It is now almost common to hear about athletes who suffered a number of concussions over their careers having some difficulties later in life. The damage can be very serious.
Chronic Traumatic Encephalopathy(CTE) is associated with repeated head traumas — concussions or sub-concussive hits — that are not allowed to properly heal. It is a progressive degenerative disease found in individuals who have been subjected to multiple concussions and other forms of head injury. A variant of the condition, dementia pugilistica, is primarily associated with boxing. CTE has been most commonly found in professional athletes participating in gridiron football, ice hockey, professional wrestling and other contact sports, who have experienced head trauma, resulting in characteristic degeneration of brain tissue and the accumulation of tau protein. Individuals with Chronic Traumatic Encephalopathy may show symptoms of dementia such as memory loss, aggression, confusion and depression which may appear within months of the trauma or many decades later.
A number of athletes have been affected by the condition with serious consequences. Recently a former NFL lineman committed suicide after serious mental decline. His wife said it started with the nightmares and progressively got worse.
Bob Probert’s brain was examined after his early passing at the age and was found to have CTE (read more here).
A couple of years back with the Chris Benoit tragedy the issue of CTE and it’s effects were put on the map and other athletes began to take notice.
Other players are worried and should be about the possible effects of concussions not only during their playing career but also long after they have retired. CTE is a serious medical condition that should not be taken lightly. A brain injury that goes untreated can have serious long term consequences. We should applaud efforts by the NHL and the NFL to address vicious hits to the head but they need to go farther. Teams need to be proactive in helping to identify possible head injuries.
Often athletes and coaches will push to play even when there may be some lingering effects of a head injury. Athletes have long tried to play through injuries and in certain sports it is almost a crime to take yourself out of a game. Teams and / or the league need to mandate some sort of criteria for athletes they suspect may have head injuries. This can hopefully help prevent or lessen the possibility of CTE. While we may not be able to prevent CTE – following certain procedures (such as a qEEG and ERP) after an “event” may lessen the likelihood of CTE occurring in the first place.
The Pittsburgh Penguins forward Sidney Crosby recently has been out almost three months with post-concussion symptoms. This is a great loss for hockey fans when you have one of the sports top performers not playing due to a head injury. A recent study shows that more players are losing playing time due to concussions (see the full story on ESPN.com) The NHL is finally addressing this issue. One big step is pulling players out of the game for at least 15 minutes for a concussion test. The new Concussion Removal Protocol is designed to keep players with head injuries out of the game.
It was great to hear that the Pittsburgh Penguins, as part of a new initiative, will offer free baseline concussion testing and educational programs to youth hockey players in the region. “Heads Up Pittsburgh” is a combination effort with the Pittsburgh Penguins Foundation and UPMC Sports Medicine, aimed at making more hockey families aware of concussions in the sport. Hopefully more teams will follow suit.
more relevant links..
–What is CTE? Boston University – Center for the Study of Traumatic Encephalopathy
–NHL governors discuss player safety Updated: December 6, 2011, 10:16 PM ET
–CTE found in Lew Carpenter’s brain Updated: February 14, 2012, 6:58 PM ET
–Head injuries: A growing issue in hockey Author: Kevin Hoy, khoy@wkbt.com Published On: Dec 21 2011 05:51:38 PM CST Updated On: Dec 21 2011 07:49:50 PM CST
–Report: Derek Boogaard had CTE ESPNNewYork.com Updated: December 6, 2011, 8:26 AM ET
–Concussions in Sports Updated: June 30, 2013, 11:03 AM ET
–A simple way to curb concussions from SI.com
–Former NFL players sue league over head injuries Author: By David Ariosto CNN Published On: Dec 22 2011 12:50:19 PM EST Updated On: Dec 22 2011 05:55:47 PM EST
–Former NFL players sue league over head injuries Author: By David Ariosto CNN Published On: Dec 22 2011 12:50:19 PM EST Updated On: Dec 22 2011 05:55:47 PM EST
–Concussions impact male, female soccer players equally Author: By Trisha Henry CNN Published On: Oct 02 2012 10:46:56 AM EDT Updated On: Oct 02 2012 11:36:55 AM EDT
–UCLA study examining long-term effects of concussions By Erin Weaver, Special to SI.com
–Brain Disease in Football Players – CTE Author: By Stephanie Smith CNN
–Seau had brain disease that comes from hits to head, NIH finds By Nadia Kounang and Stephanie Smith, CNN updated 10:18 AM EST, Fri January 11, 2013
– American Medical Society for Sports Medicine position statement: concussion in sport. Harmon KG, Drezner JA, Gammons M, Guskiewicz KM, Halstead M, Herring SA, Kutcher JS, Pana A, Putukian M, Roberts WO; Endorsed by the National Trainers’ Athletic Association and the American College of Sports Medicine.
Source: Department of Family Medicine, for Stanley Herring Department of Physical Medicine and Rehabilitation, University of Washington, , Seattle, Washington, USA.
–Scan may detect signs of NFL players’ brain disease By Stephanie Smith, CNN updated 6:57 AM EST, Wed January 23,2013
–Brain damage in American football linked to head trauma 15:04 17 October 2013 by Hal Hodson – Journal reference: Scientific Reports, DOI: 10.1038/srep02972
–League of Denial : The NFL Concussion Crisis FrontLine PBS.org October 8, 2013
–First Major League Baseball player diagnosed with CTE By Stephanie Smith and Dan Moriarty, CNN updated 8:51 PM EST, Sun December 15, 2013
–NIH and NFL tackle concussion research Embargoed for Release: Monday, December 16, 2013, 9 a.m. EST
–Degenerative Brain Disease Threatens Afghan War Vets Posted: 08/15/2012 3:28 pm
–Are Repeated Concusions Really Killing NFL Football Players? By Alex Berezow 12/11/2013 @ 2:51AM
–Scientists Find Way To Trace Concussion-Related Tau Proteins In Former NFL Players Posted: 01/23/2013 12:27 am EST
–Tony Dorsett Diagnosed With Signs Of CTE, Dealing With Memory Loss And Depression (VIDEO) Posted: 11/07/2013 3:23 pm EST
–Early-onset dementia, CTE in pro athletes focus of UB study By ELLEN GOLDBAUM Published November 21, 2013
–The NFL Fumbles the CTE Issue Again By Lloyd Glauberman, Ph.D. Clinical Psychologist, Hypno-technologist Posted 04/1/2013 4:56pm
–Is the NFL’s Settlement of the Concussion Class Action Lawsuit a Victory or Setback for Brain Injury Awareness? Posted: 09/04/2013 7:55 pm
–Jovan Belcher’s body exhumed for brain examination Posted by Mike Florio on December 14, 2013, 6:48 PM EST
–U.S. to spend $14 million on concussion research, using NFL funds BY CAREY GILLAM Mon Dec 16, 2013 2:59pm EST
Tragedies like this make us pause and appreciate what we have. A moment of pause should also be directed at the source of this incident and others like it… repetitive sports related head injuries, whether football, rugby, soccer, wrestling, basketball, baseball, tumbling or any other spot where head contact may be made. The recently improved American Academy of Neurology position paper on sports injury and concussion points to the increased visibility of the need for professional evaluation after head injury to provide proper clearance prior to athletes re-entering the game. I see that baseball has just introduced a ruling that requires players to have a week out of action after a concussion, and clearance prior to returning to active participation in the game.
Obviously there still needs to be a sea-change in the attitude of football players when too many believe that they will “just be replaced” if they suffer a brain injury and need treatment or recovery time before returning to the game… so they suffer and the brain injury worsens with repetition, and “substance Tau” builds up and up, ruining brain function in the process. In a game where millionaires are playing for billionaires, this should not be an issue.
Our ability to see the brain function and dysfunction associated with white matter or gray matter injuries has advanced over the last decade, and now we have technologies that can measure even small changes in function associated with brain injury. The structural imaging will catch the gross issues, like a cortical contusion or a bleed, but functional imaging is needed to see the subtle impacts on neural networks. The addition of Event Related Potentials to the evaluation has allowed our approach using ICA analysis to show the subtle impacts on neural processing of head injuries.
The ICA approach initially was used in research in Trondheim Norway on know TBI and normal clients done by Professor Dr Juri Kropotov, and subsequently in funded research in Switzerland this is being replicated in a much larger study paid for by the insurance industry.
The offshoot of the work shows that the EEG alone does a poor job of seeing TBI, with a weak discrimination ability. The ERP however appears to be a robust and sensitive metric that also has high specificity. Together the EEG and ERP provide uniquely powerful imaging which can not be matched by any other medical imaging approach with respect to temporal resolution. We have millisecond time domain resolution using these electrographic EEG and ERP approaches, whereas the functional MRIs and PET/SPECT approaches are “smeared” across time, with 100 to 1000 times less resolution.
It is a shame that human tragedy seems needed to move opinions and practices after-the-fact. I am encouraged that these modern imaging tools are providing us with tools that allow insight into these physiological processes.
The neuroscience is moving ahead, and older approaches have been shown to be unreliable, but superior methods are now available and are being proven in solid neuroscience research internationally.
Jay