It seems like it should be common knowledge, but new research has just shown that when children experience concussion–or mild traumatic brain injury–those with more severe symptoms will need a longer amount of time to recover. Mild concussions may heal within 3 to 4 days, but bigger hits may require a month or longer to heal.
Scientist from the Boston Children’s Hospital and the University of Pittsburgh Medical Center examined medical records from 182 children with concussion. They looked for a group of symptoms and rated them on a scale of 0-6. Symptoms included headaches, vomiting, balance problems, changes in sleep patterns, sensitivity to light or noise, fatigue, numbness, visual problems, and difficulty with memory or concentration.
According to study author William Meehan, M.D.: ”Parents, physicians and caregivers of athletes who suffer from a high-degree of symptoms after a sports-related concussion should start preparing for the possibility of a prolonged recovery.”
Most physicians recommend that children who receive a concussion while playing sports shouldn’t return to play until all symptoms resolve. It’s a difficult call to make–coaches may want to put star players back in the game…and the injured child may downplay symptoms so they can return to play more quickly. It’s up to parents, teachers, doctors, and other adults to observe the child and make sure they are confident that the injury has healed entirely before sending the kids back out onto the playing field.
Over the past three years, I have written several blogs about preventing falls in the home. (The most recent blog was posted on September 20, 2012, to honor National Falls Prevention Awareness Day. To read that blog, click here: National Falls Prevention Awareness Day).
After years of researching information for Health & Safety blogs, I thought I knew everything. I was wrong…and I’d like share what I learned when a happy event turned to tragedy for my family.
On December 1, 2012, my parents finally moved from California to North Carolina to be nearer to us. (And by near, I mean two blocks away, which was great because my mother is a fantastic person.)
On December 3, while my mom and I were carrying bags of new towels and floor mats into her new house, up three small steps from the garage, she lost her balance and fell backwards—straight onto her head on the concrete floor.
The nightmare of the past two weeks has been…educational. And during long days spent in the ICU, I’ve had a chance to reflect on the event itself, and to gather lessons for preventing and dealing with a fall, things I don’t recall reading anywhere else.
We discovered that my mother’s skull had fractured in two places, she had a brain bleed at the site of the fractures, another brain bleed at the front of her brain where the brain whiplashed against the front of the skull (a contrecoup injury), and a large gash in her scalp. My mom spent three days in ICU, and another day in the neurological ward before coming home. Since then, we’ve returned to the ER twice because her symptoms got worse and worrisome. After the latest hospital run, we were told that she has “Post Concussion Syndrome,” a disorder commonly found in professional football players who sustain lots of hard hits to the head.
We’re not sure when my mother will be back to “normal.” We’re lucky in that her memory seems fine and her personality is the same as before the accident. She is unsteady on her feet, has big headaches, is unable to concentrate for very long, and is very easily fatigued.
It could have been much worse, and it was pretty close to being fatal. And do you know what my last words to my mom would have been? “Are you sure you can handle that big bag, Mom?” Seriously. I saw that it was too big for her, and I asked. She reassured me that she could handle it. In 20/20 hindsight, I shouldn’t have asked. I should have simply taken the bag from her and allowed her to walk up the steps without the encumbrance. That’s my final lesson: If you have to err at all, err on the side of being over-protective. I don’t think anyone has died from an abundance of caution.
Wishing you all a safe and healthy holiday season!
What do you call an activity requires strength, stamina, flexibility, agility, planning, and coordination with team members? What if the participants were required to train with weight-training and aerobic exercises? And what if that activity was performed in gymnasiums, in stadiums, and on outdoor fields? And what if teams competed regionally and nationally? Sounds like a sport, right? Well, not according to sports authorities. For decades, even as Cheer has evolved from pompom waving to rough-and-tumble tumbling, sports experts have continually rejected the notion that Cheer is a sport. They call it an activity in support of “real” sports, like football and basketball, but not a sport in and of itself.
Now, finally, medical experts have weighed in, and they believe it is time for cheerleading to gain acceptance as an official sport. Yay! Gimme a “C”…gimme an “H”…gimme an “E”…well, you get the idea. We think it is a spectacular idea, and about time.
In 2011, we wrote a 3-part series about why Cheer should be recognized as a sport, namely because doing so would afford participants with more safety protections. According to an article on MedPageToday.com:
…the rate of catastrophic injuries — such as head or spine injuries resulting in death or permanent disability — is considerably higher for cheerleading than for other sports. Cheerleading has accounted for about two-thirds of all catastrophic injuries in female high school athletes over the past 25 years.
In addition, concussion rates have increased at a much faster pace in cheerleading compared with other sports.
In response, the American Academy of Pediatrics (AAP) has said that school sports associations should designate cheerleading as a sport, and to make it subject to safety rules and better supervision. That should include on-site athletic trainers, restrictions on difficult stunts in high school squads, limits on practice time, and better qualified coaches. In addition, just like other athletes, cheerleaders should be required to do conditioning exercises and undergo physical exams before joining the squad.
According to an article by The Associated Press:
“Not everyone is fully aware of how cheerleading has evolved over the last couple of decades. It used to be just standing on the sidelines and doing cheers and maybe a few jumps,” said Dr. Cynthia LaBella, a sports medicine specialist at Chicago’s Lurie Children’s Hospital and an author of the new policy….
Last year, there were almost 37,000 emergency room visits for cheerleading injuries among girls aged 6 to 22, according to data from the Consumer Product Safety Commission. That’s more than four times higher than in 1980, when cheerleading was tamer.
Although some cheerleaders themselves think that rules will make the sport less exciting, sports medicine specialists are all for the proposed changes, which includes limiting the height of human pyramids in high school cheerleading to just two people, and that routines that include pyramids, tumbling, or tosses should not be performed on hard surfaces.
“Most serious injuries, including catastrophic ones, occur while performing complex stunts such as pyramids,” guidelines co-author Dr. Jeffrey Mjaanes, a member of the AAP Council on Sports Medicine & Fitness, said in an academy news release. “Simple steps to improve safety during these stunts could significantly decrease the injury rate and protect young cheerleaders.”
To read our 3-part blog series on making Cheer a sport, click here:
This is a story about athletes and concussions.
When you read that sentence, what picture popped into your mind: 250-pound football players… or 10-year-old girls with ponytails? According to research published in The American Journal of Sports Medicine, the severity of symptoms after a concussion is–in part–dependent on the age and gender of the patient. Girls and young women suffer worse symptoms than men, and young people suffer more than older people.
The study tested young athletes for balance and verbal and visual memory. Researchers tracked the athletes for two years. In that time, about 300 of the athletes received a concussion and were tested again. Results showed that high school athletes performed worse for their age than college-aged athletes, and that female athletes with concussion had more symptoms and worse visual memory than male athletes with concussion. In addition, symptoms lasted longer in younger athletes than in older athletes.
According to an article in The New York Times:
The findings suggest that because of anatomical differences that make them more vulnerable, female athletes, and younger athletes in particular, may need to be managed more cautiously after a concussion, said Tracey Covassin, an associate professor of kinesiology at Michigan State University and the lead author of the report.
“Parents need to understand that if their daughter has a concussion, that they may potentially take longer to recover from that concussion than their son who is a football player,” she said.
Experts think that younger brains suffer greater damage from concussion because they haven’t fully developed…and because we tend to treat them as miniature adults when it comes to sports and expectations. According to Mark Hyman, author of “Until It Hurts: America’s Obsession With Youth Sports and How It Harms Our Kids” (Beacon Press, 2009):
“The brain and head of a small child are disproportionately large for the rest of the body,” he said. “The result is that their heads are not as steady on their shoulders. When they take a big hit in a football game or are slammed with an elbow in a soccer game, their brains move inside their skulls. That’s when concussions occur.”
To read an abstract of the article in The American Journal of Sports Medicine, click here: The role of age and sex in symptoms after concussion
To read the full article in The New York Times, click here: Concussions May Be More Severe in Girls and Young Athletes
For Eastern Oregon University student and softball pitcher Holly Martin, February 25, 2010 was both the luckiest and unluckiest day of her life. On that day, she suffered a life-threatening, life-changing head injury. Given the reported lack of care she received after the injury, Holly was lucky to survive.
According to an article in an Oregon newspaper called The Observer, Holly Martin was pitching during practice from a distance of about 10 to 20 feet (significantly closer than the regulation distance of 40 feet). The batter, who was using a composite bat, struck the ball directly back to the pitcher, striking her in the head behind her right ear. A length of chain-link fence had been set up as protection, but it didn’t keep Martin safe.
So far, there were four mistakes made: The pitching distance was too short, the batter should not have been using a composite bat, the protective cage was inadequate, and the pitcher should have been required to wear a helmet.
But as far as we can discern from the article, those problems were compounded by the coach’s actions after the injury occurred.
Once hit, Martin fell to the ground, unconscious and bleeding from her ear. While other players urged coach Melissa Wheeler to call 9-1-1, she ignored them and called a trainer instead. According to the article:
Martin was transported on a golf cart to the training room. The suit alleges she was kept in the training room about two hours before Wheeler took her to the Grande Ronde Hospital in her personal car.
At the hospital, Martin was diagnosed with a longitudinal fracture of her right temporal bone. She was flown to Emmanuel Hospital in Portland for treatment.
That is hardly an appropriate reaction to a head injury. The injured Martin should have been transported by ambulance after a 9-1-1 call. This was a serious injury. According to the article, Martin suffers from permanent severe headaches, memory loss, inability to perform tasks requiring sustained attention, trouble with math and deductive reasoning, and more.
“She had all the signs of a head concussion but they kept her there for over two hours,” [Holly Martin's mother, Dawn Martin] said. “My whole point is, why wasn’t 9-1-1 called? It took them two hours to call me, and then another half hour to get them to take her to the hospital.”
The Martin family has filed a lawsuit to recover economic damages and other costs. Apparently, the University is fighting the lawsuit on a few grounds, including that the statute of limitations had passed.
That would be a shame. Holly Martin has been harmed enough.
To read the full story in The Observer, click here: Softball player sues EOU over head injury
Junior Seau was a star. He was the kind of football hero that put butts on couches and raised Sunday TV ratings.
Junior Seau died on May 2 of an apparent suicide. In echoes of the suicide of another former NFL great Dave Duerson, Seau killed himself with a shot to the chest, presumably because he wanted to preserve his brain so that experts could determine whether he was suffering from chronic traumatic encephalopathy (CTE). CTE is a form of progressive brain damage caused by multiple concussions. It can cause mood changes, memory difficulties, neurologic impairments, and dementia.
The tragedy of CTE—make that one of the many tragedies—is that the damage can be suffered when a person is young, strong, and seemingly quick to recover from any injury… but there is no way to diagnose CTE. The only way to tell the extent and progression of the injury is to examine the brain after death. Hence, one of the new preferred suicide methods for people who believe they have suffered enough brain injury to cause CTE is a gunshot to the chest, preserving the brain for autopsy.
According to an article on the Huffington Post:
After defensive back Andre Waters’ suicide in 2006, Dr. Benet Omalu of the Brain Injury Research Institute at West Virginia University told the New York Times that the 44-year-old “Waters’ brain tissue had degenerated into that of an 85-year-old man with similar characteristics to those of early-stage Alzheimer’s victims.”
When the Bengals’ troubled Chris Henry died, Dr. Omalu and his colleagues determined that the wide receiver suffered from the same chronic traumatic encephalopathy. He was 26 years old.
Seau was a former All-Pro linebacker who played for 19 seasons in the NFL, for the San Diego Chargers, New England Patriots, and Miami Dolphins. According to an article on Forbes.com, on the day Seau’s death was reported, NFL commissioner Roger Goodell handed out suspensions for the New Orleans Saints players involved in the team’s bounty program.
Have you heard about the bounty program? As we wrote in a previous blog, the New Orleans Saints had a bounty program, in which players were paid thousands of dollars for hard hits that knocked opponents out of games. Supposedly, players were paid $1000 for a “knockout hit,” and another $1000 if a player needed to be carried off the field. Those are just some of the tactics that have driven more than 1000 former NFL players to sue the league for their head trauma and potentially permanent disability.
How many more players and former players will have to commit suicide before the NFL puts more safety measures in place? Then again, maybe the hundreds of pending lawsuits against the NFL will be the deciding factors. Very often, safety and progress only come after an issue has been screened through the filter of the legal system: Bad actors go to trial, good laws evolve.
Better a courtroom than an autopsy room any day.
To read the HensonFuerst blog about the bounty program, click here: “Organized Savagery” in the NFL
To read the full article in Forbes.com, click here: NFL’s Junior Seau Dies in Suspected Suicide
To read the full article on the Huffington Post, click here: Junior Seau–Changing the NFL Forever
Ray Easterling, former player for the Atlanta Falcons, died Thursday at age 62 of an apparent self-inflicted gunshot wound. According to an article in The New York Times, Easterling was part of a group of former NFL players who sued the league, claiming that it had failed to treat players for concussions, and for attempting to conceal links between football concussions and long-term brain injuries.
An article on USAToday.com reported that the 61st concussion lawsuit was filed in federal court in Philadelphia by 28 former NFL players. In total, more than 1,260 players have filed concussion-related suits against the NFL. The suits blame that the players suffered long-term damage from concussions due to the league’s “carelessness, negligence, intentional misconduct, and concealment of information.”
As we wrote in previous blogs last year, multiple concussions can result in a brain disorder known as chronic traumatic encephalopathy, or CTE. This progressive, incurable condition leads to memory loss, depression, and dementia. Unfortunately, the only way to definitively diagnose CTE is after death, by autopsy. Boston University’s Center for the Study of Traumatic Encephalopathy has been researching the link between football and CTE. Of the brains of 15 former NFL players, 14 showed signs of CTE.
According to The New York Times, Easterling’s widow, Mary Ann Easterling, will continue to pursue the lawsuit on behalf of her husband, and she is urging the league to establish a fund for players with traumatic brain injuries related to their playing days.
“Half the time the player puts themselves back in the game, and they don’t know what kind of impact it has,” she said. “Somehow this has got to be stopped.”
Friends and Easterling’s attorney, Larry Coben, said that Easterling had not been himself for about the past six months. According to Coben:
“I could tell he was not on his game. He kept repeating himself and getting confused. It’s pretty tough, pretty tough.”
To read the full story in The New York Times, click here: Ray Easterling, of Atlanta’s Gris Blitz, Dies at 62
To read the full story on USAToday.com, click here: Easterling’s death will impact concussion lawsuit
To learn more about the NFL lawsuits, click here: NFLConcussionLitigation.com
To watch our video about concussion, click here: Concussion Safety
After a head injury, patients face numerous physical and emotional challenges. During and even after hospitalization, there are many medical decisions that need to be made as part of treatment. But the very act of making decisions is a problem, according to research published in the April 11, 2012, issue of the medical journal Neurology.
According to an article in ScienceDaily, the severity of the injury directly corresponds to the amount of decision-making impairment. One month after the initial injury, patients with mild traumatic brain injury (TBI) showed little residual impairment, while those with more severe TBI had significant impairment. This impairment can affect patients’ health in ways that go beyond simple decision making.
“Immediately following injury and during the rehabilitation and recovery period, patients and their families must make ongoing and often complex medical decisions, including treatment of brain trauma and orthopedic injuries, choice of rehabilitation programming and treatment of neuropsychiatric problems,” said Daniel C. Marson, J.D., Ph.D., professor of Neurology, director of the UAB Division of Neuropsychology and senior author of the study.
This study suggests that doctors and caregivers need to be more aware of what patients are, and are not, capable of. Patients may not be able to give consent to medical procedures for months after the initial injury. It could be that caregivers need to take a more active role in medical decision making for a longer period of time than previously thought.
Unfortunately, there is no test to help us judge when a patient is capable of making decisions. Caregivers will need to rely on physicians and other experts to help them make proper decisions for their injured loved ones. This study points out another reason why TBI attorneys are valuable members of a treatment team for people with brain injury–attorneys have experience dealing with the long-term needs of patients, needs that include help for caregivers who may need to take control over their loved one’s lives for months or years after the patient leaves the hospital.
To read the full article in ScienceDaily, click here: Head Injuries Often Impair
To learn more about how an attorney can help in TBI cases, visit our dedicated TBI webpage: www.lawmed.com/braininjury/
There are two new and wonderful resources about concussion. You know we write a lot about mild traumatic brain injury (MTBI), and it takes a lot to impress us, but these resources are truly special: One is a physician-developed smart phone app designed to help coaches, parents, and athletes recognize and assess concussion; the other is a CDC info pamphlet about recognizing and treating concussion in children, including strategies for addressing concussion symptoms at school.
There’s an App for Concussion, Too!
When they say “There’s an App for That,” they’re not kidding…and that’s a good thing.
Concussion Recognition & Response gives real-time advice about recognizing and treating concussion. Menu items include “NEW INCIDENT,” which walks you through a series of assessment screens, including evaluative questions, such as “Was there likely a blow to the head or body, jerking the head?”, and did you observe vomiting, balance problems, or other specific (and listed) signs of concussion?
The app also provides a list of criteria to help you decide whether to treat a head injury as an emergency and call 911, questions to ask the child who experienced the head injury, and Frequently Asked Questions. Finally, the app tells you whether a concussion is likely, what led to that assessment, and what you should do about it. (Of course, there is a disclaimer at the first page of the app which states: This application is not intended to replace seeking help from a trained medical professional. If the youth has lost consciousness, even briefly, call 911 immediately. That makes sense—no app should ever replace common sense or rational concern when it comes to a child’s health.)
Should you need to seek medical attention for the child, the app provides a summary of all the information you input to share with a doctor…even by email.
“Concussion Recognition & Response” (CRR) is available on iTunes and Android Market. It works on smart phones, iPods, and tablets (such as the iPad). It was developed by two experts with ties to the University of North Carolina at Chapel Hill (UNC-CH), Jason Mihalik, Ph.D., an assistant professor of Exercise and Sports Science in UNC’s College of Arts and Sciences, and Gerard Gioia, Ph.D. (UNC ’84) of the George Washington University School of Medicine. This new app is so impressive that it has already been nominated for an Appy Award–and it is one of three finalists in the medical category. The app is priced at $3.99 for a limited time, and a portion of the proceeds of the sale go to support concussion research at the Children’s National Medical Center, and the Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center.
According to developer Dr. Mihalik:
“We see as many as 60 percent of concussions go unreported or undiagnosed,” Mihalik said. “This app will really help to provide a systematic diagnostic approach to that injury, and we’re hopeful that it will capture more diagnoses of concussions so that kids can be managed properly.”
And despite the focus on sports, don’t think that the benefits of this app are only for young athletes. According to a press release by UNC:
“This is not just an application for kids that play sports,” said Karen Earp, as her 9 year-old daughter climbed on playground equipment behind her. “This is an application for anybody and everybody to use whether you play sports, whether you play on a playground, ride your bike or are just outside having fun.”
For more information about the CRR App, click here: Concussion App publisher. (You can find links to the Android Market and iTunes purchase pages here, too.) It is easy to get confused by the offerings on iTunes–there are at least four other concussion-related apps, but this is the best app of this type we have seen..by far. The full name is Concussion Recognition & Response: Coach & Parent Version. And the icon looks like this:
Information from the CDC to Read at Home
One of the biggest changes resulting from recent research is how young victims of concussion are treated at home and at school. Questions many parents have are:
These questions are all answered in a fabulous new PDF document from the U.S. Centers for Disease Control and Prevention (CDC) titled Heads up to Schools: Know Your Concussion ABCs. Even though it is called “a fact sheet for school professionals,” parents will find it a valuable tool, as well.
You can download a free copy of this pamphlet here: http://www.cdc.gov/concussion/pdf/TBI_Returning_to_School-a.pdf
About 18 months ago, we wrote with great excitement about the National Football League (NFL) and the new attention they were bringing to the crisis of concussion. The 2010 football season began with new concussion awareness posters in the locker rooms. As quoted in The New York Times, the Baltimore Ravens’ center, Matt Birk, said:
“To put it out there in writing in locker rooms, at least it’s publicly acknowledging that, ‘Hey, this is real.’ There’s risks in everything you do, and this one is real. You can’t sweep it under the rug anymore.
Unfortunately, there didn’t seem to be much change in the culture of the sport: Players were not removed from play after either giving or receiving hard head hits—the kind that are likely to cause concussion. The concussion prevention program was little more than words on a page, talk with no back-up action.
Now, a new scandal has rocked the NFL, and this one is difficult to understand, under any circumstance.
An investigation has revealed a “Pay for Pain” bounty program in the New Orleans Saints. Head coach Sean Payton and general manager Micky Loomis have taken full responsibility. According to a Reuters news article, under the bounty program, players were reported with payments of thousands of dollars for hard hits that knocked opponents out of games. Supposedly, players were paid $1,000 for a “knockout hit” and another $1,000 if a player were to be carried off the field.
The program was administered by former Saints defensive coordinator Gregg Williams, who issued a statement acknowledging his involvement:
“It was a terrible mistake, and we knew it was wrong while we were doing it. Instead of getting caught up in it, I should have stopped it,” said Williams. “I take full responsibility for my role. I am truly sorry. I have learned a hard lesson and I guarantee that I will never participate in or allow this kind of activity to happen again.”
This seems like quite a cold-blooded apology for such a heinous and injurious program. Oops, sorry, won’t do it again. Perhaps he and everyone else who actively or passively condoned this program shouldn’t be allowed a chance to do it again…perhaps they should lose their jobs…perhaps they should pay restitution of some sort to the players who were seriously injured by this program.
As Charles P. Pierce wrote on the website Grantland.com:
“What we shave here now is the face of organized savagery, plain and simple…. These events were not incidental to the playing of the game. They were an essential part of it. The players who participated in the program did not do so accidentally. The coaches who designed the program did not do it without knowing full well what it entailed, including the possibility of retaliation if the story ever got out, and a subsequent football arms race that would end up with someone dead on the field.
How much violence and physical damage is too much before we start to realize that our national pastime needs to change the unwritten rules of the game? We have a crisis of concussion… players dying young due to chronic traumatic encephalopathy (CTE) and dementia… players committing suicide as they experience catastrophic declines in their physical and mental health… and now aggression bounties. As Mr. Pierce wrote:
Gradually, football has seen its appeal slip at the most basic levels. Pediatricians are advising parents not to let young children play organized football too early in life. Local high schools are looking at skyrocketing insurance rates and wondering, in a time when school budgets are being squeezed to a pulp all over the country, whether this particular game is worth the candle. Major college programs have all the economic problems present in the high schools combined with all the workplace-safety issues with which the NFL is grappling. Football may be losing some of what once appeared to be its unbreakable purchase on the country’s soul.
I’ve always been one of those people who cringe and look away when aggressive football hits are replayed in slow motion, so maybe I’m out of touch with what football fans are willing to bear. But I’ll never again be able to enjoy the pure sport of football without wondering exactly what nefarious plays are being planned in the huddle or the locker room. And I’ll never be able to assume that any on-the-field injury was due to an accident, rather than a calculated hit.
And maybe it’s time for the New Orleans team to change its name. “The Saints” just doesn’t seem to fit anymore.
To read the full Reuters article, click here: Saints coach and GM take blame for bounties
To read the full article on Grantland.com, click here: The Saints, Head-hunting, and (Another) Disaster for the NFL
To read more about the scandal on ESPN, click here: Saints coach, GM sorry for bounties