Concussion Data, Articles, & More

Now that it's football season (Go Giants!), it's also time to rethink concussions in the sport. There have been some good articles lately, such as Melissa Segura's heartbreaking story about three girlfriends/wives of retired NFL players. Also some indications that the NFL and NCAA are taking concussions seriously: Darrelle Revis was held out of yesterday's Jets game due to last week's head injury, and Arkansas' quarterback Tyler Wilson was held out of yesterday's game against Alabama.

Additionally, some of my students are working on sports infographics, including one dealing with concussions. I collected links to data & graphics for that class here as well.

Data on Concussions

• Concussion in Sports and Play: Get the Facts from the CDC. 
• Concussion resources from MedlinePlus, including these videos and medical encyclopedia entries.
• The Concussion Blog, maintained by Dustin Fink, a certified athletic trainer (ATC) working in Central Illinois. Includes weekly NFL Concussion Report, a compilation of reported head injuries in the NFL. Active on Twitter as @concussionblog.

Recent articles about NFL concussions & related issues

• Battista, Judy. A Player’s Concussion, a Family’s Ordeal: Former N.F.L. Player Mitch White Learns to Adjust To Postconcussion Life. New York Times, September 16, 2012.
• Holt, Bob. Tyler Wilson not OK to play. Alabama.com, September 16, 2012. 
• Leavy, Jane. Neuropathologist Dr. Ann McKee has been accused of killing football, but she may be the sport's only hope. Grantland, August 17, 2012. 
• Segura, Melissa. The Other Half of the Story: Too Often Forgotten in the NFL Concussion Debate are the Wives and Girlfriends. Sports Illustrated, September 10, 2012.
• Shpigel, Ben. Darrelle Revis Ruled Out of Jets-Steelers Game After Concussion. New York Times, September 14, 2012.

Bibliographies & Resources

• NFL Evolution - Health & Safety Resources. News & links from the NFL on their efforts to address concussions in the league. 
• Publications by the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at UNC-Chapel Hill, 2008-present. (see a librarian to get the full-text of any of these articles!)
• Prior CogSciLibrarian blog posts tagged concussion.
• Scientific Publications on CTE (chronic traumatic encephalopathy), generated by the Sports Legacy Institute.

Just a Ding? Good overview of concussion issues in the NFL

Andrea Goetschius, one of my student colleagues at the University of North Carolina School of Journalism and Mass Communication, wrote a terrific case study called

"Just a Ding? The NFL Responds to Research on Football-Related Concussion" (summary & links; pdf)

It's a terrific overview of the concussion issues the NFL and its players have been facing for the last few years. It starts with the first cases of CTE (chronic traumatic encephalopathy) that neuropathologist Dr. Bennet Omalu, discovered during the autopsies of three former NFL players. It chronicles former WWE wrestler Chris Nowinski's interactions with the New York Times' Alan Schwarz, as well as his founding of the Sports Legacy Institute at Boston University. Throughout, Goetschius chronicles the NFL's response, ranging from the Mild Traumatic Brain Injury (MTBI) committee to the revamped Head, Neck and Spine Medical Committee.

There are also four pages of citations, which provide more information on all of these issues. I've read most of the articles Goetschius cites and she's done a great job of synthesizing all of them into a 9-page case study.

And the Arthur W. Page Society* agrees with me: they awarded Goetschius's case study the Grand Prize in its 2011 Corporate Communications Case Study Competition (all papers in this year's competition look interesting!). *The Arthur W. Page Society is "a professional association for senior public relations and corporate communications executives."

If you're interested in the topic of concussions and NFL players, this case study is worth a read.

Concussions

Not surprisingly, the spate of concussions on Sunday, Oct. 17 yielded a lot of discussion among newspapers, magazines, and the blogosphere on the safety of the game of football as it's currently played in the National Football League. Here are some of the items that caught my eye and are worth another look:

• The November 1, 2010 issue of Sports Illustrated has CONCUSSIONS on the cover, complete with a stunning cover photo of Steelers linebacker James Harrison's hit on Browns wide receiver Mohamed Massaquoi. Inside are several articles, including a conversation with Ravens linebacker Ray Lewis on concussions and modified play and a discussion of how players might better protect themselves from concussions (via tensing their necks).
• I most enjoyed David Epstein's article Unexpected Findings: The Damage Done, which chronicles research at Purdue detailing the cumulative effect of minor hits to the head throughout a game and season.
• Peter King's cover article includes a great description of Boston University's Ann McKee (associate professor of neurology & pathology; diagnoser of chronic traumatic encephalopathy, or CTE, in football players, in former NFL players) getting ready for a football-ful Sunday.
• The articles are good, but the entire package is so well-done (and the photographs so striking) that I recommend buying the print issue, or reading it at your library.
• The New York Times has been giving this a tremendous amount of coverage, of course. I particularly enjoyed William C. Rhoden's October 19 column Thirty-Yard Penalties Would Help Lower N.F.L. Violence and Michael Sokolove's Oct. 23 "Week in Review" essay Should You Watch Football? (yes).
• Finally, Tweeter and blogger @concussionblog counts the hits at The Concussion Blog. It's a grim, but useful accounting of who got hit when, and not just in the NFL. Dustin Fink includes rugby, soccer, MLB, and more in his counting. He also does a nice job linking to current coverage of concussions around the country.

For More Information

• The Purdue Study:
• Talavage TM, Nauman E, Breedlove EL, et al. Functionally-Detected Cognitive Impairment in High School Football Players Without Clinically-Diagnosed Concussion. Journal of Neurotrauma. October 2010. [Epub ahead of print]

The NFL & the Brain

I'm going to (try to) keep track of much of the reputable coverage of the NFL, concussions, and long-lasting effects of concussions on brain health. Recent coverage includes:

WVU's Dr. Julian Bailes and Bennet Omalu, M.D., a neuropathologist now practicing in California, appeared on ABC's Nightline program (with guest host Martin Bashir) on October 16, 2009 to discuss the long-term impact of concussions to NFL football players.

• Concussions and Congress and the Future Game NYTimes.com Fifth Down Blog, Nov. 1, 2009. Includes YouTube video of Representative Linda Sánchez (D., CA) questioning NFL Commissioner Roger Goodell.
• Hard Knocks: Does Playing in NFL Cause Brain Trauma? Online NewsHour (PBS), Oct. 29, 2009.
  
• Malloy, Daniel. Hearing spotlights NFL concussions Pittsburgh Post-Gazette, Oct. 29, 2009.
• Schwarz, Alan. Commissioner Criticized Over N.F.L.’s Handling of Players’ Brain Injuries. New York Times, October 28, 2009.
• Schwarz, Alan. In Gay Culverhouse, N.F.L. Players With Head Injuries Find a Voice New York Times, October 27, 2009.

Catch up on current stories about nfl concussions via Google News.

This is Your Brain in the NFL

As I watched the Giants play football yesterday, I rooted for my favorite players, the offensive line, to have a great game. I also worried about their future, as those players are often susceptible to debilitating brain injuries after retirement.

That's according to some recent and troubling stories about brain injuries among former NFL players. The most detailed is the most disturbing: GQ's October 2009 article entitled Game Brain (available only through GQ's web site in a Very Clunky Format; soon to be available in LexisNexis & InfoTrac). Author Jeanne Marie Laskas interviews neuropathologist and self-proclaimed "brain chaser" Bennet Omalu in his quest to identify this new strain of "punch-drunk syndrome," formerly associated only with boxers. He calls it "gridiron dementia" in his readable and sobering book Play Hard, Die Young: Football Dementia, Depression, and Death.

Omalu named this disease strain chronic traumatic encephalopathy (CTE) and published his findings in the journal Neurosurgery; Laskas notes that the article contained "scientific evidence that the kind of repeated blows to the head sustained in football could cause severe, debilitating brain damage." What Omalu found literally were "[b]rown and red splotches. All over the place. Large accumulations of tau proteins. Tau was kind of like sludge, clogging up the works, killing cells in regions responsible for mood, emotions, and executive functioning."

Laskas also spoke with Julian Bailes, a neurosurgeon of considerable renown who had for a decade worked as a Pittsburgh Steelers team doctor. Bailes, chairman of neurosurgery at West Virginia University Hospitals, who was the first to tell Omalu that he believed in his research. The GQ article details both the medical quest to identify and the political issues as Omalu, et al. try to convince the NFL of their findings.

Since it's football season, there are some other articles about this as well, including one from last month's New York Times and today's New Yorker.

image from GQ

For More Information

• Carpenter, Les. 'Brain Chaser' Tackles Effects of NFL Hits Washington Post, April 25, 2007.
• Gladwell, Malcolm. Football, Dog Fighting, and Brain Damage The New Yorker, Oct. 19, 2009.
  
• Laskas, Jeanne Marie. Game Brain. GQ. October, 2009.
• Omalu Bennet, et al. Chronic Traumatic Encephalopathy in a National Football League Player. Neurosurgery. 57(1):128-134, July 2005.
• ----. Chronic Traumatic Encephalopathy in a National Football League Player: part II. Neurosurgery. 59(5):1086-1093, November 2006.
  
• Omalu, Bennett. Play Hard, Die Young: Football Dementia, Depression, and Death. Lodi, Calif. : Neo-Forenxis Books, 2008.
  
• Schwarz, Alan. Dementia Risk Seen in Players in N.F.L. Study. New York Times, September 29, 2009.

Additional Info:

• Study Links Concussions To Brain Disease 60 Minutes - CBS News, Oct. 11, 2009.
• Fatsis, Stefan. Health Care Reform ... for the N.F.L. New York Times Op-Ed, Oct. 11, 2009.
  
• New York Times Fifth Down Blog, Malcolm Gladwell on Concussions, and the Gagliardi Solution Oct. 18, 2009

Concussion Awareness Research

Today's News & Observer had an article about the UNC football team, a body temperature pill, heat-related injuries, and concussions. Combine football with science, and throw in a brain injury ... and I'm hooked.

This CorTemp capsule allows coaches to monitor players' body temperature, which is helpful in assessing whether or not they should continue practice in hot weather. The N&O article has a neat photo of a player's temperature being taken through his back.

The pill is also part of a study that is assessing situations that could promote concussions. Kevin Guskiewicz, head of UNC's department of exercise and sport science, referred to a "theory that dehydration could make concussions more likely;" he added that because symptoms are so similar, it can be difficult to tell if a player is dehydrated or if he has suffered from a concussion.

Guskiewicz has been working on another study, in which sensors are inserted in players' helmets to correlate the amount of force it takes in different locations for a player to sustain a concussion. Used together, the temperature pill and the helmet sensor can help determine if the player has sustained a concussion. Further, because Guskiewicz has been testing the pill on other teams, he says that the the aggregate data can help " 'compare the G-forces to the temperature, and try to correlate whether the [G-forces] get higher when the body temperature is hotter.' "

I'm glad to read that researchers are trying to develop methods to prevent situations that can cause dehydration and concussion, because ... I'm ready for some football!

For More Information

• Pickeral, Robbi. UNC Gauges a Gut Reaction. News & Observer, August 12, 2009. page A1.
  
• HQ Inc. Press Stories and Downloads (about using the CorTemp pill to detect stress). Sources include NBC Nightly News, a PowerPoint showing CorTemp's use on the Minnesota Vikings in 2006 training camp, and a 2006 IEEE Spectrum article on CorTemp.
  

Concussion Study Among Athletes

Twelve retired sports players have pledged to donate their brains to Boston University’s Center for the Study of Traumatic Encephalopathy (at BU's School of Medicine) which is devoted to studying the long-term effects of concussions. The Center said last week in a press release that the brain of former Houston Oilers linebacker John Grimsley "... exhibited pronounced chronic traumatic encephalopathy (CTE), a condition that is often seen in retired athletes, such as boxers, who have a history of repeated concussions.

The New York Times notes that one of the NFL players who is donating his brain, former New England Patriots linebacker Ted Johnson, "... hoped the center would help clarify the issue of concussions’ long-term effects, which have been tied to cognitive impairment and depression in several published studies." The Times reports that the NFL believes that "... the long-term effects of concussions are uncertain."

Players do not intend their donation to be a condemnation of the NFL; the Times quotes Johnson: "I'm not being vindictive. I'm not trying to reach up from the grave and get the NFL. But any doctor who doesn't connect concussions with long-term effects should be ashamed of themselves." ESPN.com quotes former NFL linebacker Isaiah Kacyvenski: "There might be a connotation that this is a witch hunt, point the finger at the NFL. It's just not like that."

Six NFL players' brains have been examined post-mortem, and five were found to have evidence of chronic traumatic encephalopathy. Dr. Ann C. McKee, a co-director of the new brain-study center, told the Times:

“I’ve seen thousands of brains of individuals with neurogenerative diseases and debilitating diseases. I can say this is identical to the pugilistica dementia that I’ve seen in boxers in their 70s and 80s. It’s milder because the patients are younger. But once triggered, it seems to progress. The people that develop this disease, most of them show symptoms 10 or 20 years after retirement. It progresses inexorably until death.”

While it's only five cases, McKee says, it is a strong argument for "unequivocal evidence that on-field impacts were a primary cause of the damage, perhaps in association with genetic and other factors her program will attempt to identify."

Boston University released a statement about the study on September 26, which includes some convincing images of brain damage which is an "an indicator of the degenerative brain disease CTE." The images from Dr. McKee show a "microscopic brain section from a 65-year-old control subject," along with a creepy image of linebacker John Grimsley's brain, and a disturbing image of the same cells of "a 73-year-old world-champion boxer with end-stage CTE and dementia."

The press release at Boston University quotes John Grimsley's wife Virginia, who says she plans to reach out to more NFL players, urging them to consider participating in the BU study. "The stigma needs to go away that you’re a sissy if you come out of the game and don’t go back in. A concussion is a big deal. It’s not just a ding."

For More Information

• Former players to donate brains for study of concussions. ESPN.com, September 24, 2008.
• Daniloff, Caleb. NFL, U.S. Soccer Athletes Donate Brains to BU: New Center to Study Concussions and Permanent Damage. BU Today: Science & Technology. September 26, 2008.
  
• Schwartz, Alan. 12 Athletes Leaving Brains to Concussion Study. New York Times, September 24, 2008.
  

Test to Assess Concussion

The NewsHour reported on Nov. 26, 2007 about a test that measures cognitive impairment after concussion, and is more accurate than the more common "how do you feel" assessments that are done before sending athletes back onto the field following concussion.

Betty Ann Bowser reports on "ImPACT, which stands for immediate post-concussion assessment and cognitive testing, a sophisticated computer program that measures function in all four lobes of the brain. It is the first diagnostic tool developed that can map out how a concussion has caused impairment." She interviews Mickey Collins, neuropsychologist and assistant director of the University of Pittsburgh Medical Center, who says that ImPACT "... looks at one's ability to remember information. It looks at one's reaction time. It looks at one's ability to multitask, to do two things at once. It looks at one's ability to really maintain attention and concentration." He also comments:

You can't manage concussion with a cookbook. The minute I hear a clinician say, "You've had a concussion, sit one week out, and you'll be fine," is the minute I realize the clinician has no idea what they're talking about.

One of my favorite Giants, Antonio Pierce, was diagnosed with concussion following a recent game. He played again the next week, but ... was he really ok to play? Here's more about it, according to the Canadian Press (Nov. 15):

"Antonio Pierce vowed to play for the New York Giants against the Detroit Lions despite nagging 'little headaches' from a concussion suffered last weekend.

" 'If I ain't totally broke and I can play and run, I should be out there, and I think I will be,' Pierce said Thursday after missing his second straight day of practice for Sunday's game in Detroit." [article no longer available online]

I can't find any mention of it since then, and he's played all games, so I guess he's ok ... but after hearing more about concussion from the NewsHour, and knowing what happens to many retired NFL folks ... I worry.

Wayne Chrebet, terrific (retired) receiver for the Jets retired because of postconcussion syndrome two years ago. The Times reported on Dec. 22 that "Mr. Chrebet, 34, has recently acknowledged he has bouts of depression and memory problems so severe that he cannot make the routine drive from his New Jersey home to his Long Island restaurant without a global-positioning system." They refer to an interview with Chrebet published in the Star Ledger in early September:

"Six documented concussions - in all probability, he suffered twice as many in his career - forced Chrebet, the sure-handed and fearless wide receiver, into retirement after the 2005 season. Today, the migraines and darkness still stalk him, sneaking up from behind like a cheap-shotting cornerback."

I'd like to see more care taken to diagnose concussion on the field and more caution when sending folks back in to play. Moral question: should I stop watching football because it's so potentially dangerous to the players' brains? [sigh]

For More Information

• Bowser, Betty Ann. New Research Raises Questions on How to Treat Concussion 'Epidemic'. NewsHour, November 26, 2007. Discussion & links.
• DiCaro, Martin. Concussions - Part 2. Posted Nov 17, 2007. Another story at scout.com about the Jets and others on concussion.
• ImPACT test Web site.
  
• Manahan, Kevin. Jets Great Chrebet Ready to Say Goodbye. New Jersey Star Ledger online, September 19, 2007. Partial story online for free; full-text available @ your library.
• Schwarz, Alan. For Jets, Silence on Concussions Signals Unease New York Times, December 22, 2007.