Discussion of Minnesota Girls High School Hockey

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Meghan Graham

Post by greybeard58 » Sat May 04, 2019 1:56 am

Meghan Graham dies at 24 from complications of her head injuries

Meghan Graham and her dog, Summit.

As a teenager, Meghan Graham of Minnetonka was a five-time national snowboard racing champion for her age group. By 2012, Graham was crowned the U.S. slalom champion for women in the open division.

“She was on track to be an Olympian,” said Jessica Zalusky, director of the Twin Cities-based G Team, the largest competitive snowboard team in the country.

Two significant concussions caused Graham to retire from the sport in 2013, but she didn’t give it up. Within a few years, she turned to coaching youngsters, and several of them, like her, also became champion snowboard racers.

Graham died unexpectedly April 21 in Minnetonka from complications of her head injuries. She was 24. The news reverberated throughout the snowboarding world.

“Across the country, there is a lot of shock and devastation,” Zalusky said. “Everyone just spent two weeks in Colorado where she was coaching athletes to the national title. … We were talking about next season. She was so excited.”

Graham was born in Mountain View, Calif., and her parents, Jennifer and Rick Graham, who grew up in Minnesota, moved the family back to the state in 2001. Her father said that in a family of skiers, Meghan was exposed to snowboarding when she was in grade school.

“She loved it,” Rick Graham said. “She was fearless.”

Zalusky called Graham a natural talent, but “more than that, she was driven and motivated.”

At 16, she moved to Steamboat Springs, Colo., where she trained every day while working to complete her high school degree. She eventually racked up 70 regional wins over the course of her career. Her brother and best friend Ricky became a star snowboarder too, winning the national championship in his age division in 2014.

Zalusky said Meghan Graham gave coaching the same intensity she had given competition. She excelled quickly as an Alpine coach and within a year was coaching the pro-am team and traveling on the North American championship circuit where top riders compete.

“I had a lot of respect for her coaching style,” said Lily Janousek, 15, of Greenwood. “She knew exactly how the snow felt and how racing felt.”

Jason Gust, a manager at Tonka Cycle and Ski in Hopkins, said the store sponsored Graham when she was racing.

“She was very determined to do well,” he said. “She pushed it all the time. Super happy, super stoked to do everything. She was never in a bad mood. Even when she crashed and had an injury, she looked forward to getting back on snow.”

A graduate of Minnetonka High School, Graham was a student at Normandale Community College and spoke of pursuing a career in therapeutic recreation. She worked part-time at DayBridge Adult Day Services at the Glenn Hopkins senior facility in Hopkins where she had a special affinity for older people, said Jackie Byington, the adult day director. “She loved our people,” Byington said.

Once a week, she’d bring her dog, Summit, to the facility.

Byington said that on Good Friday, two days before she died, Graham and Summit arrived at the facility, both wearing bunny ears, while she passed out candy from a basket to the entire campus.

“She was loved by everyone,” Byington said.

A few days after her death, about 200 people including family and friends and members of the snowboarding community gathered on the beach in the commons area in Excelsior and made tie-dye shirts in her honor.

“She loved to wear them,” said Zalusky.

A Tie-Dye Celebration service is scheduled for 2 p.m. on May 9 at the Woods Chapel, 525 Leaf St., Long Lake. Attendees may gather in the amphitheater at 1 p.m.

Minnetonka snowboarding champion Meghan Graham dies at 24
Read more at: ... 509451071/

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Meghan West Graham Obituary

Post by greybeard58 » Sat May 04, 2019 1:59 am

Meghan West Graham Obituary

Graham, Meghan West June 6, 1994 April 21, 2019 It is with great sadness that we announce the loss of our beautiful 24 year old, daughter, grand daughter, niece and friend, Meghan Graham. Meghan passed away unexpectedly on Easter morning of complications resulting from previous brain injuries. She is survived by her loving parents, Jennifer and Rick Graham, her best friend and brother, Ricky Graham, grandfather Keith West, grandmother Pat Graham, and the scores of family and friends whose lives were forever changed by knowing her. She was preceded in death by her grandmother, Maribee West and her grandfather, Dr. John "Jack" Graham.

Meghan was born in Mountain View, CA and moved with her family "back home" to Minnetonka, Minnesota at age 8, where she grew up surrounded by the love of her family, grandparents, aunts, uncles and many cousins. Her natural athletic talents were evident from a very early age. Embracing the colder climate in Minnesota, she took her first run on a snowboard and flying down the mountain quickly became her passion. She competed on the world's biggest stages, accumulated hundreds of awards and took home National Championships year after year.

At 16, she moved to Steamboat Colorado to pursue her dream of becoming an Olympic snowboarder. In Colorado she trained every day while working to complete her high school degree. She attracted prominent sponsors and was striving to earn her place on the US Olympic team. Unfortunately, multiple head injuries forced her to give up competing in the sport she loved. It was a tremendous loss for Meghan, but like everything in her life, she faced her challenges with bravery, grit and determination.

Recovering from her head injuries was her greatest trial but she did the hard work both mentally and physically. She was well on her way down her new chosen path to a happy and successful life. She traded in her racer's jacket for a coach's jacket. She loved her job coaching talented young competitors, guiding many of them to the podium at Nationals. This past year, she was doing well in college. She and her dog, Summit, were beloved by the seniors she worked with at the Glenn Hopkins Daybridge Program. Most recently, she was training for a 5K Marathon.

Meghan loved working with kids and actively supported the Special Olympics. She also walked each year to raise money and awareness for NAMI the National Alliance for Mental Illness. To know Meghan was to love Meghan. She touched so many lives and impacted them each profoundly - yet it all came so naturally to her. Her energy and positive attitude were magnetic. She always seemed to spot the person who felt left out or in pain, and she reached out time and time again. Everyone in her sphere got a hug, a laugh, just the right encouragement or a "toughen up" when they needed it most. She welcomed everyone with open arms and an open heart.

Meghan was a bright light that warmed and inspired everyone who knew her. May she rest in peace among wild flowers and snow-covered mountains with tie-dye rainbows. Please join Meghan's family and friends as we remember her too-short but well-lived life with a "Tie-Dye Celebration". May 9, 2019 at the Woods Chapel. Gather at the amphitheater at 1:00 p.m. Service will commence at 2:00 p.m.

In lieu of flowers, donations can be made to the Special Olympics and/or NAMI National Alliance for Mental Illness ( ... 000307382/

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Not dead but gone:

Post by greybeard58 » Fri May 10, 2019 10:42 am

Not dead but gone: how a concussion changed my girlfriend's personality forever
We have no place in our culture for this kind of grief. After her brain injury, Gabrielle was still there – it just wasn’t the her I had loved
Lori Fox
Wed 24 Apr 2019 01.00 EDT

‘She didn’t owe me anything. But I loved her more than I had loved my own health and happiness.’

It’s strange the way that, in a crisis, your mind stops filming and starts taking polaroids; essential snapshots of sound and color and light you can hold at arm’s length afterward.
There is the call from Gabrielle*, her voice frantic: I have been in an accident, please come, please come right now.
There is me standing on the frozen street, staring at the car sprawled across two empty lanes with the driver’s side door crushed and hanging ajar, like an unfinished thought.
There is the blood and hair, stuck to the inside of the window in the bitter, bitter January cold.
There is a paramedic talking to me. There is red glass from busted tailgates strewn across the road, shimmering like hot coals as we get into the ambulance.
There is Gabrielle on a stretcher, with her neck in a brace and her lips pale and bloody. There is her hand, slipping into mine, squeezing.
In the hospital waiting room a police officer explains to me that Gabrielle made an illegal left-hand turn and was struck by a vehicle traveling the same direction, and that the driver could not possibly have stopped.
She has a concussion, the doctor tells me as he uses a curved needle – gleaming under the sterile lights of the emergency room – to stitch her scalp up.
I come home with Gabrielle leaning heavily against my side and we wobble through the doorway of our apartment.

In bed with the lamp turned down low, she sleeps, deeply, the way old dogs or sick children sleep, so solemnly and quietly you feel compelled to see they are still breathing.
Stitches glisten black and damp and raw against her white scalp. I whisper in her ear – I love you. You are safe. I will protect you, no matter what. I turn off the light and cry, quietly, because the doctor said not to wake her.
For the first few days after the accident, things were exactly as we were told they would be. Gabrielle suffered terrible headaches and nausea, worsened by external stimuli – sound, light, strong odors – and motion. Gabrielle was unable to do more than lie on the bed or sit up in a chair.

After a week these initial symptoms began to abate, but other, more complicated ones sprang up. Her body was healing, but something in her brain appeared to be malfunctioning. She was having difficulty expressing complex thoughts, which made her angry and confused. She would often stumble trying to explain her feelings, flailing for words, or burst into tears of anger when met with a task that used to be easy. She would snap at me and blame me for things that weren’t my fault, like a broken cup, a malfunctioning printer, the phone ringing. Making choices caused her intense disorientation. Our first trip to the grocery store together, a week after the accident, selecting from the rows of products – as well as all the people, lights and music – was too much sensory data for her to process. She shut her eyes and leaned against my chest. I had to take her back to the car and shop alone. When I returned, she was curled up against the window with her eyes closed, exhausted.

Gabrielle had lost the intuition as to whether 10 minutes or 10 hours has passed. She would wake up three or four times in the night, irritable and anxious, because she was uncertain how much time had passed. The only thing that would help her get back to sleep was if I read to her, which often meant rereading the same few pages over and over, because she did not remember what she had just heard. In this broken way we enjoyed André Alexis’ masterful Fifteen Dogs together. It took two months to finish it. I still cannot bear to look at a copy.
We did not know what was happening to Gabrielle or why while all of this was happening

We did not know what was happening to Gabrielle or why while all of this was happening. All we knew for sure was that she was not like this before the accident and that the changes had to be related. It was only later, through research, that we came to understand the mechanics of the change.
A concussion is, at a fundamental level, a bruised brain. Imagine you have a mason jar that is full of thick liquid and just big enough to accommodate a peach. If you shake the jar violently, the peach sustain multiple impact points. When you take the peach out, the bruised places are visible. If you cut into the bruise, you will see the damage spreads beyond the area around the impact sites.
In a peach, these bruises taste bad. In a brain, these neurons are now “bad”; they no longer function the way they should in the context of their neural network, interrupting – and sometimes changing – the flow of information which regulates not only basic body functions, but the building blocks of who were are. This damage is thought to be largely irreversible.

The doctors in the emergency room and in her single follow-up appointment told us Gabrielle’s concussion was not severe. According to Paul van Donkelaar, a professor at the University of British Columbia and specialist in the behavioral and psychological effects of brain injury, the severity of a concussion doesn’t necessarily indicate how a person will be affected by it. “Just because [the concussion] is mild doesn’t mean the outcome is mild,” he told me. This is partly because we don’t fully understand just how far the damage spreads beyond the initial site of impact. Understanding of how the brain is damaged during a concussion is a rapidly evolving field of study, he said, but unfortunately many doctors, especially those in small towns like the one we lived in, often lack the specialized and updated training necessary to properly identify and treat concussions with the most up-to-date resources.

Gabrielle and I knew none of this before her accident. We were sent home from the hospital with a single sheet of paper that read “How to care for someone with a concussion” at the top.
I lived in a state of chronic exhaustion. I worked from home as the editor of a small weekly paper – a job which demanded consistent overtime. I often slipped out of bed after Gabrielle was asleep to edit copy or return emails. I was never “off-duty”, either at the paper or for Gabrielle.

I realize now I should have asked for help, but even if I had, I don’t know to whom I would have appealed. Her parents lived on the other side of the country and did not speak English. Doctors often did not believe Gabrielle when she tried to tell them what was wrong with her. Our friends could not see the seriousness of the problem; Gabrielle could appear to be frustratingly normal for brief stretches of time, only to completely break down later, when there was only me there to see these things.

I felt that as long as I believed in her, she would get better
I began drinking heavily. I lost so much weight I started missing periods. I took caffeine tablets when I had to drive, because I was so sleep deprived I worried it was unsafe. I often thought of leaving her; once I even went so far as to pack my truck and drive out of town. I got outside the city limits and turned around. I felt that as long as I believed in her, she would get better.

Then, six months after the accident, I went camping for three weeks without her. Gabrielle didn’t want me to go but I felt I had to start taking care of myself again. I was gone for less than two weeks when she cheated on me.
She told me she had met someone and had been unfaithful, very calmly. She was not calling to apologize; she was calling me to ask if I would mind if she did it again.
She said she had simply not been thinking about me. It was only cheating if she didn’t tell me about it, she said. We were not in an open relationship. We had been together for two years. I did not yell. I did not cry. I just kept asking, over and over, How could you do this to me? I was stunned. The last time I had come into town, she had begged me to end my vacation early.

She held on to her curious logic with childlike tenacity, warbling between emotionless repetition of her beliefs – it wasn’t cheating, she had done nothing wrong – and angry outbursts. She accused me of not loving her, claiming I had only taken care of her to control her. She said, over and over, that she owed me nothing.
She was half-right. She didn’t owe me anything. But I loved her more than I had loved my own health and happiness.

At the time all this was happening I was hurt so deeply I was unable to see the familiar pattern, one I had observed countless times since her accident: confronted with something emotionally and cognitively difficult – her behavior, my emotions, her breakup – she was shutting down, flattening out and then, when pushed beyond what she could tolerate, lashing out.

‘You can love more than one person in your lifetime’: dating after a partner’s death
I believe she genuinely did not understand what she had done was wrong; she was not in a place where she could organize the linear events of how her actions had affected me, could not process my own reactions, could not handle the emotional, social and intellectual intricacies being asked of her. She was possibly as hurt and confused and frustrated as I was.

I balk to write that; it seems patronizing or dismissive. But I think back on the way she treated me after the accident – her inability to see when I was exhausted, the way she would lash out at me for things I couldn’t possibly be responsible for – and I cannot help but believe that. I don’t think she understood what the words I was telling her meant or felt the emotional impact they should have drawn.

Following this, I spiraled into a black depression; already taxed to breaking by six months of caring for Gabrielle, I had no emotional reserves left for this blow. It took me almost two years to understand that the hurt was not just heartbreak, but that what I was feeling was grief and loss. Someone had, as I intuited, actually died. I expected that, in exchange for my labors, I would get my girlfriend back, or at least a close approximation of her, but I was wrong. It must have been a terrible burden for her – the new her – to carry that expectation.
The woman I had known and loved – Gabrielle of the easy smile and quick laugh, Gabrielle of the fingers on the back of my neck as we drove – was dead. She had died the moment she made a careless mistake and turned without signaling, when her head had struck the glass and neurons began to die.
We have no place in our culture for this kind of grief; when someone dies, we have a funeral, and everyone comes and holds the people who are left behind and says We are so sorry for your loss. This was unavailable to me. I faced this grief alone. Gabrielle was still there – it just wasn’t the her I had loved. That woman is gone and she is never coming back.
*Name has been changed

Not dead but gone: how a concussion changed my girlfriend's personality forever ... riend-away

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Teenage concussions

Post by greybeard58 » Fri May 17, 2019 5:27 am

Teenage concussions and traumatic brain injuries linked to suicide
Published: 15 May 2019 Written by Rita Hitching

May is Mental Health Awareness Month, an initiative sponsored by Mental Health of America, now in its 70th year.

This year, MHA expands its #4Mind4Body theme, emphasizing a whole-body approach to mental health and the relationship among body, brain and mind. #4Mind4Body provides recommendations on all aspects of health, physical wellness, nutrition, sleep, exercise and stress.

One aspect of whole-body mental health is the relationship between head injuries and suicidal behavior, which has been studied for some time. Researchers at the Suicide Prevention Center in Denmark have conducted a 10-year study and found the incidence of suicidal behavior increases by 75 percent following head injury.

New research reported in the Journal of Affective Disorders revealed that the impact is significantly higher for teenagers and young adults. In the U.S., suicide is the second leading cause of death in teenagers. Typically, psychological issues such as depression, alcohol and substance use are linked to the risk of attempted suicide among teenagers. Now, we must add head injury to the list of risk factors.

The Centers for Disease Control and Prevention reports that 812,000 children aged 17 years and younger sustained a traumatic brain injury in 2014. TBI is any interruption to normal brain function that can be attributed to a jolt to the head, bump, blow or penetrating head injury. TBI can range from “mild,” defined as a brief change in mental status, to “severe,” typically including a period of loss of consciousness or memory following the injury.

TBI symptoms include difficulties with recalling events or impaired thinking, physical changes (headaches, sensitivity to loud noises or bright lights), sleep disruption (more or less sleep) and psychological changes (mood, anxiety, irritability or sadness). The typical recovery time from a concussion ranges from a few days to a few weeks but can persist for longer.

Concussion is the most common type of TBI, with 283,000 children in the U.S. seeking medical care due to a sports- or recreational-activity-related injury. Contact sports accounted for 45 percent of those concussions (127,350 children). The CDC ranked the sports most associated with concussions as football, basketball, playground activities and soccer. Boys most often sustained head injuries from football, and girls from playground activities.

Significantly, the risk of TBI is amplified for teenagers because their brains are in a sensitive state required for maturation, plus they are more likely to be involved in sports and other behaviors that expose them to head injury.

The Journal of Affective Disorders recently found that suicidal thoughts and behavior are reported in 1 percent of people ages 12-29 in the U.S. However, the incidence of suicidal thoughts and behavior increases significantly to 4.6 percent of young adults who have sustained a TBI.

Additionally, the research revealed that the age of first suicide attempt was significantly younger in children with a history of TBI, and that the risks are higher for girls and those with more repeated and more severe TBIs.

So what can be done to reduce the suicide risk among children who sustain a head injury? The recommendation by researchers is to focus first and foremost on preventing TBI, and then careful mental health monitoring of children following a TBI. By parents and clinicians being aware of the associated risks of suicide and TBI, a more proactive approach to care, including counseling services, is likely to provide children with better outcomes following a head injury.

Rita Hitching is a local researcher and teacher who writes on teen brain development. For more information, visit ... lth/60097-

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Concussion research suggests longer recovery time

Post by greybeard58 » Fri May 24, 2019 11:16 am

Concussion research suggests longer recovery time for learning - Story | KMSP ... r-learning

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82.8 percent continued to play

Post by greybeard58 » Mon May 27, 2019 7:47 am

82.8 percent continued to play after at least 1 concussion-producing impact

There is a high incidence of sports-related concussion (SRC) in collegiate women’s ice hockey and a concerning level of symptom nondisclosure. Additional research is needed to understand the causes of concussion and reasons for the lack of symptom disclosure, including factors specific to female athletes and contextual issues specific to women’s collegiate ice hockey.

In an anonymous survey of 459 women's ice hockey players:

During the 2014-15 season:

34.2%, experienced concussion-like symptoms after at least 1 impact

82.8% continued to play after at least 1 of these impacts

66.8% never disclosed any symptoms after at least 1 impact.

In sports that involve contact or collision, sports-related concussions (SRCs) are now recognized as a potentially serious injury among both male and female athletes. A concussion is defined as a pathophysiological process that affects the brain and is caused by a direct blow to the head or neck or a jarring force, such as during a whiplash injury. A concussion may result in rapid or delayed onset of symptoms that resolve spontaneously over time and may or may not involve loss of consciousness. Thus, SRCs are often difficult to diagnose, as there is a dependence on the athlete to disclose his or her symptoms, which may be nonspecific.

Incidence of diagnosed SRCs in the United States has risen rapidly over the past 2 decades, from an estimated 300,000 reported concussions per year in 1998 to 1.6 to 3.8 million reported concussions in 2006. Recent estimates of SRC incidence rates (IRs) from 2009 to 2014 in sports participating in the National Collegiate Athletic Association (NCAA) indicate that, while the overall incidence of concussion across all sports has remained steady, incidence continues to increase within individual sports such as men’s football, men’s ice hockey, and women’s ice hockey.

Both men’s and women’s ice hockey are recognized as physical, high-speed sports with significant collision and concussion potential. The greatest difference between men’s and women’s ice hockey is body checking. Deliberate body checking, a motion using the trunk of the body (hips and shoulders) to force or separate an opponent from the puck, is not allowed in women’s ice hockey at any level of competition. However, incidental and legal body contact remains a frequent occurrence and is defined by USA Hockey as “contact that occurs between opponents during the normal process of playing the puck, provided there has been no overt hip, shoulder, or arm contact to physically force the opponent off of the puck.” Such contact places women’s ice hockey athletes at risk for injuries, and particularly head injuries. Several studies have indicated that even in the absence of deliberate body checking, player-to-player contact was the cause of approximately 50% of concussions in game situations in women’s hockey.

Collegiate men’s and women’s ice hockey have two of the highest concussion IRs among collegiate sports, along with men’s football and wrestling. A recent epidemiologic study using data collected from the NCAA injury surveillance program during 2009-2014 indicates that women’s ice hockey has the highest concussion IR across all collegiate female sports (7.50 concussions per 10,000 athlete-exposures [AEs]). However, utilization of the NCAA injury surveillance program to calculate IRs has limitations, as participation in the system is voluntary at the institutional level. Fewer than 20 colleges and universities that sponsor women’s ice hockey participated in data collection in the 2013-2014 season.

It is possible that attention to concussion safety, and potentially concussion IRs, are different at schools that do and do not participate in this injury surveillance program. Another limitation of the NCAA surveillance program is the criteria for reported injury. In order to report an injury, it must be a direct result of participation in organized intercollegiate practice or competition, require medical attention by a team athletic trainer or physician, and result in restriction of the participation of the student athlete for 1 or more days beyond the day of injury. Therefore, undisclosed injuries or any incidents where a player is put back into play after evaluation by the medical team are not included in the injury surveillance data.

Outside of NCAA surveillance data, there is little published literature on the incidence of head injuries and concussions in women’s ice hockey, potentially because of the newness of the sport. As a result, there is a lack of knowledge on the incidence, risk factors, and consequences of both diagnosed and undisclosed symptoms of SRC in collegiate women’s ice hockey.

A growing number of studies suggest that many concussions are not disclosed. Previous research that assessed concussion symptom nondisclosure has used survey-based methodology, asking athletes whether they believed they had experienced a concussion or a given set of post impact symptoms that may indicate a concussion, but chose not to disclose the incident to a coach or medical provider.

A recent study showed that athletes who do not immediately disclose concussion symptoms and continue to participate in practice or competition are at risk for a longer recovery when compared to athletes who immediately disclose their symptoms. While rare, death can occur as a direct result of brain trauma in sport if an athlete sustains an additional impact during a period of heightened neurologic vulnerability after an initial injury. No studies to date have assessed the rate of nondisclosure of concussion symptoms in collegiate women’s ice hockey.

Prior literature has found a higher concussion IR among males as compared with females in rule-matched sports, but it has also found a higher rate of intention to disclose concussion symptoms among female athletes. However, intention to disclose may only explain a small fraction of the variability in player behaviors.12 Consequently, there is also a need to understand the extent to which these athletes are choosing not to disclose concussion-like symptoms.

The purpose of this study was twofold. First, we aimed to assess the incidence of concussions among NCAA women’s ice hockey players, and second to determine the incidence of undisclosed impacts followed by concussion-like symptoms in this population. We hypothesized that the incidence of concussions is higher than previously reported in the literature and that many concussion-like symptoms are not disclosed. Achieving a greater understanding of how frequently concussions occur, and the characteristics of players who experience potentially concussive symptoms but choose not to disclose them, may help determine a course of action to reduce the burden of SRC in women’s ice hockey.

The present study indicates that despite rules prohibiting deliberate contact through body checking in women’s ice hockey, player-to-player contact is the most common injury mechanism for SRC, and the incidence of SRC is similar to that previously observed in men’s hockey.

The results of this study also raise the possibility that, as has been found in other contact and collision sports, there may be substantial nondisclosure of concussion-like symptoms that warrant medical evaluation. These findings suggest a need for greater research and program development focused on women’s ice hockey players.

This includes evaluation of the effectiveness of the current NCAA rules and standards of play that disallow deliberate player contact through body checking. It also includes population-specific player education and/or contextual interventions to help ensure that women’s ice hockey players are seeking medical attention for all impacts that are followed by symptoms of a possible concussion.

Incidence of Sports-Related Concussion Among NCAA Women’s Ice Hockey Athletes
Read the entire study at:

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Concussions: Traumatic brain injury

Post by greybeard58 » Mon May 27, 2019 8:45 am

Concussions: Traumatic brain injury can go beyond physical to mental illness - News - Crookston Times - Crookston, MN - Crookston, MN
By Troy Krause
Posted May 26, 2019 at 12:01 AM

In 2012, a professional football player named Junior Seau was found dead, as a result of a suicide. The story of his death has brought an under the radar issue to the forefront, and since then has led to a number of changes in the way the game of football is played.

It has been reported that Seau may have experienced concussions numbering in the hundreds during his playing days – one report has that number at 1,500 – and reports add those traumatic brain injuries (TBI) are what led to his death.

What started out as TBI led to a bigger issue for those experiencing multiple injuries known as chronic traumatic encephalopathy (CTE), and a post mortem diagnosis determined that Seau had CTE.

It is in CTE where brain injuries turn into something much more serious as mental illness begins to manifest itself in the life of the individual.

While much research is still needed, the U.S. Centers for Disease Control and Prevention (CDC) is beginning to recognize that symptoms of depression and anxiety have been found in those who face CTE, as have mood swings, personality changes, memory loss and, in cases like Seau’s, suicide. However, the CDC officially states the link between CTE and suicide is unclear.

What is clear is that studies are showing the link between mental health symptoms and TBI, which indicates just how important it is for people who think they may have suffered a concussion to get checked out and if a concussion has been diagnosed to go through the proper follow-up care.

While it is in sports that concussions have garnered the most attention, the reality is that they can happen in a number of different settings, including many types of TBI. In fact, statistics show one of the population groups that often find themselves facing concussions and TBI more often are those who have served in the military.

According to the National Institutes of Health, many of the studies related to TBI have been conducted amongst those in the military, as some have begun too conclude there may be a direct link between TBI and post-traumatic stress disorder (PTSD).

While facing a head injury is a common occurrence, most do not rise to the level of a concussion, but there are symptoms that will show up that might indicate the injury has risen to that level.

The Minnesota State High School League has implemented a number of rules in recent years to address concussions. Studies have shown a concussion can have a much more serious impact on the brain of a youth as their brains are still developing. The high school league offered a list of signs and symptoms for coaches, sports officials and parents to look for in dealing with an athlete who might have sustained a concussion.

They include:

‒ Headache

‒ A feeling of “fogginess”

‒ Difficulty concentrating

‒ Confusion

‒ Slowed thought process

‒ Memory issues

‒ Nausea

‒ Lack of energy

‒ Blurred vision

‒ Sensitivity to light

‒ Mood changes

Schools across Minnesota have implemented a program whereby students who plan to play sports must first undergo a cognitive test that establishes a base line for each individual student. When there is a question about whether or not that student has a concussion, the baseline information can play a part in determining the diagnosis.

The bottom line for the Minnesota High School League is “when it doubt, sit them out.”

While it is assumed the coaches of any particular sport where concussions can happen will do the right thing (the list is not limited to football, as any sport where contact is taking place, blows to the head may happen or the potential for falling may occur – i.e. basketball, soccer, wrestling, gymnastics, etc. – could lead to concussions), parents are encouraged to speak up for their child if they have any concerns at all.

One concussion can pose a problem, but if that initial concussion is not properly addressed and another concussion occurs the potential for more significant problems down the road in terms of mental health may occur.

No, that does not mean parents should keep their children from playing sports, as research also shows those students who are involved in athletics see an increased level of success in the classroom because of their involvement in sports.

What the Minnesota State High School League stresses is playing the games the right way. In most cases, that means keeping your head up.

According to the NIH, the concept behind CTE was initially discovered in the late 1920s in the world of boxing, as those in the ring began showing signs of what was then described as being “punch drunk.”

To learn more about CTE, visit the CDC Web site at

The MSHSL concussion protocol can be found online at ... al-illness

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High school athletes sandbag concussion tests

Post by greybeard58 » Mon May 27, 2019 7:40 pm

High school athletes sandbag concussion tests, keep playing on Vimeo

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Why Brain Injury is Actually a Chronic Disease

Post by greybeard58 » Mon Jun 03, 2019 7:00 am

Why Brain Injury is Actually a Chronic Disease

You never expect these things to happen in life. But last year, three days before Christmas, I experienced a traumatic brain injury. As a practicing Functional Medicine doctor who has been in the field for more than 20 years, I love what I do and take great care of my health. I never expected something like this, so sudden and disruptive, to happen to me.

It’s hard to believe what seemed like such a minimal incident turned into something so big. I was at CrossFit with my wife and while doing a pull-up, I hit my head on a bar that I didn’t see above me. Of course, I didn’t think much of it, because I’ve hit my head a lot worse in life. About 20 minutes later though, in the workout, I suddenly had the worst headache of my life. It was like someone took an ax and buried it in my head. I got nauseous and dizzy and just fell overall pretty awful. My wife took me home and the headache seemed to dissipate.

As the day went on, it got worse, and then it got better again. Several days went by, and finally, I ended up in the emergency room on Christmas Eve. The headache was just so bad I couldn’t imagine doing one more thing without getting some relief. In the ER, they did a CAT scan and found that I had a subarachnoid hemorrhage, which is basically a bleed in the middle of my brain. Like I said before, it’s incredible that what seemed like a small bump on the head turned out to be something so dangerous.

I ended up in a neurointensive care unit in Boston for three days. If you’ve ever been in one, it’s like an oxymoron, because they wake you up every hour to make sure that you’re not going into a coma. So, you can’t sleep, you can’t concentrate, you’ve got tubes and wires all over you. I just recently told my wife, “One of the best days of my life was when you took me out of the intensive care unit.” When we left, I was just told to, “Go home and rest.” That was it!

I went home with pain medication for my headaches. Very shortly after I got home, I realized that my life had changed dramatically. After the headaches started to dissipate, I really noticed that I was disconnected. I was feeling emotionally flat, isolated. I noticed that I had a lot of mental and physical fatigue. My sleep was disrupted, so I couldn’t sleep. I couldn’t focus. I couldn’t concentrate. I had a hard time remembering things. It’s not like I forgot things altogether, I just had a hard time finding them in my brain. Every day, I felt like my brain was on fire. I could actually feel my brain and it all seemed to just get worse over time.

I’ve had injuries before, and I’ve used my mind to get my body to do what I want it to do. In the past, I’ve been able to overcome significant injuries pretty well. I’ve even been able to feel better than I was before the injury. Your brain and mind can push your body, but when your mind isn’t working, you can’t do anything about it.

I was really worried that I wouldn’t get my memory back—that my focus, attention, and my ability to learn new material, wouldn’t return. That was really scary.

Another scary piece was feeling extremely disconnected. My wife and I have been together for 39 years. She’s my soulmate. When I’m laying in bed next to her and I’m feeling absent, and not connected, that’s a terrible feeling. I think that’s where I learned a lot. I had two sons who played soccer, and they both had very significant concussions and brain injuries, and I’d done a lot of research about concussions to help them get better. So when I had my own brain injury, I continued to do some reading to learn what else I could do to heal. Over time, I was able to support my body in multiple ways and fully recover to once again feel my best.

What I really began to understand in my research, and I think many people don’t get, is that traumatic brain injury doesn’t just come and go. It’s actually a chronic disease, and depending on how you’re wired—depending on your genetics, your lifestyle, and any other diseases you may have developed—your brain may not recover, or the neuroinflammation may persist.

On a larger scale, right after a traumatic brain injury, I personally think the two areas that are most important and most impacted by neuroinflammation are the basal ganglia and the hippocampus. The basal ganglia is comprised of a group of structures that connects the cortex to the brain stem; this area is responsible for coordinating focus, learning, concentration, higher-level reasoning, coordination, motor activity, and mood regulation. If the basal ganglia’s been impacted, you’re going to struggle with all those areas.

The hippocampus, on the other hand, is involved in memory and recognition. Making new memories, maintaining memories, and recognizing things. Neuroinflammation really impacts those things—when you can’t recognize, and your memory isn’t working, and your day-to-day activities are impacted by the fact that you can’t focus, concentrate, reason, or control your mood or your motor activities, you feel like you will never be productive again.

Now, inflammation is good. When you get injured, particularly in a brain injury, you’re going to have an inflammatory response that begins the healing process. You have these proinflammatory cytokines and anti-inflammatory cytokines that are working together to help your brain heal. But if those inflammatory processes and coinciding immune processes continue, they can lead to more inflammation and more damage over time. That’s where that chronic degeneration of the brain over months and years can occur.

If you haven’t dealt with those issues, if you haven’t done anything to turn that inflammation off, then you might find that those issues that you’re having early-on with memory, mood, physical coordination, and learning just get worse. Neuroinflammation needs to be turned off; if that doesn’t happen, or if there’s anything else that’s promoting inflammation, you’re in trouble.

Recently, they have found that there’s actually a lymphatic system in the brain, called the glymphatic system. Previously, the brain wasn’t thought to have its own lymph system. The glymphatic system actually is connected to the peripheral lymph system, which is a direct connection to your immune system. That means if you have leaky gut, you’re going to have leaky brain.

So think of it like this: You’ve just had trauma to your brain, your blood-brain barrier’s been damaged, and the soft tissues of your brain have been damaged too. You already have an inflammatory process going on in your gut (as many Americans do)–which is now linked to your brain through the lymph system. That inflammation and any autoimmunity that is occurring in your gut could potentially lead to more inflammation and autoimmunity in your brain.

Plus, your immune system can start to make antibodies against that damaged brain tissue. Now you have neuroinflammation, an immune response that could be leading to ongoing damage to tissues in your brain that had nothing to do with the original impact, or in my case, bleed.

The really good news is that there is so much you can do to reverse the damage of a traumatic brain injury and reduce neuroinflammation. One thing within reach for all of us is sleep. The glymphatic system, that detoxification pathway I mentioned earlier, is actually at its most active state when we sleep. That gives the brain a chance to clean out all the neurological waste and distribute beneficial nutrients around.

Sleep also increases brain-derived neurotrophic factor (BDNF), a protein that supports our existing brain cells and helps create new ones. Exercise is also a great way to increase BDNF. And guess what? Sleep and exercise both also boost your mitochondria, the cellular powerhouses responsible for producing energy from food. Supporting BDNF and mitochondria are two major pieces when it comes to healing from a traumatic brain injury, and sleep and exercise are two lifestyle factors all of us can prioritize on our healing journey.

It’s also important to eat a nutrient-dense diet rich in antioxidants and healthy fats to support brain healing, while avoiding any foods that lead to inflammation, like refined sugars, gluten, and vegetable oils among others. Choose organic and grass-fed or pasture-raised foods when possible to avoid exposing your body to toxic chemicals and hormones that can also lead to immune dysfunction and inflammation.

These are just some of many different interventions you can take to support the brain, whether you’ve had an injury or not. I hope my story has helped you understand why traumatic brain injuries really are a chronic disease, but that there is hope to heal and fully recover.

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Eric Lindros on concussion awareness:

Post by greybeard58 » Thu Jun 13, 2019 8:25 am

Eric Lindros on concussion awareness: ‘We’ve got a long way to go’

Eric Lindros remembers looking at the Penguins logo on his towel and feeling confused.

A powerful, hulking, skilled centre for the Philadelphia Flyers, he’d taken a big hit from feared Pittsburgh defenceman Darius Kasparaitis earlier that afternoon in a game between the Pennsylvania rivals.

Lindros didn’t understand it fully at the time, but the collision had left him concussed.

"He tuned me really well," he recalled. "I got into the showers, and when you’re in the visiting team’s locker room, all the emblems on the towels have the home team’s logo. I truly thought I got traded to Pittsburgh.

"I joke about it now. I thought I was getting a chance to play with Mario Lemieux, but that moment was bad … it was bad."

Years later, after his Hall of Fame career was cut short by repeated blows to the head, Lindros is hoping a new campaign launched across Ontario will help amateur athletes, parents and coaches avoid similar experiences by assisting them to better identify the signs and symptoms of a concussion.

"You see anything that’s off or someone’s not feeling quite right, let’s pull them (out of the game)," Lindros said in an interview with The Canadian Press on Tuesday. "Let’s not even question it."

The provincial government’s ad campaign — entitled "Hit. Stop. Sit." — follows on the heels of the passing of Rowan’s Law, the first of its kind in Canada and set to come on the books beginning July 1.

The law is named after Rowan Stringer, a youth rugby player who died in 2013 from second impact syndrome after suffering multiple concussions in a condensed time frame.

Rowan’s Law establishes protocols for players to ensure they’re taken out of action if a concussion is suspected, requires a review of awareness resources and outlines a code of conduct that sets out rules of behavior.

"We’re here because Rowan pushed it," Lindros continued. "She had three concussions in six days — that’s an extreme case — and she ended up dying. We don’t want anything close to that happening."

A jarring commercial featuring a female soccer player receiving repeated blows to the head before collapsing on the field has been shown at movie theatres across Ontario as part of the campaign. The spot made its TV debut during Monday’s Game 5 of the NBA Finals.

An imposing mountain of a man at six foot four and 230 pounds during his playing days, Lindros said getting everyone on board, especially when decisions need to be made in the heat of the moment, won’t be easy, but added it’s what has to happen.

"We want everyone to buy in," said the 46-year-old father of three. "Parents are going to protect their kids. Let’s look out for your kid’s teammates.

"Let’s go a step further and look out for the opposition."

Lindros testified before a special House of Commons committee looking into what, if anything, the federal government should do about sports-related head injuries back in February. He wants to see a single national concussion protocol based on Rowan’s Law.

"You always get a better message across when it’s one brand," Lindros said. "Look at Amber Alerts. Everyone knows it means there’s a missing kid.

"It would be great if in time if you say ‘Rowan’ you think ‘concussion."’

Lindros, who doesn’t want the threat of concussions to deter kids from playing sports, also favors a ban on all hits to the head across hockey — including the NHL — and the teaching of body contact at a much later age than the current standard.

He’s focused his attention on amateur athletes, but when Lindros testified in Ottawa, the No. 1 pick in the 1991 NHL draft said the government shouldn’t even bother trying to work with professional leagues because money muddies the waters.

NHL commissioner Gary Bettman has consistently questioned any direct link between multiple concussions and chronic traumatic encephalopathy (CTE) — a brain condition associated with repeated blows to the head.

"I don’t believe there has been, based on everything I’ve been told — and if anybody has information to the contrary, we’d be happy to hear it — other than some anecdotal evidence, there has not been that conclusive link," Bettman told the committee on Parliament Hill on May 1.

The symptoms of CTE, which can only be diagnosed after death, include memory problems, personality changes, aggression and depression.

"I wish I would have known," Lindros said of the dangers of concussions. "I would have toned it down quite a bit, for sure."

He also let out a sigh when asked about Bettman’s concussion and CTE comments.

"I don’t understand how the NFL can change their tune and speak to CTE in a far different fashion now than in the past, and it not be acknowledged by our guys," said Lindros, who also played for the New York Rangers, Toronto Maple Leafs and Dallas Stars. "There are some owners that really want to get ahead of this, get in front of it, support it, and maybe this will happen.

"I’d really like to think so."

But for now, Lindros is working to help amateur athletes, parents and coaches across Ontario identify and deal with concussions.

"Things have improved over the last 10 years," he said. "But we’ve got a long way to go."

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Implementation and effect of concussion education in collegiate women’s ice hockey

Post by greybeard58 » Thu Jun 20, 2019 10:53 am

Implementation and effect of concussion education in collegiate women’s ice hockey
Lauren E Piana, Kirsten D Garvey, Emily Kroshus, Emily M Brook & Elizabeth G Matzkin
Received 23 Jan 2019, Accepted 14 Apr 2019, Accepted author version posted online: 27 May 2019, Published online: 03 Jun 2019
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Objective: This study aimed to determine whether collegiate women’s ice hockey players are receiving pre-season concussion education and evaluate the nature and delivery of this education. Secondarily, we aimed to assess whether players who recall receiving this education have greater knowledge about concussion or are more likely to have reported suspected concussions than their peers.

Methods: An anonymous survey was completed by 459 NCAA women’s ice hockey players. Players self-reported receipt of pre-season concussion education, year in school, division of competition, player position, and average length of ice hockey career. Players also completed scales assessing concussion knowledge, attitudes and prior reporting behavior for suspected concussions.

Results: 65.3% of athletes affirmed that they received pre-season concussion education. Lecture by an athletic trainer was the most common modality. There were no differences in concussion knowledge or attitudes by concussion education status, NCAA division of competition, or year in school. Players with higher knowledge scores were more likely than their peers to have experienced a suspected concussion and to have not reported it (p = 0.056).

Conclusions: Not all NCAA women’s ice hockey players are receiving (or recall receiving) mandated concussion education from their institution. The inverse association between concussion knowledge and concussion reporting behavior, while not statistically significant, is concerning and warrants further study. More work is needed to develop educational materials about concussion that are acceptable and memorable to this population, and that help increase concussion care-seeking behaviors.

KEYWORDS: Concussion, NCAA concussion education mandate, women’s ice hockey, concussion reporting
Additional information
This paper was not funded.

Declaration of interest
E Kroshus provides consultancy work for NCAA Sport Science Institute. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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"I love hockey, but I love my brain more"

Post by greybeard58 » Thu Jun 20, 2019 12:52 pm

"I love hockey, but I love my brain more"

Katrina O’Neill
"As the severity of my recent concussion sinks in, I am saddened by the feeling that I have played my last competitive hockey game. I love hockey, but I love my brain more and I do not want to risk my future quality of life or the possibility of another cheap shot blow to the head. If you play competitive sport, please play hard, play clean and don’t be an axxxxxe and hurt someone else’s head. I have officially began rehab treatment. I will not be working for a MINIMUM of 7 days, possibly longer if symptoms don’t improve (sorry clients/friends). For any paint Inquries, I’ll forward you to my colleague, Marc.”

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Implications for pediatric and young athlete populations at risk of mTBI

Post by greybeard58 » Thu Jun 27, 2019 5:50 am

Implications for pediatric and young athlete populations at risk of mTBI

• In aging adults, early-life mTBI leads to worst brain outcome than late-life mTBI.
• Brain anomalies are mostly visible using DWI measures of white matter integrity.
• Brain anomalies are visible even in neurologically normal individuals.

These results have implications for pediatric and young athlete populations at risk of mTBI. It could be proposed that these younger populations are more vulnerable to mTBI-related neurodegeneration because of their young age at trauma onset which translates to a lifelong interaction between mTBI and aging. This proposition would agree with a growing body of evidence relating age of first exposure to contact sports with worse later-life neurologic outcomes (Stamm et al., 2015; Alosco et al., 2017, Alosco et al., 2018a).

Mild traumatic brain injury: The effect of age at trauma onset on brain structure integrity

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workarounds if your concussion causes trouble reading

Post by greybeard58 » Tue Jul 02, 2019 8:40 am

workarounds if your concussion causes trouble reading

Once you learn how to read, it’s easy to take the skill for granted. Like breathing or walking, we don’t give the ability much thought unless it begins to deteriorate. But trouble reading can develop at any age for a variety of reasons, including difficulty concentrating, mild cognitive impairment, and physical changes.

Mental roadblocks can cause trouble reading

Fuzzy thinking and difficulty concentrating can get in the way of reading. “If your attention isn’t focused on the sentence you’re reading, you’re not likely to register enough of the sentence to understand what your eyes just passed over,” notes Dr. Joel Salinas, a neurologist at Harvard-affiliated Massachusetts General Hospital.

You might experience fuzzy thinking or difficulty concentrating because of
• a lack of sleep
• stress
• nutrient deficiency
• a medication that makes it harder to concentrate
• reading or learning disabilities.
Sometimes age-related cognitive changes affect reading skills. Reading requires attention, short-term memory, and recall, which decline a little as we get older. “It’s normal when you’re older that your reading might be slower or that you have to occasionally read a sentence more than once to get its meaning. Your ability to read and retain information may take more effort,” Dr. Salinas explains.

Mild cognitive impairment can cause trouble reading

Mild cognitive impairment (MCI) may also be behind a decline in reading skills. MCI can make it harder to understand or retain what you’re reading.

MCI is a noticeable change in thinking and memory skills, but not enough that it becomes a huge barrier to your ability to take care of yourself and accomplish your daily tasks. You may miss some appointments, lose things often, have more difficulty recalling names or words you’d like to use, or have a harder time finding familiar places and keeping track of important dates.

Physical challenges can cause trouble reading

Physical changes, such as accidents or chronic disease, can also affect your ability to read. Examples include:

• Poor vision. Maybe you have double vision, or you can’t see up close, or maybe it’s hard to read in a room that isn’t well lighted.
• Arthritis. “Osteoarthritis at the base of the thumb, wrist, or fingers is common with age and can affect your ability to hold a book,” says Dr. Robert Shmerling, a rheumatologist at Harvard-affiliated Beth Israel Deaconess Medical Center.
• Neuropathy (pain or numbness in the extremities). This may result from diabetes or back pain, and can make it uncomfortable to hold reading material for extended periods.
• Traumatic brain injury. A concussion that you suffer from a sports injury, fall, or car accident might create difficulties concentrating or seeing (such as blurry vision).
• Shaky hands from essential tremor, multiple sclerosis, or other conditions may keep you from holding a book still enough to read the words.
When to seek help

Talk to your doctor when you notice trouble reading. Start with your primary care doctor, who can perform a mini evaluation or send you to a neuropsychologist for a thorough evaluation. “Neuropsychologists can test for how fast you read, how much you understand, and what you recall from what you read,” Dr. Salinas says.

When physical changes are the problem, treating the underlying condition can help you read better. For instance, maybe you just need a new pair of glasses.

Try these workarounds

Sometimes using a few simple strategies can make reading easier. If you have pain or tremors, Dr. Shmerling recommends propping up a book on a pillow or book holder. If you find it’s hard to flip pages, try an electronic reading device like an iPad or Kindle. With an electronic device, the page stays steady, and it’s just a tap to turn the page. For vision challenges, electronic reading devices and large-print books can help greatly.

When attention is the challenge, Dr. Salinas suggests reading in a quiet space, reading out loud, mouthing the words as you read, listening to the audiobook recording while you read, or using a sheet of paper to reveal one line of text at a time so you don’t skip ahead.

The important thing is to try. “There are solutions that work for most obstacles to reading,” says Dr. Shmerling, “and for most people, it’s a great way to keep up with what’s happening in the world and to keep the mind working.”

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Pseudomedicine for sports concussions in the USA

Post by greybeard58 » Sun Jul 07, 2019 10:42 pm

Pseudomedicine for sports concussions in the USA
Kathleen E Bachynski
James M Smoliga
Published:July 03, 2019DOI:
PlumX Metrics

Over the past decade, medical studies, media coverage, legislation, and education campaigns have all contributed to heightened public awareness of the risks of traumatic brain injury (TBI). The perception of concussion among athletes is shifting from simple idioms, such as “seeing stars” or “getting your bell rung”, to that of a TBI with potential long-term health implications. Public education and laws intended to address TBI have helped prompt athletes and their parents to seek treatment for brain injury symptoms.
However, growing concerns about concussion from parents, athletes, and sports organisations have also fostered an environment ripe for dubious product claims for concussion prevention and treatment as well as the more nebulous concept of brain protection. The increasing availability of such products cultivates an inflated sense of safety in inherently high-risk sports and distracts from evidence-based strategies to address brain injuries. This trend parallels a troubling rise in dietary supplements and other forms of so-called pseudomedicine marketed to the aging population, with claims of preventing or mitigating dementia and Alzheimer's disease. These types of products usually lack compelling efficacy data and are often promoted by practitioners with financial conflicts of interest. Yet, the dangers of pseudomedicine targeting at-risk athletes also include several distinct features.

First, non-medical professionals have a role in athlete safety and might make decisions without a valid evidence basis. This allows pseudoscience to influence schools and sports organisations. Amid growing concerns over athlete safety, athletic organisations are pressured to take some sort of action, and pseudoscientific interventions can seem valid and appealing due to their scientific-sounding justifications and ease of implementation. For example, in late 2015, several public-school officials planned to spend thousands of US dollars to purchase a specific chocolate milk product to protect athletes' brains. They were motivated by press releases promoting an industry-funded, unpublished study claiming that the beverage could speed concussion recovery. An investigation of this study raised several ethical concerns, including whether the high school athletes involved in the research knew that they were involved in a study. The University of Maryland eventually disavowed the study, but the hasty decision by school officials to adopt this product demonstrates just how attractive a so-called quick fix can be to address the concussion crisis.
Furthermore, there are numerous examples of coaches recommending, or even requiring, children to use non-evidence based practices in the name of TBI prevention. These include headgear for soccer, which has been demonstrated to be ineffective in reducing the impact of heading the ball, and mouthguards, which have also been demonstrated to be ineffective in reducing concussion risk. Stakeholders might truly believe these interventions protect them from TBI, while vulnerable athletes remain at unnecessarily increased risk.

Second, the evidence base for sports medicine is sometimes considered to be relatively poor, making it easier for pseudoscientific interventions to permeate the peer-reviewed literature. A particularly troubling example is a device, which supposedly “uses the body's natural physiology to protect against mild traumatic brain injury” by using jugular compression to mimic woodpeckers' evolutionary adaptations. The jugular compression device is justified by claims that: woodpeckers avoid brain injury by using their omohyoid muscle to occlude their jugular vein; peer-review studies suggesting that exposure to higher altitude (>196 m above sea level) reduces the risk for concussion due to mild brain swelling; and externally applied jugular compression can mimic the first two supposed protective effects. Although the concept sounds intuitively appealing, woodpeckers have many evolutionary adaptations to protect their brain from impacts that are biomechanically distinct from those that humans experience in collision sports, and jugular compression is not one of them. Likewise, the claims regarding altitude are not physiologically supported and are based on non-replicable epidemiological associations.
According to various entries in the database, industry-sponsored studies investigating the jugular compression collar specifically referred to it as an “anti-concussion” device and examined incidence of concussive events in children. However, actual injury outcomes remain unreported in favor of unvalidated surrogate measures of brain health in multiple small sample-size studies. Regardless, marketers use these published preliminary data to lure athletes to their product, mischaracterising their device as “bubble-wrap for the brain” and “no more dangerous than yawning” as they state they are seeking FDA approval.

Third, concussion-related pseudomedicine often targets the paediatric population. This not only includes children, but also parents, coaches, and youth sports organisations. Notably, the chocolate milk product and jugular compression collars were tested on children without prior study in adults. They also represent just two of many examples of pseudoscientific interventions marketed for children. As another example, manufacturers of one specific training device, a product which claims to produce stronger neck muscles and thereby prevent brain injuries, are marketing their product at high school coaching events. As of 2018, 300 college and high school sports teams in the USA have adopted this specific neck training equipment, although no research studies appear to have evaluated whether it effectively prevents brain injuries among children or adults.
In 2017, Pop Warner Little Scholars, one of the largest youth football organisations in the USA, announced an official partnership with a manufacturer of omega-3 fatty acid supplements “for healthy brains.” The company has advertised its drink in Inside Pop Warner, a magazine aimed at child football players and their parents, quoting a former professional football athlete as saying, “I wish I knew there was such a simple way to better protect my brain while I was playing football”. The manufacturer is marketing its dietary supplement to child athletes, although no known dietary supplement can protect the brain from TBI. A foundation set up by this manufacturer has also funded published research that claims that collegiate football athletes (mean age 20·3, SD 1·7 years) are deficient in omega. These claimed deficiencies are based on extrapolations for cardiovascular disease risk from a subsample of a cohort with a median baseline age of 59 years, rather than any indicator of brain health in young athletes.

Fourth, athletes often attempt to emulate the practices of successful sports figures. Celebrity endorsement of concussion pseudomedicine might be convincing to at-risk athletes even in the absence of clinical validity or scientific expertise. For instance, prominent National Football League (NFL) quarterback Tom Brady once stated that a particular sports drink made him “feel comfortable that if I get a concussion I can recover faster and more fully”. Similarly, professional baseball player Clint Frazier began drinking bottled water after receiving a concussion based on the advice of NFL player Russell Wilson. According to Frazier, the mechanism of action was that water “pumps oxygen to your brain a lot”. Wilson is an investor in a fortified water company which claims to prevent concussions. Such pseudoscience permeates social media and could shape public perceptions that TBI can be readily self-treated.
Proponents of dubious interventions to protect young athletes' brains often attempt to legitimise their product through marketing materials suggesting scientific validity. Sometimes, tangentially related research not directly associated with the product is used to support claims of protection. In other cases, companies contract with universities and highly publicise the research process itself, which instills the public with a sense of product validation before results are available. While research is essential in evaluating whether an intervention has value, it must be considered that athletes, including children, continue to be exposed to substantial risks of repetitive brain trauma while the research process is underway. This exposure becomes especially problematic in industry-sponsored research of products with weak scientific rationales, as they are unlikely to provide protection.
The risks of repetitive TBI are well-established, and new data continues to emerge on the dangers in high-impact collision sports. Similar to other forms of pseudomedicine, questionable products marketed to prevent or treat TBI in young athletes are not ethically, medically, or financially harmless. Pseudomedicine in sports can undermine public health initiatives that have been demonstrated to be effective in protecting athletes. Inaccurate perceptions of the safety afforded by these products might influence parents' and athletes' decisions to participate in sports with high rates of concussion, promote more aggressive game play, or encourage self-treatment following suspected TBI.
Researchers and clinicians should be aware that patients concerned about concussions face a landscape of products that appeal to hopes for relatively quick fixes. Many of these products are based on questionable research beset by conflicts of interest and implausible physiological mechanisms. Clinicians must critically evaluate scientific-sounding claims for products highlighted in news stories and available on the market. They must also be prepared to discuss the dangers of weakly justified or untested brain protection methods with individual patients and athletic organisations. Researchers and institutional review boards must address ethical considerations in how some of these products are tested, especially in paediatric populations. Pseudoscientific interventions targeted at athletes distract from the actual dangers of certain sports, divert interest and resources away from more feasible interventions, and harm public health.
Article Info
Publication History
Published: July 03, 2019

© 2019 Elsevier Ltd. All rights reserved.
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A concussion can cost your job, especially if you are young and well educated

Post by greybeard58 » Wed Jul 17, 2019 9:16 pm

A concussion can cost your job, especially if you are young and well educated

In the aftermath of a concussion the ability to prioritize many tasks is often impaired and patients are often better off doing simple tasks that are completed one by one. That may be the reason why people with no or few years of education are better able to keep their job than those with a higher education. Credit: University of Copenhagen
A hard tackle on the football-field, a crash on your bike or a fall from a ladder in your home can easily cause a concussion, which eventually can cost your job—especially if you are in your thirties, and have a higher education.

These are some of the findings in a large new register-based data research study from a team of researchers at the University of Copenhagen in Denmark led by Ph.D. student in Public Health, Heidi Graff, and neuropsychologist Hana Malá Rytter from the Department of Psychology.

Each year 25,000 people in Denmark are diagnosed in hospitals with concussion (mild traumatic brain injury) that make up roughly 90% of all injuries causing trauma to the head. Although mortality is low, and surgical intervention rarely required, up to 15% of patients suffer from persistent symptoms and functional impairment following the injury, that may have severe personal costs and often make it hard to resume their normal jobs and lives.

The Danish study includes all groups of patients and is representative for the general population in Denmark in terms of age, geography, education, family background and marital status.

Using register data from 19,732 Danes between the ages of 18 and 60 that were all diagnosed with a concussion, researchers traced the patients' attachment to the labour market during five years and compared the data to an equally sized control group of people without concussion.

They found that people with concussion have a markedly higher risk of being out of a job five years after the trauma. Instead they are unemployed, receiving payments due to disability or early pension or working part-time supported by social benefits.

Especially two groups of patients were severely struck by long-term symptoms: Those in their thirties and those with a higher education.

Five years of labour market data

The researchers did not examine the patients physically or screen their medical records to assess the patients´ medical symptoms following the concussion. They merely looked at their labour market data six months and five years after the head trauma respectively. Accordingly, they were surprised to find out that people between the ages of 30-39 and those with a higher education are much more likely to have lost their connection to a normal job following a concussion.

While people with low education levels (that is having 9 years of primary education and no other education after that) have a 30% higher risk of leaving the normal labour market following a concussion than people without concussion. The same risk is over 215% for people with higher education (that is having 12 or more years of education, for instance studies at college or university level)

"It is surprising, that the effect of a concussion has such severe consequences for this group of people and their ability to maintain a normal job even five years after the trauma. Long-term symptoms like fatigue and difficulties in concentrating can of course afflict anyone regardless of their level of education. What stands out is that those with a higher education are in such higher risk of losing their job. It could be due to the fact, that they often hold jobs where they plan and prioritise their tasks and the workload by themselves, and that the mental surplus and overview required to do so are some of the skills that are often severely impaired in the aftermath of a concussion," explains Hana Malá Rytter, Associate Professor in Neuropsychology at the University of Copenhagen and Head of the Danish Concussion Center.

Not able to do the same

Even though it might sound like a great advantage to be able to plan your workday yourself whilst recovering from a head trauma, it is in fact often an advantage for these patients if someone else takes charge and hands out simple, well defined job tasks to be completed one at a time. This may be one of the reasons, why researchers find that people with low education levels are better able to keep their job.

"People with higher education often hold positions, where they are required to multi-task, engage in teamwork and shift focus between different tasks while making decisions and taking responsibility. Skills that are often challenged, when long-term symptoms after concussion impair the ability to concentrate. Our data indicate that part of these patients must face that they simply are not able to do the same, as they used to before," says Hana Malá Rytter.

The study is the first register data-based study that analyses patients' labour market activity up to five years after a concussion, and it is the first study to reveal what specific groups of patients are affected the most in terms of their employment status in the aftermath of a concussion.

Worst for the 30-somethings

The researchers also identified another specific group of patients that were markedly more at risk of leaving the labour market following a concussion: People between the ages of 30-39. Data showed that their risk of having left a regular job five years after a concussion was twice as high, compared to people of the same age in the control group without concussion. According to Hana Malá Rytter, this may have to do with the life situation in which people in their thirties often find themselves.

"Men and women in their thirties have often completed their education a few years earlier and are just establishing themselves in their professional life and as a family too. In this phase of life, people often make high demands on themselves both in and outside their workplaces. Moreover, becoming parents is a challenging and stressful process for young families. Expectations regarding the capacity of the individual are often towering—both from employers, colleagues, family members and from the individuals themselves. So once they are struck by long-term consequences of a concussion that often reduce their mental surplus and their ability to focus. Their whole life situation suffers so much harder, than if this happened later in life. And this seems to make some of them give up on their job," explains Hana Malá Rytter.

For people in their forties, the risk of losing a job following a concussion is raised approximately 30% compared to peers without concussion, while the researchers hardly saw any increase in people leaving the workforce following a concussion in the group of 50-59-year-olds.

"Senior professionals may have a more relaxed attitude to what they are supposed to accomplish in life in general and in their professional career in particular. From other studies we also know that it is easier to adjust to a long-lasting disease, if this happens later in life," says Hana Malá Rytter.

Better advice for patients

According to Hana Malá Rytter, patients should receive better and more precise advice from both doctors, nurses and other professionals in the health and social care system following a concussion. It is important that the patients' entire life situation is taken in to account.

Patients with concussion rarely receive actual treatment, as the brain primarily needs time and rest in order to heal. In general, patients are advised to merely go home and take it easy for a few weeks—and to pay attention to what level of activity they feel they are able to handle. And that can create a false expectation that they are soon back in business.

"It differs greatly how much activity people expect of themselves, and health professionals need to draw attention to the cognitive and mental limitations that often strike the young professionals and those with higher education in the wake of a concussion. They need to be told, that this may take many weeks or even months, before they can expect to be back at full speed in the way they were prior to the head trauma. If not, they may strain their mental capacities and that can delay the healing of the traumatized brain," explains Hana Malá Rytter who continues: "Furthermore, they may experience defeat, when the exhaustion causes symptoms to worsen again and they have to give up. This can cause stress and we know from other studies that this will delay the healing process."

The researchers also identified two other groups that are at particular high risk of losing attachment to the labor market: Patients with chronic diseases (i.e. diabetes, heart or liver disease or HIV) prior to the concussion, and patients that were of non-Danish origin. This is not surprising, as plenty of research points to the fact that chronic disease in itself has a very negative effect on a person's perceived life quality. In addition, being part of a minority group is linked to a series of problems that increase the risk of early retirement and receiving disability payment.

A concussion can cost your job, especially if you are young and well educated
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Impacts in ice hockey were mostly long duration events

Post by greybeard58 » Tue Jul 23, 2019 5:19 pm

Impacts in ice hockey were mostly long duration events

The purpose of this research was to conduct reconstructions of concussive and non-concussive impacts in ice hockey to determine the biomechanics and thresholds of concussive injury in ice hockey. Videos of concussive and non-concussive impacts in an elite professional ice hockey league in North America were reconstructed using physical and finite element model methods. Eighty concussive and 45 non-concussive events were studied. Logistic regressions indicate significant thresholds for concussion for linear/rotational acceleration and CSDM10%. Impacts in ice hockey were mostly long duration events, longer than 15 ms.

The biomechanics of concussion for ice hockey head impact events ... 19.1577827

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Driven to the end: Olympic cyclist Kelly Catlin could do it all. Until it all became too much.

Post by greybeard58 » Tue Jul 30, 2019 10:43 am

For the video and pictures use the link at the bottom

Driven to the end
Olympic cyclist Kelly Catlin could do it all. Until it all became too much.

(Jenn Ackerman for The Washington Post)
By Kent Babb
JULY 29, 2019

MINNEAPOLIS — On the day he’d bury his daughter, Mark Catlin stepped out of a chapel and into the fresh air.

“Nice day for a walk,” he said, looking up, and on this morning in late March, the weather was flawless: cloudless, crisp, a bright blue sky.

He took a breath and set off, heading down the cemetery’s path and falling behind the procession of cars ahead, talking as gravel crunched beneath his shoes. He asked if the memorial service, laboriously planned near the lakefront cycling trails Kelly Catlin had explored before becoming a silver medalist in the 2016 Olympics, had been good enough. He apologized if it had been too sad. The afternoon reception, he assured friends and visitors, should be more lively.

A few paces up the winding path, a longtime friend shook his head. Mark, the friend whispered, would do anything to distract himself — he always had — in this case to avoid facing “the darkness”: Kelly’s suicide two weeks earlier, her thoughts during those final days and weeks, the way she’d planned her death in the same meticulous, results-oriented way she’d lived her life.

Back on the walkway, Mark wore a blank expression as he accepted condolences and told people about his plans for the coming weeks. Eventually he reached a gravesite surrounded by mourners, and he stopped at the rear of the group as if happening upon a stranger’s funeral.

Gradually the faces turned, and after a moment Mark noticed his wife and two other children waiting near a charcoal-colored casket.

“I guess we’ll go lay her to rest now,” he said, stepping forward.

If you or someone you know needs help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255). You can also text a crisis counselor by messaging the Crisis Text Line at 741741.

At 20 Kelly Catlin became an Olympic medalist. Three years later she killed herself
Next to the computer in the basement of his home, Mark has a notebook labeled “To Do: Kelly” with seven projects listed: photos to organize by year, 60 hours of video to edit, a bio to write, calls to make and emails he’ll send after jolting awake most nights around 2. But now he’s working on No. 1: the enormous memorial he’s designing alongside a touch-screen information kiosk, like something at a museum, he imagines at Kelly’s graveside.

“So people can remember,” he says.

He wants people to know Kelly wasn’t just the daughter of Carolyn and Mark, the triplet sister of Christine and Colin. She was more than an intelligent but socially awkward 23-year-old from the Twin Cities. Kelly built herself into an Olympian and a three-time world champion in the four-rider group race known as the team pursuit. She was fluent in Chinese and had been first-chair violinist in her high school orchestra, a competitive pit bull who folded origami and played badminton with the same joyless ferocity that she brought into a velodrome or classroom.

Kelly’s father wants you to know all of it: She took classes at the University of Minnesota in 11th grade, notched a perfect score on the SAT, had enrolled last fall in the computational mathematics program at Stanford’s graduate school. This was a young woman who had become convinced, like so many of her high-achieving peers, that pedaling to the peak of one mountain only meant a better view of the other, taller ones in the distance.

“The very characteristics that made you successful will be self-destructive,” Mark says he has realized, though he prefers to keep himself busy than think too deeply about it, and indeed as much as his daughter was an outlier in life, she was part of a trend in death.

Mark is a retired medical pathologist, and he has learned these past few months that young people in the United States — and, in particular, young women and girls — are killing themselves at a rate the Centers for Disease Control and Prevention considers a national health crisis. Between 2007 and 2015, according to a CDC study, the suicide rate doubled among females aged 15 to 19 and reached a 40-year high. Major depressive episodes and suicide attempts have skyrocketed among women under 35, according to a 12-year analysis by the National Survey on Drug Use and Health, as a society fixated on collecting and comparing achievements seemingly has conditioned a promising generation of young people to ignore emotional alarms — insomnia, anxiety and depression — and work toward the next goal.

Sometimes that pressure comes from family or peer groups, and it can manifest itself in ways good and bad: pushing certain individuals to astonishing heights and others to alarming depths. Kelly, though, found herself at both extremes — climbing the Olympic medal stand three years before taking her own life in the bedroom of her Stanford apartment — and seemed determined from an early age to prove herself in increasingly intense arenas, only exacerbating her best and worst tendencies.

And even that, mental health experts say, is more and more common as suicide has been on a consistent rise among individuals born between 1982 and 1999. Kat Giordano, Kelly’s former roommate at Stanford who discovered her body, has experienced the highs and lows of existing in a culture that seems to have convinced its young people that being average is unacceptable — leading some to grow up believing they must be exceptional or die trying.

“I am someone who thrives under pressure, but … you’re surrounded by it,” said Giordano, a Stanford Law School student who in 2018 graduated magna cum laude from Princeton. “It feels like the best motivation and something dangerous simultaneously.”

On the day of Kelly’s funeral, Colin Catlin sat on a nearby tombstone and watched the gravediggers bury his sister. He already had taken photographs of her casket, crouching and experimenting with angles to find the perfect light. He’d picked up handfuls of dirt and let it slide through his fingers.

“With her to the very end,” he’d say later, going on to point out it was just his way of coping.

His sister Christine’s, though, was to bolt toward a car once the eulogies concluded. If her father and brother had somehow found ways to channel the emotions of the previous weeks, Christine felt engulfed by them: despair, anger, regret. None, though, was as prevalent as guilt, and considering the family she was born into, she knew lingering at the grave would lead to a breakdown — exposing her yet again as the black sheep of the Catlin flock.

“I was,” she’d say later, “the weak one.”

Triplet siblings are often measured against one another from birth — Kelly won her first race by being the first to enter the world, a minute ahead of Christine — and the competitions and labeling never stop. Kelly was the cyborg, ruthless and analytical by third grade, and Colin was the bohemian: a beekeeper, Eagle Scout and gardener. Christine, though, was the crier. She’d fly upstairs after a cross word or remark about her being underweight, sobbing and reading alone. She’d disappear from conversations and ruminate on what had been said, channeling her feelings into short stories and plays.

During those early years, Kelly would act out the roles in Christine’s imagination — she took home theater as seriously as everything else — but as time passed, the competitions became more intense. Mark, for reasons the triplets wouldn’t understand until much later, seemed fixated on his children growing into highly successful adults. His own father had been a heavy drinker, and Mark and his seven siblings had grown up in poverty and fear. His dad died young, and Mark beat his family’s odds by putting himself through medical school and entering the most emotionless of specialties: looking through a microscope. And for decades his charge was finding answers that, to others, were invisible — but, if he zoomed in enough, were there somewhere.

Along the way he decided that when the time came, he’d raise his own kids by surrounding them with activities, reminding them of traps, exposing them to sports and the arts and travel and culture — everything, it would seem, but the possibility of failure.

Mark enjoyed his job, and it allowed him a vacation home and time to indulge his many hobbies — “I used to call them obsessions,” Carolyn would say, though she remained supportive of her husband’s interests and largely deferential to his parenting decisions — and introduce his children to the methodical pursuit of results. That pursuit, the parents reminded the kids, could even be a matter of life and death: Exercise and determination enrich and extend lives, but certain distractions — alcohol and a lack of focus — could derail or perhaps shorten them. The kids would say later they grew up learning anger and intensity were acceptable but crying was a show of weakness.

“We didn’t do touchy-feely,” Colin says now, adding in a separate interview that “the three of us stopped looking to the parents for affection.”

Carolyn and Mark insist the kids began resisting their parents’ embraces around middle school, but although Mark admits granting his children space, Carolyn would approach Kelly with a bear-hug sneak attack.

“It’s too hard to resist,” Carolyn would say.

Still, the triplets learned the art of strategy and the way to properly build things: Mark’s 70-foot retaining wall, a modest field of hop plants, a sprawling tomato garden. Mark coached their soccer teams and introduced them to culture during trips to Italy, South Africa and England. Watching television was forbidden, and the siblings were allowed to watch movies only while using an exercise machine. When they were 8, Christine says, their $20 monthly allowance depended on whether they exercised 30 minutes a day, five days a week. They had to log their totals on a chart that required a parent to initial it.

Time passed, and at least on the surface the plan was working: Colin carefully tracked his workouts at age 14, and his grape jelly recipe won third place in the Minnesota State Fair. Christine was 13 when she published her first book, a kids’ guide to raising monarch butterflies, and was a distance runner with a resting heart rate of 45 beats per minute. Kelly, to her siblings’ constant discouragement, excelled at most everything she took on — skiing, fencing, competitive shooting — and the kids learned that their parents were supportive, though earning their approval was sometimes a different matter.

“A pet peeve of mine: So many parents just automatically say: ‘Good job,’ ” Carolyn says even now. “Their kids are successful getting a fork to their mouth: ‘Good job!’ ”

Kelly, pursuing whatever it was she was pursuing, simply amplified her intensity and determination, seeming to never break. But Colin looked forward to his classical guitar lessons because the instructor allowed him to cry. Christine increasingly felt like an outsider, once writing a story about a family of opera-singing mice from the perspective of the one mouse who couldn’t sing.

Christine moved out when she was a teenager, searching for belonging in Maine and California and New York. The siblings had all been pushed, but Kelly — the one pushed hardest — had won the household Olympics, Christine decided. Leaving everything behind, Christine assumed her sister was embarrassed by her, so she stopped calling. She stopped texting and emailing. Kelly did the same.

Until one day this past February, Christine was watering plants at home when her phone rang. She saw “Kelly Sista” on the display and answered immediately.

The years passed, Kelly’s intensity grew, and Mark felt equally fascinated with and alarmed by his daughter.

“She has created this lofty image of herself that she is forced to maintain and live up to,” he wrote to a friend in 2010, when Kelly was 14. “We have talked to her about starting over in high school — not sure if she can.”

She was spending an increasing amount of time alone, staying home on weekends to study or put in extra hours on an indoor training bike. She recoiled if anyone touched her and locked herself in her room for violin practice, vowing to become first chair, and after her death relatives would struggle to reconcile a certain dichotomy: These were the extremes that made Kelly Kelly, but they were also the things that would cost them Kelly. Should they have stopped her? Could they have? She’d refuse to admit defeat or even to feeling stress, preferring to write in one of her three diaries and add to “The Code,” a list of personal guidelines she’d begun honing in third grade.

“A fact about who I am: I do not cry,” she’d write.

Sticking to what would eventually become her 13 commandments — “Fear not physical discomfort” and “Never use coarse or vulgar language” among them — would propel her to the mountaintop; any deviation or show of weakness, she’d come to believe, could topple her. Four of her rules pertained to her belief that socializing was, like crying, a display of submission.

“Never allow yourself to become close enough to another,” she’d write, “that their actions or inactions might cause you (any amount of) distress or pain.”

Kelly read science fiction novels as she brushed her teeth and crafted meticulous to-do lists. She simplified her meals — lunch most every day was a sandwich with deli meat and hummus, two clementine oranges and yogurt with chocolate, her favorite food — and usually wore black.

“She always wanted to basically be this monolithic, terrifying force of power,” Colin would say, and after a while family members and acquaintances didn’t just avoid touching her. Many of them stopped talking to her. One longtime cycling coach, Charlie Townsend, sometimes wondered if she even enjoyed the activities she seemed to obsess over; the only time he saw her smile, he’d say, was on the medal stand.

Mark watched his daughter as she’d disappear for a 12-hour study session or a 60-mile bike ride, preferring to be alone with only her thoughts and Beethoven’s Fifth Symphony as company. Olympians, she believed, were made and not born. She would make the sacrifices and maintain focus and get into Harvard or Cambridge or Stanford. She would.

“Never give or receive touch of a romantic or sexual nature,” The Code instructed.

“Never engage in a relationship that could be defined as having a significant other. (In my case, a so-called ‘boyfriend.’)”

“Never love.”

Kelly stepped off the medal stand in Rio de Janeiro, and soon after her smile was gone. It wasn’t just the end of a long and grueling journey; she hadn’t felt this connected to something since the triplets began drifting apart in middle school.

Kelly returned to Minnesota and her solitary discipline, back to the things that made her, and looked toward an uncertain future. Following her graduation from the University of Minnesota, where she completed degrees in biomedical engineering and Chinese, she applied to Harvard and Stanford for graduate school. Kelly wrote essays, recommitted herself to the violin and writing, made her lists — “loaf of bread (28 pieces for breakfast and lunch)” — and sometimes planned her outfits weeks in advance.

She joined a professional road cycling team, Rally UCH, and planned for the international cycling schedule: races in Canada, Chile, Belarus, the United Kingdom. She traveled with teammates but often remained disconnected, and if the talk turned to gossip or relationships, Kelly would leave the table. If she said anything, it was to point out that these discussions are pointless and that dating was, a teammate would recall, a “waste of resources.” When a new cyclist introduced herself with hugs, the veterans said nothing as the rookie approached Kelly, who recoiled with such disgust that the teammates wondered if she might throw a punch. If there were team-building exercises or games, Kelly could usually be found in her room.

They were in Belgium when the group learned Kelly had never seen “Mean Girls” or “High School Musical,” and a few of them arranged a two-night viewing and hounded Kelly until she joined them on the sofa. They were in London when some teammates wouldn’t stop talking about seeing “School of Rock” on the West End, and Kelly complained all the way to the theater before singing “Stick it to the Man” all the way back.

The weeks and months passed, and Kelly eased out of her room, slowly removed her ear buds, occasionally spoke. If Kelly had once been a curiosity, now she was entertainment, and she was best in debate mode: speech quickening, legs pacing, hands directing the traffic of her restless mind. Kelly and Christina Birch, a cyclist with a PhD from MIT, bonded over academics and the feeling that no matter what either of them accomplished, they never felt complete. There was just more to do — more, more, more — and the antidotes to fear were harder work and force of will.

“She got to the top and found that it wasn’t what she was expecting,” says Birch, who wasn’t the only person who wondered if Team USA’s silver medal — Britain won gold by 1.02 seconds — had somehow been a disappointment to Kelly. “It still sucked. It still wasn’t enough.”

The teammates talked sometimes about the things that define a meaningful life and whether it was possible to actually reach the height of human potential. Kelly hated talking about the future — in her mind marriage and career representing such cliches — and a teammate would recall that she once admitted a preference for “disappearing into the mist.” She blushed when teammates joked about her secret crush on Lionel Messi, the Argentine soccer star, and laughed when they’d slip Kelly, as averse to coffee as alcohol, a caffeine gel. Kelly brought dinner once to Sara Bergen, a Canadian cyclist who’d suffered a concussion after a crash, and kept her company on a training bike. She joined in the occasional trivia contest against the male cyclists and, on Valentine’s Day, thanked Birch for sending her an anatomically correct chocolate heart.

The countries and trails changed, and somehow so did Kelly. She recoiled and disappeared less often — even standing there, arms dangling, when Bergen insisted on celebrating the end of a stage by wrapping each of her teammates in a big, sweaty, 15-second hug.

“She wouldn’t hug back,” Bergen says. “But she wouldn’t run from them anymore.”

In the fall of 2018, Kelly had come to Stanford, posted a welcome note from Giordano next to an Olympic flag on her dresser and leaned into a future she was unsure she wanted. But she was here, another box checked, and she tried to overpower her doubts as she always had. She made her lists, chopped away at her violin, repeatedly cleaned her bicycles.

And that was part of the problem: Cycling was a chore now, not an escape. In October, she crashed and broke her arm. Another crash led to a concussion. She had opened herself to new friendships, sure, but what about the politics of being an Olympian? She had begun to dread the grind, 40 days at a track camp between November and December 2018, and when she returned to school there waited a mountain of work. It felt overwhelming, and one day last year she at last allowed herself to cry. She nonetheless filled recovery days with studying and makeup tests, and though she’d been admitted to one of her dream schools, she was never there for the classes, the guest lectures, the networking events. The 2020 Olympics in Tokyo, which she saw as a correction of Rio and a chance to win gold, were on the horizon. She couldn’t just stop, and indeed Kelly wept not because there were no worlds left to conquer but because there were so many.

Late last January, with a chocolate chip cookie at her side, Kelly stood at her desk and began typing, “Well hello, one and all!”

In what eventually became an eight-page letter to six people — Mark and Carolyn, Christine and Colin, a cycling coach and a former high school classmate — Kelly included a confession: Yes, she cried. More and more often she’d wake in the night, feeling no guilt, and just let it rip.

On this evening, she typed that she felt “somehow unequal” to Stanford and that she had sent a collectible dagger out for sharpening, intending to stab herself in the heart. She was curious about the sensation of bleeding out, she wrote, going on to explain a fantasy of becoming a serial killer with an elaborate and meticulous ritual. “Oh, the drama I could create,” she wrote.

Instead, she had rented two cylinders of compressed helium and waited for the halls to clear before dragging them to her room. She ordered supplies to construct an “exit hood,” and on the evening of Jan. 25, she began writing her email. She was planning to end her life in six days because, on Jan. 31, she was scheduled to meet the queen of Spain. Instead, she’d be dead, and even Kelly Catlin’s suicide note had to be perfect. “I really did want a nice hook opener,” she wrote.

She kept typing, 470 words in the email’s body: instructions for Colin, final wishes, the phone number for the Santa Clara County medical examiner’s office. In addition to the eight-page document was a separate nine-page personal addendum. She listed 27 songs and their corresponding links on YouTube, a playlist meant to accompany the reading.

“In truth my mind has conquered me,” the document read. “Its never ending spinning spinning spinning would not rest. Always, always was it sprinting a marathon, thoughts never at rest, never at peace. It just wouldn’t stop.”

She suspected that she had major depressive disorder, though to her seeking therapy was another show of weakness. “I would rather suffer than ask for help,” she wrote, going on to describe her delight in the problems her death would cause Team USA and some thoughts about her upbringing.

“I suspect a large part of why I am the way I am — both ‘good’ and ‘bad’ — is our childhood environment,” she wrote. “We are triplets. And we are, none of us, truly functional. … Those parched for affection from a young age do not quickly heal. I shall say no more.”

Kelly finished her documents and waited her six days. On Jan. 31, she gave herself the morning off from training, and before sliding in her ear buds and twisting the helium valve, she had one last thing to say.

“I was dancing before the end. Just so you know,” she typed before hitting send. “I woke up, danced a dance, played my fiddle, and died.”

But then, hours later, she woke up.

In the moments and hours after Kelly’s suicide attempt, those who’d received her email tried to make sense of it. Was this, as Colin initially suspected, a dark and elaborate prank? Her parents, panicked after having been alerted by the high school classmate, called Stanford police. Kelly had never been evaluated for anxiety or depression, her father would say, and none of her family members would recall Kelly ever mentioning suicide.

Kelly, according to relatives, was perhaps as confused by her survival as anyone. She had done as her research suggested, and indeed the helium had caused her to drift off. But after a while, she’d write in her journal later, she simply regained consciousness; the first thing she remembered was standing fully clothed in the shower. Colin would say authorities had arrived, discovering Kelly’s materials and rushing her to Stanford Hospital, where she’d spend seven days on an involuntary hold. Kelly either couldn’t remember, or wouldn’t reveal, much else.

“What I can say with certainty,” she’d write later, “is that I have indeed been given a second chance and I do not intend to waste it.”

She vowed to graduate from Stanford, to read autobiographies of suicide survivors, to study and adopt their lessons. Kelly promised her family she had no intention of a second attempt — “Her word was her bond,” Carolyn would write later — and after her parents returned from California, Kelly and her mother spoke by phone every few days. She never said anything about lingering feelings of hopelessness or depression, Carolyn would say. Christine texted Kelly and mailed books to her hospital room, which — despite what was meant as a mandatory rest period from cycling and classwork — she often escaped each day to spend a few hours on the facility’s stationary bike. The hospital recommended Kelly remain under supervision another week, Mark Catlin would say, but Kelly felt frustrated and trapped before threatening legal action and being released to her apartment.

Attempting to resettle into a new routine, Kelly wrote a letter demanding equal pay for female cyclists and had an essay published in VeloNews. She met with faculty advisers and agreed to reduce her academic load to one class for the remainder of the spring term. She told Colin of her renewed optimism and a willingness to cast aside social inhibitions.

But as the weeks passed, Colin suspected that something was gnawing at her: For perhaps the first time in her life, Kelly had put her mind to something — truly committed to it — and fallen short.

“I suck,” she told her brother, going on to describe the fellow students in her mandatory group therapy sessions who, she believed, only wanted attention when they had threatened or attempted suicide. Those students, Kelly told Colin, hadn’t been as dedicated — as serious as she’d been — and it became clear that, even here, it wasn’t empathy she felt but a desire to compete.

“She wanted to prove that she was not one of them,” Colin says now, and when Kelly brought up her frustrations, he tried to change the subject.

During Carolyn’s phone calls with Kelly, they’d discuss politics or she’d talk about something lighthearted to make Kelly smile. Mark occasionally heard anger in his daughter’s voice when she described her suicide attempt, and he assured her it wouldn’t be long before she’d be back on her bike.

But he didn’t get it. Nobody seemed to. By then it was mid-February, and it seemed clear Kelly just wanted someone to listen, so she called a number she hadn’t in a long time.

“I could relate,” Christine would say later. “It makes perfect sense.”

Kelly had become increasingly alarmed that either her concussion or her suicide attempt had caused permanent brain damage, and she remained anxious about life after cycling and school. She had, after her hospital discharge, exchanged emails with a staffer at Stanford’s student health center, and the staffer expressed increasing concern that Kelly hadn’t scheduled an appointment with a mental health specialist.

Kelly had, she emailed back to the staffer, called a telephone counseling service contracted by the U.S. Olympic Committee but hung up after being put on hold for 20 minutes; a subsequent email to the service, Kelly wrote, yielded only plans to look into potential treatment. A USOC spokesman said extensive efforts were made to provide support following Kelly’s initial suicide attempt. Olympic athletes are required to complete intake surveys, whose questions include asking individuals to self-identify symptoms of depression and anxiety, though potential treatment is up to each athlete’s team of service providers.

During the sisters’ phone call, Christine kept listening. Eventually she reminded Kelly that she was 23; she didn’t have to plan the rest of her life as she did her meals and outfits. Painful as it had been, Christine told Kelly, detaching her identity from writing — from the expectations of others — had been liberating. Kelly could do the same: quit cycling, leave school, live for her own happiness.

Kelly said she’d think about it, though when it was time to end the call, she casually mentioned that if things didn’t change in a month, she might again attempt suicide. Christine begged her sister to reconsider, and after they hung up, she called their parents and sounded the alarm. She says they told her she was overreacting.

“They didn’t take me seriously at all,” she’d say, and though it’s common for parents of suicide survivors to remain in denial, Mark and Carolyn would say later they had no idea which words or behavior might signal a second attempt — or whom to call if they suspected Kelly might break her promise.

In the days after calling Christine, Kelly wrote out the pros and cons of living and dying. One day she was reminding herself of her strength — “I can fight through this,” she wrote. “I can live for tomorrow” — and the next she was chastising herself for delaying the inevitable.

At one point, she filled four pages with her thoughts.

“Principle: If I am not an athlete, I am nothing,” she wrote at the end. “Principle: If I am in therapy, I have failed.”

In her journal she typed out her to-do list for a week in early March and identified the day Giordano, her roommate, would be studying and absent from their apartment.

Monday: “… packages sometime, assemble hood”

Tuesday: “train, practice run with ear buds”

Wednesday: “train, practice run with ear buds”

Thursday: “… tuck sheets under, switch Verizon to DO NOT DISTURB, meditate … set out DNR note and Helium note and printed/signed letters, start exit by 11.”

In the weeks after their call, Christine kept texting, kept reminding Kelly she was still there. She sent an article about the Italian town where Stradivarius violins are made, shipped her a Chinese string instrument called an erhu, began planning a road trip to northern California. Though Kelly had mentioned a second possible suicide attempt as an aside, Christine believed her sister had given her a deadline. Christine would, before the month was out, drive west with Scottie, her chihuahua mix, and surprise Kelly at Stanford. Christine would listen as long as it took.

Then, on March 8, Christine’s phone rang again. This time, Kelly had done what she’d set out to. She always did.

Almost immediately after Kelly’s death, Mark Catlin kept himself busy. There was a funeral to plan and photographs to sort. He had a shooting competition in Arizona, chores on the farm, a memorial bike ride to think about.

The family donated Kelly’s brain to Boston University’s CTE Center, which in the past two years has seen an uptick in the brains of women. Mark studied his daughter’s medical records and requested the Olympic Training Center’s post-concussion protocol. A lawyer had to talk him out of suing Stanford, which he said wouldn’t offer treatment for Kelly because she wasn’t a varsity athlete. (The Stanford spokesman said the school’s follow-up is the same for athletes and non-athletes.)

“You create a barrier in your mind,” Mark says, “and the barrier is between normal activities and thoughts about Kelly.”

The triplets were teenagers when Mark told them about his own father. He hadn’t been much older than them when his own dad died from a gunshot; though the official cause of death was a hunting accident, Mark says, he always suspected his father had taken his own life.

“How could anyone get there?” he’d wonder, and he dealt with his trauma by ignoring it: Mark skipped the funeral, devoted himself to self-improvement, became convinced alcohol and misplaced priorities were to blame. Mark, using force of will, would defy the odds; he’d become the only one of his siblings to graduate college, the only one who’d never have a drink. With the advantages Mark could offer his own children, they would succeed at an even higher level than he had. They would.

But his plan had ended in tragedy, and now Mark reached into a bedside table one night around 2 a.m. and removed the four-page letter Kelly had written shortly before her death. Mark, again attempting to overpower emotion, had avoided reading it until that moment.

“So what do I want?” she had written. “Love.”

Mark, feeling a need to understand what Kelly had felt — his answers, as they’d been while he was a pathologist, were down there somewhere — kept reading.

“I do desire to be valued, to be special, to have great power and responsibility. But, beyond all else, I desire ‘love and connection.’ ”

By now the darkness was all-consuming, and he kept sinking, kept absorbing his daughter’s final words.

“I cry,” Kelly wrote, “because I only ever truly desired Love. Kindness. Understanding. Warmth. Touch. And these things shall be denied, for eternity.”

Overcome, Mark will say later, he considered his own suicide.

“Just dwelling on our failures and what I feel is my failure,” he’ll say. “That made me so sad: There were things I could’ve done.”

But then, he says, he thought of Christine and Colin and Carolyn. He couldn’t go quite as far as Kelly had gone. But in his mind, he’d felt what she had. He had his answer.

“I could pull myself back, and she couldn’t,” Mark says, and that night he lay in bed and cried for a long time.

Maybe no emotion is more complicated, or personal, than grief: not just the inevitable questions about how and why, but the thoughts and actions that begin the march forward.

In those first days after Kelly died, Christine and Mark knew they needed to talk but were uncertain they even knew how. They were either too different or too similar, depending on whom you asked, and years ago daughter and father struggled to be honest with each other unless they were on their bicycles, quarantined on some faraway trail.

And so, at the beginning, their actions were to delay: Mark sending his emails, designing his models, imagining having Kelly cloned. Christine, her instincts telling her as always to flee, would disappear to Cuba and California, attempting to drown guilt with silence or noise.

“I just ran out of time,” she kept saying, and that was among the sentiments she shared with Mark.

Eventually they’d conclude there was something about Kelly they both admired and feared, and it’s what pushed her to the top and her bottom: Once she made up her mind on something — anything — there could be no changing it.

“To be so obsessed with something,” Mark says, “that you can’t give it up.”

When Christine came home to Minnesota for her sister’s funeral, most of the snow had melted. The ground had begun to thaw. Family and friends had gathered to hold Kelly’s silver medal and eat chocolate and tell stories. Colin made jokes, believing Kelly would’ve hated a somber memorial, and Carolyn tried to hide her overwhelming despair.

“The devastating consequences of our trust,” she’d write in an email months later, overcome with regret because she’d believed Kelly’s promise.

At one point in the day, Mark and Christine slipped out of the reception without telling anyone, heading out to do something necessary — a thing they hadn’t done in years. The trails would be muddy and treacherous, but out there the air wouldn’t feel so heavy. So a little after noon, they pulled on their tights and helmets, taking their first steps away from a fractured past and toward an uncertain future, setting off, just the two of them, to go for a ride.

Additional reporting by Cindy Boren, video by Ashleigh Joplin, photos by Jenn Ackerman, design by Brianna Schroer and photo editing by Thomas Simonetti.

Driven to the end: Olympic cyclist Kelly Catlin could do it all. Until it all became too much.
Kelly Catlin was a silver medalist and Stanford graduate student. At 23, she took her own life. ... h-cyclist/

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Rise in concussions in female athletics

Post by greybeard58 » Tue Aug 06, 2019 9:10 am

Rise in concussions in female athletics
Posted: 8:32 AM, Jul 05, 2019 Updated: 7:52 AM, Jul 05, 2019
By: Frank Cipolla

We’re digging into new reports claiming the number of concussions among teenage girl athletes across our country is going up, especially those playing lacrosse and soccer.

Fox 4 investigator Frank Cipolla explains how changes to prevent concussions may instead be causing more.

17-year-old Sophia Chickering plays on the Naples High School girl's varsity lacrosse team. She's had two concussions within a 6-month period but continues to play.

As she puts it, there's nothing she can do worrying about it.

Her teammate Teagan Nabors suffered a concussion this spring and says she doesn't remember much about the game. She says for the next two days she was 'out of it'. As she puts it, “just staring at the wall.”

Her mother, Michaela Adam, remains concerned and watchful.

A study which compiled data from over 200 high schools and 26 colleges, shows women's lacrosse ranks second only to football in the number of concussions.

MORE: Mount Sinai Hosts First Ever Conference on CTE in the Female Brain

In 2018 Florida became the first state in the nation to mandate high school female lacrosse players wear helmets.

But some believe it has led to more concussions. The coach of the Naples High lacrosse team, Jayson Saunders, argues helmets lead to more aggressive play, and he remains firmly in the 'no helmet' camp.

In fact, he says, if he had his way, his players wouldn't wear them.

Why? According to Jayson, they give players a false sense of invincibility. Also, he believes referees feel they don't have to be as vigilant in calling fouls.

Sophia has been on the receiving end of that aggressiveness. In her case, she says an opposing player swung to check her and hit her helmet. She's convinced if she did not have the helmet on, her opponent would not have swung her stick to begin with.

Meanwhile research from the American Academy of Orthopaedic Surgeons shows high school girls soccer players suffer a higher concussion rate than boys playing the same game. For them, helmets are not required.

Recently a group called Pink Concussions , based in Connecticut, began investigating why young women suffered more on-field concussions.

Executive Director Katherine Snedaker says she is very concerned. She agrees with a University of Rochester Study which shows the severity and frequency of concussions in young girls and women is connected their hormones.

The study shows in the first two weeks of a woman's menstrual cycle the effects of a concussion are longer lasting. In the last two weeks, not as much.

In addition, she points out, symptoms in girls don't often show up for a day or two days later. And playing post-concussion shows the recovery time is longer.

The bottom line, says Coach Saunders, is parents need to be vigilante in spotting concussions since they know their children best. Any complaint or change in personality post game should be a warning sign.

Rise in concussions in female athletics ... -athletics

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Her interest in concussions comes from her own hockey career, having sustained the injury herself

Post by greybeard58 » Thu Aug 15, 2019 2:45 pm

Her interest in concussions comes from her own hockey career, having sustained the injury herself

A love of hockey and an education in behavioural neuroscience.

Together, they gave Maria Powell, B.Sc.(Hons.)’12, MD’17 , the motivation and tools to fight a debilitating injury that is pervasive in contact sports — concussions.

Personal experience
The former Memorial medical student co-founded Concussion-U with four other classmates in 2015. The group was founded with the goal to make sports safer for young people. Concussion-U is all about delivering education on sports-related injury in an accessible way that resonates with youth.

“Our common interest in sport-related concussions and backgrounds, along with support from the Faculty of Medicine, that’s what led to Concussion-U,” says Ms. Powell.

She grew up playing hockey in Newfoundland and Labrador. Her interest in concussions comes from her own hockey career — having sustained the injury herself — and seeing many teammates and friends deal with sports-related head injuries.

“We created a model for the group to be self-sustainable — for new students to take over.” — Maria Powell
In 2017 Ms. Powell relocated to Calgary to complete her residency in internal medicine but ultimately hopes to return to Newfoundland and Labrador. Concussion-U lives on at Memorial.

“We created a model for the group to be self-sustainable — for new students to take over and continue to provide support and up-to-date information to athletes, parents and coaches,” she says.

Ms. Powell credits Concussion-U with being a passion project that challenged her to step outside of her comfort zone, something she feels she needed in order to become a better doctor.

“In Newfoundland and Labrador, we have the added challenge of living on an island with a smaller population, so we have to find ways to be innovative and create opportunities to grow.”

Maria Powell:
New grads on fire: 10 alumni, 20-something and going places
Read more: ... ia-powell/

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Another HS hockey career cut short by concussion

Post by greybeard58 » Wed Aug 21, 2019 8:37 am

Another HS hockey career cut short by concussion

Mia Dunning has come a long way.

The Ashwaubenon senior qualified for the WIAA state track and field meet last Thursday in the shot put and discus.

Her winning throw in the discus of 141 feet, 11 inches was almost 10 feet farther than her previous personal-best toss and also earned her the No. 1 seed for Division 1 heading into her first state meet.

While it’s an impressive feat for someone who hasn’t competed in the sport in three years, Dunning has come a much farther way outside of the throwing circle.

Her ability to simply take in the beautiful sunset at Schneider Stadium in De Pere last week as she cheered on her teammates marked a huge accomplishment in and of itself.

“I want to get more memories to replace the eight months that I missed,” Dunning said.

Eight months.

That’s how Dunning measures the time she lost while recovering from a concussion sustained at the end of her junior season of hockey.

The all-state defenseman doesn’t recall much from the eight months following the injury, which ended her days competing on the ice.

She wore an aqua blue dress to her junior prom, but doesn’t remember wearing it. She only knows it was that color and that she went with her friends based on the photos she has.

“I was so lost for those months,” Dunning said. “I just didn’t know what I was going to do.”

Dunning was a heavily recruited hockey player and was considering attending Yale for college.

She harnessed her skills on the ice by playing on boys teams up until she reached high school, which saw her lead the Bay Area Ice Bears to the WIAA state tournament in 2017.

The concussion was almost like a bad case of déjà vu from when she sustained one in sixth grade during a tournament in Michigan.

“Someone came from my blind spot and they took me out,” Dunning said. “Being a girl, a lot of guys targeted me because I had the ponytail out.”

The concussion sustained at the end of her junior season not only affected her short-term memory, but made her sensitive to light and easily susceptible to getting sick from even the slightest motion or noise.

“I was very secluded,” Dunning said. “I would really try to get out there and work with people, but I would get so sick if there was too much movement.

“I missed a lot of school. I would try every day and try so hard, but I would get sick at school because there is too much light or too much noise. It’s stimulus upon stimulus.”

Dunning has a Goldendoodle named Mowgli.

However, he is more than just a dog to her. He is a lifesaver.

“The doctors were afraid at first because in my brain the neurons weren’t connecting during my baseline tests,” Dunning said.

“They feared there was a chance I would lose some of my personality because that’s what can happen with a concussion. I needed to develop a relationship with something else. That’s why we got him.”

Dunning trained Mowgli as a therapy dog. She said the experience aided her tremendously on her road to recovery.

She brings Mowgli to school for parts of the day sometimes. She does it not just for herself, but to allow her peers to be comforted by the 95-pound therapy dog as well to help deal with anxiety or depression.

An avid Disney fan, Dunning named the curly-haired dog after the main character from the “Jungle Book.”

“The Jungle Book is about someone that’s out there and not understood,” Dunning said.

Mowgli helped Dunning return to her social butterfly self again.

“She’s always the most positive person,” said Ashwaubenon senior Sage Wagner, a state qualifier in the 800-, 1,600- and 1,600-meter relay.

“You just want to go out there and do good things because of her demeanor and how she carries herself. She makes everyone better themselves.”

Dunning devotes her time to helping with Special Olympics athletes and the Goody Triathlon.

“Their personalities are amazing,” Dunning said. “The relationships I have with them will last forever. I’ve been able to help them with my therapy dog and bring him in to teach them about certain things.

“I hope everyone I surround myself with learns something new and is able to expand their horizons a little bit more.”

Dunning snacked on Airheads last Thursday before making her personal-best throw in the discus.

The sugar boost was exactly what she needed after an insulin check revealed her levels were too low.

“I was at a 55,” she said. “I’m supposed to be between 80 and 120, so it was quite low.”

Dunning was diagnosed with Type 1 diabetes when she was about 5 years old and has used an insulin pump since she was 6.

However, she never used it as an excuse for not being able to perform at a high level in school or sports.

“It doesn’t affect your ability to perform,” Dunning said. “It’s just one or two extra steps in the process.”

Although she’ll never be able to compete in a contact sport like hockey again, the process to return to athletic endeavors for Dunning was a long one.

She had to regain her endurance and strength after going through several months with limited physical activity.

“It started out with her coming out for cross-country,” Ashwaubenon cross-country/ track and field coach Cal Kromm said.

“She ran cross-country and scored on JV multiple times. She was amazing. Teammates loved her. She would make little gift packs before races.”

Dunning then set her sights on returning to the throwing circle.

She was very successful as a freshman in 2016, placing third at the Fox River Classic Conference meet in the shot put and discus before focusing on club hockey in the spring.

Throwing is in her bloodlines as well. Her older sister, Erin, currently competes at the University of Minnesota and was a multiple-time state medalist in both throws, winning the D1 shot put state title in 2016.

Both of her parents were throwers in high school. Her mother, Marguerite, set school records in the shot put and discus at Bay Port before playing college basketball at Minnesota State-Mankato, where her father, Eric, played football.

Before she could step back into the thrower’s circle, Dunning had to regain her strength. She enlisted the help of Ashwaubenon throws coach Kile Lindow to draft a weightlifting plan.

Once she was able to squat 350 pounds again, Dunning started attending Sunday sessions at the Madison Throws Club in the winter.

“She’s a high-character kid,” Ashwaubenon activities director Nick Senger said. “She’s a hard worker, a lifter. Her technique, good coaching and work ethic has really paid dividends for her.”

Dunning said her muscle memory was aided by the form work she had done her freshman year with assistant coach Dan Schmidt, who made the throwers do 500 reps of the glide and spin motions before getting to throw in an actual meet.

“It kept on going,” Dunning said. “Form, form form, and practice, practice practice. I’m so grateful for how I’ve been able to come back into the groove of things.”

The chemistry room is Dunning’s place to escape at school.

She’ll go there during lunch periods to lie down or do chemical reactions to relax.

“I love doing reactions in the chem room,” said Dunning, who has a 4.2 GPA. “I’m just fascinated by how reactions happen and the equations that go behind them.”

Dunning is thankful for her teachers and how they helped her during her recovery process. She was able to do coursework during that time, but came in during the summer to finish exams when her short-term memory got better.

Dunning recalls Joelle Zuengler, a science teacher, coming in on her own time so she could repeat labs.

“I was determined,” Dunning said. “Even my doctors told me, ‘Take a break. You can’t be doing this right away.’ But I love school, and I think school teaches us so much.”

Dunning will attend St. Nobert College. She’ll compete in track and field, while studying molecular biology.

Her goal is to help find a cure for super bugs.

“Being a Type 1 diabetic, I have a weak immune system, so I’ve always been curious with how the body works,” Dunning said. “I just want to expand that and be able to figure out what a virus is actually doing in the body and what makes it trigger.”

Dunning has been wearing one of her dad’s flannels during what has been a rather cold and wet spring.

“It’s really comfy,” she said. “When I first started wearing the flannel I was so tired of my hair falling out. I cut my hair short because every time I cut my hair, it’s like a new start.”

The Ashwaubenon senior has come a long way since the start of the season, which began with her wearing ear plugs and noise-canceling headphones at the indoor state meet to offset the over stimulus she was experiencing.

Dunning has been getting closer to her sister’s school records this year. Erin’s mark of 47-3¼ in the shot put may be out of reach for Mia, whose personal-best is 40-1½ and leads the Green Bay area.

However, the discus record of 143-7 may be attainable if she continues on the pace she has been on in recent weeks.

Dunning recorded a personal-best throw of 131-1½ in the discus at regionals. She bit down on her shirt while making throws to prevent her head from turning before her hips did.

Her form was spot on at sectionals, allowing her to make a personal-best throw of 141-11, which is seeded No. 1 for the state meet and ranks third on the state honor roll this season.

“She’s been nothing but positive,” Kromm said. “To see where she started and now where’s she going to finish, you can’t ask for more than that. She has just been awesome.”

Dunning will be shooting for spots on the state podium this weekend in La Crosse.

Regardless of the results, she’s going to enjoy simply being in the spotlight of the throwing circle on the state’s biggest stage and having fun with teammates, like fellow senior Mabel Kirst, who also qualified in the shot put for a second straight year.

“A lot of people have number goals,” Dunning said. “For me, with my concussion, I feel like I went through one part of my athletic life and now I’m starting fresh and new.

“My goal is to replace my picture from my first team all-state hockey picture with a track picture in our hallway at school. My goal is to make new and better memories and grow off of my experiences. I want to enjoy myself. I want to have fun.”

Ashwaubenon’s Dunning finds her groove again
Read more: ... ove-again/

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Concussion Risk is Higher in Female Athletes | UKNow

Post by greybeard58 » Wed Aug 28, 2019 10:11 am

Concussion Risk is Higher in Female Athletes
By Matthew Hoch Aug. 19, 2019

The University of Kentucky Public Relations & Strategic Communications Office provides a weekly health column available for use and reprint by news media. This week's column is by Matthew Hoch, Ph.D., associate professor with the University of Kentucky’s Sports Medicine Research Institute.

LEXINGTON, Ky. (Aug. 19, 2019) — With schools starting back for the year, many young athletes are returning to sports – and with that comes the possibility of injuries, including concussions.

Sport-related concussions are often recognized as a health issue in football. However, athletes in nearly all sports are susceptible to these injuries, and research shows that young female athletes have nearly double the risk of concussion compared to their male counterparts in common sports including basketball and soccer.

Why is concussion risk greater for female athletes? Right now, the reasons for this are not clear. Possible factors leading to higher concussion rates in women/girls include head and neck strength, hormonal differences, and a difference in the reporting habits of a concussion between boys and girls.

Which sports are at the greatest risk for concussion in female athletes? The sports at greatest risk are those that include the most physical contact, including soccer, basketball, cheerleading and ice hockey.

However, it’s important to note that a concussion can happen in nearly any sport. Athletes, parents, coaches and healthcare professionals need to be able to recognize the signs and symptoms of these injuries.

What are the symptoms of a concussion? The most common symptoms include headache, nausea, trouble thinking normally, memory problems, fatigue, impaired balance, dizziness, vision problems and changes in sleep patterns. Research suggests that women report more of these symptoms than men.

While many of these symptoms begin right after an injury, some may take days or weeks to manifest.

What should I do if I suspect my child has a concussion? If you suspect your child has sustained a concussion, seek medical treatment as soon as possible because delaying treatment can have serious consequences and can prolong recovery time.

Many schools have an athletic trainer on staff, and they are trained to recognize the symptoms of and manage sports-related concussions. If your young athlete has as head injury, report it to the athletic trainer immediately.

If your child experiences mild symptoms outside of the school setting, I recommend going to your family physician, a sports medicine specialist, or an urgent care treatment center within 24 hours. If symptoms are severe or progress, go to the emergency department.

Once a healthcare professional has diagnosed your child with a concussion, give him or her time to recover. While some patients become symptom-free within a few days, others may require more time – and research shows that female patients may take longer for symptoms to resolve.

After a physician gives the okay to return to sports, take it slow. Work with your healthcare team to develop a plan for a gradual return to activity. ... e-athletes

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"the rate of concussions in girls’ hockey doesn’t seem to be going down anytime soon"

Post by greybeard58 » Sun Sep 08, 2019 10:55 pm

"the rate of concussions in girls’ hockey doesn’t seem to be going down anytime soon"

As we head into the summer months, I wanted to share one key idea with you about how we need to do things differently when it comes to what we teach ON the ice. We have to teach more CONTACT CONFIDENCE in the female game.

COACHES: Do you teach checking/contact to your players? If so, at what age do you start? How often do you work on the details of checking in your practices? Do you work on it off the ice too?

PLAYERS: Do you feel confident going into contact situations on the ice? Do you know how to protect yourself and the puck in battles along the wall? How about in front of the net? How about in open ice? Has anyone ever showed you how to “move into” contact so as to lessen the force you have to absorb? Has anyone ever showed you how to “take the lane” and own the space between your opponent and the puck when you’re in a 1-on-1 race?

We all know there is no full body checking in the female game. But the rate of concussions in girls’ hockey doesn’t seem to be going down anytime soon. Some of that might be due to greater rates of reporting as a result of better awareness about concussions among coaches, trainers, players and parents. But I don’t think that tells the whole story.

I have a theory on why the rate of concussions has gotten so high in the female game over the past 15 or so years. I may not be right and it might be a bit controversial. This theory is based on my own experiences as a player and coach. I’ve probably spent more time in the rink around the female game than anyone else over the past 15 years, so bear with me here.

Back in the mid-2000s, there was a rule change that had a massive impact on all levels of hockey. When the NHL cracked down on obstruction and interference, and tried to take out all the clutching and grabbing that was slowing down the game, it took awhile for all of us to adjust. I was playing pro when it happened, and the first season with the new rules was a challenge for players, coaches and refs alike. We were the best players in the world and we definitely struggled with trying to figure out how to slow our opponents down with these new rules. We worked a lot on our special teams in those first few years, but we eventually figured it out.

Most people would argue that the crack-down on obstruction and interference was a great thing for the men’s game. But I’m not so sure it was the best thing for the female game.

Please understand, I’m not saying we should have a “stick-work” free-for-all and let players run moving picks all over the ice like the “good old days.” but I think we need to take a close look at how female hockey players race and battle for pucks in games and practices and think about how we could make it safer. Before this rule change, we definitely ran moving picks and used our stick/arms/body to interfere so that our teammates had a bit more time to make plays. We were buying them time and we were also keeping them safe. We also did our fair share of clutching and grabbing in 1-on-1 battles to be the one to come out with the puck. Ultimately, we were using these tactics to SLOW our opponent down. Now, it often seems like we’re watching a game of chicken out there on the ice.

Two players have their eyes laser-focused on the puck and are racing as fast as they can to get there first. They aren’t allowed to make much contact (if any) with their opponent before they reach the puck, so they just try to get there first at full-tilt. I try to teach my players how to gain the lane and own the space on the way to these pucks, but sometimes there just isn’t the time and space to get it done before contact is made. The instinct of most female players is not to worry about contact or “getting hit” in these types of situations. And from what I’ve seen, they certainly aren’t initiating contact or moving into contact in these situations.

I’ve asked many male players about this scenario and it is always in the back of their mind that they might get laid out when they win that race. So they protect themselves accordingly. The female players I’ve asked don’t have that same seed planted in their head to worry about the big hit. They are definitely more puck-focused and less body-focused in these types of battles. And I think that’s one of the big reasons we have more concussions in the female game.

I believe that if we do a better job of teaching contact confidence with our female players at all age and ability levels, we will see much safer races and battles for pucks. I don’t think they are going to change the rules back so that we can clutch and grab to slow our opponents down any time soon, so we need to teach our players to do a better job of protecting themselves.

Teaching Contact Confidence in Female Hockey
We need to teach our players to do a better job of protecting themselves
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"Young players are leaving the game with their destinies unfulfilled"

Post by greybeard58 » Sat Sep 14, 2019 10:55 pm

"Young players are leaving the game with their destinies unfulfilled"

The biggest stars in the world are pledging their brains. Young players are leaving the game with their destinies unfulfilled. The stories they tell spark fear and raise questions. And the science hasn't even begun to provide answers.

Four clear jars sit atop a wooden shelf, each containing a human brain. An actual human brain. A faded-yellow liquid, the color aging books turn, surrounds each brain, almost seeming to make them float. These brains are just for display, but nearby a hundred or so others are waiting to be examined for various neurodegenerative diseases on this morning in early August at Boston's VA-BU-CLF Brain Bank, tucked discreetly behind the V.A. Hospital.

There will be a brain dissection in a few hours. Most of the brains are housed in large freezers, set at minus 80 degrees Celsius. It's eerie, peering inside those freezers. Each is filled with dozens of small, square containers, which hold various portions of brains. The containers are stacked on top of one another, identified by seemingly indecipherable coding.

These are people. People who had dreams, athletic prowess. Families, memories. Shortcomings, talents. Joys, disappointments. People now reduced to letters and numbers.

Almost all were younger than age 32 when they died. About half took their own lives. Forty percent have been found to have CTE, or chronic traumatic encephalopathy, a degenerative brain disease found in people with a history of repetitive brain trauma.

Most of the brains belonged to men. To football players.

Less than 5 percent belonged to women.

Yet, we know that female athletes have endured repetitive blows to the head, too. Girls soccer players, in particular, have been found to be about as likely to suffer concussions as boys football players—and three times more likely than boys soccer players. But very little is known about what that means for the future, because researchers are hardly studying the long-term consequences of repetitive hits over time in women.

"They're definitely still focused on football. They can't get past football," says neuropathologist Dr. Ann McKee, the director of the VA-BU-CLF Brain Bank, whose research has been integral to our expanding understanding of CTE. "Women aren't even on the radar."

That's a problem, McKee goes on, because while we don't have enough research to know how differently head trauma affects women than men over time, we do know that the effect does seem to be different. And more high school girls are playing soccer than ever—394,105 in 2018-19, up from 356,116 in 2009-10 and 17,970 in 1978-79, according to the NFHS. It's a trend that will likely only accelerate after the U.S. women's national team's gold-medal winning run at the World Cup this summer.

Over the past decade, women have played a major role in the narrative of men's football brain trauma. Mostly, they've been quoted in articles as advocates, as confidantes. The image has become increasingly familiar: the mothers, wives, girlfriends, sisters, daughters, cast in supporting, caregiving roles, mourning and questioning why this happened to the men close to them who have suffered playing a game they love.

But women are not only on the tragic periphery of CTE and head-trauma issues. They're at the heart of them. Though their place in it has mostly gone unexplored, untold, female athletes have their own stories to tell.

The only thing stopping Briana Scurry from taking her own life was thinking of the woman who gave her life. Robbie Scurry, her mother. I can't do that to her, Scurry would think. She didn't want anyone to have to tell her mother that she was gone.

But Scurry felt gone. Gone from the woman she used to be: the Hall of Fame goalkeeper, World Cup champion and two-time Olympic gold medalist.

Who am I? she'd ask herself.

A brutal concussion ended her career in 2010. Caused her to spiral down through three years of darkness, three years of "wilderness," as Scurry, now 48, calls them. She didn't recognize herself. Didn't know how to stop her head from pounding. How to stop suicidal thoughts from swarming her.

She was deeply depressed, rarely leaving her apartment because of light sensitivity and the intensity of her headaches and anxiety. She couldn't work and struggled to make money. She was receiving disability benefits. She'd forget where she put things. "I could barely function," she says. "I went from someone who could focus on the panel of a ball with 90,000 people watching on the biggest stage to save a penalty kick to someone who couldn't hold a thought in my head."

She saw doctor after doctor, none understanding what she was going through. They told her that she was past the point of recovery, that this was who she was going to be. "I wouldn't accept it," Scurry says. Finally, she had occipital nerve release surgery in 2013, which helped tremendously.

She is in a better state nowadays but has pledged her brain to be studied when she dies—one of many former national team players to do so, including Megan Rapinoe, Abby Wambach, Michelle Akers, Brandi Chastain and Cindy Parlow Cone.

Most of those players declined to be interviewed for this story. They've acknowledged the issue through their actions but don't seem to want to talk about it.

Out loud, at least.

Scurry thinks often of the teammates who suffered in secret, eventually drifting from the game.

"There's silence; that's the other problem," Scurry says. "Nobody talks about it. At the time, nobody was willing to discuss, 'OK, I left behind my beloved sport because my head hurt.'

"You think, 'I just don't want to play anymore,' but it's actually a symptom of your head injuries. It's part of the emotional changes, the mood changes, and the very powerful ways a concussion can change you as a person."

Concussions are known to cause emotional distress and other symptoms, such as depression, anger, paranoia and impaired judgement. In 2016, researchers found that concussions significantly increased the long-term risk of suicide among adults.

Scurry understands why brain injuries are hard to discuss out loud. She used to cry after sharing her story. For some, there can be shame and fear and confusion. Not wanting to be perceived as weak or vulnerable or "hysterical," labels that have long been unfairly attached to women. It's taken female athletes decades to be seen. To be respected as this powerful, talented, brilliant.

There is also fear that people won't fully understand the pain of a brain injury because they can't see its effects on the body. But that doesn't mean they're not there. Or won't be there, down the line.

"I'm a knower. I would rather know than not know," Scurry says.

But she has noticed that others don't want to know. That the unknown is uncomfortable.

"It's a dark pool," Scurry says, "and you don't know where the bottom is." She pledged her brain to inspire visibility. "It's basically myself and my teammates coming out of the dark," she says.

"This is like a little black box, and we're basically saying, 'Hey, here, open the box.'"

Several elderly men in wheelchairs wearing "Korean War Veteran" hats await doctor's appointments on the ground floor at the V.A. Hospital.

McKee, 66, is best known for her landmark 2017 American Medical Association study that found the incidence of CTE to be considerably higher in football players than the general population—the one in which 110 of 111 players examined had CTE. She studies veterans too.

Today, she's sitting upstairs in one of her offices. It's small, cozy. A microscope hovers above her desk. An old magazine cover of Vince Lombardi is tacked onto one wall. Multicolored Post-its are scattered with reminders about brains, about phone calls, like the one she's scheduled to have in an hour with the mother of a deceased 26-year-old former college football player who had CTE.

McKee has spent the past 12 years making hundreds of calls like this, to women like this.

She opens a cardboard box filled with slides revealing tau, the protein found in high levels in the brains of people who have CTE, forming clumps throughout the organ and killing brain cells. "These are all guys' brains, of course," she says, laying a few flat on the table. A 30-year-old man. A 25-year-old man. Then 27-year-old Aaron Hernandez, the former New England Patriots tight end who took his life while in prison for murder. He had CTE. She puts his slide under the microscope, revealing two darkened lines, each about a half-inch long, indicating a tau deposit: "You can't believe that people aren't taking this seriously."

Take her seriously, too. She's been told her research is garbage. That she is trying to ruin football. Ruin men. Ruin American life. "The NFL treated me like a dizzy dame," she says.

She is hesitant to speak out about the kind of vitriol she faces. She feels physically and psychologically drained from people saying nasty things about her work. "It bleeds your energy," she says.

But she keeps going. She's committed to the work. She's still accustomed to being the only woman at conferences. She remembers one in the '90s, in Moscow, where men asked her if she was a "real" doctor. They also discussed whether women were less intelligent because their brains are smaller.

Few inroads have been made in studying female athletes' long-term brain health since those days. "It's a major unaddressed issue," McKee says. She is eager to study more women, but there's only so much one person can do. As a woman who has spent her life studying men, constantly told stay in your lane, she already occupies a tricky position: "I still feel marginalized as a woman."

"We've had such a hard time pushing the rock up the hill, focusing just on football and traditionally male sports," she says. And as much as she and others, such as Dr. Bennet Omalu, have discovered about CTE, there is still so much unknown about how the disease manifests, even in men. It's extraordinarily complicated. There's still no way to detect CTE in a live person.

And hardly anything is known about how CTE might manifest differently in women. Which again is a problem because, according to Dr. McKee, there's every reason to believe that an accumulation of hits—hits that may not result in immediate, post-concussive symptoms but nonetheless rattle the brain—may have a different and possibly great impact on women. As would differences in injury treatment and management in women's sports.

Biologically, women have thinner, weaker necks, and according to Chris Nowinski, Ph.D., co-founder and CEO of the Concussion Legacy Foundation, that's been found to make them more susceptible to concussions, though there has been almost no research focusing on the effects of heading exclusively in girls and women's soccer. Only one study has been published on the topic, according to the CLF. "We're further with women veterans than we are with women athletes," McKee says.

That's partially because female athletes, in this case soccer players, are just now reaching the ages of 40, 45, 50, the point at which long-term consequences from recurring hits typically would begin to be felt. Women have mostly only been full-time athletes since Title IX in 1972. The U.S. women's national team played its first match in '85. The first FIFA Women's World Cup occurred in '91.

"I wouldn't have expected to see much until now," says Dr. Robert Stern, Professor of Neurology at Boston University School of Medicine and Director of Clinical Research at B.U.'s CTE Center. "And if there is something, I would expect it to be a major growing problem over the next 10 to 20 years."

Up until 2016, when the U.S. Soccer Federation banned heading before the age of 10 (and limited heading for children aged 11 to 13 to 30 minutes per week), coaches weren't restricted from having girls (and boys) head the ball as often as they wanted, as young as they wanted. But we know that kids' brains are still developing at that age, and that trauma can impact that development.

Plenty of research has pointed out potential negative consequences of heading. But again, the bulk of that research has not focused on girls and women. A recent study led by Dr. Michael Lipton at the Albert Einstein College of Medicine found that heading can alter cognitive function, but 78 percent of the study's participants were male.

The question is: Do blows to the head affect girls and women differently? And what about in the future?

Akers, a member of the '91 and '99 Women's World Cup championship teams and one of only two women to score five goals in a single World Cup match, aims to spread awareness. She suffers from chronic migraines. "I've headed the ball a million times, so how has this possibly affected me?" Akers says. "What might have happened to my brain?"

"My point is," she adds, "why aren't we talking about this more?"

Part of the reason has to be limited awareness of women's sports as a whole. In 2015, a study found that women's sports receive just 4 percent of all sports media coverage. Concussions and CTE have spread to public consciousness largely because of football and the newspapers, magazine stories, movies and documentaries that bring an abundance of awareness to those issues.

And death.

There are a number of high-profile football players who were found to have CTE: Junior Seau, Aaron Hernandez, Ken Stabler. Women's soccer doesn't have those examples. With less public awareness, most people still likely conflate brain trauma with football, with men's sports.

"It's the same reason why men get paid more than women, or why the U.S. women's national team is asking for equal conditions compared to the men's team," Akers says. "The priority isn't necessarily on how things can affect women. There's an inequality there that's cultural."

There are other reasons for lack of study: Sample size. The slow process of science. Securing funding for any topic is challenging, especially without compelling preliminary data.

There are some signs of progress, though. A nonprofit called Pink Concussions has devoted itself to improving "the pre-injury education and post-injury medical care for women and girls challenged by brain injury including concussion incurred from sport, violence, accidents or military service." And as a result of advocacy from players like Akers, and with funding by the Concussion Legacy Foundation and the National Institute on Aging, there will be a landmark study beginning in October led by Stern and Dr. Jesse Mez called SHINE (Soccer, Head Impacts and Neurological Effects). They'll examine 20 former women's soccer players over age 40 who have played at the game's highest levels and will compare their findings to those of other studies of neurodegenerative diseases involving both women and men.

It's a start, but it's still nowhere near gaining the momentum that is needed.

"You don't get that same sense of urgency," Nowinski says. "People aren't funding studies on long-term effects. They're not investing in it."

Emily Oliver didn't yet realize she had suffered a concussion during her high school game. But later that night, when her coach asked her to drop off a ball bag at her car, she found herself aimlessly walking around the parking lot. She had forgotten why she was there and where she needed to go.

The next day, she was diagnosed with the first of four concussions she'd suffer as her career continued. She'd later help Stanford win the 2011 national championship as starting goalkeeper and NCAA College Cup Defensive MVP. But few outside of the Cardinal program knew how hit after hit shattered her sense of stability. Made her question if she'd ever recover.

"You get to a point where you don't even remember what being normal feels like anymore," says Oliver, now 27.

The worst one came in a game against Santa Clara. A player undercut Oliver while she was jumping up to catch a free kick. She landed on the back of her head. A referee asked her if she felt OK, and she said yes and kept playing.

In the days that followed, she struggled to read, skipping paragraphs. Her eyes failed to track words. She couldn't go outside because it was too bright, so she'd stay in her room with the shades closed. She was depressed and emotionally irritable over the next five months.

"It was demoralizing. I felt hopeless," Oliver says. "Every day you wake up and you're not better. It was like, 'Am I ever going to get better? Is this my life?'"

When she was finally cleared to play, in the fall of her junior year, she was still dealing with heavy mood swings because of the medication she was taking. She battled migraines heading into the Final Four game against North Carolina. Her symptoms worsened that winter break and through the next semester. She started to feel better, though, by the fall and was elected a team captain.

Then three games into the season, against Portland, she was hit again. After the game, the athletic trainer asked her to name the months backward. She missed April twice. "We're diagnosing this as your fourth concussion," the athletic trainer told her. "The medical staff is recommending you go down the road of medical retirement."

Oliver was stunned. Devastated. But proud of the decision she then made to retire. She knew it was right, even if she would miss her senior season and miss out on a professional career. These days, she misses soccer most during August. The start of the season. She misses the urge to compete. She feels jealous of the women who can.

She feels much better than she did back then but doesn't necessarily want to think about possible future impacts of the hits she took.

"I don't know that I want to know what that means for me," she says.

Living through them was hard enough.

McKee spends most of her days in B.U.'s brain bank. Her team is about 100 brains behind. There are just that many to examine, and it's a slow, meticulous process. In efforts to work less, McKee says she isn't going to give any more talks. She finds that difficult. On stage, she isn't talking about a brain like some abstract object in a textbook. She's talking about someone's brain.

Someone's life that mattered beyond sports.

Someone's life that still matters to those he is survived by.

There are so many questions, and she doesn't have all the answers. No one really does.

It is difficult for McKee to give answers, in particular, about women, because much of this generation is still alive. It's also true, McKee surmises, that those alive might be hesitant to discuss brain donations or their symptoms in fear of being perceived as weak or vulnerable. "Especially for the military population, women with brain trauma," McKee says. "I think they are even less likely to come forward than a man because they don't want to be marginalized, because we already feel that." B.U.'s bank has yet to declare a woman with CTE.

CTE does exist in women, though, recorded in two instances: One, in 1991, of a 24-year-old woman with autism who banged her head often; the second, in '90, of a 76-year-old woman whose husband had physically abused her for decades.

There have been several men's soccer players who have been diagnosed with CTE, including Jeff Astle, Brazilian star Bellini, Patrick Grange and Curtis Baushke. But of course, there are simply more cases of men's soccer players to study, because of their game's longer history and the greater number of men who have played than women.

And because CTE can only be diagnosed posthumously, it's difficult to learn much about the disease for anyone. One question multiplies into so many more: Why do some people get it and others don't? How does a person's genetic history factor into the equation? What is the effect of other variables that might increase or decrease the resilience to showing manifestations of CTE? If bias in healthcare causes some doctors to take women's pain, and especially the pain of women of color, less seriously, how does that affect the data? Are researchers considering how transgender women and women who don't have XX chromosomes might be affected? Does CTE affect different parts of the brain in men and women?

Research is advancing, however, most notably with an April study in the New England Journal of Medicine. Stern, the lead author, used PET scans in attempting to detect tau buildup, and thus perhaps CTE, in a living person. The researchers tested 26 living former NFL players between the ages of 40 and 69 and found that "tau PET levels were significantly higher in the former NFL players than in the control group, and that the tau was in the same areas of the brain as in post-mortem cases of diagnosed CTE." It was an important step. But the study didn't include one woman.

It's not all about CTE either. There are other long-term problems stemming from repetitive head trauma. We just don't know how exactly that manifests in women yet, and more inclusive research could help. "If repetitive headers and the collisions that are caused by attempting headers are causing CTE or other neurogenerative diseases," Nowinski says, "if we can establish that today, we can save a bunch of women and girls a lot of trouble in the future by changing how we play the sport.

"Until we have these answers, we're still going to have 11-year-olds heading soccer balls."

The ball seemed bigger than Esther Lovett's body when she began playing soccer at three. Like a little bumblebee, buzzing up the field, she was energized, focused. She headed the ball many times before age 10—the year of her first concussion. Sometimes she felt a little dazed after a header, but she'd snap right back. That's soccer. That's playing year-round. That's dreaming of the pros.

She is 20 now, heading into her sophomore year of college. She struggles to answer the question How many concussions have you had? because there are ones she knows she's had and ones she doesn't know she's had, and a number doesn't convey what having pounding headaches every single day for the past six years feels like.

She chooses five. Five diagnosed concussions. "Definitely more than that," Lovett admits. The worst one came at age 13, back in April 2013. A girl took a shot on goal and hit her in the back of her head. Few noticed it happened because it was not a particularly obvious, gruesome hit. Her coaches didn't take her out. She really thought she was good. "I played the rest of the game," she says, "even though I could barely see. I didn't really know which side of the field I was on."

A horrible, nauseating headache throbbed the next day. She couldn't read the white board at school a few days later. Pain continued for weeks, months. "It was terrifying," says Barbara Piette, her mother. Lovett can only wonder if she is still suffering because of years of hits that came before, like the time in middle school she was on defense, marking the goal post for a corner kick. A girl on offense ripped a shot on goal that hit her straight in the face. Her head smacked back against the post. Her nose was bleeding, and her coaches checked to see if it was broken. No one thought to also check for a concussion.

There are times she is frustrated, thinking about that moment, but she didn't have control. She was a child who just wanted to play the game she loved. A child who did not have the medical knowledge or wherewithal in the moment of trauma to understand what was happening. Because that medical knowledge didn't exist then and, in some ways, still doesn't now.

"It's a lot for a kid," she says. "The onus sort of falls on you to self-diagnose: Come out if you think you have a concussion. What does that mean?"

Her doctor told her she'd have to stop playing after the 2013 concussion. She did stop playing but was more susceptible to additional concussions and suffered three more that were diagnosed after that, non-sports concussions, including one in 2015 that led her to take a medical leave and defer junior year.

Leaving soccer was painful. Lonely. Especially when the ball had almost been a best friend. But she has morphed into an advocate, sharing her story so she can help other girls.

She stayed up all night before her 18th birthday to pledge her brain right after the clock struck midnight. She sent in the form at 12:01. She is the youngest person to ever pledge to the CLF.

Lovett still suffers daily headaches. Migraines occasionally. Some dizziness still, some nausea. "There are so many people silently suffering with this and soldiering on and thinking, as I did, that there isn't anybody else going through this," Lovett says. "You think something's crazy about your case. About you."

When B/R reached out to FIFA for comment about concussions and repetitive subconcussive hits in soccer, a FIFA spokesperson said protecting the health of players is a "top priority" and that it takes these issues "very seriously" but that: "To our very best knowledge, there is currently no true evidence of the negative effect of heading or other subconcussive blows. Results from studies on active and former professional football players in relation to brain function are inconclusive."

However, the idea that repetitive subconcussive injury can have neurological consequences is widely accepted by the medical community at large, as well as the Centers for Disease Control.

"This is a corporate response to a problem that they may be responsible for," Nowinski says, referring to FIFA's comments. "It's not that different from the NFL's original response to research on long-term effects, or the smoking industry's original response to research on the long-term effects of smoking."

The SHINE study will involve neurological examinations, motor examinations, cognitive assessments, MRI scans of the brain, blood tests, lumbar punctures and more. "If girls are more prone to concussion," Stern says, "they also may be more prone to subconcussive injuries that are so much more common and are associated with heading—that may possibly be a critical factor for later-life disease."

The hope is that with increased knowledge will come increased awareness and, in turn, increased attention paid to what can be done to make the game safe as it continues to grow in popularity.

"The imperative," Stern says, "is that we must study it.

"We don't want to wait until it's too late."

Why Women’s Soccer Players Are Worried About Their Brains
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Female Athletes Seek Specialty Care for Concussion Later than Males, Potentially Contributing to Longer Recovery

Post by greybeard58 » Sat Sep 21, 2019 6:58 am

Female Athletes Seek Specialty Care for Concussion Later than Males, Potentially Contributing to Longer Recovery

Children’s Hospital of Philadelphia (CHOP) researchers found that girls had longer times for neurocognitive and visual recovery as well as a much longer time before playing sports again.

Female athletes seek specialty medical treatment later than male athletes for sports-related concussions (SRC), and this delay may cause them to experience more symptoms and longer recoveries. Researchers from the Sports Medicine Program at Children's Hospital of Philadelphia (CHOP), reported these findings after analyzing electronic health records of sports participants aged 7 to 18.

The study raises the question of whether, in youth and high school sports, inequities in medical and athletic trainer coverage on the sidelines are contributing to delayed identification and specialized treatment of concussion for female athletes, leading to more symptoms and longer recovery trajectories. The study was published in the Clinical Journal of Sports Medicine .

"There is speculation in the scientific community that the reasons adolescent female athletes might suffer more symptoms and prolonged recoveries than their male counterparts include weaker neck musculature and hormonal differences," says senior author Christina Master, MD, a pediatric and adolescent primary care sports medicine specialist and Senior Fellow at CHOP's Center for Injury Research and Prevention. "We now see that delayed presentation to specialty care for concussion is associated with prolonged recovery, and that is something we can potentially address."

Dr. Master and her team analyzed a dataset containing records of 192 children between 7 and 18 who were diagnosed with an SRC and seen by a sports medicine specialist. Females took longer to present to specialist care and had longer recovery trajectories than males. The median days to presentation for a subspecialty evaluation was 15 for females with SRC and 9 for males. This delay is important since time to presentation to specialized care greater than 1 week has been described as a factor associated with prolonged recovery.

Five distinct outcomes indicating return to preinjury function were measured to determine "recovery" in this group of athletes. By looking at average-days-to-recovery for female and male patients across these outcomes, researchers found that females returned to school later (4 vs. 3 days), returned to exercise later (13 vs. 7 days), had neurocognitive recovery later (68 vs. 40 days), had later vision and vestibular (balance) recovery (77 vs. 34 days) and returned to full sport far later (119 vs. 45 days).

Importantly, when researchers limited the analysis to those female and male patients that presented to the specialty practice for evaluation within the first 7 days of injury, the differences between males and females on all outcomes disappeared.

In sports where females sustain the highest rates of concussion -- including those in this cohort of patients -- specifically soccer, basketball, and cheerleading, there is generally less sideline medical coverage for games and inconsistent athletic training coverage for practice because they are categorized as "moderate-risk sports" based on all-cause injury. In stark contrast, many high school leagues require athletic training coverage at all football, ice hockey and men's basketball practices and games.

"It is possible that the lack of athletic training coverage at the time of injury may affect the time to concussion recognition during the first critical hours and days after injury," says Dr. Master. "This period is a window of opportunity where specific clinical management, such as immediate removal from play, activity modification and sub-symptom threshold exercise is correlated with more rapid recovery."

Those who study pediatric concussion have been investigating why some concussions take longer to resolve than others so that they can identify those concussions early and implement appropriate concussion management plans to hopefully prevent persistent post-concussion symptoms. This study builds on that knowledge and suggests a tangible cause and solution: close the gap in athletic training and medical coverage between female and male sports.

Female Athletes Seek Specialty Care for Concussion Later than Males, Potentially Contributing to Longer Recovery

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