Concussions Part 1: Head Injuries and Chronic Traumatic Encephalopathy In Pro Athletes


Uploaded by MSLawdotedu on 11.04.2012

Transcript:
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the sports world has long glorified athletes who play through pain
they're gritty they're gamers they have heart all positive attributes
their creaky knees and aching backs are testaments to their warrior like playing
days
but this play at all costs mentality is creating an epidemic that in some cases
carries the ultimate price
in a four month span in two thousand eleven three former n_h_l_ enforces passed away
all under the age of forty
at least one of them was known to have chronic traumatic encephalopathy
or c_ t_ e_
damage to the brain as a result of repeated blows to the head
among many others one of the effects of c_t_e_ is depression
the two players whose autopsies were not made public committed suicide
and two of the players struggled with substance abuse
you know it's it's pure speculation to assume some of the recent NHL deaths
are associated with
brain injuries until you study the brain
our experience has been that we've studied the brains of two enforcers
both who had
those sorts of issues including depression and and strange behaviors
both of them were suffering from chronic chronic traumatic encephalopothy
would i be surprised i would be most surprised if any of those three athletes
did not have
CTE
so
would could CTE have contributed to their outcomes
absolutely
do we know for sure we'll you can never know
but our c_ t_ people in the brain bank now many of them committed suicide
most of them suffered from depression most of them suffered
from uh...
impulse control issues
most of you know many of them suffered from
drug overdoses that had late onset drug addictions of you know
within the last few years of their life
didn't it wasn't something a life issue so
um... I would be surprised if
one of you know any of those three did not have the disease to be honest
well let's kinda think about what goes on in the medial temporal lobe of the brain
and think about where c_ t_ e_ is most maximally involved the abnormal tau
protein deposition is in the medial temporal lobe
and the medial temporal lobe of the brain along with the under surface and tip of
the frontal lobe
is the part of the brain that most often is injured with these jarring shaking
movements that occur
so not just in c_t e but in concussive injury
you can have injury to the medial temporal lobe
in the medial temporal lobe is housed our memory
uh... especially recent memory and with it's connections to the frontal lobe is
housed our what we call executive
function our abilities to multi task to do multiple things at the
same time
so cognitive functions are medial temporal lobe addictive behaviors are medial
temporal lobe it also houses
uh... in the amygdala and inter rhinal our limbic system which is our
emotions
panic anxiety
depression
all of that's medial temporal lobe
so if you injure that area of the brain
you can have dysfunctions in any and or all of those areas
chris nowinski is a former college football player and professional wrestler and the
author of
head games football's concussion crisis
after absorbing numerous blows to the head both in football and especially in
wrestling chris now suffers from post concussion syndrome
and not a week goes by in which he does not feel its effects uh... but it's it's day
to day i actually feel terrible today
and uh...
you know it's just one of those things you wake up and and everything seems a little
fuzzier than usual
uh... you know I tried to have four or
five coffees to kinda get my brain to where
i feel it was yesterday I don't know uh... just not consistent like I was
but uh...
but I you know i'll take what i have today
I don't want it to get
much worse
but I'll take what I have today
well i didn't realize i was getting concussions at any point along the way
until i actually had to retire
um... the last concussion the only one that ever made me tell anyone
uh... i was wrestling the dudley boyz in hartford connecticut and bubba
kicked me in the chin really hard and when i hit the ground i remember a
throbbing headache and complete disorientation where I didn't know where I was
what we were doing how we were supposed to finish the match or anything and so
when i got we finished though of course we didn't stop this was two thousand three you didn't call
time out and we went backstage and the trainer stopped me and he said you look like
something went wrong you know did you get hit in the head
and i told them to leave me alone
and
uh...
those headache though never went away
and so i
i remember
holding my head it's throbbing uh... on the ground for hours before i left the
arena that night
and
for five weeks with a headache and with memory problems i kept wrestling and
working out every day for the first the time in my career I was forgetting
spots in matches and things I was supposed
actually during a live broadcast I forgot my lines like that stuff had
never happened to me
uh... then uh... i had to stop and then I met doctor robert cantu who became
my first my doctor now
my mentor but
he was the first doctor
to help me appreciate the fact that I had been getting concussions all long
simply by asking me two questions first one was have you had concussions
before i said no
and he said ok have you been hit in the head or seen stars or got dizzy or got confused
I was like yeah a lot he goes okay those are concussions I'm like really
you know twenty four
college graduate
I should know that been banging my head for nineteen years at that point
uh... so then in his office just remembering I could remember at leaset five others
actually I was just uh... exchanging emails with one of my concussors a guy named spike dudley who
in our match had elbowed me in the face and given me this scar
and uh... i remember having double vision for the rest of the the match and so i
wouldn't tag back in
but after the match the only concern was gluing my face back together and not
anyone asking why I didn't tag back into the match they thought it was the cut
uh... in football the sky would change colors on me a lot
when i got helmet to helmet hits at least a few times it would go orange and that's
how i would remember that
something was a little wrong
but that's you know they weren't that spectacular you know one was a kick
to the head that caused a
about a ten-second blackout I remember being on one side of the ring and realizing I'm on another
but in the match I also broke my nose so again I never spoke up
in two thousand seven chris and doctor robert cantu founded the sports legacy
institute
a non-profit organization devoted to sports concussion advocacy research and
education
a year later the institute collaborated with boston university school of medicine to
form the center for the study of traumatic encephalopathy
the center for the study of traumatic encephalopothy here at boston university
uh... we're trying to understand the long-term effects of repetitive brain
trauma which come in the form of the disease chronic traumatic encephalopothy
or CTE
we have
a number of programs really to help us appreciate what the disease is
and with the end goal being treating it and hopefully curing it
uh... it's been a incredibly neglected disease
it was first actually appreciated and named in nineteen twenty eight as punch drunk
disease
but it was found in boxers which is why they called it and I don't know if none had sympathy
for boxers or something but
there was no doctor or research center ever
in the next eighty years
that was ever focused on this until we started ours
and so um... we have now the world's largest athlete brain bank with ninety
six cases
of uh... of
athletes who've past away and their families have donated
uh... doctor ann mckee runs that study she's completed over seventy
analyses and over fifty have shown this disease which tells us it's
must be more widespread than anyone ever realized
and then uh... we have a basic sciences program to appreciate how the disease
how the disease actually starts and then we have a clinical program of a five
hundred athletes that are signed up to donate their brains when they pass away
including me
uh... of which the high-risk group is being tracked
annually with cognitive evaluations and phone calls
and with that
that'll be the population that we actually
do intervention studies with and one we're kicking off shortly will involve
actually trying to find what's called a biomarker for the disease or a way to
diagnosis it in living people so that'll mean that now we'll be scanned with m_r_i_'s
and DTIs and MRS and they'll be taking blood and spinal fluid and genetic
material
and all these different ways that hopefully we can find a pattern
that'll tell us this you have this in living people
what are you doing now to raise awareness for concussions
well I donated my brain
uh... that's that's a tough one
when you sign that paper
uh... that allows ah...
doctor cantu or
someone from the institute
to uh... essentially cut off the top of your head and remove your brain
uh you know you're
you're walking the walk as we say
uh... so so that's my primary
contribution
uh... to
to the issue
why is this cause so important to you
it started
uh... because
i couldn't simply couldn't believe that i didn't
know the information that i was taught by dr cantu as an athlete
that i was out there completely recklessly
uh... getting hit in the head and and
didn't care
i know i would have changed my behaviors had i had this information i know that i
wouldn't have gone through five years of post concussion syndrome and I
it became readily apparent that other people wouldn't be doing this to themselves
either
you know there's a few kids every year who die from second impact syndrome because
they think they're being tough by not talking about their concussions
there's now you know
hundreds thousands tens of thousands hundreds of thousands of ex-athletes
walking around
with CTE in their brain that are e-mailing calling us every day going i wish
i knew about this because i didn't need
to lead with my head i didn't need to lie about my concussions and so
the goal when I originally wrote head games was just to simply give everybody a
choice
to say i i i
tanked my own career out of pure ignorance I wouldn't have done it this way again
if you have this information you won't do the same thing
tom mchale was an n_f_l_ offensive lineman for nine years
he died at age forty five leaving a wife and three children the oldest of whom
has cerebral palsy
after allowing his brain to be examined by the center tom's widow attributes his
death to the concussions he suffered during his career
and clearly now when you look back and i see the images of his brain and I
hear doctor mckee you know say his area his brain was it was damaged significantly
in the areas that control impulses and decision making and you know emotional
liability all the things that are seriously hampered you know by that
that you need to get in order with substance abuse and i believe uh... with all my
heart that he's dead because of chronic because of CTE
did you know your husband was suffering from the effects of head trauma
had absolutely no idea
in fact uh... when i got the phone call about donating his brain
it was really the first time
that uh...
I had ever thought about at all and in fact i said you know i guess uh
you can have his brain but you're not going to find what you're looking for because I had never know tom
to have had a concussion
uh had never heard of chronic traumatic encephalopothy
and uh you know in fact of all the in in watching him struggle for all for really a number of
years
uhm it never once crossed my mind
never occurred to him
that it could have anything to do with playing sports
ron johnson was an nfl running back from nineteen sixty nine to nineteen
seventy five
the majority of that time with the new york giants with whom he earned two
pro bowl honors
his wife started noticing changes in his behavior in two thousand five
three years before his diagnosis of alzheimer's
my husband uh is going to be sixty four next week and he
was diagnosed officially
july of '08
when he was sixty so we started noticing
as a family
two to three years prior
to '08 as early as '05 when he was in
his late fifties mid to late fifties just so many things
initially it was flukish losing his keys
not remembering where he parked the car
getting maybe an extra speeding
ticket that you know just
erratic type things
not following up with business things we have a family business
and uh my son our son works
with their uh…my husband
in the family business after undergrad he went into the business
so he was noticing
it at the office
on a day in and day out basis and I was noticing it at home on a
personal level and his moods and his behavior personality changed 0:13:31.100,0:13:32.320 he became much more highly agitated
much more frequently
about inconsequential things I mean small things would just set him off
I subsequently learned from the doctors that this was his way of covering he understood that he was uh having diminished cognitive funtioning 0:13:53.520,0:13:56.250 and because he's such a bright person
this was his way of compensating for it and when he failed he was angry with himself and so he vented outwardly 0:14:07.960,0:14:14.960 because he was so frustrated so this went on and on you know for two or three years and then it just became increasingly increasingly obvious 0:14:23.900,0:14:30.880 that there was a disconnect that something was terribly terribly wrong and he himself started to withdraw because he understood he was not able to function
how many concussions would you estimate he had
well that's just it technically my husband's never been diagnosed as
concussed and you know as I've educated myself my husband stopped playing in 1978 back then 0:14:45.760,0:14:49.830 the definition of concussion was so very
very narrow a player had to be literally
knocked out unconscious taken
off the field on a stretcher
before someone would say mm maybe something's going on here
you know fortunately my husband
was always able to
jump up
you know he might have been down briefly and
we we're always more concerned
he was a running back about the appendage
injuries which my husband did he had
two zippers one on each knee and a thigh
a hematoma
and later on after he retired he
had a uh two vertebrae replaced in his neck
so it was always appendages never
every did we think about any type of cognitive
injury or whatever
but obviously it was there just latent
we didn't know about it
so uh...
that's our story
that technically
there's no concussion history but there definitely is a trauma 0:15:48.900,0:15:52.050 a head trauma there's no doubt about that
part of the problem is that players may hesitate to report symptoms
they may believe their injuries are no big deal
or they'll try to tough it out and return to the game for their team
there maybe pressure from parents other adults or other players to keep playing
don't let your athlete convince you that they're just fine or that they can tough it out
emphasize to athletes and parents that playing with a concussion is dangerous
if a coach suspects a concussion in a young football player it is critical
that that player not return
to play or practice
if one of your players has a concussion their brain needs time to heal
a repeat concussion one that occurs in a short time period before the brain
recovers from the first can be very dangerous as it may slow recovery or
increase the chances of long term problems it can even be fatal
most people who suffer a concussion fully recover however returning to
sports and other regular activities to quickly can add weeks or months to an
individual's recovery time
for boys and girls who are in school concussions not only affect
sports performance they can affect school
performance as well
students may find they can't do their homework they can't concentrate or study because it prolongs their symptoms
jus like a premature return to sports
exercising or activities that involve concentration such as studying working
on the computer and playing video games may cause concussion symptoms
such as headache or tiredness to reappear or get worse
after a concussion physical and cognitive activity such as studying
and learning should be carefully managed and monitored by a health care professional
doctor eleanor perfetto serves on the board of directors for the sports
legacy institute
her husband ralph wenzel was an offensive linemean for the pittsburgh steelers san
diego chargers and st louis cardinals and he has resided in an assisted living
facility for the past five years
he is sixty eight
i'm when we first had
an appointment with the neurologist
who who was diagnosing him at that time the neurologist said to him
have you ever had concussions
he laughed and he said yes of course
i played professional football and
the neurologist said
how many
and he said
to many to even count and he said you ever get completely knocked out
and he said yeah a few times
and he said did you ever get
completely knocked out
and when you came to
you really had no idea where you were or what you were supposed to be doing
and he said oh yeah i did and he said I got up and I continued to play
and i was running the wrong way on the field and my
my fellow football players got me off the field
'cause i was running in the wrong direction
dr cantu one of the leading experts on concussions
is a co-director of the center
he explains that a concussion is more properly characterized as a process than
an event concussion comes from the latin word concussus which means to
violently shake
the brain is
violently shaken inside the skull
the frontal parts of the brain bounce off the
inner surface of the skull the occipital parts of the brain bounce
off the
uh... occipital part of the skull and then the temporal lobes are
very much traumatized in the middle faucet
and in reality the brain is experiencing both linear
which means longitudinal or in one plane
stretching forces as well as rotational forces which are twisting forces
that stretch brain tissue even more and as a result of those
uh... stretching of brain tissue axons
and neurons are rendered dysfunctional
well the event is the sudden violent shaking
and then the process is that over a period depending upon the severity of
the concussion
uh... that can be minutes hours days weeks sometimes years
recovery has to happen
and recovery
is reestablishing the correct ionic
uh... makeup and the correct neuro transmitters back on the
axons
that can be negatively influenced if the concussion is not managed properly
and the symptoms can be made to last a lot longer and sometimes can cause some
cells to die that wouldn't otherwise have died
how does one diagnose a concussion
it's a clinical diagnosis in every case and you make the diagnosis
by virtue of one of two or both
changes that happen
to the brain after it is uh been subjected
uh... to traumatic forces linear and rotational forces most of the time those
forces are traumatically induced by a direct blow to the brain or the head
striking an object
but they can be indirect blows as well a violent blow to the chest that snaps your
head forward
a violent blow to the back of your
thorax that snaps your head back that also if they're violent enough can produce
concussion symptoms
what are the symptoms well the symptoms are either A
uh... an alteration in level of consciousness which on one extreme
is coma unconsciousness which is uncommon but happens about five to ten percent of
the cases
on athletic fields
uh... or
simply being stunned
losing orientation for a period of time
so it can be either that
and or
any one of the other twenty-six post concussion symptoms
that can be brought on by these traumatic forces such as
difficulty remembering difficulty concentrating headache dizziness
light-headedness sensitivity to light sensitvity to noise trouble with balance
trouble with coordination and so on
so you can have
no alteration in level of consciousness just those symptoms occurring and it's a
concussion
or you can have just alteration in con uh... consciousness without those other
symptoms
but more often you kinda have both
how many concussions do you think and i know it's impossible to know for sure
go undiagnosed
probably somewhere between sixty and eighty percent and it depends upon the sport
sports that are
at high risk of concussion like football
ice hockey
for sure there have been studies I've been a part of an ice hockey study where
they put observers up in the stands and their job was to look at the rink
and when somebody got up slowly and looked like they may be a bit stunned yet went
back in to play to examine them between periods and determine whether
uh... they felt they had a concussion or not
and they found the incidence of concussion was seven times higher
from these physician observers than from the medical personnel on the bench and
there've been rumors football studies by delaney and others
that have shown that if you ask players at the end of the season when there
isn't an issue with peer pressure and coaches looking down on them and
all that kind of thing
about whether they've had concussion symptoms like after a hit have you ever
seen stars have you ever lost orientation could you not remember the
place
um about sixty to seventy percent of individuals will say yes during the season at
some point they've had these symptoms so they've obviously had a concussion
and yet only about five to eight or nine percent
of concussions are recognized
uh... in football during a season so
the unrecognized group far exceeds the recognized group
is it because of the athlete mentality i don't want to miss any playing time i want
to get back into the game pain is normal
or is it i had no idea that I even had a concusssion
well i think it's all the above
uh...
mike mcrae a neuro psychologist it's done a lot in the athletic arena
once
wrote a paper on exactly that subject
when concussions were missed
what were the reasons and the most common reason at the time i hope that's
not true now and i certainly
commend you for what you're doing with your program because it'll make it less
likely in the future
but the most common um...
reason at the time he wrote the paper a few years ago was that the athletes
didn't know what concussion symptoms were were not aware of the severity of
uh... playing through them and essentially life altering changes that could happen
uh...
receiving a concussion while already symptomatic
um but yes the
warrior mentality of collision sports
the not wanting to let your teammate down the fear of losing your position if
you let somebody else get in while you're on the sideline all of those
things were reasons that they gave as well
what is second impact syndrome
second impact syndrome is
an individual that's still symptomatic from an initial brain injury
and because the most common athletic brain injury is concussion most of the injuries
were concussions
but not all of them some were subdural hematomas that were missed
some were brain contusions or bruising of the brain
so the brain is injured
you have post concussion symptoms you have brain injury symptoms and then the
individual's subjected to another brain trauma sometimes very minor
and the brain loses its ability to control blood flow
it's a loss of auto regulation
blood flow
rushes in the brain
pools because it can't get out fast enough
and increases intracranial pressure
and sets up a scenario that's very unique to this condition where somebody
is
subjected to brain trauma sometimes not all that dramatic
uh... may get up a little stunned
but within minutes
two three four five
goes from this alert conscious state to being comatose fixed dilated pupils
respiratory embarrassment due to bring herniation
and it's a life threatening condition
m_r_i_ that shows evidence for intracerebral bleeding
what you see is this dark area here
uh... within the ventricle which is largely filled with blood
this is an individual that had quite severe intracerebral bleeding as a
result
of his brain injury
while concussions have always existed
awareness about the severity and pervasiveness of the problem has
increased in the past decade thanks in large part to nowinski and doctor
cantu
their center and nowinski's book head games
have played a large role in helping people to understand the long-term
damage that results from repeated blows to the head
it was through nowinski's desire to educate himself during his own recovery
that he realized how little had been reported about such a big problem
i couldn't simply couldn't believe that i didn't
know the information that i was taught by dr cantu as an athlete that i was
out there completely recklessly
uh... getting hit in the head and and
didn't care
i know i would have changed my behaviors had i had this information i know that i
wouldn't have gone through five years of post concussion syndrome and I
it became readily apparent that other people wouldn't be doing this to themselves
either you know there's a few kids every year who die from second impact syndrome because they
think they're being tough by not talking about their concussions
there's now
hundreds thousands tens of thousands hundreds of thousands ex athletes
walking around
with CTE in their brain that are
e-mailing and calling us every day going i wish i knew about this because i didn't need
to lead with my head i didn't need to lie about my concussions and so
the goal when i originally wrote head games was just to simply give everybody a
choice
to say i i i
tanked my own career out of pure ignorance I wouldn't have done it this way again if
you have this information you won't do the same thing
what grew out of that though was the appreciation that the long term affects were much
worse than i realized in two thousand and six
the concussion problem itself has not gotten worse it merely seems that way because
people have become more educated on what actually constitutes a concussion
well it's a traumatic brain injury that causes your brain to function
differently
at some threshold of force
uh... you get actually these chemical and metabolic changes within your brain
and your brain actually becomes injured and injured for a period of time not unlike a
broken bone where
it's very vulnerable and it needs time to recover
and and people didn't appreciate that this window is very long it used to be
if you were knocked out and you woke up and you could remember your name
you were good to go the concussion was over
we've now learned that everybody it takes days
or weeks for those chemical changes those metabolic changes
even some physical changes to go away
if they go away completely
the definition of concussion is a clinical one and people make it
different ways some people are very
careful about utilizing
neurologic exams and
symptom checklists
and uh... a variety of
tools so to speak to come to the conclusion somebody's had a concussion
and other people or more
superficial and they're willing to say that a given tool or two may be enough
to make the diagnosis
so there's a lot of literature out there that is based on
primarily neuropsychological tests
not taking into consideration also
that um... you need a neurologic exam you need a symptom checklist or you're
going to miss
uh... concussions if you just base them only on a neuro psychological test
score
because a neuropsychological test score is testing cognition
it's not testing balance issues it's not testing sleep issues it's not testing
visual issues it's not testing a lot of things that can
be off with a concussion
when you have
a concussive injury
you have this metabolic chaotic event
where the potassium that normally is inside the cell
goes outside the cell
so it goes from the inside to the outside extracellular space
it allows the positively charged calcium ions to replace them inside the cell
but these calcium ions shutdown the a_t_p_ which is the energy pump
that's needed to pump
them out
and pump
the potassium
back in
uh... so it leads to this metabolic dysfunction
and it's at this stage that the cell is alive but the cell is not functional
functioning
and if you stress it either physically or cognitively you can tip the balance
and cause this cell to die
and that's why the hallmark of concussion management
is physical and cognitive rest until symptoms have cleared so
uh... i think it's important that
that all of the tools in the tool box get used
now you write in your book
that one of the reasons for this concussion epidemic is
the lack of education awareness of high school and college athletes why is that
you know one of the things that first made me realize that no one has their handle
on this issue was the fact that we have never
really appreciated how many concussions actually happen
when medical professionals talked about this five or ten years ago
they would confidently say that only five or ten percent of athletes got
concussions each year and they were using data that was taken from athletic trainers
i knew and there were luckily some other doctors who new as well that
athletic trainers don't hear about every
concussion symptom that an athlete experiences and so by asking the
athletes themselves we found the concussion rate is not five or ten percent
it's more like fifty or seventy percent in contact sports like football soccer
hockey
every season so half the kids out there are getting a concussion every season
the only reason they haven't we haven't heard about that is because the athletes
have never known to say anything
we used to think it was 'cause athletes actually wanted to hide the injury when
someone actually did the study and asked the athletes they found out no it wasn't that
this was a choice this was that they didn't think a headache was worth
talking about or the fact that they saw stars for a few minutes
and so uh... that was kind of step one if you want to solve this problem you've
got to tell the athletes
what's happening
you know you get a hard hit
and your head doesn't feel right it's diagnosed as a concussion uh when we
were younger i believe that you know you had your bell rung and take a couple
deep breaths and relax and and you were right back at it
you know i was diagnosed with probably
two as a player
uh... you know mild ones but i'm sure i had
a few more than that
not the ones where you get knocked out unconscious but that's
you know we're learning now more about concussions and it's more than just a
the high end ones so i probably had
you know a handful
i think that it's
it's become okay to say you don't feel well
there's just so much more or
there's more knowledge on the concussions where at the time you just
sorta your head hurt and you just squirted some water on your face and just went out there and
kinda gutted through it i guess
i think all the leagues from from the lower leagues right up to the n_h_l_ have been
more proactive and i think that now
you know when kids
when you can see a kid get hit on the ice i think they're doing a better job
right away of of
taking the kid and and finding out what
you know how they feel
one report investigated the frequency of unreported concussions and estimated more
accurately
the rate of concussions in high school football players
this report showed that the most common reasons for concussions not being
reported included a player not thinking the injury was serious enough to warrant
medical attention
sixty six point four percent of unreported injuries
motivation
not to be withheld from competition forty one percent and lack of awareness
of probable concussion thirty six point one percent
concussions and other head injuries must be taken seriously
if you're a player protect yourself and your teammates if you think you're hurt don't hide it
report it and take time to recover if you're a coach or parent know concussion symptoms
and warning signs and never let athletes return to action before a health professional
says it's okay
help take head injuries out of play
to learn more contact the cdc
nowinski reports in his book that ten to fifteen years ago six separate studies
of high school and college football players
revealed a concussion incidence rate of four to eight percent
those studies were conducted by asking the trainers how many concussions they
treat each season
when the players were asked anonymously however the numbers jumped to
fifteen to seventy percent
what can coaches or what should coaches and schools be doing now to reduce the number of
concussions
well i think the most important thing that coaches and schools can do
is to have a concussion management plan in place
at all levels
and most importantly for the coach the athletic director uh... is that
if they don't have a certified athletic trainer as part of their staff if they
don't have employed team physicians as part of their staff
that anybody suspected of having a concussion
needs to be
pulled out of play pulled out of game play and or practice and cleared only by
somebody with that proper expertise
with a concussion
you can't do a study that will show you the injury
c_t_ is normal routine m_r_i_ is normal it's a clinical diagnosis
it needs to be made based on
the symptoms
a symptom checklist in going very carefully through every one in terms of
whether they're there or not
a neurologic exam
and part of the neurologic exam is a cognitive assessment
and yes a cognitive assessment
is done in a more refined manner
with computerized neuropsychological testing
but that's only testing cognitive function so it can't be used as a red
light green light or you're going to miss concussions
um for a coach to
suspect a concussion he's gonna have to have concussion education himself and
the same goes for the player and the same goes for the parent
it was between you know yourself and the trainer a lot of times
uh…you saw a doctor but at the end of the day it was a dialogue between uh...
yourself and a trainer and how you
felt
and uh... you know as a competitive athlete at the time you want to get out
there and play and sometimes you
dis disregard uh...
you know your body a little bit
well everybody I played with really
well i mean you know we're all we're all exposed to the same trauma
i was not special
you know the only thing that i did differently was three years of wrestling and get a few
extra concussions but
you know everyone I played with in high school everyone I played with in college you know we all talk about
this as we all know we're in a high-risk bracket
uh...
since then you know a day doesn't go by where i don't have a conversation
with somebody who's suffering
in their forties fifties sixties
uh who believe i mean i just got an email this morning from one of my old colleagues from the
WE saying hey my primary care just told me
that he's worried about my brain from all the knocks around you have someone i
can go see
you know and this guy's uh... early forties
and he's already obviously symptomatic and so
um... there's a lot more people walking around with this than we think
because it's not just the guys who played pro or college we even have
a lot of people in the brain bank who just played high school sports
and when do you think you
suffered your first concussion
uh you know that's it's it's a tough question i i would say probably uh…high school
probably was was the first time that you know
i was never diagnosed uh... i think at at that time we kind of said you know you
got your bell rung
how many do you think you've had since then
you know i was diagnosed with probably
two as a player
uh... you know mild ones but i'm sure i had
a few more than that
did you ever return
too soon for what you thought like maybe i shouldn't be out here yet
there was one
a little later in my career where uh...
you know i i know i didn't feel well
uh... actually
during that game
and i talked to the trainer i get hit in the head and
and uh... we discussed whether i should play or not and and i you know i said i
was fine and went out and played and and
you know that was a something that i
i wanted to be out there i didn't want to miss time but in hindsight it probably was
uh...
probably the wrong decision
mick foley has been a professional wrestler for more than twenty years
he is best known for being thrown from a cage sixteen feet above the ring
one-time into the announcer's table and another with a metal chair falling on
top of him a stunt that knocked him unconscious
knowing what you know now about concussions would you have done this
would you have wrestled and done all the crazy stunts that you did
well yes i would have wrestled
uh... i would have uh... changed a couple things around uh...
we didn't know at the time that uh one need not
be hit in the head
to suffer uh…a brain injury
so a lot of the things that i did were actually just very impactful to the body
but also you know kind of sent my uh my brain
uh... bouncing around in the skull so
had i known that i may have done things a little bit differently I probably would have
blocked a few of those chairs
uh... which is the normal reaction to a
a hard metal
object
uh... arriving at high speeds but uh... i was you know I was
young and naive at the time
did you ever return in the match when you knew
you might not have known you had a concussion but you knew you didn't feel right did you ever return in the
same match there was uh... one notable match where
the only time I was ever knocked unconscious
uh...
you know i guess if it had been uh... you know
uh... quote and i won't do the air quotes but quote unquote real sport the match would have
stopped
but probably my most
famous or infamous match involved me being
knocked unconscious
and uh...
and returning
uh... which is not something that would happen now i think that was the last
time you will ever see
a wrestler knocked out and uh...
and uh... and continue out of
the for you know for the
well-being of the performers
was there pressure to return when you wrestled
always
internal pressure i don't think there was ever external pressure
i think now
uh... guys are finding out that uh... it takes a tougher man to admit when he's
hurt
than uh than to pretend when he's not
so I definitely see a
uh... a change in mindset
for the better when it comes to head injuries
jay fiedler was an n_f_l_ quarterback for eleven years leading the miami
dolphins to a division title in two thousand
kyle turley was an offenive tackle for this for nine seasons playing for the
new orleans saints saint louis rams and the kansas city chiefs
while both players acknowledge having suffered concussions only turley is
believed now to be suffering from the effects of c_t_e
like foley neither regrets his decision to play the sport and both concede that
they would do it again
you know I knew about concussions with
you know when i was growing up concussion was defined by
being out cold
pretty much uh... and seeing stars
uh...
you know not like it is today
did you
know or think that you had concussions
you know there were a couple times that i you know
probably in my college
and pro career that
you know at the time i got
dinged up and you know
a little dizzy
and kinda knew that it
was a concussion but uh you know
it definitely wasn't a diagnosed concussion at the time
how many do you think you had before you actually knew you were having concussions
I didn't I don't think I had very many but
you know uh... I mean the ones that i knew about i i i knew about
uh... i'm not sure if there was any that uh...
would be diagnosed now that
you know i would have felt uh back when i was playing how many of the ones that you
knew about did you have
'bout three or four
would you have continued to play
if you knew now
knew then what you know now about concussions
ooh you know that's a tough question i probably would
you know ... i'd want to be out there uh...
you know none of my concussions
uh you know had me out cold 0:42:18.909,0:42:23.309 uh... had me you know in a state where i felt i was uh
you know not uh...
able to perform
and go out there and and have my senses and wits about me
but I'm sure now you know with all the
you know with all the studies and research that's out there
you know i know now that I really didn't have all my wits
uh you know even though that i felt that i did
would you have done anything differently
no I don't think I would have
uh... you know i'd probably do do everything all over again
I'd expect the medical staff would uh...
you know might have kept me out of one or two of those games though
speaking of medical staff and trainers and coaches did you ever feel pressure
to return too soon
either in the same game or a subsequent practice or game you know I never felt
pressure from anyone else uh... that was more more internally
uh...
you know i wanted to be out there i was always you know a job security issue
uh... you know as an athlete you always uh you know you never want anyone else to take your place so
uh...
you know whether it was a head injury or any other injury you know if i was able to
go out there and perform that's what i wanted to do
I uh... I've had
over my career I played about ten years and had a
number of concussions looking back and then some a couple very serious ones uh... was
hospitalized once and
and then post career
had an episode
of blackout episode and was hospitalized for a few days and
the doctors
didn't know what was happening and then real severe vertigo and vomiting all over and
and uh some seizure activity and things like that
um which was
quite concerning and
to not only me but to the doctors 'cause they didn't know what's going on
uh... so
the answer pretty much just came back the only thing they can relate it to is my
activity from playing football and
the multiple concussions that I received
did you ever feel pressure to return to a game either when
you had a concussion or too soon to practice oh yeah yeah yeah I mean
the sport of football especially
is uh... you know one of those sports that
you're expected to go
it's not a question you know uh
as as a player
you pride yourself on
being there that's part of it you know
that toughness side of it that that was instilled in you as as a kid
that you've gotta push it that you gotta go you've got to be there for your team
and your teammates so that
overrode a lot of you know
decisions that would
make more sense to not play uh you know
because you had to be there for your guys and your team
how are you feeling these days
you still feel the effects of the concussions
you know what i realize
that uh... when they occur
they A
occur more easily and B require more time off so i may have had my last
match I may have
uh... one more left in me but i the last time i felt I got a concussion
I I
drew the line and said i can't i can't do this anymore
you wrote in head games about two incidents in which NFL quarterbacks brett favre
and kurt warner
suffered a concussion during the game yet finished the game anyway per their
coaches decision
who makes the decision is it the coach is it the trainer is it the medical
the team doctor and who should make the decision
today medical professionals are the only ones making the decision
and that hasn't always been the case so if you do have a team with multiple
medical staff your most senior person or your expert should be making that
decision
athletic trainers are incredibly well trained on this issue and often better
than a lot of doctors
but historically
we've been letting coaches make that decision
and there's a lot of reasons why that was
that some of it was ignorance but not all of it
some of it was that at the pro athlete level the doctors have a huge conflict
of interest
and a lot of them like being the team doctor and if they hold the star quarterback out in
the fourth quarter they would be fired and the fact that there haven't been
doctors fired every season out of the n_f_l_ means that they've been doing
what the coaches have asked
even if it was against their better judgment and there's
overwhelming evidence of that and i know this from
you know friends of mine that have played in the NFL
so um...
yeah unfortunately we've been leaving medical decisions about the most important organ
of the body up to coaches who are paid millions of dollars to win
now you mention team doctors
how do team doctors who frequently as you revealed in your book pay for the right
to be the team doctor how does how do they contribute to the concussion problem
it's amazing the power that that team doctors have contributing to the problem
because
everybody models themselves off of the pros whether it's doctors themselves the players
coaches and so you know the best example is is wayne chrebet in two thousand
five
who was knocked unconscious
playing for the new york jets
face down in the field for a minute
every published guideline since doctor cantu first published guidelines in
eighty-six says they're knocked out they aren't going back into the game
it was even his eighth
diagnosed concussion
in the n_f_l_
but the team doctor who happened to be the head of the n_f_l_'s concussion
committee elliot pellman who was not trained in concussions he's a
rheumatologist
put wayne chrebet back into the game ten minutes later and he finished the game
and what that tells
everybody watching
which is a
you know these are the most popular things on television is that kids know that
they should be tough and get back in there the doctors believe that that's
if the NFL doctors are doing it that must be the standard of care
and and therefore they were kind of complicit in perpetuating this myth
that you recover from a concussion if you wake up from being knocked
unconscious when that you know you
you could say you look at various points in time where that shouldn't have been based
on the literature
it goes pretty far back we should have
we've probably known this for a long time
well you know i think there's risk in in any sport that you play you know football's not the
only sport that concussions are prevalent in uh
you know i think uh...
you know i i think personally the lessons that you learn from football and
the life experiences that
uh... that that you can gain from it uh... you know have tremendous value
you know I think you also have to be aware of
you know what the risks are
and make sure that you know if uh
you know you come into a situation where the risk factor all of a sudden increases a
significant amount
you know whether it be a
concussion or or other injuries
you have to know what you're what you're getting into ahead of time
knowing what i know now i could've addressed those
you know situations a lot better when i had a concussion i can say alright I'm out
and uh…I need to wait until i'm not experiencing these things anymore
before I come back to play
especially on the serious uh you know cases where
you know you get the real bad concussion symptoms uh
you know the dizziness the
almost slight blindness at times uh...
blurred vision and all these other things
uh and knocked unconscious where i was uh... I had one of those uh you know where I
spent three
two days in the hospital and was let out and then
right back to practice you know
and played in the next game
so knowing what i know now yes I'd still play the game of football 'cause I love it but that's never
it hasn't been the problem
the problem has been uh
the way that they've addressed the injury
turley a first round draft pick
is one of twenty one former players who filed suit against the n_f_l_ in
december for deliberately ignoring and concealing the risks and permanent
affects of repeated head trauma
the suit also alleges that player's were returned to the field too soon often in
the same game in which they suffered the injury
he is not only suing the n_f_l_ to make it accountable but he also wants the
league to seriously address the concussion problem
well there's a lot of things they can do
uh... you know there's many ways that they can definitely address this problem and uh
the sports legacy institute has done uh... tremendous job of uh
being there to inform them of how they can make it better
but uh they're unfortunately it's a reactive frame of mind as a opposed to a proactive frame of mind and
so I wanna hopefully see changes made uh...
doctors on the sidelines and you know
people in the booth reviewing I mean
i guess if i could sit on my couch at home and see a guy get a concussion
i know they can see it so you know
when i see guys like that go back in the game
uh... that really makes me upset
and those are the type of things that i want to see change personally
the potential linkage between ALS even now and uh head trauma
uh traumatic brain injury is a very serious thing
uh you know we're not talking about
just a game we're talking about life-and-death and uh...
so I just I just hope one day that everybody will
see that light and get past the archaic mentality of you know
we've got to be tough you know and
that's because
it's still it's just a game at the end of the day and
i don't know any parent that's lost a child because of the game of football or
any other sport for that matter because of a head injury or any other injury um
would say well they you know
it was worth it you know so
the serious side of it is is the death side
and that's what we need to start eliminating
i think what they're doing to protect the players is something that's necessary
I think they're doing a lot right now i think
uh... there's definately
an increased focus on
uh…on player safety right now
you know with the penalties that are being
uh... instituted and with the the focus on
um you know reducing the
the high impact
hits the helmet to helmet hits the the head hits uh...
you know i think uh...
you know some rules changes could could possibly do that but you know
until the rule changes are instituted and you see what the effect is you know
sometimes
you know some rules you know have adverse effects so you know you have to
you have to try different things and see what's what's working ah... and i think you know
a lot of it starts from you know the youth and
and high school level to and just teaching the right techniques
of uh... of hitting and playing the game to
uh... you know to not always lead with the head and and go for the helmet
to helmet hits
for its part one example of commitment that the n_f_l_ is showing to this
crisis is the announcement that it is going to expend one hundred million
dollars to the study of concussions over the next ten years
good that the n_f_l_'s is going spend a hundred million dollars over ten years
you know brain injury is historically a terribly under funded
uh... research area
uh... we the n_f_l_ gave us a one million dollar unrestricted gift last year which has
been very helpful to advancing research
a hundred million dollars is a legitimate amount of money
so i'm hopeful that
that the right studies are done
uh... with that money to get us somewhere
uh... you know i what i've heard about some of the things some of that money might go to
a havn't been
overly excited about
i mean the n_f_l_
started their concussion committee in nineteen ninety four
and it's two thousand and eleven and
most of the money they spent on studies was wasted
and it was
done to do the wrong studies the wrong way ticket they gave bad information
uh... I hope they have the right people in place i don't know if i
believe it
uh... some of the comments made by some of the leadership who will be determining where that
money's spent has been
i would say foolish
so i don't know we'll see which way that goes
you think the n_h_l_ will follow suit
the NHL doesn't have the same amount of money to share
unfortunately
so i do hope the n_h_l_ will invest in in concussion research as well I
let's be honest if they
how much
how what was the value to them if they could have prevented sidney crosby
being out a year and possibly longer or his career being jeopardized
any amount of money
would've protected that and i
they should realize that if they had sat the athletes down at any point in the last
five years and really pushed the old
if you don't speak up when you're hit in the head you're going to jeopardize your
career
maybe sydney would've spoken up and so i think we have not invested in prevention
we have not invested in education
and i'm hoping that the professional sports leagues don't just see this as a
long-term liability issue but they see this is as a keep my best players on the
field issue and increase revenue
is wrestling doing anything to minimize the risk
oh sure wrestling has done quite a bit uh
after that match i mentioned which was in nineteen ninety eight
i mean you know anyone who wanted to try something that would be considered out of the
ordinary you know
had a professional
coordinator uh playing a hand in it uh they've completely
in wwwe at least completely banned ah...
shots to the head
with chairs and luckily we are in a form of entertainment where
you can work around injuries
uh...
and so
we are able to provide
uh... an entertaining
event
spectacle if you want to call it that
with with while putting uh…you know
uh... a minimum on the uh...
potential damage
at least that's the way i feel
it's a very tough business when you combine the pressures that go along with
it
uh... the sense that
some people are living out their dreams only to find out that it's a very tough
row to hoe
uh... and when you compound that with head injuries uh... the
depression
can uh…you know
apparently lead some people to believe that you know
the life they have uh... remaining is uh...
is not as good an option as no life at all but i think we are uh
making a lot of progress with that by determining head injuries and uh…also you know
assigning some people to work on guys uh
uh mind sets to keep them from
wishing such uh…you know
such terrible outcomes for themselves
while professional leagues have started to address the concussion crisis
much more can and should be done beginning with the earliest levels of
sports
join us next week as we examine the safety of the equipment the effects of
concussions in children and the importance of concussion education
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each year more than three million athletes suffer a sports related brain
injury known as concussion
sometimes the effects can be serious especially if they return to play too
soon before it's safe according to the american academy of neurology any
athlete who is suspected of having a concussion should be removed from play until
evaluated by a doctor who has training in sports concussion this is for all
athletes in all levels
play it safe protect your brain from concussion
a message from the american academy of neurology learn more at aan.com