Frawley. Last year, a Victoria state coroner recommended that Australian Football League players be encouraged to donate their brains post-mortem to science to help further the understanding of CTE, a degenerative brain disease found in people with a history of repetitive brain trauma.
Frawley, who’d been suffering from anxiety and depression, died at the age of 56 in a car crash in 2019 and a post-mortem examination revealed he had CTE, which can only be diagnosed by autopsy.
“CTE must be taken extremely seriously, and it isn’t just something that we need to worry about in adult sport, damage to the brain can happen at an early age whenever there are repeated knocks to the head,” Higgins says.
The effects of concussions on athletes in professional contact sports is well-documented. Boston University CTE Center has done studies which show that more than 300 National Football League players have developed chronic traumatic encephalopathy.
“My job as a GP is to prevent and pick up any more complicated issues down the track,” Higgins says in an interview with the AP. “There is no such thing as ‘it’s just a little knock.’” She said someone with even an apparent minor injury can have more complex reactions in the future.
Many professional sporting codes have allocated resources to illustrate the dangers of concussions and their long-term effects, including the NFL, World Rugby and England Rugby.
Higgins has a son and two daughters who play Australian rules football and netball and a husband who coaches and has played Aussie rules. So she’s spent many afternoons and evenings on the sidelines watching young athletes in action.
“As a GP and a parent of children who loves contact sport, I can tell you that we certainly don’t want kids and adults walking away from contact sport and sitting on the couch,” Higgins says. “This must be taken seriously.”
Gray, who lives in the Queensland state regional city of Mackay, where Higgins is also based, is still struggling with her illness.
She still has difficulty multitasking — walking and talking, eating and conversing, singing and reading music. She has what she calls “fatigue and malaise” and “decreased lack of executive functions — self control, emotional control, task initiation, working memory . . . planning and time management.”
“It’s affected my ability to work, run errands, participate in hobbies, socialize and my relationships with friends and family — who are very supportive and caring,” Gray adds.
She began a graduated return to work in January 2022 but the six hours she had planned to work every day “broke my brain” and she realized she had pushed too hard to return to work.
“I got to the stage where I realized I was burning out, and I had overdone it,” she said.
Now she works three days a week for four hours a day and has what she calls a “multi-disciplinary approach” with her treatment.
“GP-directed care, psychiatrist, physiotherapy, massage, chiropractor, behavioral optometrist . . . and regular psychology reviews,” she says. She formerly saw a neurologist and occupational therapist.
More research, like the GP group is recommending, will help determine what works and what doesn’t.
“More light is being shed on it because with everyone being so different, there is no gold standard for treatment,” Gray says. “My doctors have said I’m doing all the right things to aid my recovery. The length of recovery time is uncertain . . . it will be slow and will be seen with time.”
Coping with concussions: long road to recovery for some
Read more: https://apnews.com/article/sports-head- ... 97b0aaea58
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Football bonded them. Its violence tore them apart
Football bonded them. Its violence tore them apart
https://www.washingtonpost.com/sports/i ... _p001_f006
https://www.washingtonpost.com/sports/i ... _p001_f006
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Even mild concussions can 'rewire' the brain, possibly causing long-term symptoms
Even mild concussions can 'rewire' the brain, possibly causing long-term symptoms
After a mild concussion, parts of the brain can become "hyperconnected," and this may contribute to patients' long-lasting symptoms.
Even light bumps on the head can cause long-term problems, and researchers may now have an idea why: The brain's wiring can change in the aftermath of mild concussions.
Prior studies suggested that even mild traumatic brain injuries (TBI) that don't cause any observable structural damage can still trigger symptoms that persist for more than six months. These symptoms range from problems with concentration and fatigue to depression and anxiety. Now, Rebecca Woodrow(opens in new tab), a doctoral student at the University of Cambridge's Division of Anaesthesia, and her colleagues report that there can sometimes be an increase in the connectivity of the brain immediately after mild TBI that may help to predict and explain these long-lasting symptoms.
An estimated 50 million new TBI cases(opens in new tab) are reported worldwide each year and this figure has been increasing. The trend prompted scientists to launch CENTER-TBI, a European Union-funded project aimed at improving care for TBI patients.
The recent study, published in February in the journal Brain(opens in new tab), used CENTER-TBI data and found that, even for mild TBI, in which the patient is expected to make a full recovery within six months, problems often persist beyond that point.
"We were surprised at how many of these patients have a poor outcome," Woodrow, the study's first author, told Live Science. "It was almost half.”
Although there are treatments available for patients in intensive care for moderate to severe TBI, the understanding of mild TBI and its long-lasting symptoms remains poor, Woodrow said, adding, "There is limited care for those symptoms, little support for these patients.”
The brain changes identified in the new study hint at a way of identifying which patients will likely suffer long-lasting symptoms, as well as possible targets for drugs that may aid the recovery.
Woodrow and colleagues analyzed data from 108 TBI patients and 76 controls. This data included not just standard MRI and CT scans, which show brain structure, but also functional MRI (fMRI) scans, which provide data about brain function and are not usually collected for mild TBI. fMRI reveals the regions that have activity levels changing in sync, which are then inferred to be functionally connected.
The CENTER-TBI dataset is unique because, in addition to brain scans, it includes behavioral data, clinical outcomes and biomarkers, co-senior author Emmanuel Stamatakis(opens in new tab), whose University of Cambridge lab specializes in developing methods to understand fMRI data, told Live Science in an email. "This makes it feasible to relate brain function to observed behaviour," he said.
Although the CT and standard MRI scans didn't reveal structural changes in the TBI patients' brains, the fMRIs showed significantly higher connectivity between the thalamus and the rest of the brain, compared with the healthy controls.
The thalamus is often described as the "relay" of the brain because many signals pass through the structure before being shuttled elsewhere. The thalamus is involved in not only primary sensory functions, such as seeing and smelling, but also various complex functions that activate multiple brain regions simultaneously, like concentrating, Woodrow said.
It may be that the brain adapts to injury in other areas of the brain by increasing their connections to the thalamus. Woodrow pointed out that the thalamus' position at the center of the brain also makes it vulnerable to injury from impacts, whatever direction they come from, so the increased connectivity could also be a response to direct thalamus injury.
Increased connectivity across the brain has already been identified in moderate and severe TBI, and in their new study, the authors noted that several past(opens in new tab)studies(opens in new tab) "support this adaptive hyperconnectivity hypothesis.”
"We can't claim to fully understand why it happens yet," said Stamatakis. Some scientists theorize that, immediately after mild TBI, the brain becomes hyperconnected, but that connectivity later dwindles and becomes lower than usual, in the long-term.
But Woodrow explained that in mild TBI, it was thought that such hyperconnectivity effects may be much subtler than that seen in severe TBI and not significantly different from the varying connectivity levels normally seen from person to person. Past fMRI studies of mild injuries used small sample sizes of around 20 to 40 people, which limited their ability to identify a trend above baseline noise.
The current study includes "the largest sample studied with resting-state functional MRI in mild injury," Stamatakis said.
The study showed that not only is it possible to identify connectivity changes in the wake of mild TBI, but that regions where this hyperconnectivity is most prominent correlate with particular symptom types, such as emotional versus cognitive. These connectivity changes also correlate with concentrations of chemical messengers, or "neurotransmitters" in these brain regions. The study authors suggest that modulating these neurotransmitters could be a fruitful target for developing drugs to treat mild TBI.
Next, the researchers plan to look at the effects of repetitive concussion, as often seen in sports, to see whether TBI has cumulative effects that could make the consequences of concussion increasingly serious with each knock to the head.
Even mild concussions can 'rewire' the brain, possibly causing long-term symptoms
Read more: https://www.livescience.com/health/neur ... m-symptoms
Acute thalamic connectivity precedes chronic post-concussive symptoms in mild traumatic brain injury
Read the study: https://academic.oup.com/brain/advance- ... ogin=false
After a mild concussion, parts of the brain can become "hyperconnected," and this may contribute to patients' long-lasting symptoms.
Even light bumps on the head can cause long-term problems, and researchers may now have an idea why: The brain's wiring can change in the aftermath of mild concussions.
Prior studies suggested that even mild traumatic brain injuries (TBI) that don't cause any observable structural damage can still trigger symptoms that persist for more than six months. These symptoms range from problems with concentration and fatigue to depression and anxiety. Now, Rebecca Woodrow(opens in new tab), a doctoral student at the University of Cambridge's Division of Anaesthesia, and her colleagues report that there can sometimes be an increase in the connectivity of the brain immediately after mild TBI that may help to predict and explain these long-lasting symptoms.
An estimated 50 million new TBI cases(opens in new tab) are reported worldwide each year and this figure has been increasing. The trend prompted scientists to launch CENTER-TBI, a European Union-funded project aimed at improving care for TBI patients.
The recent study, published in February in the journal Brain(opens in new tab), used CENTER-TBI data and found that, even for mild TBI, in which the patient is expected to make a full recovery within six months, problems often persist beyond that point.
"We were surprised at how many of these patients have a poor outcome," Woodrow, the study's first author, told Live Science. "It was almost half.”
Although there are treatments available for patients in intensive care for moderate to severe TBI, the understanding of mild TBI and its long-lasting symptoms remains poor, Woodrow said, adding, "There is limited care for those symptoms, little support for these patients.”
The brain changes identified in the new study hint at a way of identifying which patients will likely suffer long-lasting symptoms, as well as possible targets for drugs that may aid the recovery.
Woodrow and colleagues analyzed data from 108 TBI patients and 76 controls. This data included not just standard MRI and CT scans, which show brain structure, but also functional MRI (fMRI) scans, which provide data about brain function and are not usually collected for mild TBI. fMRI reveals the regions that have activity levels changing in sync, which are then inferred to be functionally connected.
The CENTER-TBI dataset is unique because, in addition to brain scans, it includes behavioral data, clinical outcomes and biomarkers, co-senior author Emmanuel Stamatakis(opens in new tab), whose University of Cambridge lab specializes in developing methods to understand fMRI data, told Live Science in an email. "This makes it feasible to relate brain function to observed behaviour," he said.
Although the CT and standard MRI scans didn't reveal structural changes in the TBI patients' brains, the fMRIs showed significantly higher connectivity between the thalamus and the rest of the brain, compared with the healthy controls.
The thalamus is often described as the "relay" of the brain because many signals pass through the structure before being shuttled elsewhere. The thalamus is involved in not only primary sensory functions, such as seeing and smelling, but also various complex functions that activate multiple brain regions simultaneously, like concentrating, Woodrow said.
It may be that the brain adapts to injury in other areas of the brain by increasing their connections to the thalamus. Woodrow pointed out that the thalamus' position at the center of the brain also makes it vulnerable to injury from impacts, whatever direction they come from, so the increased connectivity could also be a response to direct thalamus injury.
Increased connectivity across the brain has already been identified in moderate and severe TBI, and in their new study, the authors noted that several past(opens in new tab)studies(opens in new tab) "support this adaptive hyperconnectivity hypothesis.”
"We can't claim to fully understand why it happens yet," said Stamatakis. Some scientists theorize that, immediately after mild TBI, the brain becomes hyperconnected, but that connectivity later dwindles and becomes lower than usual, in the long-term.
But Woodrow explained that in mild TBI, it was thought that such hyperconnectivity effects may be much subtler than that seen in severe TBI and not significantly different from the varying connectivity levels normally seen from person to person. Past fMRI studies of mild injuries used small sample sizes of around 20 to 40 people, which limited their ability to identify a trend above baseline noise.
The current study includes "the largest sample studied with resting-state functional MRI in mild injury," Stamatakis said.
The study showed that not only is it possible to identify connectivity changes in the wake of mild TBI, but that regions where this hyperconnectivity is most prominent correlate with particular symptom types, such as emotional versus cognitive. These connectivity changes also correlate with concentrations of chemical messengers, or "neurotransmitters" in these brain regions. The study authors suggest that modulating these neurotransmitters could be a fruitful target for developing drugs to treat mild TBI.
Next, the researchers plan to look at the effects of repetitive concussion, as often seen in sports, to see whether TBI has cumulative effects that could make the consequences of concussion increasingly serious with each knock to the head.
Even mild concussions can 'rewire' the brain, possibly causing long-term symptoms
Read more: https://www.livescience.com/health/neur ... m-symptoms
Acute thalamic connectivity precedes chronic post-concussive symptoms in mild traumatic brain injury
Read the study: https://academic.oup.com/brain/advance- ... ogin=false
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Almost half of people with concussion still show symptoms of brain injury six months later
Almost half of people with concussion still show symptoms of brain injury six months later
Even mild concussion can cause long-lasting effects to the brain, according to researchers at the University of Cambridge. Using data from a Europe-wide study, the team has shown that for almost a half of all people who receive a knock to the head, there are changes in how regions of the brain communicate with each other, potentially causing long term symptoms such as fatigue and cognitive impairment.
Mild traumatic brain injury – concussion – results from a blow or jolt to the head. It can occur as a result of a fall, a sports injury or from a cycling accident or car crash, for example. But despite being labelled ‘mild’, it is commonly linked with persistent symptoms and incomplete recovery. Such symptoms include depression, cognitive impairment, headaches, and fatigue.
While some clinicians in recent studies predict that nine out of 10 individuals who experience concussion will have a full recovery after six months, evidence is emerging that only a half achieve a full recovery. This means that a significant proportion of patients may not receive adequate post-injury care.
Predicting which patients will have a fast recovery and who will take longer to recover is challenging, however. At present, patients with suspected concussion will typically receive a brain scan – either a CT scan or an MRI scan, both of which look for structural problems, such as inflammation or bruising – yet even if these scans show no obvious structural damage, a patient’s symptoms may still persist.
Dr Emmanuel Stamatakis from the Department of Clinical Neurosciences and Division of Anaesthesia at the University of Cambridge said: “Worldwide, we’re seeing an increase in the number of cases of mild traumatic brain injury, particularly from falls in our aging population and rising numbers of road traffic collisions in low- and middle-income countries.
“At present, we have no clear way of working out which of these patients will have a speedy recovery and which will take longer, and the combination of over-optimistic and imprecise prognoses means that some patients risk not receiving adequate care for their symptoms.”
Dr Stamatakis and colleagues studied fMRI brain scans – that is, functional MRI scans, which look at how different areas of the brain coordinate with each other – taken from 108 patients with mild traumatic brain injury and compared them with scans from 76 healthy volunteers. Patients were also assessed for ongoing symptoms.
The patients and volunteers had been recruited to CENTER-TBI, a large European research project which aims to improve the care for patients with traumatic brain injury, co-chaired by Professor David Menon (head of the division of Anaesthesia) and funded by the European Union.
In results published today in Brain, the team found that just under half (45%) were still showing symptoms resulting from their brain injury, with the most common being fatigue, poor concentration and headaches.
The researchers found that these patients had abnormalities in a region of the brain known as the thalamus, which integrates all sensory information and relays this information around the brain. Counter-intuitively, concussion was associated with increased connectivity between the thalamus and the rest of the brain – in other words, the thalamus was trying to communicate more as a result of the injury – and the greater this connectivity, the poorer the prognosis for the patient.
Rebecca Woodrow, a PhD student in the Department of Clinical Neuroscience and Hughes Hall, Cambridge, said: “Despite there being no obvious structural damage to the brain in routine scans, we saw clear evidence that the thalamus – the brain’s relay system – was hyperconnected. We might interpret this as the thalamus trying to over-compensate for any anticipated damage, and this appears to be at the root of some of the long-lasting symptoms that patients experience.”
By studying additional data from positron emission tomography (PET) scans, which can measure regional chemical composition of body tissues, the researchers were able to make associations with key neurotransmitters depending on which long-term symptoms a patient displayed. For example, patients experiencing cognitive problems such as memory difficulties showed increased connectivity between the thalamus and areas of the brain rich in the neurotransmitter noradrenaline; patients experiencing emotional symptoms, such as depression or irritability, showed greater connectivity with areas of the brain rich in serotonin.
Dr Stamatakis, who is also Stephen Erskine Fellow at Queens' College, Cambridge, added: “We know that there already drugs that target these brain chemicals so our findings offer hope that in future, not only might we be able to predict a patient’s prognosis, but we may also be able to offer a treatment targeting their particular symptoms.”
Almost half of people with concussion still show symptoms of brain injury six months later
Read more: https://www.cam.ac.uk/research/news/alm ... nths-later
Acute thalamic connectivity precedes chronic postconcussive symptoms in mild traumatic brain injury.
Read the study: https://academic.oup.com/brain/advance- ... 56/7051141
Even mild concussion can cause long-lasting effects to the brain, according to researchers at the University of Cambridge. Using data from a Europe-wide study, the team has shown that for almost a half of all people who receive a knock to the head, there are changes in how regions of the brain communicate with each other, potentially causing long term symptoms such as fatigue and cognitive impairment.
Mild traumatic brain injury – concussion – results from a blow or jolt to the head. It can occur as a result of a fall, a sports injury or from a cycling accident or car crash, for example. But despite being labelled ‘mild’, it is commonly linked with persistent symptoms and incomplete recovery. Such symptoms include depression, cognitive impairment, headaches, and fatigue.
While some clinicians in recent studies predict that nine out of 10 individuals who experience concussion will have a full recovery after six months, evidence is emerging that only a half achieve a full recovery. This means that a significant proportion of patients may not receive adequate post-injury care.
Predicting which patients will have a fast recovery and who will take longer to recover is challenging, however. At present, patients with suspected concussion will typically receive a brain scan – either a CT scan or an MRI scan, both of which look for structural problems, such as inflammation or bruising – yet even if these scans show no obvious structural damage, a patient’s symptoms may still persist.
Dr Emmanuel Stamatakis from the Department of Clinical Neurosciences and Division of Anaesthesia at the University of Cambridge said: “Worldwide, we’re seeing an increase in the number of cases of mild traumatic brain injury, particularly from falls in our aging population and rising numbers of road traffic collisions in low- and middle-income countries.
“At present, we have no clear way of working out which of these patients will have a speedy recovery and which will take longer, and the combination of over-optimistic and imprecise prognoses means that some patients risk not receiving adequate care for their symptoms.”
Dr Stamatakis and colleagues studied fMRI brain scans – that is, functional MRI scans, which look at how different areas of the brain coordinate with each other – taken from 108 patients with mild traumatic brain injury and compared them with scans from 76 healthy volunteers. Patients were also assessed for ongoing symptoms.
The patients and volunteers had been recruited to CENTER-TBI, a large European research project which aims to improve the care for patients with traumatic brain injury, co-chaired by Professor David Menon (head of the division of Anaesthesia) and funded by the European Union.
In results published today in Brain, the team found that just under half (45%) were still showing symptoms resulting from their brain injury, with the most common being fatigue, poor concentration and headaches.
The researchers found that these patients had abnormalities in a region of the brain known as the thalamus, which integrates all sensory information and relays this information around the brain. Counter-intuitively, concussion was associated with increased connectivity between the thalamus and the rest of the brain – in other words, the thalamus was trying to communicate more as a result of the injury – and the greater this connectivity, the poorer the prognosis for the patient.
Rebecca Woodrow, a PhD student in the Department of Clinical Neuroscience and Hughes Hall, Cambridge, said: “Despite there being no obvious structural damage to the brain in routine scans, we saw clear evidence that the thalamus – the brain’s relay system – was hyperconnected. We might interpret this as the thalamus trying to over-compensate for any anticipated damage, and this appears to be at the root of some of the long-lasting symptoms that patients experience.”
By studying additional data from positron emission tomography (PET) scans, which can measure regional chemical composition of body tissues, the researchers were able to make associations with key neurotransmitters depending on which long-term symptoms a patient displayed. For example, patients experiencing cognitive problems such as memory difficulties showed increased connectivity between the thalamus and areas of the brain rich in the neurotransmitter noradrenaline; patients experiencing emotional symptoms, such as depression or irritability, showed greater connectivity with areas of the brain rich in serotonin.
Dr Stamatakis, who is also Stephen Erskine Fellow at Queens' College, Cambridge, added: “We know that there already drugs that target these brain chemicals so our findings offer hope that in future, not only might we be able to predict a patient’s prognosis, but we may also be able to offer a treatment targeting their particular symptoms.”
Almost half of people with concussion still show symptoms of brain injury six months later
Read more: https://www.cam.ac.uk/research/news/alm ... nths-later
Acute thalamic connectivity precedes chronic postconcussive symptoms in mild traumatic brain injury.
Read the study: https://academic.oup.com/brain/advance- ... 56/7051141
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greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Work strengthens the hypothesis blaming repeated mild head impacts for higher risk of dementia
Work strengthens the hypothesis blaming repeated mild head impacts for higher risk of dementia
Elite soccer players face higher risk for dementia, Swedish study says.
If you follow sports like football, boxing, ice hockey, or rugby, you know repeated hits to the head have been linked to later brain damage and disease. A new Lancet study from Sweden finds the same connection for male soccer players, suggesting they’re 1.5 times more likely than similar men to develop dementia. That held true for outfielders, who were 1.4 times more likely than goalkeepers to be diagnosed with Alzheimer’s and other dementias, but among all the players, there was no link to ALS or Parkinson’s.
Because the players shared generally good health, the researchers say their work strengthens the hypothesis blaming repeated mild head impacts that the fielders but not the goalies sustained over their playing days. There are caveats: The results, gleaned from players from 1924 through 2019, might not hold up among more contemporary players and they may not be the same for elite female players.
Neurodegenerative disease among male elite football (soccer) players in Sweden: a cohort study
Read more: https://www.thelancet.com/journals/lanp ... 0/fulltext
Elite soccer players face higher risk for dementia, Swedish study says.
If you follow sports like football, boxing, ice hockey, or rugby, you know repeated hits to the head have been linked to later brain damage and disease. A new Lancet study from Sweden finds the same connection for male soccer players, suggesting they’re 1.5 times more likely than similar men to develop dementia. That held true for outfielders, who were 1.4 times more likely than goalkeepers to be diagnosed with Alzheimer’s and other dementias, but among all the players, there was no link to ALS or Parkinson’s.
Because the players shared generally good health, the researchers say their work strengthens the hypothesis blaming repeated mild head impacts that the fielders but not the goalies sustained over their playing days. There are caveats: The results, gleaned from players from 1924 through 2019, might not hold up among more contemporary players and they may not be the same for elite female players.
Neurodegenerative disease among male elite football (soccer) players in Sweden: a cohort study
Read more: https://www.thelancet.com/journals/lanp ... 0/fulltext
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greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
“Many people don't know that during the Olympic season, I not only experienced a significant concussion, but I also full
“Many people don't know that during the Olympic season, I not only experienced a significant concussion, but I also fully tore my ACL"
The Canadian women’s hockey team made an emphatic statement to finish a seven-game, pre-world championship series with the U.S.
The Canadians routed the Americans 5-0 on Wednesday in Laval, Quebec, their biggest win in the rivalry since 2005, according to Hockey Canada. After losing the first three games of this year’s Rivalry Series, Canada won the last four to take the series 4-3.
Ann-Renée Desbiens stopped all 25 U.S. shots. “Many people don't know that during the Olympic season, I not only experienced a significant concussion, but I also fully tore my ACL,” said Desbiens.
Blayre Turnbull scored twice, Laura Stacey had three assists and Marie-Philip Poulin had a goal, her 98th with the national team.
“It’s always a battle between these two teams, and their goaltender shut the door tonight,” U.S. head coach John Wroblewski said, according to USA Hockey. “It’s obviously not the way we wanted to close out the series, but we’ll regroup and look ahead to April.”
Last May, the former AHL coach Wroblewski was named U.S. head coach to succeed Joel Johnson, who coached the team to silver at last year’s Olympics.
Canada is rolling into hosting April’s world championship tournament in Brampton. In November, the U.S. reeled off its first three-game win streak against Canada since early 2019, but Canada has taken back momentum and seeks a third consecutive world title.
Last year, it swept the Olympic and world titles, repeating as world champion for the first time since it won the first eight world championships from 1990 through 2004.
Wednesday’s result was the biggest blowout in the rivalry since the U.S. beat Canada 9-2 in group play at the 2012 World Championship. A week later, Canada beat the U.S. 5-4 in overtime in that world championship final.
Wednesday was Canada’s biggest margin of victory over the U.S. since a 7-0 win in November 2005 in Italy.
Canada women’s hockey team gets most lopsided win over U.S. since 2005
Read more: https://olympics.nbcsports.com/2023/02/ ... ry-series/
Despite limited international appearances and accolades to her name, Desbiens has proven herself to be ready to seize an opportunity should it present itself. The Quebec native has overcome hardships in her career, including a concussion and a knee injury which could have derailed one of the most prolific goalie careers that college hockey fans have ever seen. The stage is set for Desbiens to step into the spotlight. One can only hope that it happens sooner rather than later.
Read more: https://www.theicegarden.com/2018/8/25/ ... eam-canada
The Canadian women’s hockey team made an emphatic statement to finish a seven-game, pre-world championship series with the U.S.
The Canadians routed the Americans 5-0 on Wednesday in Laval, Quebec, their biggest win in the rivalry since 2005, according to Hockey Canada. After losing the first three games of this year’s Rivalry Series, Canada won the last four to take the series 4-3.
Ann-Renée Desbiens stopped all 25 U.S. shots. “Many people don't know that during the Olympic season, I not only experienced a significant concussion, but I also fully tore my ACL,” said Desbiens.
Blayre Turnbull scored twice, Laura Stacey had three assists and Marie-Philip Poulin had a goal, her 98th with the national team.
“It’s always a battle between these two teams, and their goaltender shut the door tonight,” U.S. head coach John Wroblewski said, according to USA Hockey. “It’s obviously not the way we wanted to close out the series, but we’ll regroup and look ahead to April.”
Last May, the former AHL coach Wroblewski was named U.S. head coach to succeed Joel Johnson, who coached the team to silver at last year’s Olympics.
Canada is rolling into hosting April’s world championship tournament in Brampton. In November, the U.S. reeled off its first three-game win streak against Canada since early 2019, but Canada has taken back momentum and seeks a third consecutive world title.
Last year, it swept the Olympic and world titles, repeating as world champion for the first time since it won the first eight world championships from 1990 through 2004.
Wednesday’s result was the biggest blowout in the rivalry since the U.S. beat Canada 9-2 in group play at the 2012 World Championship. A week later, Canada beat the U.S. 5-4 in overtime in that world championship final.
Wednesday was Canada’s biggest margin of victory over the U.S. since a 7-0 win in November 2005 in Italy.
Canada women’s hockey team gets most lopsided win over U.S. since 2005
Read more: https://olympics.nbcsports.com/2023/02/ ... ry-series/
Despite limited international appearances and accolades to her name, Desbiens has proven herself to be ready to seize an opportunity should it present itself. The Quebec native has overcome hardships in her career, including a concussion and a knee injury which could have derailed one of the most prolific goalie careers that college hockey fans have ever seen. The stage is set for Desbiens to step into the spotlight. One can only hope that it happens sooner rather than later.
Read more: https://www.theicegarden.com/2018/8/25/ ... eam-canada
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Study of injury patterns of non-fatal accidents related to ice hockey
Study of injury patterns of non-fatal accidents related to ice hockey
Objective
This study was carried out to identify the frequency and types of injuries in adult ice hockey, in order to better understand injury patterns and identify potential areas for injury prevention.
Methods
We conducted a retrospective database review of acute injuries reported in ice hockey in patients presenting to a Level-1 adult Emergency Centre in Switzerland. Patients between January 1, 2013 and December 31, 2019 and over 16 years of age were identified in our computerized patient database. Each consultation was reviewed to derive information on demographics, playing level and the features of the injury, including location, type, mechanism and consequences. Different age groups were compared, as were amateur and professional players. A statistical analysis was performed.
Overall considerations and patients’ characteristics
From January 1st 2013 to December 31st 2019, 230 patients aged ≥ 16 years presented to our emergency room (ER) after an acute trauma while playing ice hockey. Of these, 97% were men (n = 223) and 3% women (n = 7). The small number of women patients did not allow us to draw any statistically relevant considerations.
The most numerous age category was the youngest (16–25 years), that included 54.8% of cases (n = 126). The number of cases decreased for each subsequent age cohort: 27% for the 26–35 years cohort (n = 62), 11.3% for the 36–45 years cohort (n = 26) and 7% for the ≥46 year old cohort (n = 16). Overall, the youngest patient was 16 and the oldest 64 years old, with a mean age of 27.2 years. Patients mostly played at a non-professional level, corresponding to 82.2% (n = 182), compared to 17.8% of patients who played at a professional level (n = 41).
Results
A total of 230 patients were identified. The most common diagnoses were fracture (28.3%), contusion/abrasion (23.9%), laceration (12.6%) and concussion (10.4%). The most commonly affected body parts were the face (31.3%), the shoulder/clavicle (13.0%) and the head (12.2%). Most lesions were caused by player-player contact (37.4%), contact with the puck (24.3%) and falls (10.9%). In comparison to the younger cohorts, patients >36 years of age more frequently suffered injuries caused by falls, (p < 0.001) and were less frequently injured by player-player contact (p = 0.01813). In amateur players, significantly more injuries were caused by stick contact (OR 0, 95% CI (0.00–0.83), p = 0.02) and surgery was more rarely performed (OR 2.35, 95% CI 0.98–5.46, p = 0.04).
Overall injury characteristics
90% of patients sustained monotrauma (n = 207), with a combined trauma in 10% (n = 23). No patient reported polytrauma. The most common diagnoses were fracture (28.3%, n = 65), contusion/abrasion (23.9%, n = 55), laceration (12.6%, n = 29) and concussion (10.4%, n = 24). This was followed by sprain and strain (7.4%, n = 17), dislocation (5.2%, n = 12), dental injury (4.3%, n = 10), eye injury (3.5%, n =
, major haematoma (2.6%, n = 6), ear/tympanum lesion (0.9%, n = 2) and intracranial bleeding (0.9%, n = 2)
The types of injury were as follows:
• Shoulder/clavicle injuries (6 contusions, 7 acromioclavicular joint injuries (contusion, sprain/strain or dislocation), 6 dislocated shoulders, 7 clavicle fractures, 2 glenoid fractures, 1 laceration and 1 other sprain);
• Head injuries (24 concussions, 2 intracranial bleedings, 1 laceration and 1 temporal bone fracture);
• Back/neck/throat injuries (19 contusions, 3 vertebral fractures and 1 thyroid cartilage fracture);
• Hand and finger injuries (2 lacerations, 2 contusions, 2 sprains, and 12 finger fractures);
• Pelvis/hips/thigh injuries (6 contusions, 2 sprains, 1 laceration, 1 trochanter minor fracture and 5 major haematomas with 2 cases of compartment syndrome);
• Knee injuries (1 laceration, 5 contusions, 1 Bucket-handle meniscal tear, 3 lesions of the medial collateral ligament and 4 other simple sprains/strains);
• Wrist injuries (1 laceration, 2 contusions, 5 distal radius fractures, 1 trans-scaphoid perilunate fracture dislocation, 1 distal forearm fracture);
• Chest and flank injuries (7 contusions, 1 major haematoma with retroperitoneal haemorrhage from the upper pole of the kidney);
• Ankle injuries (2 contusions, 1 undefined medial malleolar fracture, 1 ankle fracture dislocation and 2 type Weber B fractures);
• Arm injuries (1 laceration, 1 humerus fracture, 1 forearm fracture and 2 sprains including a biceps tendon rupture),
• Foot/toes injury (1 contusion).
Concussion
Concussion was reported in 10.4% of patients (n = 24). 95.8% of them were treated on an outpatient basis (n = 23), whereas one patient, corresponding to 4.2%, was hospitalized for analgesia and monitoring. 75.0% were caused by contact with another player (n = 18), 16.7% by falls (n = 4) and 8.3% by contact with the boards (n = 2). In the specific case of a player-player contact, 22.2% (n = 4) were boarding. There is no significant difference between the various age cohorts for concussion (p > 0.05). Concussion was present in 12.2% of patients playing professionally (n = 5) and in 10.1% of those playing non-professionally (n = 19), but without a significant difference (OR 1.24, 95% CI (0.34–3.74), p = 0.78).
Conclusion
Injuries continue to play a major role in ice hockey, especially in the face and due to player-player contact. Future investigations should focus on player-player contact and possible effective preventive measures. Players must be encouraged to employ face protection and to wear a mouth guard at all times.
Contact between players and a facial involvement appear to be central in ice hockey injuries. Prevention initiatives should focus on strategies that limit player-to-player contact. As authors of this study, we strongly recommend increased facial protection.
Injury patterns of non-fatal accidents related to ice hockey, an analysis of 7 years of admission to a Level-1 Emergency Centre in Switzerland
Read more: https://journals.plos.org/plosone/artic ... ne.0268912
Objective
This study was carried out to identify the frequency and types of injuries in adult ice hockey, in order to better understand injury patterns and identify potential areas for injury prevention.
Methods
We conducted a retrospective database review of acute injuries reported in ice hockey in patients presenting to a Level-1 adult Emergency Centre in Switzerland. Patients between January 1, 2013 and December 31, 2019 and over 16 years of age were identified in our computerized patient database. Each consultation was reviewed to derive information on demographics, playing level and the features of the injury, including location, type, mechanism and consequences. Different age groups were compared, as were amateur and professional players. A statistical analysis was performed.
Overall considerations and patients’ characteristics
From January 1st 2013 to December 31st 2019, 230 patients aged ≥ 16 years presented to our emergency room (ER) after an acute trauma while playing ice hockey. Of these, 97% were men (n = 223) and 3% women (n = 7). The small number of women patients did not allow us to draw any statistically relevant considerations.
The most numerous age category was the youngest (16–25 years), that included 54.8% of cases (n = 126). The number of cases decreased for each subsequent age cohort: 27% for the 26–35 years cohort (n = 62), 11.3% for the 36–45 years cohort (n = 26) and 7% for the ≥46 year old cohort (n = 16). Overall, the youngest patient was 16 and the oldest 64 years old, with a mean age of 27.2 years. Patients mostly played at a non-professional level, corresponding to 82.2% (n = 182), compared to 17.8% of patients who played at a professional level (n = 41).
Results
A total of 230 patients were identified. The most common diagnoses were fracture (28.3%), contusion/abrasion (23.9%), laceration (12.6%) and concussion (10.4%). The most commonly affected body parts were the face (31.3%), the shoulder/clavicle (13.0%) and the head (12.2%). Most lesions were caused by player-player contact (37.4%), contact with the puck (24.3%) and falls (10.9%). In comparison to the younger cohorts, patients >36 years of age more frequently suffered injuries caused by falls, (p < 0.001) and were less frequently injured by player-player contact (p = 0.01813). In amateur players, significantly more injuries were caused by stick contact (OR 0, 95% CI (0.00–0.83), p = 0.02) and surgery was more rarely performed (OR 2.35, 95% CI 0.98–5.46, p = 0.04).
Overall injury characteristics
90% of patients sustained monotrauma (n = 207), with a combined trauma in 10% (n = 23). No patient reported polytrauma. The most common diagnoses were fracture (28.3%, n = 65), contusion/abrasion (23.9%, n = 55), laceration (12.6%, n = 29) and concussion (10.4%, n = 24). This was followed by sprain and strain (7.4%, n = 17), dislocation (5.2%, n = 12), dental injury (4.3%, n = 10), eye injury (3.5%, n =
, major haematoma (2.6%, n = 6), ear/tympanum lesion (0.9%, n = 2) and intracranial bleeding (0.9%, n = 2)The types of injury were as follows:
• Shoulder/clavicle injuries (6 contusions, 7 acromioclavicular joint injuries (contusion, sprain/strain or dislocation), 6 dislocated shoulders, 7 clavicle fractures, 2 glenoid fractures, 1 laceration and 1 other sprain);
• Head injuries (24 concussions, 2 intracranial bleedings, 1 laceration and 1 temporal bone fracture);
• Back/neck/throat injuries (19 contusions, 3 vertebral fractures and 1 thyroid cartilage fracture);
• Hand and finger injuries (2 lacerations, 2 contusions, 2 sprains, and 12 finger fractures);
• Pelvis/hips/thigh injuries (6 contusions, 2 sprains, 1 laceration, 1 trochanter minor fracture and 5 major haematomas with 2 cases of compartment syndrome);
• Knee injuries (1 laceration, 5 contusions, 1 Bucket-handle meniscal tear, 3 lesions of the medial collateral ligament and 4 other simple sprains/strains);
• Wrist injuries (1 laceration, 2 contusions, 5 distal radius fractures, 1 trans-scaphoid perilunate fracture dislocation, 1 distal forearm fracture);
• Chest and flank injuries (7 contusions, 1 major haematoma with retroperitoneal haemorrhage from the upper pole of the kidney);
• Ankle injuries (2 contusions, 1 undefined medial malleolar fracture, 1 ankle fracture dislocation and 2 type Weber B fractures);
• Arm injuries (1 laceration, 1 humerus fracture, 1 forearm fracture and 2 sprains including a biceps tendon rupture),
• Foot/toes injury (1 contusion).
Concussion
Concussion was reported in 10.4% of patients (n = 24). 95.8% of them were treated on an outpatient basis (n = 23), whereas one patient, corresponding to 4.2%, was hospitalized for analgesia and monitoring. 75.0% were caused by contact with another player (n = 18), 16.7% by falls (n = 4) and 8.3% by contact with the boards (n = 2). In the specific case of a player-player contact, 22.2% (n = 4) were boarding. There is no significant difference between the various age cohorts for concussion (p > 0.05). Concussion was present in 12.2% of patients playing professionally (n = 5) and in 10.1% of those playing non-professionally (n = 19), but without a significant difference (OR 1.24, 95% CI (0.34–3.74), p = 0.78).
Conclusion
Injuries continue to play a major role in ice hockey, especially in the face and due to player-player contact. Future investigations should focus on player-player contact and possible effective preventive measures. Players must be encouraged to employ face protection and to wear a mouth guard at all times.
Contact between players and a facial involvement appear to be central in ice hockey injuries. Prevention initiatives should focus on strategies that limit player-to-player contact. As authors of this study, we strongly recommend increased facial protection.
Injury patterns of non-fatal accidents related to ice hockey, an analysis of 7 years of admission to a Level-1 Emergency Centre in Switzerland
Read more: https://journals.plos.org/plosone/artic ... ne.0268912
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Study: Depression after traumatic brain injury
Study: Depression after traumatic brain injury may not be the same as depression from other causes
By RICK SOBEY | rick.sobey@bostonherald.com | Boston Herald
PUBLISHED: July 7, 2023 at 12:10 p.m. | UPDATED: July 7, 2023 at 12:49 p.m.
A new study suggests that depression after traumatic brain injury may not be the same as depression related to other causes, according to researchers from Brigham and Women’s Hospital.
The study of 273 people found that brain circuits associated with depression were different between people with traumatic brain injury (TBI) and those without TBI.
“Our findings help explain how the physical trauma to specific brain circuits can lead to development of depression,” said study leader Shan Siddiqi, of the Brigham’s Department of Psychiatry and Center for Brain Circuit Therapeutics.
“If we’re right, it means that we should be treating depression after TBI like a distinct disease,” Siddiqi added. “Many clinicians have suspected that this is a clinically distinct disorder with a unique pattern of symptoms and unique treatment response, including poor response to conventional antidepressants — but until now, we didn’t have clear physiological evidence to prove this.”
The study included 273 adults with TBI, usually from sports injuries, military injuries, or car accidents. People in this group were compared to other groups who did not have a TBI or depression, people with depression without TBI, and people with post-traumatic stress disorder.
Study participants went through a resting-state functional connectivity MRI, a brain scan that looks at how oxygen is moving in the brain. These scans gave information about oxygenation in up to 200,000 points in the brain at about 1,000 different points in time — leading to about 200 million data points in each person.
Based on this information, a machine learning algorithm was used to generate an individualized map of each person’s brain.
The location of the brain circuit involved in depression was the same among people with TBI as people without TBI, but the nature of the abnormalities was different.
Connectivity in this circuit was decreased in depression without TBI and was increased in TBI-associated depression. This implies that TBI-associated depression may be a different disease process, leading the study authors to propose a new name: “TBI affective syndrome.”
“I’ve always suspected it isn’t the same as regular major depressive disorder or other mental health conditions that are not related to traumatic brain injury,” said David Brody, a co-author of the study and a neurologist at Uniformed Services University. “There’s still a lot we don’t understand, but we’re starting to make progress.”
https://www.twincities.com/2023/07/07/d ... ham-study/
By RICK SOBEY | rick.sobey@bostonherald.com | Boston Herald
PUBLISHED: July 7, 2023 at 12:10 p.m. | UPDATED: July 7, 2023 at 12:49 p.m.
A new study suggests that depression after traumatic brain injury may not be the same as depression related to other causes, according to researchers from Brigham and Women’s Hospital.
The study of 273 people found that brain circuits associated with depression were different between people with traumatic brain injury (TBI) and those without TBI.
“Our findings help explain how the physical trauma to specific brain circuits can lead to development of depression,” said study leader Shan Siddiqi, of the Brigham’s Department of Psychiatry and Center for Brain Circuit Therapeutics.
“If we’re right, it means that we should be treating depression after TBI like a distinct disease,” Siddiqi added. “Many clinicians have suspected that this is a clinically distinct disorder with a unique pattern of symptoms and unique treatment response, including poor response to conventional antidepressants — but until now, we didn’t have clear physiological evidence to prove this.”
The study included 273 adults with TBI, usually from sports injuries, military injuries, or car accidents. People in this group were compared to other groups who did not have a TBI or depression, people with depression without TBI, and people with post-traumatic stress disorder.
Study participants went through a resting-state functional connectivity MRI, a brain scan that looks at how oxygen is moving in the brain. These scans gave information about oxygenation in up to 200,000 points in the brain at about 1,000 different points in time — leading to about 200 million data points in each person.
Based on this information, a machine learning algorithm was used to generate an individualized map of each person’s brain.
The location of the brain circuit involved in depression was the same among people with TBI as people without TBI, but the nature of the abnormalities was different.
Connectivity in this circuit was decreased in depression without TBI and was increased in TBI-associated depression. This implies that TBI-associated depression may be a different disease process, leading the study authors to propose a new name: “TBI affective syndrome.”
“I’ve always suspected it isn’t the same as regular major depressive disorder or other mental health conditions that are not related to traumatic brain injury,” said David Brody, a co-author of the study and a neurologist at Uniformed Services University. “There’s still a lot we don’t understand, but we’re starting to make progress.”
https://www.twincities.com/2023/07/07/d ... ham-study/
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Why depression after traumatic brain injury is distinct — and less likely to respond to standard treatment
Why depression after traumatic brain injury is distinct — and less likely to respond to standard treatment
Traumatic brain injury multiplies the risk of major depression eightfold. While the emotional trauma of whatever caused such deep damage may be understandable, from a blast in a war zone to a blow on the playing field, there’s a physiological component, too, that neuroscientists have long suspected but have been unable to identify.
“As clinicians, a lot of us had a gut feeling that [TBI-associated depression] is a different disease,” said Shan Siddiqi, a Harvard Medical School assistant professor of psychiatry and a clinical neuropsychiatrist at Brigham and Women’s Hospital in Boston. “Why did nobody detect it before? I think the reason is because unlike other psychiatric disorders, TBI caused a sort of structural reorganization of the brain.”
Now, thanks to improved imaging techniques and the advent of brain stimulation, there may be a way to first map and then target brain circuits disrupted by TBI that lead to a specific form of depression. Siddiqi led a cohort study that pinpoints a distinct brain connectivity profile in TBI-associated depression, one that was independent of TBI (not all patients with TBI develop depression), major depressive disorder, post-traumatic stress disorder, and depression severity across different types of patients.
Siddiqi talked with STAT about the study, published Wednesday in Science Translational Medicine. This interview has been edited and condensed for clarity.
What’s different about people who have clinical depression after a traumatic brain injury compared to people who have other kinds of depression?
There are actually multiple clinical trials showing that antidepressant medications and antidepressant psychotherapy don’t really work for people’s traumatic brain injury. Certain things are different about them in terms of their symptoms, but nobody’s ever been able to find a physiological difference. There are also certain hypotheses about how their brains might be different, but that’s never been proven.
How are their symptoms different?
Usually in people with major depression, we see inability to experience pleasure. In patients with TBI, we often see difficulty being motivated by pleasurable things, but also difficulty learning from frustration. And these are similar brain networks. Learning from experience of pleasure is largely a dopamine-mediated phenomenon that involves a specific chemical we know about. Pleasure and frustration together involve different neurotransmitters, but they involve the same brain circuits that have a specific anatomical connection that teaches you to learn both from pleasure and from frustration.
Regular major depression may feel like, “I don’t care about anything, I’m useless, what’s the point?” But people with TBI-associated depression, you often see them repeatedly engaging in things that, normally, people would learn and be frustrated from and give up on. For example, they can become impulsive and start getting angry and become easily frustrated by seemingly small things because they’re not learning from the frustration.
What is it about a TBI that causes this?
The hypothesis is that whether it’s a blast injury or even a motor vehicle accident or repetitive head trauma from football, it turns out that it differentially affects the long pathways, the long axons in the brain. Even if you don’t have a physical focal structural injury in the brain — when you have a brain injury affecting the whole thing because of shear stress that almost causes your brain to twist on itself — it causes damage to the longest connections in the brain, which go from the orbitofrontal cortex into the limbic system, a specific circuit. That circuit seems to be disproportionately affected in these patients.
What did your study do?
We set out to try to design a brain stimulation treatment for these patients. In the process of designing that treatment, we had to find the right targets.
So you applied precision functional mapping of brain network connectivity to functional MRI data, and you also previously had done a pilot clinical trial using brain stimulation?
We designed a clinical trial where we did individualized brain mapping to the networks that we hypothesized were involved in TBI-associated depression. And it worked, at least in the pilot study. We only treated about nine patients and five controls, but it worked. And we were excited about this because no other treatment had been shown to work for these people.
But the targets that we used were speculative. It was a hypothesis. We never proved that they were the right targets. One big lingering question that I had in my mind is, before we spend $5 million launching a multi-center clinical trial, I really want to get a little more confidence in the target that we’re using.
Then we did this analysis to try to determine if this network was actually abnormal in these patients. And the more data we looked at, the more we found the same answer.
What did this confirm?
Unlike other psychiatric disorders, TBI caused a sort of structural reorganization of the brain. And because of that, you have to map each person’s individual brain. … We didn’t have that technology until very recently.
Now that we’ve got the technology to map individual brains, we can detect these differences. And we tested that in the study. It turns out that the individualized mapping does significantly better than using sort of group-level assumptions about where the networks are located.
Any caveats?
We didn’t prove that this network is causally involved in TBI-associated depression. The one thing that we still don’t know: Is it damage to the network that’s causing the depression after TBI or is it something else in the healing process that is leading to some sort of damage to this network, as sort of an after-effect or some sort of compensation? That’s something that we want to study, by watching people longitudinally.
One thing that we’d like to do in this longitudinal study is to do a more careful and sophisticated phenotyping so that we can get a more clear idea of whether there are specific symptom patterns that correlate with these specific connectivity patterns.
How long might that take?
I think the trial will take four or five years at most to run. If it’s successful, then we should be seeing this individualized, personalized treatment in the not too distant future. That’s the individualized, personalized treatment. We already have an FDA-cleared brain stimulation treatment for depression. There are some studies that suggest that it works just as well for people with traumatic brain injury.
I think the fact that this is a distinct disorder is something that we’ve been looking for confirmation of in the clinic for a long time. So I think we can already use that information to help us think about our patients a little bit differently.
What’s the bottom line?
Among clinicians, there is an ongoing debate about when people develop depression after traumatic brain injury, whether it’s related to the physical trauma of the brain injury or the emotional trauma associated with the brain injury. And I think this work adds more evidence in the camp that it’s probably due to the physical trauma rather than the emotional trauma. We’ve seen in the past when we show that certain things have detectable changes in the brain, it influences policymakers to think about them differently.
What do you say to patients?
That there’s actually physical brain damage associated with the depression. I think that that’s important to tell these patients, even though emotional trauma is important, just as important potentially. But then people feel more legitimized when it’s related to the physical trauma.
Why depression after traumatic brain injury is distinct — and less likely to respond to standard treatment
Read more: https://www.statnews.com/2023/07/06/dep ... in-injury/
Precision functional MRI mapping reveals distinct connectivity patterns for depression associated with traumatic brain injury
Read the study: https://www.science.org/doi/10.1126/sci ... ed.abn0441
Traumatic brain injury multiplies the risk of major depression eightfold. While the emotional trauma of whatever caused such deep damage may be understandable, from a blast in a war zone to a blow on the playing field, there’s a physiological component, too, that neuroscientists have long suspected but have been unable to identify.
“As clinicians, a lot of us had a gut feeling that [TBI-associated depression] is a different disease,” said Shan Siddiqi, a Harvard Medical School assistant professor of psychiatry and a clinical neuropsychiatrist at Brigham and Women’s Hospital in Boston. “Why did nobody detect it before? I think the reason is because unlike other psychiatric disorders, TBI caused a sort of structural reorganization of the brain.”
Now, thanks to improved imaging techniques and the advent of brain stimulation, there may be a way to first map and then target brain circuits disrupted by TBI that lead to a specific form of depression. Siddiqi led a cohort study that pinpoints a distinct brain connectivity profile in TBI-associated depression, one that was independent of TBI (not all patients with TBI develop depression), major depressive disorder, post-traumatic stress disorder, and depression severity across different types of patients.
Siddiqi talked with STAT about the study, published Wednesday in Science Translational Medicine. This interview has been edited and condensed for clarity.
What’s different about people who have clinical depression after a traumatic brain injury compared to people who have other kinds of depression?
There are actually multiple clinical trials showing that antidepressant medications and antidepressant psychotherapy don’t really work for people’s traumatic brain injury. Certain things are different about them in terms of their symptoms, but nobody’s ever been able to find a physiological difference. There are also certain hypotheses about how their brains might be different, but that’s never been proven.
How are their symptoms different?
Usually in people with major depression, we see inability to experience pleasure. In patients with TBI, we often see difficulty being motivated by pleasurable things, but also difficulty learning from frustration. And these are similar brain networks. Learning from experience of pleasure is largely a dopamine-mediated phenomenon that involves a specific chemical we know about. Pleasure and frustration together involve different neurotransmitters, but they involve the same brain circuits that have a specific anatomical connection that teaches you to learn both from pleasure and from frustration.
Regular major depression may feel like, “I don’t care about anything, I’m useless, what’s the point?” But people with TBI-associated depression, you often see them repeatedly engaging in things that, normally, people would learn and be frustrated from and give up on. For example, they can become impulsive and start getting angry and become easily frustrated by seemingly small things because they’re not learning from the frustration.
What is it about a TBI that causes this?
The hypothesis is that whether it’s a blast injury or even a motor vehicle accident or repetitive head trauma from football, it turns out that it differentially affects the long pathways, the long axons in the brain. Even if you don’t have a physical focal structural injury in the brain — when you have a brain injury affecting the whole thing because of shear stress that almost causes your brain to twist on itself — it causes damage to the longest connections in the brain, which go from the orbitofrontal cortex into the limbic system, a specific circuit. That circuit seems to be disproportionately affected in these patients.
What did your study do?
We set out to try to design a brain stimulation treatment for these patients. In the process of designing that treatment, we had to find the right targets.
So you applied precision functional mapping of brain network connectivity to functional MRI data, and you also previously had done a pilot clinical trial using brain stimulation?
We designed a clinical trial where we did individualized brain mapping to the networks that we hypothesized were involved in TBI-associated depression. And it worked, at least in the pilot study. We only treated about nine patients and five controls, but it worked. And we were excited about this because no other treatment had been shown to work for these people.
But the targets that we used were speculative. It was a hypothesis. We never proved that they were the right targets. One big lingering question that I had in my mind is, before we spend $5 million launching a multi-center clinical trial, I really want to get a little more confidence in the target that we’re using.
Then we did this analysis to try to determine if this network was actually abnormal in these patients. And the more data we looked at, the more we found the same answer.
What did this confirm?
Unlike other psychiatric disorders, TBI caused a sort of structural reorganization of the brain. And because of that, you have to map each person’s individual brain. … We didn’t have that technology until very recently.
Now that we’ve got the technology to map individual brains, we can detect these differences. And we tested that in the study. It turns out that the individualized mapping does significantly better than using sort of group-level assumptions about where the networks are located.
Any caveats?
We didn’t prove that this network is causally involved in TBI-associated depression. The one thing that we still don’t know: Is it damage to the network that’s causing the depression after TBI or is it something else in the healing process that is leading to some sort of damage to this network, as sort of an after-effect or some sort of compensation? That’s something that we want to study, by watching people longitudinally.
One thing that we’d like to do in this longitudinal study is to do a more careful and sophisticated phenotyping so that we can get a more clear idea of whether there are specific symptom patterns that correlate with these specific connectivity patterns.
How long might that take?
I think the trial will take four or five years at most to run. If it’s successful, then we should be seeing this individualized, personalized treatment in the not too distant future. That’s the individualized, personalized treatment. We already have an FDA-cleared brain stimulation treatment for depression. There are some studies that suggest that it works just as well for people with traumatic brain injury.
I think the fact that this is a distinct disorder is something that we’ve been looking for confirmation of in the clinic for a long time. So I think we can already use that information to help us think about our patients a little bit differently.
What’s the bottom line?
Among clinicians, there is an ongoing debate about when people develop depression after traumatic brain injury, whether it’s related to the physical trauma of the brain injury or the emotional trauma associated with the brain injury. And I think this work adds more evidence in the camp that it’s probably due to the physical trauma rather than the emotional trauma. We’ve seen in the past when we show that certain things have detectable changes in the brain, it influences policymakers to think about them differently.
What do you say to patients?
That there’s actually physical brain damage associated with the depression. I think that that’s important to tell these patients, even though emotional trauma is important, just as important potentially. But then people feel more legitimized when it’s related to the physical trauma.
Why depression after traumatic brain injury is distinct — and less likely to respond to standard treatment
Read more: https://www.statnews.com/2023/07/06/dep ... in-injury/
Precision functional MRI mapping reveals distinct connectivity patterns for depression associated with traumatic brain injury
Read the study: https://www.science.org/doi/10.1126/sci ... ed.abn0441
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greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
"But not everyone who hits their head skiing or playing hockey or just falling down the stairs at home gets medical care
"But not everyone who hits their head skiing or playing hockey or just falling down the stairs at home gets medical care"
Four days completely gone.
“I didn’t know what happened to me,” Ethan McLeod said. “I thought I had COVID.”
Nope. Just a broken face — and a traumatic brain injury.
After he crashed while downhill skiing at Grand Targhee Resort in Alta on Jan. 9, 2022, McLeod, 27, was life-flighted to Eastern Idaho Regional Medical Center in Idaho Falls. But no one knew who he was. He’d been skiing alone and left his ID in his car.
Friends finally tracked him down and alerted his parents in Boise, Idaho. A doctor offered to do the facial reconstruction surgery that McLeod needed, but he’d never done it before, McLeod said.
So McLeod was flown to the University of Utah Medical Center in Salt Lake City. That’s where he regained consciousness — a tube doing his breathing for him, his jaw wired shut — on Jan. 13, 2022. And that’s where he had the surgery to put his face back together.
The best he can figure more than a year later is that he hit a tree after skiing somewhat recklessly that day. Someone found him there, at the base of a tree. He thinks he’d been there for at least 15 minutes.
McLeod is one of the lucky ones.
According to the Centers for Disease Control and Prevention, about 1.5 million Americans sustain traumatic brain injuries annually and about 230,000 of them are hospitalized. Of those, about 50,000 people die each year from their injuries.
But not everyone who hits their head skiing or playing hockey or just falling down the stairs at home gets medical care. Many are not even sure what happened. They’ve simply sustained a concussion, which is a type of traumatic brain injury that happens when the head and brain move rapidly back and forth.
About 1.6 million to 3.8 million Americans sustain a sports- and recreation-related concussion annually, according to the CDC.
And when it comes to contact sports, dealing with concussions and concussion protocol and managing symptoms and treatment is an inexact science that continues to evolve, especially in a place as active as Jackson Hole.
From downhill skiing to ice hockey to mountain biking, not to mention youth and high school sports such as football and soccer, there’s no shortage of opportunities for the human skull to come in contact with the ground, the ice or another athlete.
But how do you lower the risk? Should kids not play contact sports? Should a concussion signal an automatic end to a player’s season?
“The sport isn’t the problem,” said Hayden Hilke, owner of Peak Physical Therapy in Wilson. “It’s how we manage these incidents and these injuries.”
Hilke also runs Watershed Jackson, a nonprofit organization that aims to raise awareness regarding area athletes who have sustained spinal cord or traumatic brain injuries. He and other stakeholders thought they had a solution back in 2019 to lower the concussion rate and generally improve outcomes, by providing annual concussion baseline-testing and introducing a concussion management plan via medical providers, St. John’s Health, physical therapists and the Teton County School District, among others.
But then came the pandemic.
“We were just gaining momentum, and then the bottom fell out,” Hilke said.
In November 2019, Hilke spearheaded a concussion baseline screening night at Snow King Sports and Events Center, uniting medical providers, physical therapists, speech-language pathologists and St. John’s Health to build a community plan around concussion protocol.
Youth athletes from Jackson Youth Hockey and the Jackson Hole Ski and Snowboard Club, among others, received baseline tests that measure brain function, which can later help diagnose concussions through comparative testing.
A few months before that evening at Snow King a newly formed concussion support group met in a common area of St. John’s Health. Chris Smithwick, a speech-language pathologist with Teton Physical Therapy and Rehabilitation who would later choose the tests for that baseline screening night, and Oliver Goss, a St. John’s social worker, organized the group.
About eight people showed for that first monthly group in the spring of 2019, Smithwick said. But it lasted only around five months, he said, as attendance tapered.
“I’ve been asking myself, ‘Why did that happen?’” Smithwick said earlier this month.
Summer came and people got busy. It’s hard to push through summertime traffic to get to a late-afternoon meeting on the east side of Jackson. Maybe the meetings needed to be held more often?
Whatever it was, Smithwick and fellow Teton Physical Therapy therapist Margaret Blair put in countless volunteer hours developing the baseline testing program, said Lindsay Love, director of rehabilitation at Teton Physical Therapy.
“The hours that those two spent developing this program and pouring into this was remarkable,” Love said, sitting in her office at Teton Physical Therapy in East Jackson.
Love and Hilke did a lot of work together, too, trying to get a community-based concussion plan off the ground.
“Our real goal was to have everybody have these baseline screens, everybody who was involved in club or any organized sports in town, so they had just something to give us a measure to look back at. We did a lot of research.”
The thinking was, “Let’s get in on this at the forefront, and let’s be one of these models for a community-based concussion program,” Love said. “And I am 90% sure that we would have gotten to a place that was really good and useful and well received with some tweaking and changes and we were on that path if we hadn’t had that [pandemic] shutdown.”
The shutdown, of course, affected staffing and resources.
“It was all professional staff volunteering time to provide these [baseline] screens, which is difficult to sustain,” Love said. “We needed a lot of volunteers for each team.”
As they began running out of volunteers to staff the effort, the goal shifted to organizing a baseline testing day for the Teton County School District student-athletes.
“And we had it pretty dialed at that point, how it worked,” Love said. But, again, then came COVID in 2020. And then came the staffing shortages.
“Even if we reinvented how we were going to do things, health care was in a different place, so we were dealing with COVID and not dealing with concussion or a lot of other things. ... at that time,” she said.
But a lot of parents still want their children baseline-tested before playing contact sports, Love said. So Teton Physical Therapy still provides that, but it’s not free.
Cumulative impact
Hilke said the No. 1 sport she receives calls about is hockey.
“I get four or five calls a season,” she said, from parents whose children sustained a concussion or are suspected of sustaining one.
But not all youth hockey teams baseline-test, she said. It depends on the team and the parents, Hilke said.
“I definitely see it vary from program to program,” said Dr. Travis Riddell, a Jackson pediatrician and Teton County’s health officer. “It seems like the schools are more on top of it than the club sports, and definitely more driven by parents.”
Riddell doesn’t see a need to mandate public baseline scoring for student-athletes because it’s “not a public health threat.” But if baseline testing allows for a better diagnosis of concussions and for better management of head injuries, “then why not do it, from a parent perspective?” he said.
“I worry about the cumulative impacts of these [concussions],” Riddell said. “Even sub-concussive,” a bump or blow to head that doesn’t cause symptoms, “blows can have an effect over time.”
That’s why baseline testing is so important, experts say.
“I think that’s sort of what we would like to see happen, where it’s just normal to see the kid’s base-lined,” Hilke said. “But I don’t know of any community that’s been able to sustain it.”
A sustaining concussion management program — where student-athletes are regularly given baseline tests, where coaches and trainers regularly give sideline tests that compare scores to those baseline tests, where there is a flow chart of treatment protocol around head injuries — St. John’s Health needs to be a major player, Hilke said.
“I’d love to see it be in place again,” Dr. Jim Little Jr., chief of staff at St. John’s Health, of the concussion program that was gaining momentum. “But we can’t do it by ourselves. We can’t take care of all the baseline testing.” The hospital would need volunteers in the form of therapists, trainers, parents, etc., Little said.
‘I have a story’
Whatever happens, McLeod, who endured a face-shattering concussion on the slopes of Targhee, wants to be involved.
“Just so people can have support,” said McLeod, who today has only a small scar on his chin to remind him of what happened.
But the head injury you don’t see. The damage to the frontal lobe of his brain, you don’t see.
He had trouble with multitasking and impulsivity for months, he said. He did physical therapy and occupational therapy and speech therapy at a neuro outpatient program in Idaho. He was eventually OK’d to drive a car again. He has three metal plates in his face from the surgery.
“I learned a lot,” said McLeod, who was able to go stay with his parents in Boise for months and slowly recover and who recently returned to the slopes. “And I have a story, and I think there’s value in that story.”
McLeod said he was able to recover and is doing well today “because I had the tools and resources, but I realize that a lot of people who get brain injuries don’t have that.”
He was insured under the Affordable Care Act and he was able to sleep whenever he needed to at his parents’ home in Boise.
“It has changed my life in general,” McLeod said.
He recently reached out to both Hilke and Smithwick and is taking the lead on reestablishing a concussion/TBI support group.
“There’s definitely interest in it,” Smithwick said.
Smithwick and Riddell both mentioned research in the last decade that disputes the ages-old theory that all concussion sufferers need to sit in a dark room and remain inactive for weeks.
“One of the hardest things that people experience with concussion is that it can be really confusing, the balance between doing too little or too much,” Smithwick said. “What is the balance?”
Do too much too soon and it can be overwhelming, he said. But do too little and then symptoms might not improve.
“Graded exposure” is the answer, Smithwick said. That means a gradual return to school or work or athletics.
It’s a “big myth” that all concussion sufferers should retreat and avoid activity, he said.“If you can tolerate mild symptoms, that’s a good sign.”
Hilke is hoping momentum to the concussion debate in Jackson can be restored before a real tragedy happens.
“I think it’s the best community in the entire universe, and we could do anything together,” Hilke said. “It just takes a lot of factors to get the ball back rolling. We lost a lot of momentum.”
“Unfortunately, it takes something happening before everyone says, ‘Oh wait a minute, did we have a plan?’”
Head games: Seeking consensus on concussion
Read more (fyi graphic photo): https://www.jhnewsandguide.com/special/ ... 49478.html
Four days completely gone.
“I didn’t know what happened to me,” Ethan McLeod said. “I thought I had COVID.”
Nope. Just a broken face — and a traumatic brain injury.
After he crashed while downhill skiing at Grand Targhee Resort in Alta on Jan. 9, 2022, McLeod, 27, was life-flighted to Eastern Idaho Regional Medical Center in Idaho Falls. But no one knew who he was. He’d been skiing alone and left his ID in his car.
Friends finally tracked him down and alerted his parents in Boise, Idaho. A doctor offered to do the facial reconstruction surgery that McLeod needed, but he’d never done it before, McLeod said.
So McLeod was flown to the University of Utah Medical Center in Salt Lake City. That’s where he regained consciousness — a tube doing his breathing for him, his jaw wired shut — on Jan. 13, 2022. And that’s where he had the surgery to put his face back together.
The best he can figure more than a year later is that he hit a tree after skiing somewhat recklessly that day. Someone found him there, at the base of a tree. He thinks he’d been there for at least 15 minutes.
McLeod is one of the lucky ones.
According to the Centers for Disease Control and Prevention, about 1.5 million Americans sustain traumatic brain injuries annually and about 230,000 of them are hospitalized. Of those, about 50,000 people die each year from their injuries.
But not everyone who hits their head skiing or playing hockey or just falling down the stairs at home gets medical care. Many are not even sure what happened. They’ve simply sustained a concussion, which is a type of traumatic brain injury that happens when the head and brain move rapidly back and forth.
About 1.6 million to 3.8 million Americans sustain a sports- and recreation-related concussion annually, according to the CDC.
And when it comes to contact sports, dealing with concussions and concussion protocol and managing symptoms and treatment is an inexact science that continues to evolve, especially in a place as active as Jackson Hole.
From downhill skiing to ice hockey to mountain biking, not to mention youth and high school sports such as football and soccer, there’s no shortage of opportunities for the human skull to come in contact with the ground, the ice or another athlete.
But how do you lower the risk? Should kids not play contact sports? Should a concussion signal an automatic end to a player’s season?
“The sport isn’t the problem,” said Hayden Hilke, owner of Peak Physical Therapy in Wilson. “It’s how we manage these incidents and these injuries.”
Hilke also runs Watershed Jackson, a nonprofit organization that aims to raise awareness regarding area athletes who have sustained spinal cord or traumatic brain injuries. He and other stakeholders thought they had a solution back in 2019 to lower the concussion rate and generally improve outcomes, by providing annual concussion baseline-testing and introducing a concussion management plan via medical providers, St. John’s Health, physical therapists and the Teton County School District, among others.
But then came the pandemic.
“We were just gaining momentum, and then the bottom fell out,” Hilke said.
In November 2019, Hilke spearheaded a concussion baseline screening night at Snow King Sports and Events Center, uniting medical providers, physical therapists, speech-language pathologists and St. John’s Health to build a community plan around concussion protocol.
Youth athletes from Jackson Youth Hockey and the Jackson Hole Ski and Snowboard Club, among others, received baseline tests that measure brain function, which can later help diagnose concussions through comparative testing.
A few months before that evening at Snow King a newly formed concussion support group met in a common area of St. John’s Health. Chris Smithwick, a speech-language pathologist with Teton Physical Therapy and Rehabilitation who would later choose the tests for that baseline screening night, and Oliver Goss, a St. John’s social worker, organized the group.
About eight people showed for that first monthly group in the spring of 2019, Smithwick said. But it lasted only around five months, he said, as attendance tapered.
“I’ve been asking myself, ‘Why did that happen?’” Smithwick said earlier this month.
Summer came and people got busy. It’s hard to push through summertime traffic to get to a late-afternoon meeting on the east side of Jackson. Maybe the meetings needed to be held more often?
Whatever it was, Smithwick and fellow Teton Physical Therapy therapist Margaret Blair put in countless volunteer hours developing the baseline testing program, said Lindsay Love, director of rehabilitation at Teton Physical Therapy.
“The hours that those two spent developing this program and pouring into this was remarkable,” Love said, sitting in her office at Teton Physical Therapy in East Jackson.
Love and Hilke did a lot of work together, too, trying to get a community-based concussion plan off the ground.
“Our real goal was to have everybody have these baseline screens, everybody who was involved in club or any organized sports in town, so they had just something to give us a measure to look back at. We did a lot of research.”
The thinking was, “Let’s get in on this at the forefront, and let’s be one of these models for a community-based concussion program,” Love said. “And I am 90% sure that we would have gotten to a place that was really good and useful and well received with some tweaking and changes and we were on that path if we hadn’t had that [pandemic] shutdown.”
The shutdown, of course, affected staffing and resources.
“It was all professional staff volunteering time to provide these [baseline] screens, which is difficult to sustain,” Love said. “We needed a lot of volunteers for each team.”
As they began running out of volunteers to staff the effort, the goal shifted to organizing a baseline testing day for the Teton County School District student-athletes.
“And we had it pretty dialed at that point, how it worked,” Love said. But, again, then came COVID in 2020. And then came the staffing shortages.
“Even if we reinvented how we were going to do things, health care was in a different place, so we were dealing with COVID and not dealing with concussion or a lot of other things. ... at that time,” she said.
But a lot of parents still want their children baseline-tested before playing contact sports, Love said. So Teton Physical Therapy still provides that, but it’s not free.
Cumulative impact
Hilke said the No. 1 sport she receives calls about is hockey.
“I get four or five calls a season,” she said, from parents whose children sustained a concussion or are suspected of sustaining one.
But not all youth hockey teams baseline-test, she said. It depends on the team and the parents, Hilke said.
“I definitely see it vary from program to program,” said Dr. Travis Riddell, a Jackson pediatrician and Teton County’s health officer. “It seems like the schools are more on top of it than the club sports, and definitely more driven by parents.”
Riddell doesn’t see a need to mandate public baseline scoring for student-athletes because it’s “not a public health threat.” But if baseline testing allows for a better diagnosis of concussions and for better management of head injuries, “then why not do it, from a parent perspective?” he said.
“I worry about the cumulative impacts of these [concussions],” Riddell said. “Even sub-concussive,” a bump or blow to head that doesn’t cause symptoms, “blows can have an effect over time.”
That’s why baseline testing is so important, experts say.
“I think that’s sort of what we would like to see happen, where it’s just normal to see the kid’s base-lined,” Hilke said. “But I don’t know of any community that’s been able to sustain it.”
A sustaining concussion management program — where student-athletes are regularly given baseline tests, where coaches and trainers regularly give sideline tests that compare scores to those baseline tests, where there is a flow chart of treatment protocol around head injuries — St. John’s Health needs to be a major player, Hilke said.
“I’d love to see it be in place again,” Dr. Jim Little Jr., chief of staff at St. John’s Health, of the concussion program that was gaining momentum. “But we can’t do it by ourselves. We can’t take care of all the baseline testing.” The hospital would need volunteers in the form of therapists, trainers, parents, etc., Little said.
‘I have a story’
Whatever happens, McLeod, who endured a face-shattering concussion on the slopes of Targhee, wants to be involved.
“Just so people can have support,” said McLeod, who today has only a small scar on his chin to remind him of what happened.
But the head injury you don’t see. The damage to the frontal lobe of his brain, you don’t see.
He had trouble with multitasking and impulsivity for months, he said. He did physical therapy and occupational therapy and speech therapy at a neuro outpatient program in Idaho. He was eventually OK’d to drive a car again. He has three metal plates in his face from the surgery.
“I learned a lot,” said McLeod, who was able to go stay with his parents in Boise for months and slowly recover and who recently returned to the slopes. “And I have a story, and I think there’s value in that story.”
McLeod said he was able to recover and is doing well today “because I had the tools and resources, but I realize that a lot of people who get brain injuries don’t have that.”
He was insured under the Affordable Care Act and he was able to sleep whenever he needed to at his parents’ home in Boise.
“It has changed my life in general,” McLeod said.
He recently reached out to both Hilke and Smithwick and is taking the lead on reestablishing a concussion/TBI support group.
“There’s definitely interest in it,” Smithwick said.
Smithwick and Riddell both mentioned research in the last decade that disputes the ages-old theory that all concussion sufferers need to sit in a dark room and remain inactive for weeks.
“One of the hardest things that people experience with concussion is that it can be really confusing, the balance between doing too little or too much,” Smithwick said. “What is the balance?”
Do too much too soon and it can be overwhelming, he said. But do too little and then symptoms might not improve.
“Graded exposure” is the answer, Smithwick said. That means a gradual return to school or work or athletics.
It’s a “big myth” that all concussion sufferers should retreat and avoid activity, he said.“If you can tolerate mild symptoms, that’s a good sign.”
Hilke is hoping momentum to the concussion debate in Jackson can be restored before a real tragedy happens.
“I think it’s the best community in the entire universe, and we could do anything together,” Hilke said. “It just takes a lot of factors to get the ball back rolling. We lost a lot of momentum.”
“Unfortunately, it takes something happening before everyone says, ‘Oh wait a minute, did we have a plan?’”
Head games: Seeking consensus on concussion
Read more (fyi graphic photo): https://www.jhnewsandguide.com/special/ ... 49478.html
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
“We have to act with what we know now. And what we know now is pretty convincing.”
“We have to act with what we know now. And what we know now is pretty convincing.”
In a statement Wednesday, the Concussion in Sport Group, a panel of the world’s leading experts on concussion and head trauma, stopped short of definitively linking the brain disease CTE with repeated head trauma.
CTE, a brain disease diagnosed after death through autopsy, has gained notoriety for its prominence among former NFL players who have struggled with symptoms like dementia and suicide. The US Centers for Disease Control and Prevention says “the research to date suggests that CTE is caused in part by repeated traumatic brain injuries, including concussions, and repeated hits to the head, called subconcussive head impacts.”
However, in the sixth and latest International Consensus Statement on Concussion in Sport, published Wednesday in the British Journal of Sports Medicine, the concussion group says “It is reasonable to consider extensive exposure to repetitive head impacts, such as that experienced by some professional athletes, as potentially associated with the development of the specific neuropathology” described as CTE.
The consensus statement is used as guidance for protocol for many international sporting leagues, including soccer’s FIFA and the International Olympic Committee.
“The CISG statement on CTE, and their refusal to clearly acknowledge a causal relationship between contact sports participation and CTE, is a danger to the public,” Chris Nowinski, co-founder and CEO of the Concussion Legacy Foundation, said in a statement to CNN. “On the question of CTE causation, we urge the public to listen to the statements of independent organizations like the National Institutes of Health (USA), Centers for Disease Control and Prevention (USA), and National Health Service (UK), all of whom have concluded that CTE is caused by repeated traumatic brain injuries.”
Study finds that nearly 92% of former NFL players have brain disease
The Concussion Legacy Foundation and Boston University’s CTE Center have spearheaded much of the research around the condition in the United States. The most recent research from the BU/CTE Center found that nearly 92% of 376 former NFL players who were studied were diagnosed with the brain disease, which can cause changes to the brain and manifest in a variety of symptoms including memory loss, confusion, aggression, depression and even suicidality. Research has found that severe cases of the disease to have progressed to dementia.
However, there is a potential bias in these numbers because the brains donated were probably submitted by relatives who noticed these symptoms in their family members when they were living.
The consensus statement noted that the review from the Concussion in Sport Group took over five years and was informed by 10 systematic reviews of the most current CTE studies but that many of “these studies of former athletes are not cohort studies that can examine causation or quantify risk and thus were not included in the systematic review.”
Cohort studies are used in epidemiology and follow groups of people with common characteristics over a long period of time, comparing them with a group that hasn’t had the same environmental exposure – in this case, repeated head trauma.
‘We have to act on what we know now’
“There are researchers out there who, rightfully so, want really strong data. We all should be striving for very strong evidence, but it’s very hard to come by in environmental exposure cases like this,” said neuroscientist Julie Stamm, a clinical assistant professor in the Department of Kinesiology at the University of Wisconsin-Madison who was not involved in the consensus statement.
She agreed that cohort studies will yield the best evidence regarding CTE, “but that’s going to take decades,” she said.
Dr. Nsini Umoh, program director of the National Institute of Neurological Disorders and Stroke, agreed that the data was strong regarding the relationship between repeated head trauma and CTE. She said her group, a division of the US National Institutes of Health, updated its own description of CTE to say it “is caused in part by repeated traumatic brain injuries.”
“Based on the body of evidence, that’s what the research was suggesting,” said Umoh, who also was not involved in the consensus statement.
Stamm agreed that there was still much to understand about CTE. “Scientifically looking at it, yeah, we have so much to learn yet,“ but she worried how this position statement could be interpreted.
“It can be used by different organizations or individuals to say, ‘Oh, well, everything’s OK. They didn’t say there was a connection. So there’s not a connection,’ ” Stamm said.
“We have to act with what we know now,” she said. “And what we know now is pretty convincing.”
Experts say influential group’s guidance on CTE is too weak
https://www.cnn.com/2023/06/14/health/c ... nce-debate
In a statement Wednesday, the Concussion in Sport Group, a panel of the world’s leading experts on concussion and head trauma, stopped short of definitively linking the brain disease CTE with repeated head trauma.
CTE, a brain disease diagnosed after death through autopsy, has gained notoriety for its prominence among former NFL players who have struggled with symptoms like dementia and suicide. The US Centers for Disease Control and Prevention says “the research to date suggests that CTE is caused in part by repeated traumatic brain injuries, including concussions, and repeated hits to the head, called subconcussive head impacts.”
However, in the sixth and latest International Consensus Statement on Concussion in Sport, published Wednesday in the British Journal of Sports Medicine, the concussion group says “It is reasonable to consider extensive exposure to repetitive head impacts, such as that experienced by some professional athletes, as potentially associated with the development of the specific neuropathology” described as CTE.
The consensus statement is used as guidance for protocol for many international sporting leagues, including soccer’s FIFA and the International Olympic Committee.
“The CISG statement on CTE, and their refusal to clearly acknowledge a causal relationship between contact sports participation and CTE, is a danger to the public,” Chris Nowinski, co-founder and CEO of the Concussion Legacy Foundation, said in a statement to CNN. “On the question of CTE causation, we urge the public to listen to the statements of independent organizations like the National Institutes of Health (USA), Centers for Disease Control and Prevention (USA), and National Health Service (UK), all of whom have concluded that CTE is caused by repeated traumatic brain injuries.”
Study finds that nearly 92% of former NFL players have brain disease
The Concussion Legacy Foundation and Boston University’s CTE Center have spearheaded much of the research around the condition in the United States. The most recent research from the BU/CTE Center found that nearly 92% of 376 former NFL players who were studied were diagnosed with the brain disease, which can cause changes to the brain and manifest in a variety of symptoms including memory loss, confusion, aggression, depression and even suicidality. Research has found that severe cases of the disease to have progressed to dementia.
However, there is a potential bias in these numbers because the brains donated were probably submitted by relatives who noticed these symptoms in their family members when they were living.
The consensus statement noted that the review from the Concussion in Sport Group took over five years and was informed by 10 systematic reviews of the most current CTE studies but that many of “these studies of former athletes are not cohort studies that can examine causation or quantify risk and thus were not included in the systematic review.”
Cohort studies are used in epidemiology and follow groups of people with common characteristics over a long period of time, comparing them with a group that hasn’t had the same environmental exposure – in this case, repeated head trauma.
‘We have to act on what we know now’
“There are researchers out there who, rightfully so, want really strong data. We all should be striving for very strong evidence, but it’s very hard to come by in environmental exposure cases like this,” said neuroscientist Julie Stamm, a clinical assistant professor in the Department of Kinesiology at the University of Wisconsin-Madison who was not involved in the consensus statement.
She agreed that cohort studies will yield the best evidence regarding CTE, “but that’s going to take decades,” she said.
Dr. Nsini Umoh, program director of the National Institute of Neurological Disorders and Stroke, agreed that the data was strong regarding the relationship between repeated head trauma and CTE. She said her group, a division of the US National Institutes of Health, updated its own description of CTE to say it “is caused in part by repeated traumatic brain injuries.”
“Based on the body of evidence, that’s what the research was suggesting,” said Umoh, who also was not involved in the consensus statement.
Stamm agreed that there was still much to understand about CTE. “Scientifically looking at it, yeah, we have so much to learn yet,“ but she worried how this position statement could be interpreted.
“It can be used by different organizations or individuals to say, ‘Oh, well, everything’s OK. They didn’t say there was a connection. So there’s not a connection,’ ” Stamm said.
“We have to act with what we know now,” she said. “And what we know now is pretty convincing.”
Experts say influential group’s guidance on CTE is too weak
https://www.cnn.com/2023/06/14/health/c ... nce-debate
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Re: concussions
How Dangerous Are Soccer Concussions? They May Cause Lasting Damage
As the 2023 Women’s World Cup kicks off, repeated concussions and head injuries in the sport raise discussion about the lifelong consequences on the brain
• By Lauren J. Young on July 18, 2023
Briana Scurry, photographed in her Mount Pleasant apartment in Washington, D.C., on October 15, 2013. She's lived with chronic headaches from a concussion in 2010. Credit: Marvin Joseph/The Washington Post via Getty Images
An epic clash in women’s soccer starts Thursday in Australia and New Zealand as 32 teams vie for the 2023 International Federation of Association Football (FIFA) Women’s World Cup, and the U.S. national team strives for an unprecedented three-peat. But also gaining attention are clashes of a different sort: high-speed hits to players’ heads. New research highlights the danger of concussions and potential long-term brain damage in an aggressive sport that already has many star players sitting out of the World Cup because of various types of bodily injuries. When it comes to concussions, the new studies point to some ways to improve players’ protection and health.
Briana Scurry knows about all this firsthand. As a soccer goalie, she never thought twice before blocking a ball. The two-time Olympic gold medalist and 1999 World Cup Champion routinely faced down dozens of players barreling straight at her, leapt toward soccer balls catapulted at 50 miles per hour and fearlessly plunged into a scramble of knees and feet to make a save. “You don’t even really care, at the time, about all these people. You just fly in there headfirst,” Scurry says. “It’s an acquired taste to be a goalkeeper.”
During a match in April 2010 for the Washington Freedom (a former Washington, D.C., team in the Women’s Professional Soccer league, which has been replaced with the National Women's Soccer League), she bent down to stop a low shot when a Philadelphia Independence forward slammed her knee into Scurry’s right temple. The forward tried to pull away at the last second to avoid Scurry, but they both bundled over. “My first thought is, ‘Did I make the save?’” Scurry recalls. She did. But when she stood up to kick the ball back into play, she immediately knew something was off. She felt woozy, and the names on her teammates’ jerseys started to blur. Most noticeably, she had an intense pain in her right temple and a throbbing behind her left ear. Scurry later found out that the blow resulted in a traumatic brain injury that smashed her occipital nerve.
“That was the last game I played,” Scurry says. “Before I knew it, it was season-ending because I wasn’t getting better—and then it was career-ending.”
This wasn’t the first head injury Scurry experienced on the field. She had three prior documented concussions—and she suspects she has had “maybe dozens” more that went undocumented or undetected over her decades-long soccer career. Research estimates suggest sports and recreation result in up to 3.8 million concussions in the U.S. each year and that about half of those go unreported. Head injuries are most common in high-contact sports, including hockey, boxing and lacrosse, and American football alone accounts for approximately 300,000 concussions a year. Even “softer” contact sports, such as water polo, volleyball, basketball and soccer, can place players at risk of head injuries and concussions. A 2019 study of U.S. high school athletes published in Pediatrics found that soccer had the highest concussion rate among girls’ teams and the fifth highest among boys’ teams.
“It’s important to remember all of the other types of sports that can cause concussion, and soccer is actually one of the highest-risk sports,” says Lissa Baird, a pediatric neurosurgeon at Boston Children’s Hospital and an associate professor at Harvard Medical School. “Sports carry huge benefits for people of all ages, especially kids, but the cumulative risk of concussions over time can have really profound impacts on somebody’s quality of life.”
AN INVISIBLE INJURY
Though soccer isn’t normally considered a high-contact sport, the nature of the game can involve hard spills and hits from the ball, the ground and other players. People might not realize “how dangerous it actually is,” Scurry says. “As it’s gotten higher-competition, higher-stakes, you have more collisions,” she notes. “And those collisions are coming at a high rate of speed.”
The head’s sudden change in speed during an impact can cause a “kind of ricochet of the brain,” which floats in cerebrospinal fluid inside the skull, Baird explains. Such a ricochet actually stretches the brain’s neurons, which may disrupt the cells’ crucial connectivity and the flow of neurotransmitters. But signs of concussion are difficult to measure and detect, both on and off the field.
“It’s an invisible injury, so people tend to mask their symptoms,” says Teena Shetty, an associate attending neurologist at the Hospital for Special Surgery and associate professor of clinical neurology at Weill Cornell Medicine/New York-Presbyterian Hospital. “It’s not like a heart attack, where you can look at an EKG waveform and bloodwork, or an ACL injury where you can see it on an MRI.”
With concussions, neuroimaging scans typically show no signs of bleeding, bruising or other abnormalities in the brain. It usually triggers symptoms including headaches, fatigue, nausea, dizziness, blurry vision and cognitive dysfunction that could last a few days to months. Scurry says her April 2010 traumatic brain injury left her with a constellation of symptoms over the course of years. While Scurry “looked fine,” she had problems with light sensitivity, sleep, memory and balance, and a constant radiating pain behind her left ear, which eventually required surgery on her occipital nerve. The injury also took a significant toll on her mental health, she says, as she dealt with depression and anxiety. “Of all my years playing and training, my mental fitness was my greatest asset. I could focus on a ball with 90,000 people on the World Cup final looking at me in 107 degrees on the pitch,” she says. “A lot of people suffer in silence with regards to head injury and mental health.”
The severity and duration of concussion symptoms can vary immensely. Research has indicated that women present more severe symptoms and have longer recovery times, for example. And the variability is even more complex from person to person because every brain is “unique,” says Angela Lumba-Brown, a clinical associate professor of emergency medicine and pediatrics at Stanford University, who studies concussion subtypes. “We know that some people will present with the most common symptoms of headache and nausea, but then another person might mainly present with mood disruption and balance problems,” says Lumba-Brown, who sustained concussions herself while playing basketball in high school. "It really depends on the person and not necessarily where they got hit or even how they got hit.”
A player who recently sustained a concussion is more vulnerable to another concussion or injury, Lumba-Brown says. Repeatedly heading the ball has also raised alarm. In 2016 U.S. Club Soccer announced a no-heading rule for those younger than 11 and limited heading for players 13 and under; the U.K.’s Football Association is running a similar trial recommendation for those under 12. “A single header to the ball may not result in concussion immediately, but those cumulative impacts can definitely take their toll,” Baird says.
A LONG SHADOW
Multiple concussions—including repeated subconcussive impacts from heading the ball—have stirred discussion about the potential risk of future neurological conditions. A 2019 study published in the New England Journal of Medicine found that neurodegenerative disease was the primary cause of death in 1.7 percent of former male professional Scottish soccer players—approximately three times higher than in the general population. “That is a huge association,” says Peter Ueda, an assistant professor in clinical epidemiology at the Karolinska Institute in Sweden.
Ueda and his team wanted to see if similar trends could be seen in top-division Swedish soccer players. Their results, published in April in the Lancet, found soccer players had an approximately 1.5 times greater risk of Alzheimer’s disease and other dementias. “We don’t know whether this [data] is applicable to current elite players,” Ueda says. “Maybe they have a lower risk because they’re better equipped, and they have more professional [physical therapists]. Or maybe they are higher-risk because they start playing from a very early age, which they didn’t necessarily do back in the day.” He notes that trends are still emerging because many former professional players are just beginning to reach the age when these neurodegenerative diseases usually develop. Data are especially limited for women, who haven’t had the opportunity to play professionally for as long as men.
These long-term health implications have become “a big concern in the soccer community” and the public, Ueda says. On England’s 1966 World Cup team, four of the five players diagnosed with dementia recently died from it. In May three professional soccer players were diagnosed postmortem with chronic traumatic encephalopathy (CTE), a degenerative brain disease commonly studied among professional American football athletes and in other high-contact sports. CTE can present as dementia, mood swings and depression, but having any one of those conditions does not necessarily mean someone has CTE, Ueda says. The only way to diagnose the disease is through a postmortem autopsy, but even then, determining the exact causes is difficult.
“It’s not going to be possible to say CTE came from the five collisions and bad concussions you had in your career or the 10 years of heading the ball,” Lumba-Brown says. “But what the research does suggest, importantly, is that participation in professional soccer and elite soccer may result an increased risk for CTE as compared to general populations.”
A PATH TO SAFER PLAY
For now Lumba-Brown and Scurry advise focusing on treating symptoms immediately and with appropriate care. Shetty says concussions require a multidisciplinary treatment, which may include physical and cognitive therapy. Longer-term care could require lifestyle modifications or even a change of sport. “I usually will tell my patients if they have more than two concussions playing a sport, they really should look for a different sport that’s a little bit safer for them,” Baird says.
Scurry says she had to “reboot” her brain through treatment. Today, at 51, “my brain is in a really good place,” she says. Now she spreads awareness about head injuries and concussions in soccer to help prevent them. Rigorous medical policies and protocols should be enforced by governing bodies and soccer leagues to promote change, she says. “We are still in the dark ages of asking the player if they’re okay when they’ve been knocked out,” Scurry adds. “It’s part of the culture of sports: shake it off and get on with it. A head injury, you don’t shake off.”
ADVERTISEMENT
Professional soccer leagues and federations, including FIFA and the U.S. Major Soccer League, have official medical concussion protocols with preseason tests to establish neurocognitive baselines that give players a point of reference after an impact. They also conduct multiphase, on-site diagnoses and examinations. For the 2022 Men’s World Cup in Qatar, FIFA introduced an independent concussion assessment and rehabilitation service to assess any player who suffered a brain injury. This service included consultations with concussion experts to decide whether a player should remain in the game. Medical staff members and services, including injury spotters and replay video tablets to medically review collisions, were made available. FIFA also allowed one extra permanent substitute player per team for those who experienced actual or suspected concussions. According to a FIFA spokesperson, “A similar approach will be implemented for the FIFA Women’s World Cup 2023 as the wellbeing of all players involved remains FIFA’s priority.”
On the field, Baird says measures such as installing padding on goalposts can offer some simple protections. Players can also wear gear such as headbands and collars crafted to help dissipate an impact. Such devices are becoming more readily available, but Shetty says there’s still not enough evidence to medically support the safety and effectiveness of these early designs.
Scurry says more can still be done to protect player health and safety on and off the field. She continues to push for improved on-site third-party head injury evaluation after collisions, as well as training for coaches, staff and players to identify the signs and symptoms of a concussion. Importantly, Scurry hopes to shift the culture of injury in sports.
“I talk about this because I want to try to save that 18-year-old who has had a head injury, who’s trying to fight through it and doesn’t really understand why she doesn’t feel the way she used to,” Scurry says. “I want to get her understand that she’s okay, but she might need some help. It doesn’t mean you’re weak.”
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https://www.scientificamerican.com/arti ... ng-damage/
As the 2023 Women’s World Cup kicks off, repeated concussions and head injuries in the sport raise discussion about the lifelong consequences on the brain
• By Lauren J. Young on July 18, 2023
Briana Scurry, photographed in her Mount Pleasant apartment in Washington, D.C., on October 15, 2013. She's lived with chronic headaches from a concussion in 2010. Credit: Marvin Joseph/The Washington Post via Getty Images
An epic clash in women’s soccer starts Thursday in Australia and New Zealand as 32 teams vie for the 2023 International Federation of Association Football (FIFA) Women’s World Cup, and the U.S. national team strives for an unprecedented three-peat. But also gaining attention are clashes of a different sort: high-speed hits to players’ heads. New research highlights the danger of concussions and potential long-term brain damage in an aggressive sport that already has many star players sitting out of the World Cup because of various types of bodily injuries. When it comes to concussions, the new studies point to some ways to improve players’ protection and health.
Briana Scurry knows about all this firsthand. As a soccer goalie, she never thought twice before blocking a ball. The two-time Olympic gold medalist and 1999 World Cup Champion routinely faced down dozens of players barreling straight at her, leapt toward soccer balls catapulted at 50 miles per hour and fearlessly plunged into a scramble of knees and feet to make a save. “You don’t even really care, at the time, about all these people. You just fly in there headfirst,” Scurry says. “It’s an acquired taste to be a goalkeeper.”
During a match in April 2010 for the Washington Freedom (a former Washington, D.C., team in the Women’s Professional Soccer league, which has been replaced with the National Women's Soccer League), she bent down to stop a low shot when a Philadelphia Independence forward slammed her knee into Scurry’s right temple. The forward tried to pull away at the last second to avoid Scurry, but they both bundled over. “My first thought is, ‘Did I make the save?’” Scurry recalls. She did. But when she stood up to kick the ball back into play, she immediately knew something was off. She felt woozy, and the names on her teammates’ jerseys started to blur. Most noticeably, she had an intense pain in her right temple and a throbbing behind her left ear. Scurry later found out that the blow resulted in a traumatic brain injury that smashed her occipital nerve.
“That was the last game I played,” Scurry says. “Before I knew it, it was season-ending because I wasn’t getting better—and then it was career-ending.”
This wasn’t the first head injury Scurry experienced on the field. She had three prior documented concussions—and she suspects she has had “maybe dozens” more that went undocumented or undetected over her decades-long soccer career. Research estimates suggest sports and recreation result in up to 3.8 million concussions in the U.S. each year and that about half of those go unreported. Head injuries are most common in high-contact sports, including hockey, boxing and lacrosse, and American football alone accounts for approximately 300,000 concussions a year. Even “softer” contact sports, such as water polo, volleyball, basketball and soccer, can place players at risk of head injuries and concussions. A 2019 study of U.S. high school athletes published in Pediatrics found that soccer had the highest concussion rate among girls’ teams and the fifth highest among boys’ teams.
“It’s important to remember all of the other types of sports that can cause concussion, and soccer is actually one of the highest-risk sports,” says Lissa Baird, a pediatric neurosurgeon at Boston Children’s Hospital and an associate professor at Harvard Medical School. “Sports carry huge benefits for people of all ages, especially kids, but the cumulative risk of concussions over time can have really profound impacts on somebody’s quality of life.”
AN INVISIBLE INJURY
Though soccer isn’t normally considered a high-contact sport, the nature of the game can involve hard spills and hits from the ball, the ground and other players. People might not realize “how dangerous it actually is,” Scurry says. “As it’s gotten higher-competition, higher-stakes, you have more collisions,” she notes. “And those collisions are coming at a high rate of speed.”
The head’s sudden change in speed during an impact can cause a “kind of ricochet of the brain,” which floats in cerebrospinal fluid inside the skull, Baird explains. Such a ricochet actually stretches the brain’s neurons, which may disrupt the cells’ crucial connectivity and the flow of neurotransmitters. But signs of concussion are difficult to measure and detect, both on and off the field.
“It’s an invisible injury, so people tend to mask their symptoms,” says Teena Shetty, an associate attending neurologist at the Hospital for Special Surgery and associate professor of clinical neurology at Weill Cornell Medicine/New York-Presbyterian Hospital. “It’s not like a heart attack, where you can look at an EKG waveform and bloodwork, or an ACL injury where you can see it on an MRI.”
With concussions, neuroimaging scans typically show no signs of bleeding, bruising or other abnormalities in the brain. It usually triggers symptoms including headaches, fatigue, nausea, dizziness, blurry vision and cognitive dysfunction that could last a few days to months. Scurry says her April 2010 traumatic brain injury left her with a constellation of symptoms over the course of years. While Scurry “looked fine,” she had problems with light sensitivity, sleep, memory and balance, and a constant radiating pain behind her left ear, which eventually required surgery on her occipital nerve. The injury also took a significant toll on her mental health, she says, as she dealt with depression and anxiety. “Of all my years playing and training, my mental fitness was my greatest asset. I could focus on a ball with 90,000 people on the World Cup final looking at me in 107 degrees on the pitch,” she says. “A lot of people suffer in silence with regards to head injury and mental health.”
The severity and duration of concussion symptoms can vary immensely. Research has indicated that women present more severe symptoms and have longer recovery times, for example. And the variability is even more complex from person to person because every brain is “unique,” says Angela Lumba-Brown, a clinical associate professor of emergency medicine and pediatrics at Stanford University, who studies concussion subtypes. “We know that some people will present with the most common symptoms of headache and nausea, but then another person might mainly present with mood disruption and balance problems,” says Lumba-Brown, who sustained concussions herself while playing basketball in high school. "It really depends on the person and not necessarily where they got hit or even how they got hit.”
A player who recently sustained a concussion is more vulnerable to another concussion or injury, Lumba-Brown says. Repeatedly heading the ball has also raised alarm. In 2016 U.S. Club Soccer announced a no-heading rule for those younger than 11 and limited heading for players 13 and under; the U.K.’s Football Association is running a similar trial recommendation for those under 12. “A single header to the ball may not result in concussion immediately, but those cumulative impacts can definitely take their toll,” Baird says.
A LONG SHADOW
Multiple concussions—including repeated subconcussive impacts from heading the ball—have stirred discussion about the potential risk of future neurological conditions. A 2019 study published in the New England Journal of Medicine found that neurodegenerative disease was the primary cause of death in 1.7 percent of former male professional Scottish soccer players—approximately three times higher than in the general population. “That is a huge association,” says Peter Ueda, an assistant professor in clinical epidemiology at the Karolinska Institute in Sweden.
Ueda and his team wanted to see if similar trends could be seen in top-division Swedish soccer players. Their results, published in April in the Lancet, found soccer players had an approximately 1.5 times greater risk of Alzheimer’s disease and other dementias. “We don’t know whether this [data] is applicable to current elite players,” Ueda says. “Maybe they have a lower risk because they’re better equipped, and they have more professional [physical therapists]. Or maybe they are higher-risk because they start playing from a very early age, which they didn’t necessarily do back in the day.” He notes that trends are still emerging because many former professional players are just beginning to reach the age when these neurodegenerative diseases usually develop. Data are especially limited for women, who haven’t had the opportunity to play professionally for as long as men.
These long-term health implications have become “a big concern in the soccer community” and the public, Ueda says. On England’s 1966 World Cup team, four of the five players diagnosed with dementia recently died from it. In May three professional soccer players were diagnosed postmortem with chronic traumatic encephalopathy (CTE), a degenerative brain disease commonly studied among professional American football athletes and in other high-contact sports. CTE can present as dementia, mood swings and depression, but having any one of those conditions does not necessarily mean someone has CTE, Ueda says. The only way to diagnose the disease is through a postmortem autopsy, but even then, determining the exact causes is difficult.
“It’s not going to be possible to say CTE came from the five collisions and bad concussions you had in your career or the 10 years of heading the ball,” Lumba-Brown says. “But what the research does suggest, importantly, is that participation in professional soccer and elite soccer may result an increased risk for CTE as compared to general populations.”
A PATH TO SAFER PLAY
For now Lumba-Brown and Scurry advise focusing on treating symptoms immediately and with appropriate care. Shetty says concussions require a multidisciplinary treatment, which may include physical and cognitive therapy. Longer-term care could require lifestyle modifications or even a change of sport. “I usually will tell my patients if they have more than two concussions playing a sport, they really should look for a different sport that’s a little bit safer for them,” Baird says.
Scurry says she had to “reboot” her brain through treatment. Today, at 51, “my brain is in a really good place,” she says. Now she spreads awareness about head injuries and concussions in soccer to help prevent them. Rigorous medical policies and protocols should be enforced by governing bodies and soccer leagues to promote change, she says. “We are still in the dark ages of asking the player if they’re okay when they’ve been knocked out,” Scurry adds. “It’s part of the culture of sports: shake it off and get on with it. A head injury, you don’t shake off.”
ADVERTISEMENT
Professional soccer leagues and federations, including FIFA and the U.S. Major Soccer League, have official medical concussion protocols with preseason tests to establish neurocognitive baselines that give players a point of reference after an impact. They also conduct multiphase, on-site diagnoses and examinations. For the 2022 Men’s World Cup in Qatar, FIFA introduced an independent concussion assessment and rehabilitation service to assess any player who suffered a brain injury. This service included consultations with concussion experts to decide whether a player should remain in the game. Medical staff members and services, including injury spotters and replay video tablets to medically review collisions, were made available. FIFA also allowed one extra permanent substitute player per team for those who experienced actual or suspected concussions. According to a FIFA spokesperson, “A similar approach will be implemented for the FIFA Women’s World Cup 2023 as the wellbeing of all players involved remains FIFA’s priority.”
On the field, Baird says measures such as installing padding on goalposts can offer some simple protections. Players can also wear gear such as headbands and collars crafted to help dissipate an impact. Such devices are becoming more readily available, but Shetty says there’s still not enough evidence to medically support the safety and effectiveness of these early designs.
Scurry says more can still be done to protect player health and safety on and off the field. She continues to push for improved on-site third-party head injury evaluation after collisions, as well as training for coaches, staff and players to identify the signs and symptoms of a concussion. Importantly, Scurry hopes to shift the culture of injury in sports.
“I talk about this because I want to try to save that 18-year-old who has had a head injury, who’s trying to fight through it and doesn’t really understand why she doesn’t feel the way she used to,” Scurry says. “I want to get her understand that she’s okay, but she might need some help. It doesn’t mean you’re weak.”
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https://www.scientificamerican.com/arti ... ng-damage/
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greybeard58
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How Dangerous Are Soccer Concussions? They May Cause Lasting Damage
How Dangerous Are Soccer Concussions? They May Cause Lasting Damage
As the 2023 Women’s World Cup kicks off, repeated concussions and head injuries in the sport raise discussion about the lifelong consequences on the brain
• By Lauren J. Young on July 18, 2023
Briana Scurry, photographed in her Mount Pleasant apartment in Washington, D.C., on October 15, 2013. She's lived with chronic headaches from a concussion in 2010. Credit: Marvin Joseph/The Washington Post via Getty Images
An epic clash in women’s soccer starts Thursday in Australia and New Zealand as 32 teams vie for the 2023 International Federation of Association Football (FIFA) Women’s World Cup, and the U.S. national team strives for an unprecedented three-peat. But also gaining attention are clashes of a different sort: high-speed hits to players’ heads. New research highlights the danger of concussions and potential long-term brain damage in an aggressive sport that already has many star players sitting out of the World Cup because of various types of bodily injuries. When it comes to concussions, the new studies point to some ways to improve players’ protection and health.
Briana Scurry knows about all this firsthand. As a soccer goalie, she never thought twice before blocking a ball. The two-time Olympic gold medalist and 1999 World Cup Champion routinely faced down dozens of players barreling straight at her, leapt toward soccer balls catapulted at 50 miles per hour and fearlessly plunged into a scramble of knees and feet to make a save. “You don’t even really care, at the time, about all these people. You just fly in there headfirst,” Scurry says. “It’s an acquired taste to be a goalkeeper.”
During a match in April 2010 for the Washington Freedom (a former Washington, D.C., team in the Women’s Professional Soccer league, which has been replaced with the National Women's Soccer League), she bent down to stop a low shot when a Philadelphia Independence forward slammed her knee into Scurry’s right temple. The forward tried to pull away at the last second to avoid Scurry, but they both bundled over. “My first thought is, ‘Did I make the save?’” Scurry recalls. She did. But when she stood up to kick the ball back into play, she immediately knew something was off. She felt woozy, and the names on her teammates’ jerseys started to blur. Most noticeably, she had an intense pain in her right temple and a throbbing behind her left ear. Scurry later found out that the blow resulted in a traumatic brain injury that smashed her occipital nerve.
“That was the last game I played,” Scurry says. “Before I knew it, it was season-ending because I wasn’t getting better—and then it was career-ending.”
This wasn’t the first head injury Scurry experienced on the field. She had three prior documented concussions—and she suspects she has had “maybe dozens” more that went undocumented or undetected over her decades-long soccer career. Research estimates suggest sports and recreation result in up to 3.8 million concussions in the U.S. each year and that about half of those go unreported. Head injuries are most common in high-contact sports, including hockey, boxing and lacrosse, and American football alone accounts for approximately 300,000 concussions a year. Even “softer” contact sports, such as water polo, volleyball, basketball and soccer, can place players at risk of head injuries and concussions. A 2019 study of U.S. high school athletes published in Pediatrics found that soccer had the highest concussion rate among girls’ teams and the fifth highest among boys’ teams.
“It’s important to remember all of the other types of sports that can cause concussion, and soccer is actually one of the highest-risk sports,” says Lissa Baird, a pediatric neurosurgeon at Boston Children’s Hospital and an associate professor at Harvard Medical School. “Sports carry huge benefits for people of all ages, especially kids, but the cumulative risk of concussions over time can have really profound impacts on somebody’s quality of life.”
AN INVISIBLE INJURY
Though soccer isn’t normally considered a high-contact sport, the nature of the game can involve hard spills and hits from the ball, the ground and other players. People might not realize “how dangerous it actually is,” Scurry says. “As it’s gotten higher-competition, higher-stakes, you have more collisions,” she notes. “And those collisions are coming at a high rate of speed.”
The head’s sudden change in speed during an impact can cause a “kind of ricochet of the brain,” which floats in cerebrospinal fluid inside the skull, Baird explains. Such a ricochet actually stretches the brain’s neurons, which may disrupt the cells’ crucial connectivity and the flow of neurotransmitters. But signs of concussion are difficult to measure and detect, both on and off the field.
“It’s an invisible injury, so people tend to mask their symptoms,” says Teena Shetty, an associate attending neurologist at the Hospital for Special Surgery and associate professor of clinical neurology at Weill Cornell Medicine/New York-Presbyterian Hospital. “It’s not like a heart attack, where you can look at an EKG waveform and bloodwork, or an ACL injury where you can see it on an MRI.”
With concussions, neuroimaging scans typically show no signs of bleeding, bruising or other abnormalities in the brain. It usually triggers symptoms including headaches, fatigue, nausea, dizziness, blurry vision and cognitive dysfunction that could last a few days to months. Scurry says her April 2010 traumatic brain injury left her with a constellation of symptoms over the course of years. While Scurry “looked fine,” she had problems with light sensitivity, sleep, memory and balance, and a constant radiating pain behind her left ear, which eventually required surgery on her occipital nerve. The injury also took a significant toll on her mental health, she says, as she dealt with depression and anxiety. “Of all my years playing and training, my mental fitness was my greatest asset. I could focus on a ball with 90,000 people on the World Cup final looking at me in 107 degrees on the pitch,” she says. “A lot of people suffer in silence with regards to head injury and mental health.”
The severity and duration of concussion symptoms can vary immensely. Research has indicated that women present more severe symptoms and have longer recovery times, for example. And the variability is even more complex from person to person because every brain is “unique,” says Angela Lumba-Brown, a clinical associate professor of emergency medicine and pediatrics at Stanford University, who studies concussion subtypes. “We know that some people will present with the most common symptoms of headache and nausea, but then another person might mainly present with mood disruption and balance problems,” says Lumba-Brown, who sustained concussions herself while playing basketball in high school. "It really depends on the person and not necessarily where they got hit or even how they got hit.”
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A player who recently sustained a concussion is more vulnerable to another concussion or injury, Lumba-Brown says. Repeatedly heading the ball has also raised alarm. In 2016 U.S. Club Soccer announced a no-heading rule for those younger than 11 and limited heading for players 13 and under; the U.K.’s Football Association is running a similar trial recommendation for those under 12. “A single header to the ball may not result in concussion immediately, but those cumulative impacts can definitely take their toll,” Baird says.
A LONG SHADOW
Multiple concussions—including repeated subconcussive impacts from heading the ball—have stirred discussion about the potential risk of future neurological conditions. A 2019 study published in the New England Journal of Medicine found that neurodegenerative disease was the primary cause of death in 1.7 percent of former male professional Scottish soccer players—approximately three times higher than in the general population. “That is a huge association,” says Peter Ueda, an assistant professor in clinical epidemiology at the Karolinska Institute in Sweden.
Ueda and his team wanted to see if similar trends could be seen in top-division Swedish soccer players. Their results, published in April in the Lancet, found soccer players had an approximately 1.5 times greater risk of Alzheimer’s disease and other dementias. “We don’t know whether this [data] is applicable to current elite players,” Ueda says. “Maybe they have a lower risk because they’re better equipped, and they have more professional [physical therapists]. Or maybe they are higher-risk because they start playing from a very early age, which they didn’t necessarily do back in the day.” He notes that trends are still emerging because many former professional players are just beginning to reach the age when these neurodegenerative diseases usually develop. Data are especially limited for women, who haven’t had the opportunity to play professionally for as long as men.
These long-term health implications have become “a big concern in the soccer community” and the public, Ueda says. On England’s 1966 World Cup team, four of the five players diagnosed with dementia recently died from it. In May three professional soccer players were diagnosed postmortem with chronic traumatic encephalopathy (CTE), a degenerative brain disease commonly studied among professional American football athletes and in other high-contact sports. CTE can present as dementia, mood swings and depression, but having any one of those conditions does not necessarily mean someone has CTE, Ueda says. The only way to diagnose the disease is through a postmortem autopsy, but even then, determining the exact causes is difficult.
“It’s not going to be possible to say CTE came from the five collisions and bad concussions you had in your career or the 10 years of heading the ball,” Lumba-Brown says. “But what the research does suggest, importantly, is that participation in professional soccer and elite soccer may result an increased risk for CTE as compared to general populations.”
A PATH TO SAFER PLAY
For now Lumba-Brown and Scurry advise focusing on treating symptoms immediately and with appropriate care. Shetty says concussions require a multidisciplinary treatment, which may include physical and cognitive therapy. Longer-term care could require lifestyle modifications or even a change of sport. “I usually will tell my patients if they have more than two concussions playing a sport, they really should look for a different sport that’s a little bit safer for them,” Baird says.
Scurry says she had to “reboot” her brain through treatment. Today, at 51, “my brain is in a really good place,” she says. Now she spreads awareness about head injuries and concussions in soccer to help prevent them. Rigorous medical policies and protocols should be enforced by governing bodies and soccer leagues to promote change, she says. “We are still in the dark ages of asking the player if they’re okay when they’ve been knocked out,” Scurry adds. “It’s part of the culture of sports: shake it off and get on with it. A head injury, you don’t shake off.”
Professional soccer leagues and federations, including FIFA and the U.S. Major Soccer League, have official medical concussion protocols with preseason tests to establish neurocognitive baselines that give players a point of reference after an impact. They also conduct multiphase, on-site diagnoses and examinations. For the 2022 Men’s World Cup in Qatar, FIFA introduced an independent concussion assessment and rehabilitation service to assess any player who suffered a brain injury. This service included consultations with concussion experts to decide whether a player should remain in the game. Medical staff members and services, including injury spotters and replay video tablets to medically review collisions, were made available. FIFA also allowed one extra permanent substitute player per team for those who experienced actual or suspected concussions. According to a FIFA spokesperson, “A similar approach will be implemented for the FIFA Women’s World Cup 2023 as the wellbeing of all players involved remains FIFA’s priority.”
On the field, Baird says measures such as installing padding on goalposts can offer some simple protections. Players can also wear gear such as headbands and collars crafted to help dissipate an impact. Such devices are becoming more readily available, but Shetty says there’s still not enough evidence to medically support the safety and effectiveness of these early designs.
Scurry says more can still be done to protect player health and safety on and off the field. She continues to push for improved on-site third-party head injury evaluation after collisions, as well as training for coaches, staff and players to identify the signs and symptoms of a concussion. Importantly, Scurry hopes to shift the culture of injury in sports.
“I talk about this because I want to try to save that 18-year-old who has had a head injury, who’s trying to fight through it and doesn’t really understand why she doesn’t feel the way she used to,” Scurry says. “I want to get her understand that she’s okay, but she might need some help. It doesn’t mean you’re weak.”
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ABOUT THE AUTHOR(S)
Lauren J. Young is an associate editor for health and medicine at Scientific American. Follow her on Twitter @laurenjyoung617 Credit: Nick Higgins
NEUROLOGY
Soccer Headers Cause More Brain Damage in Female Players
Daniel Ackerman
NEUROLOGY
6 Things Everyone Should Know about Concussions
Karen Schrock Simring
EXERCISE
Why Sports Concussions Are Worse For Women
Katharine Sanderson and Nature magazine
https://www.scientificamerican.com/arti ... ng-damage/
As the 2023 Women’s World Cup kicks off, repeated concussions and head injuries in the sport raise discussion about the lifelong consequences on the brain
• By Lauren J. Young on July 18, 2023
Briana Scurry, photographed in her Mount Pleasant apartment in Washington, D.C., on October 15, 2013. She's lived with chronic headaches from a concussion in 2010. Credit: Marvin Joseph/The Washington Post via Getty Images
An epic clash in women’s soccer starts Thursday in Australia and New Zealand as 32 teams vie for the 2023 International Federation of Association Football (FIFA) Women’s World Cup, and the U.S. national team strives for an unprecedented three-peat. But also gaining attention are clashes of a different sort: high-speed hits to players’ heads. New research highlights the danger of concussions and potential long-term brain damage in an aggressive sport that already has many star players sitting out of the World Cup because of various types of bodily injuries. When it comes to concussions, the new studies point to some ways to improve players’ protection and health.
Briana Scurry knows about all this firsthand. As a soccer goalie, she never thought twice before blocking a ball. The two-time Olympic gold medalist and 1999 World Cup Champion routinely faced down dozens of players barreling straight at her, leapt toward soccer balls catapulted at 50 miles per hour and fearlessly plunged into a scramble of knees and feet to make a save. “You don’t even really care, at the time, about all these people. You just fly in there headfirst,” Scurry says. “It’s an acquired taste to be a goalkeeper.”
During a match in April 2010 for the Washington Freedom (a former Washington, D.C., team in the Women’s Professional Soccer league, which has been replaced with the National Women's Soccer League), she bent down to stop a low shot when a Philadelphia Independence forward slammed her knee into Scurry’s right temple. The forward tried to pull away at the last second to avoid Scurry, but they both bundled over. “My first thought is, ‘Did I make the save?’” Scurry recalls. She did. But when she stood up to kick the ball back into play, she immediately knew something was off. She felt woozy, and the names on her teammates’ jerseys started to blur. Most noticeably, she had an intense pain in her right temple and a throbbing behind her left ear. Scurry later found out that the blow resulted in a traumatic brain injury that smashed her occipital nerve.
“That was the last game I played,” Scurry says. “Before I knew it, it was season-ending because I wasn’t getting better—and then it was career-ending.”
This wasn’t the first head injury Scurry experienced on the field. She had three prior documented concussions—and she suspects she has had “maybe dozens” more that went undocumented or undetected over her decades-long soccer career. Research estimates suggest sports and recreation result in up to 3.8 million concussions in the U.S. each year and that about half of those go unreported. Head injuries are most common in high-contact sports, including hockey, boxing and lacrosse, and American football alone accounts for approximately 300,000 concussions a year. Even “softer” contact sports, such as water polo, volleyball, basketball and soccer, can place players at risk of head injuries and concussions. A 2019 study of U.S. high school athletes published in Pediatrics found that soccer had the highest concussion rate among girls’ teams and the fifth highest among boys’ teams.
“It’s important to remember all of the other types of sports that can cause concussion, and soccer is actually one of the highest-risk sports,” says Lissa Baird, a pediatric neurosurgeon at Boston Children’s Hospital and an associate professor at Harvard Medical School. “Sports carry huge benefits for people of all ages, especially kids, but the cumulative risk of concussions over time can have really profound impacts on somebody’s quality of life.”
AN INVISIBLE INJURY
Though soccer isn’t normally considered a high-contact sport, the nature of the game can involve hard spills and hits from the ball, the ground and other players. People might not realize “how dangerous it actually is,” Scurry says. “As it’s gotten higher-competition, higher-stakes, you have more collisions,” she notes. “And those collisions are coming at a high rate of speed.”
The head’s sudden change in speed during an impact can cause a “kind of ricochet of the brain,” which floats in cerebrospinal fluid inside the skull, Baird explains. Such a ricochet actually stretches the brain’s neurons, which may disrupt the cells’ crucial connectivity and the flow of neurotransmitters. But signs of concussion are difficult to measure and detect, both on and off the field.
“It’s an invisible injury, so people tend to mask their symptoms,” says Teena Shetty, an associate attending neurologist at the Hospital for Special Surgery and associate professor of clinical neurology at Weill Cornell Medicine/New York-Presbyterian Hospital. “It’s not like a heart attack, where you can look at an EKG waveform and bloodwork, or an ACL injury where you can see it on an MRI.”
With concussions, neuroimaging scans typically show no signs of bleeding, bruising or other abnormalities in the brain. It usually triggers symptoms including headaches, fatigue, nausea, dizziness, blurry vision and cognitive dysfunction that could last a few days to months. Scurry says her April 2010 traumatic brain injury left her with a constellation of symptoms over the course of years. While Scurry “looked fine,” she had problems with light sensitivity, sleep, memory and balance, and a constant radiating pain behind her left ear, which eventually required surgery on her occipital nerve. The injury also took a significant toll on her mental health, she says, as she dealt with depression and anxiety. “Of all my years playing and training, my mental fitness was my greatest asset. I could focus on a ball with 90,000 people on the World Cup final looking at me in 107 degrees on the pitch,” she says. “A lot of people suffer in silence with regards to head injury and mental health.”
The severity and duration of concussion symptoms can vary immensely. Research has indicated that women present more severe symptoms and have longer recovery times, for example. And the variability is even more complex from person to person because every brain is “unique,” says Angela Lumba-Brown, a clinical associate professor of emergency medicine and pediatrics at Stanford University, who studies concussion subtypes. “We know that some people will present with the most common symptoms of headache and nausea, but then another person might mainly present with mood disruption and balance problems,” says Lumba-Brown, who sustained concussions herself while playing basketball in high school. "It really depends on the person and not necessarily where they got hit or even how they got hit.”
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A player who recently sustained a concussion is more vulnerable to another concussion or injury, Lumba-Brown says. Repeatedly heading the ball has also raised alarm. In 2016 U.S. Club Soccer announced a no-heading rule for those younger than 11 and limited heading for players 13 and under; the U.K.’s Football Association is running a similar trial recommendation for those under 12. “A single header to the ball may not result in concussion immediately, but those cumulative impacts can definitely take their toll,” Baird says.
A LONG SHADOW
Multiple concussions—including repeated subconcussive impacts from heading the ball—have stirred discussion about the potential risk of future neurological conditions. A 2019 study published in the New England Journal of Medicine found that neurodegenerative disease was the primary cause of death in 1.7 percent of former male professional Scottish soccer players—approximately three times higher than in the general population. “That is a huge association,” says Peter Ueda, an assistant professor in clinical epidemiology at the Karolinska Institute in Sweden.
Ueda and his team wanted to see if similar trends could be seen in top-division Swedish soccer players. Their results, published in April in the Lancet, found soccer players had an approximately 1.5 times greater risk of Alzheimer’s disease and other dementias. “We don’t know whether this [data] is applicable to current elite players,” Ueda says. “Maybe they have a lower risk because they’re better equipped, and they have more professional [physical therapists]. Or maybe they are higher-risk because they start playing from a very early age, which they didn’t necessarily do back in the day.” He notes that trends are still emerging because many former professional players are just beginning to reach the age when these neurodegenerative diseases usually develop. Data are especially limited for women, who haven’t had the opportunity to play professionally for as long as men.
These long-term health implications have become “a big concern in the soccer community” and the public, Ueda says. On England’s 1966 World Cup team, four of the five players diagnosed with dementia recently died from it. In May three professional soccer players were diagnosed postmortem with chronic traumatic encephalopathy (CTE), a degenerative brain disease commonly studied among professional American football athletes and in other high-contact sports. CTE can present as dementia, mood swings and depression, but having any one of those conditions does not necessarily mean someone has CTE, Ueda says. The only way to diagnose the disease is through a postmortem autopsy, but even then, determining the exact causes is difficult.
“It’s not going to be possible to say CTE came from the five collisions and bad concussions you had in your career or the 10 years of heading the ball,” Lumba-Brown says. “But what the research does suggest, importantly, is that participation in professional soccer and elite soccer may result an increased risk for CTE as compared to general populations.”
A PATH TO SAFER PLAY
For now Lumba-Brown and Scurry advise focusing on treating symptoms immediately and with appropriate care. Shetty says concussions require a multidisciplinary treatment, which may include physical and cognitive therapy. Longer-term care could require lifestyle modifications or even a change of sport. “I usually will tell my patients if they have more than two concussions playing a sport, they really should look for a different sport that’s a little bit safer for them,” Baird says.
Scurry says she had to “reboot” her brain through treatment. Today, at 51, “my brain is in a really good place,” she says. Now she spreads awareness about head injuries and concussions in soccer to help prevent them. Rigorous medical policies and protocols should be enforced by governing bodies and soccer leagues to promote change, she says. “We are still in the dark ages of asking the player if they’re okay when they’ve been knocked out,” Scurry adds. “It’s part of the culture of sports: shake it off and get on with it. A head injury, you don’t shake off.”
Professional soccer leagues and federations, including FIFA and the U.S. Major Soccer League, have official medical concussion protocols with preseason tests to establish neurocognitive baselines that give players a point of reference after an impact. They also conduct multiphase, on-site diagnoses and examinations. For the 2022 Men’s World Cup in Qatar, FIFA introduced an independent concussion assessment and rehabilitation service to assess any player who suffered a brain injury. This service included consultations with concussion experts to decide whether a player should remain in the game. Medical staff members and services, including injury spotters and replay video tablets to medically review collisions, were made available. FIFA also allowed one extra permanent substitute player per team for those who experienced actual or suspected concussions. According to a FIFA spokesperson, “A similar approach will be implemented for the FIFA Women’s World Cup 2023 as the wellbeing of all players involved remains FIFA’s priority.”
On the field, Baird says measures such as installing padding on goalposts can offer some simple protections. Players can also wear gear such as headbands and collars crafted to help dissipate an impact. Such devices are becoming more readily available, but Shetty says there’s still not enough evidence to medically support the safety and effectiveness of these early designs.
Scurry says more can still be done to protect player health and safety on and off the field. She continues to push for improved on-site third-party head injury evaluation after collisions, as well as training for coaches, staff and players to identify the signs and symptoms of a concussion. Importantly, Scurry hopes to shift the culture of injury in sports.
“I talk about this because I want to try to save that 18-year-old who has had a head injury, who’s trying to fight through it and doesn’t really understand why she doesn’t feel the way she used to,” Scurry says. “I want to get her understand that she’s okay, but she might need some help. It doesn’t mean you’re weak.”
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ABOUT THE AUTHOR(S)
Lauren J. Young is an associate editor for health and medicine at Scientific American. Follow her on Twitter @laurenjyoung617 Credit: Nick Higgins
NEUROLOGY
Soccer Headers Cause More Brain Damage in Female Players
Daniel Ackerman
NEUROLOGY
6 Things Everyone Should Know about Concussions
Karen Schrock Simring
EXERCISE
Why Sports Concussions Are Worse For Women
Katharine Sanderson and Nature magazine
https://www.scientificamerican.com/arti ... ng-damage/
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6 Things Everyone Should Know about Concussions
6 Things Everyone Should Know about Concussions
Much of what we've heard is wrong. Here's the latest lowdown on these brain injuries plus new ideas about how to treat them
• By Karen Schrock Simring on January 1, 2016
Credit: RADIO
IN BRIEF
Injury to the Brain
• A concussion can occur when the head is jolted, either from a blow or from a sudden stop.
• After a jolt, it is crucial to avoid a second blow and to see a doctor as soon as possible.
• New research shows that resting for more than a couple of days after a concussion may do more harm than good, and targeted treatments may help with some symptoms.
• It remains very difficult to predict which patients will struggle with a lengthy recovery. Mental illness and psychiatric symptoms such as anxiety, both before and after the concussion, seem to be linked with the highest risk.
One minute I was waving hello to the neighbors during a typical Rollerblading session with my dog, and the next I was flying down a newly paved hill at a runaway speed. Aiming for a soft landing, I steered up a driveway toward a lawn. My feet hit the grass, and I flew about 10 feet through the air before landing and rolling on the ground. I had the wind knocked out of me—a truly painful experience I hadn't had since childhood—but I could tell I hadn't broken any bones. I was just congratulating myself on avoiding a serious injury when I passed out.
I didn't know it at the time, but this incident last fall was my personal introduction to the frightening and sometimes baffling experience of having a concussion. As a science editor, I had handled a number of stories on mild traumatic brain injury (TBI), as concussions are officially known, but I was not prepared for the pain and debilitation that came over the following weeks and months. That is because—for all its prevalence in the news as a danger to massive NFL players and tiny soccer tots alike—concussions remain subject to a remarkable amount of myth, mystery and misinformation. Even among well-meaning doctors. The good news is that concussion research has surged in recent years, thanks to concern from the athletic and military communities—so we are starting to learn more about the underlying causes of its symptoms and how best to treat them. And we are beginning to clear away some of the fog around who is at greatest risk for serious repercussions. Here are six key things you should know about concussions—things I wish I had known when I hit the ground.
1. YOU DON'T HAVE TO SMACK YOUR HEAD TO GET A CONCUSSION.
After my skating accident, I went to my local hospital because my abdomen hurt and one of my arms was rapidly swelling into a purple, football-sized balloon. The emergency room staff x-rayed my arm and did a CT scan of my midsection to rule out internal bleeding. As we were getting ready to go, my husband asked the doctor why he didn't assess me for a head injury. “Because she said she didn't hit her head,” the doctor replied. And that was that. I went home and went to bed.
The next morning the symptoms hit: excruciating headache, nausea, sensitivity to light, confusion. I thought I was having a bizarre and terrible migraine. I went the next day to see an associate of our family doctor, who promptly diagnosed me with a concussion. He reminded me that a sudden deceleration of the type I had undergone—from, say, 20 miles an hour to zero in less than a second—could damage the brain by causing it to slosh around within the skull.
In fact, doctors are seeing more and more concussions that do not involve a direct blow to the head, especially among military personnel exposed to bomb blasts. The shock wave from an explosion can send the brain bouncing perilously within the skull. Thousands of service members report concussions every year. Among U.S. civilians, the Centers for Disease Control and Prevention estimates about 1.36 million concussions a year. But that number is a bit shaky, in part because greater awareness of concussions has probably led more patients to seek medical attention and more doctors to notice and diagnose mild TBIs in recent years. As a result, the incidence has been rising.
Another reason the true incidence of concussions is not easy to pin down is that the diagnosis itself is based mostly on subjective symptom reporting [see “Do I Have a Concussion?” below] rather than any definitive test. Doctors diagnose a concussion if a person has had a blow or jolt to the head and reports at least a couple of the well-known symptoms, including dizziness, confusion, short-term memory loss, headache, and sensitivity to light or noise. But these symptoms can also be caused by a number of other factors, and unless there are clear neurological symptoms such as delayed pupil reflexes, which show up in some concussion cases, there is currently no way to know for sure whether symptoms are arising from a brain injury rather than, say, a migraine, the flu or post-traumatic stress disorder (PTSD). Most emergency room doctors will not order scans unless bleeding or more serious injury in the brain is suspected. Unlike these more dangerous complications, injury from a mild TBI is usually too microscopic for MRI, CT or PET scans to pick up.
There are simple steps to take if you do notice the telltale symptoms of concussion after you bump your head or after you are in any situation in which your head is jolted suddenly—including a fender bender or even a roller-coaster ride. “First, pull yourself out of risk so you don't hit your head again,” says William P. Meehan III, director of the Micheli Center for Sports Injury Prevention at Boston Children's Hospital. “Second, see a medical professional to get some guidance. And third, follow that guidance, which should be a few days of rest followed by gradually increasing activity.”
2. IF YOU THINK YOU MIGHT HAVE A CONCUSSION, MAKE SURE YOU DON'T HIT YOUR HEAD AGAIN.
When the primary care doctor warned me about this risk, I thanked my lucky stars I had not decided to get back on my skates the day after my ER visit. Experts agree that minimizing the risk of a second concussion is key because getting two in a row can lead to long-term complications or, rarely, death. The mechanism behind this effect is unknown, but cell studies suggest it might have something to do with sodium.
The brain maintains a delicate balance of sodium and potassium ions to facilitate the electrical signals between neurons. When the head is jolted, cells react by suddenly taking up more sodium, which immediately shuts down the electrical signaling. That is why a concussion can cause a loss of consciousness so much faster than asphyxiation does. “It's a blackout of the brain's electrical grid,” explains Douglas H. Smith, director of the Center for Brain Injury and Repair at the University of Pennsylvania.
Experimental evidence is starting to suggest that one way brain cells react to this blackout is to quickly add more sodium channels along their membranes to help restore the balance. “That might be a great way to get the lights back on, but it also might come at a huge cost if you get hit again,” Smith says. With all that additional access to sodium now available, getting hit again “is like pouring saltwater over live circuits,” he says.
Many decades of studies in youngsters and adults confirm that suffering a second concussion while still experiencing symptoms from the first puts a person at a hugely increased risk for long-term symptoms lasting months or even years. In some rare cases, it can even lead to permanent brain damage or death. Second impact syndrome, as this most severe reaction is known, is diagnosed when a second concussion in the minutes, days or weeks following the first causes sudden and often fatal brain swelling. The exact mechanism behind this catastrophic cascade is unclear, but confirmed cases of second impact syndrome are fatal more than 50 percent of the time.
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Most reported cases of the syndrome have been in children, prompting the strict guidelines regarding student athletes returning to play after sustaining a concussion. Prevalence is hard to measure because of the rarity of cases and the fact that the bleeding may be misdiagnosed as a direct result of the blunt trauma, but studies estimate that second impact syndrome kills about three to four people a year in the U.S.
3. IT'S OKAY TO FALL ASLEEP AFTER GETTING A CONCUSSION.
The familiar advice to keep a concussed person awake shows up in pop culture so often it has become a cliché. In reality, going to sleep a few hours after a concussion is fine and probably even helpful to your recovering brain. Here is what you should know about how much monitoring a concussed person truly needs.
Before brain-scanning technology, the only way to know if a blow to the head had caused a dangerous complication such as bleeding within the brain was to interact with patients in the minutes and hours after injury to see if their speech or motor coordination went downhill. Such interactions require a patient to be awake. That's all—there is nothing inherently dangerous about sleep, just the difficulty of assessing someone's neurological health if the person is unconscious.
Nowadays doctors can order a CT scan if major injury is suspected in the brain—for instance, if any bruising is visible under the scalp or if the patient has a severe and worsening headache. We also know a lot more about which symptoms are predictive of bleeding. In a landmark 2009 study published in the Lancet, physician Nathan Kuppermann of the University of California, Davis, and his colleagues studied 42,412 children and adolescents younger than 18. They found that for children older than two who did not have any of six specific symptoms, such as vomiting or dysfunctional cognition, there was a less than 0.05 percent chance of having a clinically important brain bleed or other dangerous complication. Four of these six symptoms did not correlate with dangerous complications when present in isolation without any of the other five. The two higher-risk symptoms, abnormal mental state as identified by the Glasgow Coma Scale or evidence of a skull fracture, suggest the need for a CT scan even in isolation.
The conclusion, as usual, is to get to a doctor as soon as possible so the call can be made about whether a CT scan or close observation is needed. But if the bump to the head was minor, and you're not sure it even caused a concussion; don't worry about falling asleep after a few hours have gone by. “Observing a person after head injury for four to six hours is a very helpful and useful strategy, but the advice to ‘wake a person up every so often to check on them’ is more aggressive than necessary,” explains physician Danny Thomas, a concussion researcher at the Medical College of Wisconsin. If the patient is breathing normally, not having a seizure, not vomiting or waking up with a worsening headache, there is no need to wake the person up fully and interact with him or her, Thomas says.
After six hours the danger has passed, according to much research. For example, a large Canadian study in 2010 in Pediatrics followed nearly 18,000 concussion patients and found that after six hours the chance that patients without altered consciousness or severely impaired cognition would have a brain bleed was 0 percent.
4. PROLONGED “BRAIN REST” IS NOT NECESSARY—AND IT MAY EVEN BE HARMFUL.
When I finally saw that primary care physician and was diagnosed with a concussion, he told me to “rest my brain” for at least 10 days—no work, no socializing, no physical exertion, no reading or watching TV. I was instructed to lie in a dark room and perhaps listen to calm classical music if I could do so without my symptoms worsening. Needless to say, I became bored and frustrated very quickly. And I now know that such a long rest period probably did me no good—in fact, it may have slowed down my recovery.
My doctor is one of many—perhaps most—who advise patients to rest for a week or more based on outdated information that was never evidence-based in the first place. The original idea was to prevent a concussed athlete from getting back into the game too soon and risking a second concussion. Athletes are often so eager to get back on the field, Thomas says, that “they underreport and lie about symptoms.” Unfortunately, a recommendation intended to protect these overeager athletes got misapplied to the general public. “Athletes tend to recover much more quickly, so the timeline the experts had in mind was a couple of days,” says concussion researcher Noah Silverberg, a visiting assistant professor of medicine at Harvard Medical School. But people like me are often told to rest until their symptoms go away—which can be weeks or even months. “I think that's not what the original recommendation meant,” Silverman says.
Prolonged rest may not merely be boring, it flies in the face of what we know about healing an injured brain. “If someone has a stroke and then sits around and doesn't do anything, the person will never get better,” Thomas observes. He recently led one of the first randomized controlled clinical trials of varying rest periods in 88 concussed patients aged 11 to 22. He and his colleagues found that those who were put on strict rest—no school, no exercise, no screen time—for five days postinjury reported more symptoms at 10 days out than those who rested for only two days, according to results from the trial published in February 2015 in Pediatrics. The handful of other studies that have attempted to look at the effect of different activity levels postconcussion tend to line up with Thomas's findings—a day or two of rest following the injury is helpful but more than that is probably not.
Concussion experts believe there are several potential explanations for why more rest is not better. Sitting around thinking about symptoms can make them seem worse, for one. Moreover, when people are told they are too ill to do anything, they sometimes take on a sick role psychologically. It is even possible that resting too much causes a deconditioning of sorts in the brain, so that very little mental effort then triggers symptoms. “We need to take guidance from the physical therapy world: push up to the pain but not through it,” Thomas says. In other words, after the initial day or two of rest, a concussed person should try to go about daily life until symptoms show up and then stop, rest and repeat. Think of it as getting your brain back in shape.
5. REST IS NOT THE ONLY TREATMENT AVAILABLE.
After enduring my interminable rest period, I tried to get back to work and discovered, much to my dismay, that reading anything on paper or a computer screen immediately triggered an excruciating headache and nausea. My physician had advised me to see a neurologist if I was still having symptoms after all that rest, so I did. The neurologist assessed my symptoms, offered some sympathy and prescribed sumatriptan, a migraine drug that has been shown to help ease post concussion headaches and perhaps even speed up recovery. And that was it. I saw her every couple weeks; she verified that my symptoms were improving slowly and re-upped my prescription when necessary. Three months passed before I could tolerate a full day's work.
When I told this story to the various concussion experts I interviewed for this story, the universal reaction was disappointment but not surprise. “What you're describing is so common, so frustrating for patients and family,” Smith says. “You're shown out of the ER and left in the wind.” People with chronic symptoms end up diagnosing themselves, he says, and unfortunately many are never referred to a concussion specialist or clinic. Concussion clinics are becoming more common, especially in major metro areas and regions with large hospitals, and they usually bring together a team of practitioners that includes neurologists, psychiatrists, sports medicine or physiology specialists, and physical and occupational therapists. They offer a variety of physical and psychological treatments, many of which seem to successfully treat certain symptoms. Headache, memory and cognition issues, vestibular problems and visual symptoms—if only I had known!—are all treatable to some degree. Scientific data about the efficacy of these programs are scarce, however, because figuring out which concussion patients to enroll in trials—which ones will have a complicated recovery—is currently almost impossible, Smith says. Yet by borrowing treatments from other fields and specialties, concussion specialists are able to ease many symptoms.
The bottom line: “You can do something to speed up your recovery, especially if you're having a difficult time,” Silverberg says.
6. IT'S IMPOSSIBLE TO PREDICT WHICH SYMPTOMS A PERSON WILL HAVE AND HOW LONG RECOVERY WILL TAKE—BUT THAT MAY CHANGE SOON.
Up until a few years ago, doctors believed that being knocked unconscious indicated a more severe concussion than simply getting dazed. That idea is outdated. The majority of research findings have now shown that passing out has no relation to the severity of postconcussion symptoms or to recovery time. In fact, nothing about the incident seems to have any consistent predictive power—the type of accident, the location of the blow on the skull, the symptoms immediately following the event.
Recent research from Smith's team and others has finally homed in on an explanation for why some concussions are so much harder to recover from than others. These concussions, in addition to causing a sodium flood, do permanent damage to the brain's axons, the long tendrils that neurons use to communicate with one another and with different regions throughout the brain. In these more serious injuries, the sudden rotational acceleration caused by a blow or jolt to the head causes some axons to break. “Axons are like Silly Putty,” Smith says. “If you make a cylinder of Silly Putty and stretch it slowly, it will stretch forever. But if you take the same cylinder and stretch it rapidly, it snaps. That's what happens to axons under sudden rotational acceleration.”
When the axons break, they release a cascade of proteins and chemicals, some of which can trigger additional damage in nearby cells. Although the broken axons never grow back, the brain is adept at finding work-arounds and creating more connections—which is why even people with axon damage recover eventually.
One type of brain scan, called diffusion tensor imaging (DTI), is designed to specifically investigate the connections between cells—the axon tracts. As such, it has shown promise in small studies for identifying the extent of damage in a concussed patient's brain. Another promising diagnostic test looks for axon proteins in the blood, which can indicate the level of damage. Smith is hopeful that one or more of these techniques will be ready for use in larger studies fairly soon. “We're on the verge of developing much better diagnostics,” he says. “Then we can have highly powered studies, so we can look at drug therapies or other types of rehab strategies.”
A rash of brand-new studies are suggesting that certain red flags in the patient's medical history—migraine and motion sickness, for example—might be indicators that recovery will be arduous. But the most robustly supported risk factor is the presence of psychiatric symptoms, manifesting either before or after the concussion. Two studies in 2015, one that looked at 72 soldiers with blast-related injuries and the other that followed 77 civilians with sport- or accident-related injuries, both found that the presence of depression, post-traumatic anxiety and other mental symptoms predicted a prolonged recovery from concussion. A major review of the literature by Silverberg and his colleagues, published in April 2015 in the Journal of Neurotrauma, concurred: the factors that most robustly predicted a slow recovery were a history of mental health issues and post injury anxiety.
“When a patient comes into a clinic, there are lots of questions asked about the nature of the injury, the mechanics, how and where you hit your head. As far as we know, none of that matters,” Silverberg says. “Clinicians should actually inquire about how concerned patients are about the fact that they've had a concussion and whether they've struggled with mental illness in the past.” As he points out, these data are cheap and easy to collect (unlike brain scans) and could be far more helpful in flagging people at risk for complications. Doctors should also try to be encouraging about patients' potential for recovery, he says—yet another reason why telling patients they must lie in a dark room for two weeks is counterproductive.
The last thing to note about concussion symptoms is that they can vary widely from one person to the next and even for the individual patient. During my recovery I found that one minute I could be conversing normally, even energetically, and the next I would suddenly feel sluggish, confused and nauseated. I heard many stories from the doctors and patients I interviewed about people being very suspicious or dismissive of patients' post concussion struggles: bosses handing out pink slips, professors giving Fs, friends and family making accusations of malingering. People recovering from a concussion look totally normal, after all, and their symptoms are usually noticeable only to themselves.
“These are subtle deficits,” cautions Daniel Corwin, a concussion researcher and physician at Children's Hospital of Philadelphia. “We don't have objective tests, so we have to take the patient's report of symptoms at face value.” Corwin and other experts hope that recent media attention to concussions will lead schools, workplaces and the general public to recognize how difficult recovery can be. “It's tough,” he says. “And it's a great point for those in the community to consider.”
As for me, I have felt blissfully myself for several months now—except for a newfound nervousness about slipping on ice, falling off my bike or otherwise knocking my noggin. I hope I never have to go through the ordeal of a concussion again—but if I do, at least I now know more about how to help my brain heal.
________________________________________
DO I HAVE A CONCUSSION?
If you have banged your head, been in a car accident or taken a spill, your doctor will probably assess you for a concussion. The diagnosis is not an exact science; a neurological examination might reveal issues with balance, reaction time or pupil dilation—but many concussions come without these obvious problems, or else these symptoms may have passed by the time of evaluation. For that reason, scientists are working feverishly to develop easy tests that can be conducted on the sidelines of a sports field to reliably identify a concussion no matter what symptoms are present. Many of these tests have shown promise in early trials, especially in cases in which a healthy comparison measurement is on file, making it easy for parents and coaches to quickly assess whether there has been a change in a player’s visual reaction time, counting or addition speed, or even ability to discriminate smells on a scratch-and-sniff card.
For those of us without reaction-time test results on file, however, doctors must rely heavily on the symptoms we report. One day blood tests or brain scans may be available, but right now the only common tool other than the neurological exam is a symptom inventory, such as the one below, developed by neuropsychologist Keith Cicerone. When doctors administer such surveys, they ask patients not only to indicate whether they have a given symptom but also to rate its severity (for example, on a 1 to 5 scale) and report how many days out of the past week it has occurred. Doctors mainly use such lists to track symptom burden over time. If mood, anxiety or sleep-related symptoms appear in the days or weeks after a brain injury, they can be a warning sign that a patient might be experiencing post-traumatic stress disorder or post concussive syndrome, which occurs when concussion symptoms linger for many months or even years. These inventories can also be helpful in the initial diagnosis—especially the first five symptoms, which are some of the classic signs of concussion. —K.S.S.
• Feeling dizzy
• Loss of balance
• Poor coordination, clumsy
• Headache
• Nausea
• Vision problems (blurring, trouble seeing)
• Sensitivity to light
• Hearing difficulty
• Sensitivity to noise
• Numbness or tingling on parts of body
• Change in taste or smell
• Loss of appetite or increased appetite
• Poor concentration, easily distracted
• Forgetfulness, not being able to remember things
• Difficulty making decisions
• Slowed thinking, difficulty getting organized, not being able to finish tasks
• Fatigue, loss of energy, easily tired
• Difficulty falling or staying asleep
• Feeling anxious or tense
• Feeling depressed or sad
• Irritability, easily annoyed
• Feeling easily overwhelmed by things
This article was originally published with the title "Six Things You Should Know about Concussions" in SA Mind 27, 1, 50-57 (January 2016)
doi:10.1038/scientificamericanmind0116-50
Rights & Permissions
MORE TO EXPLORE
Identification of Children at Very Low Risk of Clinically-Important Brain Injuries after Head Trauma: A Prospective Cohort Study. Nathan Kuppermann et al. in Lancet, Vol. 374, pages 1160–1170; October 3–9, 2009.
Biomarkers of Mild Traumatic Brain Injury in Cerebrospinal Fluid and Blood. Henrik Zetterberg, Douglas H. Smith and Kaj Blennow in Nature Reviews Neurology, Vol. 9, pages 201–210; April 2013.
Benefits of Strict Rest after Acute Concussion: A Randomized Controlled Trial. Danny George Thomas et al. in Pediatrics, Vol. 135, No. 2; February 2015.
Systematic Review of Multivariable Prognostic Models for Mild Traumatic Brain Injury. Noah D. Silverberg et al. in Journal of Neurotrauma, Vol. 32, No. 8, pages 517–526; April 7, 2015.
FROM OUR ARCHIVES
Impact on the Brain. Richard J. Roberts; December 2008/January 2009.
Fatal Strikes. Jacqueline C. Tanaka and Gregg B. Wells; January/February 2014.
Concussion Coach. Karen Schrock Simring; Reviews and Recommendations, March/April 2015.
ABOUT THE AUTHOR(S)
Karen Schrock Simring is a contributor to Scientific American.
THE SCIENCE OF CONCUSSION AND BRAIN INJURY
MIND & BRAIN
A Generation Loses Consciousness, and Grows More Conscious of Headbanging
Dina Fine Maron
MIND & BRAIN
A Safe Way to Tackle?
Larry Greenemeier
HEALTH
Concussion Is a Serious Problem for Child Athletes
The Editors
MIND & BRAIN
Helmet Sensors Reveal the Real Impact of Head Injuries
MIND & BRAIN
Head Injury May Cause Mental Illness
Tori Rodriguez
MIND & BRAIN
24-Year-Old NFL Player's Retirement Reignites Brain Injury Topic
Rachael Rettner and LiveScience
https://www.scientificamerican.com/arti ... ncussions/
Much of what we've heard is wrong. Here's the latest lowdown on these brain injuries plus new ideas about how to treat them
• By Karen Schrock Simring on January 1, 2016
Credit: RADIO
IN BRIEF
Injury to the Brain
• A concussion can occur when the head is jolted, either from a blow or from a sudden stop.
• After a jolt, it is crucial to avoid a second blow and to see a doctor as soon as possible.
• New research shows that resting for more than a couple of days after a concussion may do more harm than good, and targeted treatments may help with some symptoms.
• It remains very difficult to predict which patients will struggle with a lengthy recovery. Mental illness and psychiatric symptoms such as anxiety, both before and after the concussion, seem to be linked with the highest risk.
One minute I was waving hello to the neighbors during a typical Rollerblading session with my dog, and the next I was flying down a newly paved hill at a runaway speed. Aiming for a soft landing, I steered up a driveway toward a lawn. My feet hit the grass, and I flew about 10 feet through the air before landing and rolling on the ground. I had the wind knocked out of me—a truly painful experience I hadn't had since childhood—but I could tell I hadn't broken any bones. I was just congratulating myself on avoiding a serious injury when I passed out.
I didn't know it at the time, but this incident last fall was my personal introduction to the frightening and sometimes baffling experience of having a concussion. As a science editor, I had handled a number of stories on mild traumatic brain injury (TBI), as concussions are officially known, but I was not prepared for the pain and debilitation that came over the following weeks and months. That is because—for all its prevalence in the news as a danger to massive NFL players and tiny soccer tots alike—concussions remain subject to a remarkable amount of myth, mystery and misinformation. Even among well-meaning doctors. The good news is that concussion research has surged in recent years, thanks to concern from the athletic and military communities—so we are starting to learn more about the underlying causes of its symptoms and how best to treat them. And we are beginning to clear away some of the fog around who is at greatest risk for serious repercussions. Here are six key things you should know about concussions—things I wish I had known when I hit the ground.
1. YOU DON'T HAVE TO SMACK YOUR HEAD TO GET A CONCUSSION.
After my skating accident, I went to my local hospital because my abdomen hurt and one of my arms was rapidly swelling into a purple, football-sized balloon. The emergency room staff x-rayed my arm and did a CT scan of my midsection to rule out internal bleeding. As we were getting ready to go, my husband asked the doctor why he didn't assess me for a head injury. “Because she said she didn't hit her head,” the doctor replied. And that was that. I went home and went to bed.
The next morning the symptoms hit: excruciating headache, nausea, sensitivity to light, confusion. I thought I was having a bizarre and terrible migraine. I went the next day to see an associate of our family doctor, who promptly diagnosed me with a concussion. He reminded me that a sudden deceleration of the type I had undergone—from, say, 20 miles an hour to zero in less than a second—could damage the brain by causing it to slosh around within the skull.
In fact, doctors are seeing more and more concussions that do not involve a direct blow to the head, especially among military personnel exposed to bomb blasts. The shock wave from an explosion can send the brain bouncing perilously within the skull. Thousands of service members report concussions every year. Among U.S. civilians, the Centers for Disease Control and Prevention estimates about 1.36 million concussions a year. But that number is a bit shaky, in part because greater awareness of concussions has probably led more patients to seek medical attention and more doctors to notice and diagnose mild TBIs in recent years. As a result, the incidence has been rising.
Another reason the true incidence of concussions is not easy to pin down is that the diagnosis itself is based mostly on subjective symptom reporting [see “Do I Have a Concussion?” below] rather than any definitive test. Doctors diagnose a concussion if a person has had a blow or jolt to the head and reports at least a couple of the well-known symptoms, including dizziness, confusion, short-term memory loss, headache, and sensitivity to light or noise. But these symptoms can also be caused by a number of other factors, and unless there are clear neurological symptoms such as delayed pupil reflexes, which show up in some concussion cases, there is currently no way to know for sure whether symptoms are arising from a brain injury rather than, say, a migraine, the flu or post-traumatic stress disorder (PTSD). Most emergency room doctors will not order scans unless bleeding or more serious injury in the brain is suspected. Unlike these more dangerous complications, injury from a mild TBI is usually too microscopic for MRI, CT or PET scans to pick up.
There are simple steps to take if you do notice the telltale symptoms of concussion after you bump your head or after you are in any situation in which your head is jolted suddenly—including a fender bender or even a roller-coaster ride. “First, pull yourself out of risk so you don't hit your head again,” says William P. Meehan III, director of the Micheli Center for Sports Injury Prevention at Boston Children's Hospital. “Second, see a medical professional to get some guidance. And third, follow that guidance, which should be a few days of rest followed by gradually increasing activity.”
2. IF YOU THINK YOU MIGHT HAVE A CONCUSSION, MAKE SURE YOU DON'T HIT YOUR HEAD AGAIN.
When the primary care doctor warned me about this risk, I thanked my lucky stars I had not decided to get back on my skates the day after my ER visit. Experts agree that minimizing the risk of a second concussion is key because getting two in a row can lead to long-term complications or, rarely, death. The mechanism behind this effect is unknown, but cell studies suggest it might have something to do with sodium.
The brain maintains a delicate balance of sodium and potassium ions to facilitate the electrical signals between neurons. When the head is jolted, cells react by suddenly taking up more sodium, which immediately shuts down the electrical signaling. That is why a concussion can cause a loss of consciousness so much faster than asphyxiation does. “It's a blackout of the brain's electrical grid,” explains Douglas H. Smith, director of the Center for Brain Injury and Repair at the University of Pennsylvania.
Experimental evidence is starting to suggest that one way brain cells react to this blackout is to quickly add more sodium channels along their membranes to help restore the balance. “That might be a great way to get the lights back on, but it also might come at a huge cost if you get hit again,” Smith says. With all that additional access to sodium now available, getting hit again “is like pouring saltwater over live circuits,” he says.
Many decades of studies in youngsters and adults confirm that suffering a second concussion while still experiencing symptoms from the first puts a person at a hugely increased risk for long-term symptoms lasting months or even years. In some rare cases, it can even lead to permanent brain damage or death. Second impact syndrome, as this most severe reaction is known, is diagnosed when a second concussion in the minutes, days or weeks following the first causes sudden and often fatal brain swelling. The exact mechanism behind this catastrophic cascade is unclear, but confirmed cases of second impact syndrome are fatal more than 50 percent of the time.
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Most reported cases of the syndrome have been in children, prompting the strict guidelines regarding student athletes returning to play after sustaining a concussion. Prevalence is hard to measure because of the rarity of cases and the fact that the bleeding may be misdiagnosed as a direct result of the blunt trauma, but studies estimate that second impact syndrome kills about three to four people a year in the U.S.
3. IT'S OKAY TO FALL ASLEEP AFTER GETTING A CONCUSSION.
The familiar advice to keep a concussed person awake shows up in pop culture so often it has become a cliché. In reality, going to sleep a few hours after a concussion is fine and probably even helpful to your recovering brain. Here is what you should know about how much monitoring a concussed person truly needs.
Before brain-scanning technology, the only way to know if a blow to the head had caused a dangerous complication such as bleeding within the brain was to interact with patients in the minutes and hours after injury to see if their speech or motor coordination went downhill. Such interactions require a patient to be awake. That's all—there is nothing inherently dangerous about sleep, just the difficulty of assessing someone's neurological health if the person is unconscious.
Nowadays doctors can order a CT scan if major injury is suspected in the brain—for instance, if any bruising is visible under the scalp or if the patient has a severe and worsening headache. We also know a lot more about which symptoms are predictive of bleeding. In a landmark 2009 study published in the Lancet, physician Nathan Kuppermann of the University of California, Davis, and his colleagues studied 42,412 children and adolescents younger than 18. They found that for children older than two who did not have any of six specific symptoms, such as vomiting or dysfunctional cognition, there was a less than 0.05 percent chance of having a clinically important brain bleed or other dangerous complication. Four of these six symptoms did not correlate with dangerous complications when present in isolation without any of the other five. The two higher-risk symptoms, abnormal mental state as identified by the Glasgow Coma Scale or evidence of a skull fracture, suggest the need for a CT scan even in isolation.
The conclusion, as usual, is to get to a doctor as soon as possible so the call can be made about whether a CT scan or close observation is needed. But if the bump to the head was minor, and you're not sure it even caused a concussion; don't worry about falling asleep after a few hours have gone by. “Observing a person after head injury for four to six hours is a very helpful and useful strategy, but the advice to ‘wake a person up every so often to check on them’ is more aggressive than necessary,” explains physician Danny Thomas, a concussion researcher at the Medical College of Wisconsin. If the patient is breathing normally, not having a seizure, not vomiting or waking up with a worsening headache, there is no need to wake the person up fully and interact with him or her, Thomas says.
After six hours the danger has passed, according to much research. For example, a large Canadian study in 2010 in Pediatrics followed nearly 18,000 concussion patients and found that after six hours the chance that patients without altered consciousness or severely impaired cognition would have a brain bleed was 0 percent.
4. PROLONGED “BRAIN REST” IS NOT NECESSARY—AND IT MAY EVEN BE HARMFUL.
When I finally saw that primary care physician and was diagnosed with a concussion, he told me to “rest my brain” for at least 10 days—no work, no socializing, no physical exertion, no reading or watching TV. I was instructed to lie in a dark room and perhaps listen to calm classical music if I could do so without my symptoms worsening. Needless to say, I became bored and frustrated very quickly. And I now know that such a long rest period probably did me no good—in fact, it may have slowed down my recovery.
My doctor is one of many—perhaps most—who advise patients to rest for a week or more based on outdated information that was never evidence-based in the first place. The original idea was to prevent a concussed athlete from getting back into the game too soon and risking a second concussion. Athletes are often so eager to get back on the field, Thomas says, that “they underreport and lie about symptoms.” Unfortunately, a recommendation intended to protect these overeager athletes got misapplied to the general public. “Athletes tend to recover much more quickly, so the timeline the experts had in mind was a couple of days,” says concussion researcher Noah Silverberg, a visiting assistant professor of medicine at Harvard Medical School. But people like me are often told to rest until their symptoms go away—which can be weeks or even months. “I think that's not what the original recommendation meant,” Silverman says.
Prolonged rest may not merely be boring, it flies in the face of what we know about healing an injured brain. “If someone has a stroke and then sits around and doesn't do anything, the person will never get better,” Thomas observes. He recently led one of the first randomized controlled clinical trials of varying rest periods in 88 concussed patients aged 11 to 22. He and his colleagues found that those who were put on strict rest—no school, no exercise, no screen time—for five days postinjury reported more symptoms at 10 days out than those who rested for only two days, according to results from the trial published in February 2015 in Pediatrics. The handful of other studies that have attempted to look at the effect of different activity levels postconcussion tend to line up with Thomas's findings—a day or two of rest following the injury is helpful but more than that is probably not.
Concussion experts believe there are several potential explanations for why more rest is not better. Sitting around thinking about symptoms can make them seem worse, for one. Moreover, when people are told they are too ill to do anything, they sometimes take on a sick role psychologically. It is even possible that resting too much causes a deconditioning of sorts in the brain, so that very little mental effort then triggers symptoms. “We need to take guidance from the physical therapy world: push up to the pain but not through it,” Thomas says. In other words, after the initial day or two of rest, a concussed person should try to go about daily life until symptoms show up and then stop, rest and repeat. Think of it as getting your brain back in shape.
5. REST IS NOT THE ONLY TREATMENT AVAILABLE.
After enduring my interminable rest period, I tried to get back to work and discovered, much to my dismay, that reading anything on paper or a computer screen immediately triggered an excruciating headache and nausea. My physician had advised me to see a neurologist if I was still having symptoms after all that rest, so I did. The neurologist assessed my symptoms, offered some sympathy and prescribed sumatriptan, a migraine drug that has been shown to help ease post concussion headaches and perhaps even speed up recovery. And that was it. I saw her every couple weeks; she verified that my symptoms were improving slowly and re-upped my prescription when necessary. Three months passed before I could tolerate a full day's work.
When I told this story to the various concussion experts I interviewed for this story, the universal reaction was disappointment but not surprise. “What you're describing is so common, so frustrating for patients and family,” Smith says. “You're shown out of the ER and left in the wind.” People with chronic symptoms end up diagnosing themselves, he says, and unfortunately many are never referred to a concussion specialist or clinic. Concussion clinics are becoming more common, especially in major metro areas and regions with large hospitals, and they usually bring together a team of practitioners that includes neurologists, psychiatrists, sports medicine or physiology specialists, and physical and occupational therapists. They offer a variety of physical and psychological treatments, many of which seem to successfully treat certain symptoms. Headache, memory and cognition issues, vestibular problems and visual symptoms—if only I had known!—are all treatable to some degree. Scientific data about the efficacy of these programs are scarce, however, because figuring out which concussion patients to enroll in trials—which ones will have a complicated recovery—is currently almost impossible, Smith says. Yet by borrowing treatments from other fields and specialties, concussion specialists are able to ease many symptoms.
The bottom line: “You can do something to speed up your recovery, especially if you're having a difficult time,” Silverberg says.
6. IT'S IMPOSSIBLE TO PREDICT WHICH SYMPTOMS A PERSON WILL HAVE AND HOW LONG RECOVERY WILL TAKE—BUT THAT MAY CHANGE SOON.
Up until a few years ago, doctors believed that being knocked unconscious indicated a more severe concussion than simply getting dazed. That idea is outdated. The majority of research findings have now shown that passing out has no relation to the severity of postconcussion symptoms or to recovery time. In fact, nothing about the incident seems to have any consistent predictive power—the type of accident, the location of the blow on the skull, the symptoms immediately following the event.
Recent research from Smith's team and others has finally homed in on an explanation for why some concussions are so much harder to recover from than others. These concussions, in addition to causing a sodium flood, do permanent damage to the brain's axons, the long tendrils that neurons use to communicate with one another and with different regions throughout the brain. In these more serious injuries, the sudden rotational acceleration caused by a blow or jolt to the head causes some axons to break. “Axons are like Silly Putty,” Smith says. “If you make a cylinder of Silly Putty and stretch it slowly, it will stretch forever. But if you take the same cylinder and stretch it rapidly, it snaps. That's what happens to axons under sudden rotational acceleration.”
When the axons break, they release a cascade of proteins and chemicals, some of which can trigger additional damage in nearby cells. Although the broken axons never grow back, the brain is adept at finding work-arounds and creating more connections—which is why even people with axon damage recover eventually.
One type of brain scan, called diffusion tensor imaging (DTI), is designed to specifically investigate the connections between cells—the axon tracts. As such, it has shown promise in small studies for identifying the extent of damage in a concussed patient's brain. Another promising diagnostic test looks for axon proteins in the blood, which can indicate the level of damage. Smith is hopeful that one or more of these techniques will be ready for use in larger studies fairly soon. “We're on the verge of developing much better diagnostics,” he says. “Then we can have highly powered studies, so we can look at drug therapies or other types of rehab strategies.”
A rash of brand-new studies are suggesting that certain red flags in the patient's medical history—migraine and motion sickness, for example—might be indicators that recovery will be arduous. But the most robustly supported risk factor is the presence of psychiatric symptoms, manifesting either before or after the concussion. Two studies in 2015, one that looked at 72 soldiers with blast-related injuries and the other that followed 77 civilians with sport- or accident-related injuries, both found that the presence of depression, post-traumatic anxiety and other mental symptoms predicted a prolonged recovery from concussion. A major review of the literature by Silverberg and his colleagues, published in April 2015 in the Journal of Neurotrauma, concurred: the factors that most robustly predicted a slow recovery were a history of mental health issues and post injury anxiety.
“When a patient comes into a clinic, there are lots of questions asked about the nature of the injury, the mechanics, how and where you hit your head. As far as we know, none of that matters,” Silverberg says. “Clinicians should actually inquire about how concerned patients are about the fact that they've had a concussion and whether they've struggled with mental illness in the past.” As he points out, these data are cheap and easy to collect (unlike brain scans) and could be far more helpful in flagging people at risk for complications. Doctors should also try to be encouraging about patients' potential for recovery, he says—yet another reason why telling patients they must lie in a dark room for two weeks is counterproductive.
The last thing to note about concussion symptoms is that they can vary widely from one person to the next and even for the individual patient. During my recovery I found that one minute I could be conversing normally, even energetically, and the next I would suddenly feel sluggish, confused and nauseated. I heard many stories from the doctors and patients I interviewed about people being very suspicious or dismissive of patients' post concussion struggles: bosses handing out pink slips, professors giving Fs, friends and family making accusations of malingering. People recovering from a concussion look totally normal, after all, and their symptoms are usually noticeable only to themselves.
“These are subtle deficits,” cautions Daniel Corwin, a concussion researcher and physician at Children's Hospital of Philadelphia. “We don't have objective tests, so we have to take the patient's report of symptoms at face value.” Corwin and other experts hope that recent media attention to concussions will lead schools, workplaces and the general public to recognize how difficult recovery can be. “It's tough,” he says. “And it's a great point for those in the community to consider.”
As for me, I have felt blissfully myself for several months now—except for a newfound nervousness about slipping on ice, falling off my bike or otherwise knocking my noggin. I hope I never have to go through the ordeal of a concussion again—but if I do, at least I now know more about how to help my brain heal.
________________________________________
DO I HAVE A CONCUSSION?
If you have banged your head, been in a car accident or taken a spill, your doctor will probably assess you for a concussion. The diagnosis is not an exact science; a neurological examination might reveal issues with balance, reaction time or pupil dilation—but many concussions come without these obvious problems, or else these symptoms may have passed by the time of evaluation. For that reason, scientists are working feverishly to develop easy tests that can be conducted on the sidelines of a sports field to reliably identify a concussion no matter what symptoms are present. Many of these tests have shown promise in early trials, especially in cases in which a healthy comparison measurement is on file, making it easy for parents and coaches to quickly assess whether there has been a change in a player’s visual reaction time, counting or addition speed, or even ability to discriminate smells on a scratch-and-sniff card.
For those of us without reaction-time test results on file, however, doctors must rely heavily on the symptoms we report. One day blood tests or brain scans may be available, but right now the only common tool other than the neurological exam is a symptom inventory, such as the one below, developed by neuropsychologist Keith Cicerone. When doctors administer such surveys, they ask patients not only to indicate whether they have a given symptom but also to rate its severity (for example, on a 1 to 5 scale) and report how many days out of the past week it has occurred. Doctors mainly use such lists to track symptom burden over time. If mood, anxiety or sleep-related symptoms appear in the days or weeks after a brain injury, they can be a warning sign that a patient might be experiencing post-traumatic stress disorder or post concussive syndrome, which occurs when concussion symptoms linger for many months or even years. These inventories can also be helpful in the initial diagnosis—especially the first five symptoms, which are some of the classic signs of concussion. —K.S.S.
• Feeling dizzy
• Loss of balance
• Poor coordination, clumsy
• Headache
• Nausea
• Vision problems (blurring, trouble seeing)
• Sensitivity to light
• Hearing difficulty
• Sensitivity to noise
• Numbness or tingling on parts of body
• Change in taste or smell
• Loss of appetite or increased appetite
• Poor concentration, easily distracted
• Forgetfulness, not being able to remember things
• Difficulty making decisions
• Slowed thinking, difficulty getting organized, not being able to finish tasks
• Fatigue, loss of energy, easily tired
• Difficulty falling or staying asleep
• Feeling anxious or tense
• Feeling depressed or sad
• Irritability, easily annoyed
• Feeling easily overwhelmed by things
This article was originally published with the title "Six Things You Should Know about Concussions" in SA Mind 27, 1, 50-57 (January 2016)
doi:10.1038/scientificamericanmind0116-50
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MORE TO EXPLORE
Identification of Children at Very Low Risk of Clinically-Important Brain Injuries after Head Trauma: A Prospective Cohort Study. Nathan Kuppermann et al. in Lancet, Vol. 374, pages 1160–1170; October 3–9, 2009.
Biomarkers of Mild Traumatic Brain Injury in Cerebrospinal Fluid and Blood. Henrik Zetterberg, Douglas H. Smith and Kaj Blennow in Nature Reviews Neurology, Vol. 9, pages 201–210; April 2013.
Benefits of Strict Rest after Acute Concussion: A Randomized Controlled Trial. Danny George Thomas et al. in Pediatrics, Vol. 135, No. 2; February 2015.
Systematic Review of Multivariable Prognostic Models for Mild Traumatic Brain Injury. Noah D. Silverberg et al. in Journal of Neurotrauma, Vol. 32, No. 8, pages 517–526; April 7, 2015.
FROM OUR ARCHIVES
Impact on the Brain. Richard J. Roberts; December 2008/January 2009.
Fatal Strikes. Jacqueline C. Tanaka and Gregg B. Wells; January/February 2014.
Concussion Coach. Karen Schrock Simring; Reviews and Recommendations, March/April 2015.
ABOUT THE AUTHOR(S)
Karen Schrock Simring is a contributor to Scientific American.
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https://www.scientificamerican.com/arti ... ncussions/
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greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Goaltender out with concussion
Goaltender out with concussion
The Women’s Nunavut 2023 Hockey team has been eliminated from the Arctic Winter Games after playing their fourth match of the tournament.
The team, composed of players aged 11-19 years old, competed against teams from North Alberta, Northwest Territories, Alaska and Yukon.
“Our first match was on Monday Jan. 30 at 8:30 a.m.,” said Cassiar Cousins, goaltender for the team. “I was not too excited about waking up at 4 a.m. for the match, but it was fun!”
It is the first time the girls were playing together as a team, although some of them had played in the same hockey league in Iqaluit in the past. The team was mentored by coaches Jaime Savikataak, Lauren Perrin and Chloe Norris.
Cousins said the other teams were talented, which had her doubling efforts in the net. “I received 53 shots just on the first game.”
During the first game, the goalkeeper got hit on the head with a hockey stick by a player from the other team. During the rest of the two first games, she was hit on the head twice more by pucks shot at her.
“On Tuesday I was checked by a doctor who confirmed I had a concussion from the hits,” said Cousins.
The goaltender was not surprised, as she had been feeling side effects of the concussion already “The back side of my head hurts and I’m very sensitive to light and sound, which makes it hard to watch the other hockey games,” said Cousins.
The goalkeeper did not let that affect her presence at the following matches. “I got sunglasses and I went to cheer for the team,” said Cousins.
When asked who she thought would win the women’s hockey gold medal, Cousins said “probably Yukon or North Alberta would have the most chances.”
Now that the team was eliminated, they are spending the rest of their time in Alberta enjoying activities organized around the AWG, like cheering for the men’s Nunavut Hockey Team at the Fort McMurray Centerfire Arena.
“There is all sort of activities; we went to a puppy meet-up with dogs from the animal shelter and we also went to a drag bingo,” said Cousins.
Nunavut goaltender out with concussion at AWG
Read more: https://www.nunavutnews.com/news/nunavu ... on-at-awg/
The Women’s Nunavut 2023 Hockey team has been eliminated from the Arctic Winter Games after playing their fourth match of the tournament.
The team, composed of players aged 11-19 years old, competed against teams from North Alberta, Northwest Territories, Alaska and Yukon.
“Our first match was on Monday Jan. 30 at 8:30 a.m.,” said Cassiar Cousins, goaltender for the team. “I was not too excited about waking up at 4 a.m. for the match, but it was fun!”
It is the first time the girls were playing together as a team, although some of them had played in the same hockey league in Iqaluit in the past. The team was mentored by coaches Jaime Savikataak, Lauren Perrin and Chloe Norris.
Cousins said the other teams were talented, which had her doubling efforts in the net. “I received 53 shots just on the first game.”
During the first game, the goalkeeper got hit on the head with a hockey stick by a player from the other team. During the rest of the two first games, she was hit on the head twice more by pucks shot at her.
“On Tuesday I was checked by a doctor who confirmed I had a concussion from the hits,” said Cousins.
The goaltender was not surprised, as she had been feeling side effects of the concussion already “The back side of my head hurts and I’m very sensitive to light and sound, which makes it hard to watch the other hockey games,” said Cousins.
The goalkeeper did not let that affect her presence at the following matches. “I got sunglasses and I went to cheer for the team,” said Cousins.
When asked who she thought would win the women’s hockey gold medal, Cousins said “probably Yukon or North Alberta would have the most chances.”
Now that the team was eliminated, they are spending the rest of their time in Alberta enjoying activities organized around the AWG, like cheering for the men’s Nunavut Hockey Team at the Fort McMurray Centerfire Arena.
“There is all sort of activities; we went to a puppy meet-up with dogs from the animal shelter and we also went to a drag bingo,” said Cousins.
Nunavut goaltender out with concussion at AWG
Read more: https://www.nunavutnews.com/news/nunavu ... on-at-awg/
-
greybeard58
- Posts: 2511
- Joined: Sat Aug 21, 2004 11:40 pm
Women are 48% more likely than men to develop depression after TBI
Women are 48% more likely than men to develop depression after TBI
Women are nearly 50% more likely than men to develop depression after suffering a concussion or other traumatic brain injury (TBI), according to an analysis of nine studies and nearly 700,000 people presented at the ANESTHESIOLOGY® 2023 annual meeting.
"Most studies showing the link between TBI and depression have focused on men. Our study represents the highest-quality evidence to date that a patient's gender influences the risk of depression after traumatic brain injury.” — Isaac G. Freedman, M.D., MPH, lead author of the study and anesthesiology resident at Massachusetts General Hospital and Harvard Medical School, Boston
About 1.5 million Americans suffer a TBI every year, which can lead to long-term health effects such as memory loss and behavioral changes. Common causes of TBI in men include being struck in the head by an object, being in a motor vehicle accident, self-harm (such as from a gun) and assault. In women, common causes include falls and intimate partner violence.
Other common causes of TBI include trauma related to military service and sports-related concussion. Women's soccer has the highest rate of concussions of all contact sports, a separate study recently found. "Women who have a higher rate of soccer-related, repetitive head injuries and concussions may be at increased risk of depression," said Mani Sandhu, M.B.B.S., M.S., co-author of the study and a neurosurgery resident at the University of Iowa, Iowa City.
Women should be aware of the risk of developing depression after a brain injury, even if they have no prior history of mental health challenges, and should know what signs and symptoms to look for and when to seek help, Dr. Freedman said. Doctors should be aware of the higher risk and may consider screening women for depression if they have had a TBI.
The researchers analyzed nine studies of 691,364 people who had suffered from TBI. Of those, 360,605 were women, an estimated 105,755 (29.3%) of whom developed depression; and 330,759 were men, an estimated 72,432 (21.9%) of whom developed depression. That meant women faced 48% higher odds than men of developing depression.
Researchers aren't sure why TBI is more likely to lead to depression in women. They do know that overall, women are more likely than men to have depression, which is associated with fluctuating reproductive hormones.
"The resulting difference in brain circuits between men and women in combination with factors such as lack of social support, socioeconomic status and inadequate treatment options may make some women more vulnerable to post-TBI depression," said Benjamin F. Gruenbaum, M.D., Ph.D., senior author of the study and assistant professor of anesthesiology and perioperative medicine, Mayo Clinic, Jacksonville, Florida.
Women more likely than men to develop depression after traumatic brain injury
Read more: https://www.news-medical.net/news/20231 ... njury.aspx
American Society of Anesthesiologists: https://www.asahq.org/about-asa/newsroo ... depression
Women are nearly 50% more likely than men to develop depression after suffering a concussion or other traumatic brain injury (TBI), according to an analysis of nine studies and nearly 700,000 people presented at the ANESTHESIOLOGY® 2023 annual meeting.
"Most studies showing the link between TBI and depression have focused on men. Our study represents the highest-quality evidence to date that a patient's gender influences the risk of depression after traumatic brain injury.” — Isaac G. Freedman, M.D., MPH, lead author of the study and anesthesiology resident at Massachusetts General Hospital and Harvard Medical School, Boston
About 1.5 million Americans suffer a TBI every year, which can lead to long-term health effects such as memory loss and behavioral changes. Common causes of TBI in men include being struck in the head by an object, being in a motor vehicle accident, self-harm (such as from a gun) and assault. In women, common causes include falls and intimate partner violence.
Other common causes of TBI include trauma related to military service and sports-related concussion. Women's soccer has the highest rate of concussions of all contact sports, a separate study recently found. "Women who have a higher rate of soccer-related, repetitive head injuries and concussions may be at increased risk of depression," said Mani Sandhu, M.B.B.S., M.S., co-author of the study and a neurosurgery resident at the University of Iowa, Iowa City.
Women should be aware of the risk of developing depression after a brain injury, even if they have no prior history of mental health challenges, and should know what signs and symptoms to look for and when to seek help, Dr. Freedman said. Doctors should be aware of the higher risk and may consider screening women for depression if they have had a TBI.
The researchers analyzed nine studies of 691,364 people who had suffered from TBI. Of those, 360,605 were women, an estimated 105,755 (29.3%) of whom developed depression; and 330,759 were men, an estimated 72,432 (21.9%) of whom developed depression. That meant women faced 48% higher odds than men of developing depression.
Researchers aren't sure why TBI is more likely to lead to depression in women. They do know that overall, women are more likely than men to have depression, which is associated with fluctuating reproductive hormones.
"The resulting difference in brain circuits between men and women in combination with factors such as lack of social support, socioeconomic status and inadequate treatment options may make some women more vulnerable to post-TBI depression," said Benjamin F. Gruenbaum, M.D., Ph.D., senior author of the study and assistant professor of anesthesiology and perioperative medicine, Mayo Clinic, Jacksonville, Florida.
Women more likely than men to develop depression after traumatic brain injury
Read more: https://www.news-medical.net/news/20231 ... njury.aspx
American Society of Anesthesiologists: https://www.asahq.org/about-asa/newsroo ... depression