From Brenda Brown’s PA BrainSTEPS
Posts by: CAPP
GE, NFL & Leading Healthcare Experts Team up to Accelerate Concussion Research, Diagnosis & Treatment
$40 million research program aims to increase accuracy of traumatic brain injury diagnosis
GE, NFL, Under Armour also launch $20 million open innovation challenge to find and fund ideas to develop new solutions to diagnose and protect against traumatic brain injury
March 11, 2013 01:00 PM Eastern Daylight Time
NEW YORK–(BUSINESS WIRE)–(NYSE: GE) – GE and the NFL today announced the Head Health Initiative, a four-year, $60 million collaboration to speed diagnosis and improve treatment for mild traumatic brain injury. The goal of the research and innovation program, guided by healthcare experts, is to improve the safety of athletes, members of the military and society overall.
The initiative includes a four-year, $40 million research and development program to evaluate and develop next generation imaging technologies to improve diagnosis that would allow for targeting treatment therapy for patients with mild traumatic brain injury. In addition the NFL, GE and Under Armour launched a two-year open innovation challenge to invest up to $20 million in research and technology to better understand, diagnose and protect against mild traumatic brain injury.
GE Chairman and CEO Jeff Immelt said, “GE is a leader in developing sophisticated diagnostic imaging technology, but for all the advances in science our knowledge of the brain is far behind that of nearly every other organ in the body. With this initiative, we will advance our research and apply our learning to sports-related concussions, brain injuries suffered by members of the military and neurodegenerative diseases such as Alzheimer’s and Parkinson’s. Advancing brain science will help families everywhere.”
NFL Commissioner Roger Goodell said, “Jeff and I have had many conversations over the years about business and the game we both love – football. The future of our great game is bright. The NFL has made tremendous progress in making the game safer and more exciting. But we know we have more work to do. Our collaboration with GE and Under Armour and the launch of the innovation challenges puts us on an accelerated path to progress with experienced scientists, academics and entrepreneurs dedicated to developing game-changing technologies that will benefit athletes, the military and all members of society.”
Research to Map Brain Imaging Biomarkers
The research will take a whole brain approach to determine the key Magnetic Resonance Imaging (MRI) biomarkers for potential diagnosis, outcome prediction, and therapy management for patients with mild traumatic brain injury. The research study will be guided by an advisory board consisting of a cross-disciplinary team of medical professionals from various institutions. Among those participating:
1. Dr. Thomas McAllister is the Millennium Professor of Psychiatry and Neurology, Director of the Section of Neuropsychiatry and Vice Chair for Neuroscience Research for the Department of Psychiatry at the Geisel School of Medicine at Dartmouth. He has recently been named chair of the Department of Psychiatry and the Albert Eugene Sterne Professor of Clinical Psychiatry at Indiana University School of Medicine. He will begin his duties in the summer of 2013.
2. Dr. Richard Ellenbogen is Chief of the Division of Neurosurgery and Fellowship Director of Neurological Surgery at Seattle Children’s Hospital. He is the co-chair of the NFL Head, Neck and Spine Committee.
3. Dr. Russell Lonser is the Chair of The Ohio State University Wexner Medical Center Department of Neurological Surgery, head of the NFL’s Research Subcommittee and a member of the NFL’s Head, Neck and Spine Medical Committee.
4. Dr. Geoffrey Manley is the Chief of Neurosurgery at San Francisco General Hospital and Professor of Neurosurgery at the University of California San Francisco (UCSF).
5. Dr. Pratik Mukherjee is an Attending Neuroradiologist and an Associate Professor of Radiology and Biomedical Imaging, Bioengineering and Therapeutic at the University of California San Francisco (UCSF).
6. Lieutenant Colonel Gerald York, is an Active Duty radiologist with a Certificate of Added Qualification (CAQ) in neuroradiology serving at Brooke Army Medical Center in Houston, TX. He has expertise in interpretation of CT and MRI of the brain, spinal cord, and head-neck disorders, including many acute, subacute and chronic traumatic brain injury patients.
7. Colonel Jamie Grimes is the National Director of the Defense and Veterans Brain Injury Center. As national director, COL Grimes oversees all aspects of the organization’s mission: to serve active duty military and veterans with traumatic brain injury through state-of-the-art medical care and care coordination and through innovative clinical research and educational programs.
8. Dr. Larry Leverenz is the Clinical Professor in the Department of Health and Kinesiology and Director of Athletic Training Education at Purdue University. He has served professionally as a member of the National Athletic Trainers’ Association Education Council and as president of the Commission on Accreditation of Allied Health Education Programs. Currently, he is the President of the World Federation of Athletic Training & Therapy.
9. Dr. Teena Shetty is a Neurologist at Hospital for Special Surgery and is triple board-certified in neurology, neuromuscular medicine, and electrodiagnostic medicine.
10. Dr. Brian Hainline is the Chief Medical Officer at the NCAA. He is a leading sports medicine advocate with more than two decades’ experience most recently as the chief medical officer of the United States Tennis Association (USTA).
Open Innovation Challenge to Study and Prevent Traumatic Brain Injury
In addition to the research program, the NFL is partnering with GE and Under Armour to launch the Head Health Challenge, which has two focus areas that seek new solutions for understanding mild traumatic brain injury. The organizations are pledging to find and fund ideas that accelerate solutions for brain protection. The challenge fund could invest up to $20 million.
Sue Siegel, CEO of GE healthymagination, said, “GE is investing in research and development to fast-track advancement in head health. Through our research collaboration and open innovation challenge, we hope to stimulate the broader ecosystem of scientists, engineers, mathematicians, computer scientists, entrepreneurs, and innovators worldwide to bring their talents to this effort and accelerate the current understanding of brain trauma and improve diagnostic tools.”
Kevin Plank, founder and CEO of Under Armour said, “As longstanding partners of the NFL, we recognize the magnitude of this initiative, and the impact it will have for athletes at all levels. Under Armour was founded upon the pillar of making all athletes better through the relentless pursuit of innovation. We take great pride in supporting this effort to reward new ideas and breakthrough concepts in this space, particularly as it applies to protecting athletes and influencing positive change in sports.”
Dr. Geoff Manley, professor and vice-chair of the Department of Neurological Surgery at UCSF and Chief of Neurotrauma at San Francisco General Hospital, said, “Traumatic brain injury is one of the greatest unmet medical needs of our time. Every 20 seconds someone in the United States sustains a brain injury. A better understanding of the molecular, physiological, and behavioral/biomechanical changes that occur shortly after a traumatic event is needed to reliably diagnose the types of changes that are difficult to identify using current technologies.”
Challenge I: Methods for Diagnosis and Prognosis of Mild Traumatic Brain Injuries
Starting today, GE and the NFL are inviting proposals for technologies and imaging biomarkers that address identification and management of subclinical and mild traumatic brain injury. Multiple cash awards with a cumulative total value of up to $10 million will be made, along with the possibility of future partnership and collaboration with GE. Entries are being immediately accepted at www.NFLGEBrainChallenge.com. Specific focus areas for this challenge include:
- Development and validation of imaging and/or sensor based biomarkers that can aid in the diagnosis and prognosis of mild traumatic brain injury events. These include imaging biomarkers of brain structure, connectivity, function, cognition, neuroinflammation, and molecular markers.
- Development of new technologies that are more sensitive to small contusions and injuries that are missed by current technologies; and assessing the long-term chronic impact of these events.
- Improved algorithms for the quantification and visualization of markers of brain injury severity and longitudinal change.
- Algorithms and tools that link imaging data to clinical, cognitive, and biomechanical data.
- Models of individual risk and long-term prognosis and clinical decision support tools using population studies.
- Robust methods for triaging acute stage events and developing “Return to Play” guidelines using physiological, molecular, electrical or physical changes in brain or body functions.
Challenge II: The Mechanics of Injury: Innovative Approaches For Preventing And Identifying Brain Injuries
Launching in fall 2013, the NFL, Under Armour and GE will invite proposals for new materials and technologies that can protect the brain from traumatic injury and new tools for tracking head impacts in real time. Specific focus areas for this challenge include, but are not limited to:
Protection against Injury
- Materials or devices that can distribute the force of impact. These include smart materials or active polymers that are comfortable but can adapt to sudden impacts are highly desirable
- Systems to predict and initiate protective responses to prevent injury activation of adaptive padding at the focus of impact
Monitoring and Identifying Injury
- Systems that monitor and integrate directional and rotational impact forces. These systems should integrate information with imaging/diagnostic equipment
- Sensors to provide biofeedback to modify behaviors that predispose athletes to injury
- Systems that monitor biomechanical and physiological responses to detect injury
- Systems to efficiently collect, interpret and organize large quantities of real-time data
The winners of the challenges will be selected by a panel of external judges that include leading healthcare experts in brain research, imaging technologies, and advocates for advances in brain research. For Challenge I these individuals include:
1. Dr. William J. Heetderks is the Director of Extramural Science Programs at the National Institute of Biomedical Imaging and Bioengineering (NIBIB), NIH.
2. Dr. Walter Koroshetz is the Deputy Director of the National Institute of Neurological Disorders and Stroke (NINDS) at the NIH. Before joining NINDS, Dr. Koroshetz served as vice chair of the neurology service and director of stroke and neurointensive care services at Massachusetts General Hospital (MGH).
3. General Peter Chiarelli, USA (Ret.) is the Chief Executive Officer of One Mind for Research. He is a retired four-star General with 40 years of experience designing and implementing American defense policy for the U.S. Army and Department of Defense in peace and during combat operations.
4. Colonel Dallas Hack is the Director of the Combat Casualty Care Research Program and the Chair, Joint Program Committee 6 (Combat Casualty Care), US Army Medical Research and Materiel Command, Ft Detrick, MD, where he coordinates leading edge research focused on new techniques and products to save the lives and reduce morbidity of troops injured in the line of duty.
5. Dr. Geoff Manley is the Chief of Neurosurgery at San Francisco General Hospital and Professor of Neurosurgery at the University of California San Francisco (UCSF).
About GE
GE (NYSE: GE) works on things that matter. The best people and the best technologies taking on the toughest challenges. Finding solutions in energy, health and home, transportation and finance. Building, powering, moving and helping to cure the world. Not just imagining. Doing. GE works. For more information, visit the company’s website at www.ge.com.
About The National Football League
Throughout its history, the NFL has made the health and safety of its players a priority. This commitment extends to football played at all ages, as well as other sports. At the youth level, the NFL’s partnership with the Centers for Disease Control and Prevention and the League’s support for USA Football, including prominently their Heads Up Football initiative, helps parents, coaches, clinicians and athletes understand the signs and symptoms of possible head injuries. The league has successfully advocated for the passage of youth concussion laws in 42 states thus far. Through funding for medical studies, including a $30 million grant to the National Institutes of Health for medical research; collaboration with the military on research and recognizing and reporting potential head injuries; and the work of the NFL’s medical committees, the NFL is committed to supporting and advancing science that will have an impact far beyond football. With a continued emphasis on improved equipment, rules changes, and in-game policies, the NFL fosters a culture that promotes health and safety at every level of the game.
About Under Armour, Inc.
Under Armour® (NYSE: UA) is a leading developer, marketer, and distributor of branded performance apparel, footwear, and accessories. The Company’s products are sold worldwide and worn by athletes at all levels, from youth to professional, on playing fields around the globe. The Under Armour global headquarters is in Baltimore, Maryland, with European headquarters in Amsterdam’s Olympic Stadium, and additional offices in Denver, Hong Kong, Toronto, and Guangzhou, China. For further information, please visit the Company’s website at www.ua.com
There is statistic going around the press that has been concerning me. The basic quote goes like this…
“For young people ages 15 to 24 years old, sports are the second leading cause of traumatic brain injury, following only behind motor vehicle crashes.”
This sentence or a version of it is on many major network news websites and Congressman Udall’s site and most concussion sites but not the CDC site. As of last Saturday, NO ONE had a footnote or a source for such a bold, specific statement so I set out to see if I could find the source.
I found this exact sentence in this 2007 Study using google:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2140075/#i1062-6050-42-4-495-b1
This sentence in the 2007 study is marked with footnote referring to its source which is a 1991 study:
http://www.ncbi.nlm.nih.gov/pubmed/8680392
Abstract
The 1991 National Health Interview Survey was analysed to describe the incidence of mild and moderate brain injury in the United States. Data were collected from 46,761 households and weighted to reflect all non-institutionalized civilians. The report of one or more occurrences of head injury resulting in loss of consciousness in the previous 12 months was the main outcome measure. Each year an estimated 1.5 million non-institutionalized US civilians sustain a non-fatal brain injury that does not result in institutionalization, a rate of 618 per 100,000 person-years. Motor vehicles were involved in 28% of the brain injuries, sports and physical activity were responsible for 20%, and assaults were responsible for 9%. Medical care was sought by 75% of those with brain injury; 14% were treated in clinics or offices, 35% were treated in emergency departments, and 25% were hospitalized. The risk of medically attended brain injury was highest among three subgroups: teens and young adults, males, and persons with low income who lived alone. The incidence of mild and moderate brain injury in the United States is substantial. The National Health Interview Survey is an important national source of current outpatient brain-injury data”
From my research on google, it seems this “fact” stems from this 1991 study which would make this information very dated in 2013, to be quoted without a source. I cannot get a copy of 1991 study yet but the study seems to be talking about adults in this sentence and the category is “sports and physical activity” which is also very broad. Also, this seems to be only using LOC – pre 2008 Zurich – as a factor and we now know that LOC only occurs in 10% of concussions.
I have asked someone I know at the CDC to look it into the matter for me. I hope someone proves me wrong and we do have valid, specific data like this but I believe we do not.
We must be honest how “limited in value” the stats are that we have. For example, any study pre-2008 Zurich concerning concussions would seem to be dated to me if LOC was used as the sole determination of concussion.
Why is this important? Because we must know why and where each age group is getting hurt so we can direct resources to educate and try to reduce concussion.
And even within concussions for a particular youth sport, I would like to see concussion numbers broken down by specifics as then one could target the issue at hand.
Did the child or teen get concussed…
- Playing in a game (with refs present)
- Participating in practice drill (coaches in charge of play)
- Fooling around in practice not following directions and rules (coach present but not watching)
- Pre/Post practice with no adult at all watching in locker room or parking lot.
I would also like to see a study that looks at the use of drugs and alcohol with teens and concussions. As I follow social media and concussions, I look at what teens are posting on social media sites (non Facebook sites) where parents do not monitor their posts. I see so many teens post about being drunk or high when they were concussed.
Hopefully better data is coming soon to help guide our efforts, resources, time and money.
With this 20 minute course and this App on your phone, you can be ahead of most youth coaches and truly make a difference. I used this app four times in the Spring 2011 Season to pull four children from lax and soccer games. All four were determined later by their doctors as having suffered concussions. I made a difference by keeping these kids from returning to play and you can do the same.
1. Heads Up Online Training Course
Get prepared for the new season in less than 30 minutes
Click here for the course – at the end print the certificate for your records
http://www.cdc.gov/concussion/headsup/online_training.html
Heads Up: Concussion in Youth Sports is a free, online CDC course available to coaches, parents, and others trying to keep athletes safe from concussion. It features interviews with leading experts, dynamic graphics and interactive exercises, and compelling storytelling to help you recognize a concussion and know how to respond if you think that your athlete might have a concussion. Once you complete the training and quiz, you can print out a certificate, making it easy to show your league or school you are ready for the season.
What You Will Learn:
- Understand a concussion and the potential consequences of this injury,
- Recognize concussion signs and symptoms and how to respond,
- Learn about steps for returning to activity (play and school) after a concussion, and
- Focus on reducing risks and being prepared to try to help athletes safe season-to-season.
We can help athletes stay active and healthy by knowing the facts about concussion and when it is safe for athletes to return to play.
The training requires Adobe Flash and Adobe PDF Reader installed on your computer. It has been tested on the following browsers with Adobe Flash installed: Internet Explorer, Safari, Firefox. Please do not close/refresh your browser as this will restart the course. If you need to exit the training, you will be returned to the beginning of the course.
2. Great App to have on your Smart phone – everything you need to know/do when a kid gets head injury for 99 cents.
Click Link for App the Apple® App StoreSM or Android Market.
The Concussion Recognition & Response™ app is a new tool that helps coaches and parents recognize whether an individual is exhibiting/reporting the signs and symptoms of a suspected concussion. The app allows a coach or parent to respond quickly and appropriately to this potentially serious medical situation.
In less than 5 minutes, the user can complete a checklist of possible signs and/or symptoms to determine whether to remove the child from play and the need for further medical examination. The app allows users to record pertinent information regarding a child with a suspected concussion and share that information via e-mail with health care professionals; it also provides a system for post-injury follow-up.
With answers to Frequently Asked Questions for parents and coaches, this tool is an invaluable guide for learning about concussions.Priced for a limited time at only 99 cents, the app is available at the Apple® App StoreSM and the Android Market.
For your iPhone®, iPad®, iPod® Touch, Android™ device or tablet!
How to approach YOUR child’s team about their Concussion Policy by Katherine Snedaker
I have listed the 10 questions below which from a flyer by Gerard A. Gioia, Ph.D., a Pediatric Neuropsychologist, which Steve Stenersen, President of US Lacrosse, emailed to me yesterday. Steve and I were having one of our semi-annual talks about how to empower parents to ask their leagues about concussion policy. Steve Stenersen has been championing concussion education for years and we have been talking back and forth about concussions since I first learned about concussions from an article in US Lacrosse Magazine in 2008. I have had the honor of meeting Dr. Gioia at an NFL meeting this fall where I had a chance to talk to him one-on-one and then hear him present to the NFL Health and Safety Meeting. I was very impressed with him and look forward to presenting with him in DC on Monday, Feb. 25, 2013.
Dr. Gioio’s list of ten questions are a great way to start a conversation about concussion policy, but I need to add some suggestions on how, when and where to approach your child’s sports organization which I will call TEAM for short. Prez will stand for the President of TEAM.
1. Email or call Prez, the President of TEAM and ask to set up a time to talk face to face about concussion education with him or her. Don’t ask the coach these questions before or after practice. This is a management issue FIRST. If you cannot meet in person, then set up a call. I do not recommend you blast off an email with these questions to Prez.
2. Before the meeting, check out the Info Link Page with links to national policy is for many youth sports. For example of your child plays football or lacrosse, check out what USA Football or US Lacrosse is suggesting to their teams.
3. Start the conversation with Prez with a thanks for all he/she does and say you are just trying “to help the kids” and add to the existing program which has offered your child (say something positive here).
4. Ask the questions in a friendly tone and don’t forget to smile. BE NICE. Most youth organizations are run by volunteers who have jobs and families and they do so much without any thanks.
4. LISTEN to what Prez says in return and what the existing plans are to create a concussion policy. Most organizations start small with baby steps as not to rock the boat.
5. If you get a blank stare from Prez or a “no” to the questions below, you have three choices:
- Say ok, and just hope the conversation will generate some thought or future action. You sign your child up anyway for the sport, and then attend all practices and games and watch out for your child.
- You find another league or sport for your child which has a concussion policy. In a nice email, let Prez know why you have left TEAM and again offer thanks for the past years.
- You offer to help create the policy by researching some options. This is a really exciting way to contribute to your child’s sport and to the larger community
I am available by phone or email to help direct you and there are many resources available on my website. Here are the questions and don’t forget to smile when you ask them.
Source: Parents Taking Charge of the Youth Concussion Issue
Gerard A. Gioia, Ph.D. Pediatric Neuropsychologist
Director, Safe Concussion Outcome, Recovery & Education (SCORE) Program Children’s National Medical Center
Director, Safe Concussion Outcome, Recovery & Education (SCORE) Program Children’s National Medical Center
Ten Questions to Ask Youth Sports Organizations By Dr. Gioia
In whatever sport you and your child choose, to feel more comfortable and confident with your child’s participation as it relates to concussion risk, do your homework and ask questions of the league and its coaches about how they handle head safety. As a parent, you need to feel at ease that safety of the youth athletes is a priority. We encourage parents to ask these 10 questions.
- Does the league have a general policy in how they manage concussions?
- Does the league have access to healthcare professionals with knowledge and training in sport-related concussion?
- Are the coaches required to take a concussion education and training course?
- Who is responsible for the sideline concussion recognition and response to suspected concussions during practice and games?
- Do the coaches have readily available the tools – concussion signs & symptoms cards, clipboards, fact sheets, smartphone apps, etc. – during practice and games to guide proper recognition and response of a suspected concussion?
- Does the league provide concussion education for the parents, and what is the policy for informing parents of suspected concussions?
- What is the policy regarding allowing a player to return to play? [Correct answer – when an appropriate medical professional provides written clearance that the athlete is fully recovered and ready to return.]
- Does the league teach/ coach proper techniques (e.g., blocking and tackling in football, checking in hockey and lacrosse) in a way that are “head safe” by not putting the head in position to be struck? If the player does demonstrate unsafe technique during practice or a game, do the coaches re-instruct them with the proper technique/ method? Is head and neck strengthening taught?
- If a contact sport, are there limitations to the amount of contact? How often (# days per week, # minutes per practice) do you practice with live contact? Is that any different than past years?
- How amenable is the league/ team / coach to accepting feedback from parents about their child’s safety as it relates to head safety?
Almost 200 students turned out for the school dance for The Headbangers’ Ball – dance for Concussion Education, which made it one of our school’s largest dances ever. Boys and girls alike wore sport-themed shirts; and along with dancing all night, the kids were actually very willing to cooperate in the educational part of the event. By school tradition, each grade enjoys their refreshments in shifts in the hallway outside the dance. As the kids lined up to eat, Katherine explain what they were to do to “obtain” their food. She pointed out the CDC posters that lined the hallways and told them before they could select their snacks from the table of goodies, they had to tell a parent volunteer one sign or symptom of a concussion. The kids read the posters and seemed to enjoy the process. At what other party can you say, “throw up” to an adult and then get a cookie? (Sorry, but they are middle schoolers and gross is cool to them).
Katherine then chatted with the kids in small groups as they ate their refreshments and answered their questions about concussions. As she suspected, the kids seemed to fall in two distinct groups – those who had had concussions and knew most of the facts, and those who had never had one and didn’t know anything about a concussion. What was surprising was the number of kids who had already had concussions for a dance of mostly 6th and 7th graders!
As parents’ cars lined the parking lots and kids prepared to leave the dance, they were handed a ticket to vote whether they learned something new about concussions. The exit poll results showed that 84% of kids voted that they learned something new about concussions at the dance. At the door, each child was handed a CDC info sheet on concussions and asked to hand them to their parent waiting in the car. Hopefully the hand to hand delivery helped avoid the dark hole which seems to appear in most middle school students’ book bags. To reinforce the information on Monday and to reached students who did not attend the dance, several students made morning announcements to the whole school with concussion facts and information.
The mix of education and fun seemed to work well and we can encourage other schools to do the same type of education/fun event around this important topic.
In the last few hours, there have been a number of reviews posted about Head Games, and for a good summary of the movie see the LA Times by Kenneth Turan. Rather than write this type of review, I wanted to offer my personal take on the film as a parent of a child with concussions and as concussion educator, and why I think parents should see Head Games.
In my work as a concussion educator, I have found there are two kinds of parents in this world: those who don’t think their child will get a concussion and those who guessed wrong. This movie has something to offer both types of parents.
I used to be that parent who never thought about concussions and the risk to my three boys, even though I personally have a long history of concussions. I would have thought why watch a movie on concussions? Do we next need a movie on the dangers of sledding or skateboarding?
But now I know better after my son has suffered eight concussions; and sadly, I know if I had seen this movie years ago I would have made better choices as a parent when to allow him to return to sports. I also trusted helmets would protect him from further concussions.
What does this film offer the “un-experienced” parent? This film will help to educate parents who have not experienced concussions on why a child with possible head injury needs to see an MD, be watched for signs of concussion, and have a careful Return To Play plan. A parent’s (and a coach’s) response to pull a child out of a game or practice as soon as there is a possible injury is about the best line of defense available to try to mitigate a second blow and very serious consequences that can result.
The harsh reality right now is that there are no proven types of equipment to prevent concussions. There are no drugs or any specific medical procedures or equipment to help heal concussions. The only real defense right now is a parent’s response time and what steps a parent takes when his/her child sustains a head injury. The only way parents can respond quickly and effectively is by having the education they need as parents BEFORE they need it. BE PROACTIVE!
Is the film only for parents whose kids play sports? No, this movie is important for all parents because while it focuses on sports concussions, concussions can happen to any child in any activity– on the field, in the rink, in the bathroom, the kitchen or in the backyard. Outside of sports concussions, careless horseplay between kids, car accidents with new drivers, and teen alcohol-related accidents also play a large role in youth concussions.
Now what does the movie offer for the parents who know all to well the dangers and effects of concussions? The movie clearly shows the conflicts parents face in allowing their children – and we do make the decision – to let our kids continue to play certain risker sports – football, soccer, cheerleading, lacrosse, hockey, etc. As a parent who has watched her child suffer eight concussions it was hard to watch Headgames not because it is too graphic, but rather because for me it is too personal, so it took several viewings of the movie to really be able to get some distance. I cried several times knowing exactly what it feels like to sit in that doctor’s waiting room, in front of his desk as he gives the news, in the MRI lab waiting for my child to emerge, and at home wondering when the symptoms will end and my child will be healed. It was painful but good to see the conflict on the big screen that sadly other parents experience too.
It was painful but reassuring to see other loving, educated parents struggling with the issue of safety and risk and allowing a kid to play the sport he/she loves. It is that balance of risk and reward that is so hard to resolve over time. And as one of the experts in the movie reflects, “What is the level of respectable risk and reasonable reform?” Can we really make the sports our children play safer or their childhoods less risky; and if so, at what cost to their freedom and joy?
On a personal note, last year I pledged to donate my brain to the BU CTE Study which is featured in this film. This movie shows the freezer and cutting board where my brain is “headed.” As I watched the doctor’s purple-gloved hands slice through another volunteer’s brain, I swallowed hard but even so, I am even more determined that my brain go to research when I saw what has already been discovered in the study. I want to be part of the solution even if it is just be donating my gray matter. Ironically, yesterday was day that had been scheduled for my two and half hours interview by a CTE lab researcher on my concussion history. In recalling the sports and non sports concussions I have experienced, I realized time and time again how I did not properly treat my concussions, and that may have over the years may have led to the place I am in now. I wish doctors knew then what many know now and I had seen a film like this years ago.
It this an earth shattering movie? It depends what a parent already knows about concussions. For those of us who live in the concussion world, Head Games reiterates what we already know. If you had the privilege of seeing Chris Nowinski speak in person, you already are aware of much of the movie’s message. But if you haven’t seen Chris speak and if you don’t know much about concussions, I think you will leave the theater with a new prospective and a lot of unanswered questions.
Head Games raises concussion awareness and provides important information for parents: not all the information I want parents to know, but the topic cannot be covered in an hour and half by anyone. And while no film is perfect, just the fact that it exists at all is amazing – that concussions are finally seen as important enough that a group of people spent time and money to make this first feature film.
To watch the film on iTunes: http://bit.ly/OMNvj5
To look for screening times at theaters: http://headgamesthefilm.com/
National Federation of State High School Associations (NFHS) Sports Medicine Advisory Committee (SMAC)
The incidence of concussions in high school sports, including soccer, has been of interest and concern to the NFHS SMAC for many years. Increased knowledge, awareness, and public attention have produced major changes in management of concussions, and the NFHS SMAC continues to evaluate opportunities to improve safety and reduce concussion risks in all high school sports. The definition and methodology for initial assessments for return-to-play decisions have evolved over the last several years. Instruments such as neuropsychological and balance testing have aided researchers and clinicians to better serve our students who have suffered concussions.
The concept of padding the head to minimize the force delivered by a blow to the head has led to the development of several forms of headgear. Research has also shown that head injuries in soccer predominantly come from head-to-head, head-to-ground, head-to-goal post, and possibly ball-to-head on an inadvertent contact, instead of from the purposeful heading of the ball. Data on bio kinetic reduction in force are available and a published study in the field has suggested a decrease in self- reported concussion symptoms with use of such headgear.
At this time, the use of soccer headgear is permitted, but not required under the NFHS soccer rules. We know of no state that has chosen to require such use on a state-wide basis, though some schools or school districts may be doing so. Member state associations, school districts, schools, parents and students are free to make their own assessments regarding the advisability of soccer headgear.
The NFHS SMAC remains very interested in independent, valid research and empirical observations with respect to the effect of soccer headgear use on the incidence and severity of concussions and other injuries, and on the mode of play. At this time, the NFHS SMAC considers the current permissive rule to be reasonable, based on ongoing review and analysis of the existing data and collaboration and discussion with experts in the field.
The NFHS and other governing bodies tend to move cautiously with respect to equipment mandates, as unintended consequences (e.g. the possibility of more cervical injuries or increased aggressive play) are an ongoing concern. As additional research and information become available, the NFHS SMAC will continue to evaluate the situation, share the information with member state associations, and determine the advisability of a change in the current position. Risk management for our student athletes continues to be the primary goal and mission of the NFHS SMAC. We remain committed to that end.
Revised and Approved January 2012
Last week I had the pleasure of speaking for over an hour with Alan Goldberger about concussions and sport law. His website states that ALAN S. GOLDBERGER is an attorney, speaker, and author. A nationally recognized authority on sports officiating and sports law, his practice is concentrated in the areas of sports law, business law, sports insurance defense, association law, and business and chancery litigation. He is a partner in the law firm of Brown Moskowitz & Kallen, P.C. located in Millburn, New Jersey. Among a long list of accomplishments as a lawyer in court, Alan is the author/coauthor of five books, including Sports Officiating: A Legal Guide, now in its second edition; and Sport, Physical Activity and the Law a college textbook now in its third edition.
What is missing from his impressive bio is how enjoyable and easy it is to talk to him. He is incredibly knowledgable on sports officiating and sports law: but unlike many lawyers I have met, I could talk to Alan like he was a regular guy in a conversation about sports safety like we were standing on a field before a game. Knowledge is great to have but the ability to pass knowledge along to others is a real gift. I really learned a lot from him about the important role the official plays in reducing concussion and injury risks to players during a game. I hope to have Alan up to Fairfield County to speak to teams, coaches and parents in the near future.
Rather than paraphrase Alan, I asked to re-blog some of his articles to share some of what I learned. Thank you, Alan.
For PDF click ASG.ARTICLE.NFOQ.YOURBESTFRIEND200809
Reprinted with permission of Alan Goldberger and the National Federation of State High School Associations.
Last week I had the pleasure of speaking for over an hour with Alan Goldberger about concussions and sport law. His website states that ALAN S. GOLDBERGER is an attorney, speaker, and author. A nationally recognized authority on sports officiating and sports law, his practice is concentrated in the areas of sports law, business law, sports insurance defense, association law, and business and chancery litigation. He is a partner in the law firm of Brown Moskowitz & Kallen, P.C. located in Millburn, New Jersey. Among a long list of accomplishments as a lawyer in court, Alan is the author/coauthor of five books, including Sports Officiating: A Legal Guide, now in its second edition; and Sport, Physical Activity and the Law a college textbook now in its third edition.
What is missing from his impressive bio is how enjoyable and easy it is to talk to him. He is incredibly knowledgable on sports officiating and sports law: but unlike many lawyers I have met, I could talk to Alan like he was a regular guy in a conversation about sports safety like we were standing on a field before a game. Knowledge is great to have but the ability to pass knowledge along to others is a real gift. I really learned a lot from him about the important role the official plays in reducing concussion and injury risks to players during a game. I hope to have Alan up to Fairfield County to speak to teams, coaches and parents in the near future.
Rather than paraphrase Alan, I asked to re-blog some of his articles to share some of what I learned. Thank you, Alan.
For PDF click ASG_ARTICLE_REFEREE_Law 2_11_ONUS
Reprinted with permission of Alan Goldbeger and Referee Magazine
FOR IMMEDIATE RELEASE
9/5/12
NATIONAL FOOTBALL LEAGUE GRANTS
$30 MILLION IN UNRESTRICTED FUNDING TO THE
FOUNDATION FOR THE NATIONAL INSTITUTES OF HEALTH
FOR MEDICAL RESEARCH
Focus on Advancing Science and Medical Understanding
of Brain Injuries
The National Football League will provide $30 million in funding for medical research to the Foundation for the National Institutes of Health (FNIH), NFL Commissioner ROGER GOODELL announced today.
The unrestricted gift is the NFL’s single-largest donation to any organization in the league’s 92-year history and will be overseen by The National Institutes of Health (NIH).
NIH, a component of the U.S. Department of Health and Human Services and one of the world’s foremost medical research centers, will administer the NFL funding and research designed to benefit athletes and the general population, including members of the military.
With this contribution, the NFL becomes the founding donor to a new Sports and Health Research Program, which will be conducted in collaboration with institutes and centers at the NIH. The FNIH hopes to welcome other donors, including additional sports organizations, to the collaboration.
Specific plans for the research will remain to be developed, but potential areas under discussion include accelerating the pace of discovery to support the most innovative and promising science of the brain, including: chronic traumatic encephalopathy (CTE); concussion management and treatment; and the understanding of the potential relationship between traumatic brain injury and late-life neurodegenerative disorders, especially Alzheimer’s disease.
In addition to brain research, funding also will be dedicated to other important health areas such as: sudden cardiac death in young athletes; heat and hydration-related illness; chronic degenerative joint disease as a result of athletic injuries; the transition from acute to chronic pain; and the detection and health effects of performance enhancing substances, including human growth hormone.
“We hope this grant will help accelerate the medical community’s pursuit of pioneering research to enhance the health of athletes past, present and future,” said Goodell. “This research will extend beyond the NFL playing field and benefit athletes at all levels and others, including members of our military.”
“We are grateful for the NFL’s generosity,” says Dr. Stephanie James, FNIH acting executive director and CEO. “The research to be funded by this donation will accelerate scientific discovery that will benefit athletes and the general public alike.”
Dissemination of funding from this grant will be governed by federal law and policy applicable to NIH-funded research. In accordance with NIH policy, NIH funding recipients will be urged to disseminate the results of research to optimize the value of the science to the research community and the public. The NFL will have no early or special access to scientific study data.
About the Foundation for the NIH
Established by the United States Congress to support the mission of the NIH – improving health through scientific discovery in the search for cure – the Foundation for the NIH is a leader in identifying and addressing complex scientific and health issues. The Foundation is a non-profit, 501(c)(3) charitable organization that raises private-sector funds for a broad portfolio of unique programs that complement and enhance the NIH priorities and activities. For additional information about the Foundation for the NIH, visit www.fnih.org.
About the NIH
NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
About the NFL’s health and safety programs
Throughout its history, the NFL has made the health and safety of its players a priority and its reach extends to football and sports at all levels. At the youth level, partnerships with USA Football and the Centers for Disease Control and Prevention help parents, coaches, clinicians and athletes understand the signs and symptoms of possible head injuries. The league also collaborates with state legislatures to push for passage of youth concussion laws. Through funding for medical studies, collaboration with the military on their research and the work of the NFL’s medical committees, the NFL is committed to supporting and advancing science that will have an impact far beyond football. With a continued emphasis on improved equipment, rules changes, and in-game policies, the NFL fosters a culture that promotes health and safety at every level of the game. For more information, please visit www.nflevolution.com.
# # #
Army-NFL’s Joint Health/Wellness Initiative
FOR IMMEDIATE RELEASE
8/30/2012
U.S. ARMY AND NATIONAL FOOTBALL LEAGUE ANNOUNCE JOINT HEALTH AND WELLNESS INITIATIVE
Players & Soldiers Encouraged To Seek Help if They or Their Teammate/Battle Buddy Are Affected by a Head Injury
WEST POINT, NEW YORK — The U.S. Army and the National Football League launched today a long-term initiative to enhance the health of its soldiers and players by sharing information, providing education and engaging in discussion on concussion and health-related issues that affect both organizations.
The multi-faceted initiative, built upon the mutual respect shared by the two organizations, is designed to promote help-seeking behaviors and empower soldiers and players to maintain healthier minds on the playing field and battlefield. The initiative includes event-based programs, websites and social media that will foster peer-to-peer opportunities to share information, lessons learned and tips on how to recognize, prevent and manage concussions and reduce the stigma associated with reporting brain injuries or asking for help with health issues.
GENERAL RAYMOND T. ODIERNO, Army Chief of Staff, and NFL COMMISSIONER ROGER GOODELL made the announcement at The United States Military Academy at West Point as part of a panel discussion that included former NFL players and soldiers, as well as leading medical professionals. The discussion took place in front of an audience of nearly 200 West Point Cadets, underscoring the NFL and Army’s intention to promote healthy behaviors to younger and older generations alike.
This was the third such discussion between the two organizations. Current and former players met this offseason at The Pentagon with soldiers and Marines who have experience with the injury.
In a letter announcing the initiative to soldiers and current and former NFL players, General Odierno and Goodell said: “Our organizations share common traits: pride and passion, dedication and determination, and an enduring belief in the power of team. On a personal level, there is mutual respect, appreciation and admiration between Soldiers and Players. While the execution of our crafts is fundamentally different, these traits make America’s Soldiers and NFL Players who they are and the best at what they do. With this initiative, we are seeking to integrate the uncompromising devotion to win with a need to address traumatic brain injuries with the necessary care, consideration, and commitment to prevention that these injuries require.”
Among the initiative’s tactics:
· New interactive websites: the NFL launched today a website dedicated to this initiative– www.NFL.com/military. As an extension of NFL.com, this site provides service members with both exclusive access to football news and the most up-to-date information on brain injuries. In addition, a new site www.army.mil/tbi will serve as the Army’s first-ever centralized hub of information on traumatic brain injury for soldiers.
· Event-based forums that will bring players and soldiers together at NFL team facilities and Army bases across the country to share experiences and reinforce the need for care.
· PSAs and social media interactions designed to increase awareness and promote help-seeking behaviors in each organization.
· Development of a peer-to-peer program that matches recently retired NFL players with soldiers transitioning out of the Army.
· Sharing of medical research and information between the NFL and Army.
General Odierno and Goodell stressed the need for soldiers and players to seek help if they may be suffering from a head injury and also to get medical attention for a teammate or soldier who may need assistance.
“We know that this mission cannot be accomplished alone,” they wrote in the letter. “It is a shared responsibility. A concussion is a brain injury that is not always easily recognizable to the untrained eye. We want to encourage and empower Soldiers and players to take an active role in the education and prevention process. We all have a crucial role in making sure a brain injury is properly identified and treated.
“By coming together in this historic effort, we are combining and strengthening our forces,” the letter concludes. “As we continue to focus our efforts on encouraging safer environments, we will continue to celebrate the spirit of competition and determination that define our two organizations. Working together, we will ensure longer careers and healthier lives. Working together, we all become stronger. And working together, we have the power to make a real difference. We hope you will join us.”
# # #
Concussions: Introduction of Overlapping Concussion Syndrome
A 13 year old female soccer player collides with another player falls and hits her head on the ground. She immediately appears dazed and confused. She reports a severe global headache and mild photophobia. Her coach appropriately suspects concussion and removes her from the game. Her parents then take her to the emergency room where over the next couple hours she improves slightly. She is diagnosed with a concussion and sent home to rest and follow up with her primary care physician. Follow up with her primary care doctor occurs two days later where she demonstrates continued improvement with a mild headache, dizziness, and fatigue. She is advised to rest the remainder of the week and stay out of school. She follows the instructions and in a week reports she is doing well, therefore her parents allow her to return to school. Since she is doing well in school, she is allowed to return to soccer activities.
Sound familiar? This scenario is estimated to occur 150,000 times per year nationally for athlete’s ages14-18 years old (Bakhos, Lockhart et al. 2010).
Two weeks following her concussion, she was playing soccer again. During a game she jumps for a header and hits her head on another player’s head and immediately has a return of her symptoms. Again, she is taken out of the game and again she is diagnosed with a concussion. Unfortunately, now her symptoms are more severe and the duration significantly longer. Due to the severity of her symptoms she misses a significant portion of the school year and ultimately has to receive tutoring over the summer to catch up and stay with her grade. It was noted upon further questioning that she really was never back to normal after the first concussion. Although her headache, dizziness, and photophobia resolved, she still had subtle symptoms such as mild fatigue, difficulty concentrating in class, and homework taking longer to complete.
Sound familiar? If not think again. Although the numbers are unknown, this scenario occurs quite frequently. I personally have seen this scenario on a weekly basis. What is happening here is another concussion occurs on the tail end of a concussion where complete resolution has not yet occurred. Unfortunately, when this occurs the symptoms are often amplified and prolonged.
The medical literature is very aware of Second Impact Syndrome (SIS) where a second blow on top of a previous head injury with continuing symptoms leads to a loss of regulation of cerebral blood flow resulting in brain swelling and herniation commonly resulting in death. Second impact syndrome although catastrophic, is very rare, with estimates of less than 1 case per year (Thomas, Haas et al. 2011).
What happened in this described case is not SIS, rather a much more common injury where a concussion occurs while the athlete is still symptomatic from a previous concussion. This scenario often results in more severe symptoms that last longer. I believe this scenario deserves proper terminology. I have previously referred to this condition as Overlapping Concussion Syndrome (OCS). Patients with overlapping concussion syndrome may also be labeled as post concussive syndrome. Clinically these syndromes may be similar but there is a big difference as OCS can be prevented. In OCS there is a previous event, whether it was recognized or not. The proper recognition and management of the first event is the opportunity to prevent OCS or some of those injuries labeled as PCS.
Overlapping concussion syndrome emphasizes the need to properly manage concussions. We have to be diligent in following concussions to a resolution. The difficulty is that some of the residual symptoms can be more difficult to detect and the clinician must be carefully looking for the more subtle signs of concussions. These subtle signs may be seen in school performance, mild headaches, fatigue, personality changes, vestibular impairment, or neurocognitive testing changes, to name a few. In addition, as the child feels better, there may be pressure to return to sporting activity that leads them to hide or underestimate these mild symptoms, making them even more difficult to detect.
As we move forward, we need to improve the detection of these subtle symptoms. Neurocognitive testing is one of the mechanisms by which this is being done. We are currently looking at vestibular measurements to help as well. Some of our current research is in the area of eye motion and balance changes. Still many of the subtle symptoms can be identified by the athlete, parents, and teachers.
I believe that if we remain diligent in the diagnosis of concussions and continue this diligence to the management of concussions, we will better prevent the more severe condition of OCS as well as the rare yet catastrophic SIS.
David Wang MD, MS
Medical Director
Concussion Program
Elite Sports Medicine
Connecticut Children’s Medical Center
References:
Bakhos, L. L., G. R. Lockhart, et al. (2010). “Emergency department visits for concussion in young child athletes.” Pediatrics 126(3): e550-556.
Thomas, M., T. S. Haas, et al. (2011). “Epidemiology of sudden death in young, competitive athletes due to blunt trauma.” Pediatrics 128(1): e1-8
Dave H. Wang, MD, MS
David is a sports medicine physician with over 15 years of specialized care for athletes of all abilities, from the novice to the Olympian. He has served as a team physician for the University of Minnesota for over a decade, which is also where he received his M.D. in 1989. Most recently he has been the director of the Sports Medicine department in a large multispecialty clinic in Minnesota where he has continued to work with non surgical techniques for musculoskeletal ailments as well as medical conditions affecting the athlete. He holds a Masters degree in Exercise Physiology and has interest and experience with sports performance issues. He is a former collegiate track athlete, who has accumulated a deep understanding of the specifics of most sports and their unique training regimes. In 2009 David and his family made the decision to move to Connecticut and join the outstanding staff at Elite Sports Medicine.
Got Brains? Donate them, Leave a legacy.
Ladies, u played sports, had concussions? Want to leave a legacy to those girls on the soccer fields today who may need our help?
I have pledged my brain to the BU CTE study = only 5% r female pledges.
Got Brains? Donate them! Leave a Legacy… I want a photo shoot Vogue Style on the front of SI of all the amazing sports stars who will pledge their brains!
I became concussion educator after suffering # of concussions. Once in the CTE study I started asking how many other females where involved. They are not YET even studying how the female brain is different from the male brain (yes, there are differences). 5% is not enough and we need to change that now.
Got Brains? Donate them! Leave a legacy.
Email me Katherine@SportsCAPP.com to join up -
