Helmets: do they work to prevent concussions?

Posted by Vanessa Fabrizio, MSIV Drexel University College of Medicine

FOOTBALL: the most popular sport in America. Little boys dream of growing up and playing in high school, then college, then hopefully the NFL. Even little girls dream of dating football players in school or marrying a NFL superstar.

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Those who have never played football can pour money into the sport by simply watching it on TV or more drastically via sports betting. With advancements in the sport and the increasing athelticism of the players, the injury risk has drastically increased while the lifetime of a player in the NFL has decreased. More attention is being brought to the media about concussion and their long term sequelae in professional athletes, yet not enough people question how well the helmets are actually working.

What is a concussion?

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Concussion: a mild traumatic brain injury that leads to a temporary loss of brain function.  Symptoms of a concussion are commonly headaches, dizziness, nausea, vomiting, difficultly on ones feet and balancing, and loss of fine motor coordination. Other symptoms can include light sensitivity, blurry vision, tinnitus, and can even produce seizures. Most individuals who experience a concussion will also experience post-traumatic amnesia and experience difficulty paying attention and disorientation. Post concussive syndrome exists and these symptoms can linger for months affecting lifestyle in many ways.

Treatment for concussion is typically and simply rest. Avoiding head trauma is key to recovery.

Football is not the only sport where its players experience concussions. Boxing is an extremely dangerous sport and many of its victims experience neurological deficits due to their involvement. Soccer, basketball, volleyball, softball, and baseball to name a few all have increased risks of concussions greater than the general public.


This video demonstrates that not only professional players are at risk as it shows a 12yr old on the wrong end of a “hard hit”.

What do the studies say about helmet protection?

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Recently an article in the LA times was published that talked about how the American Academy of Neurology is currently studying the effectiveness of different football helmets on the market today and how well they decrease concussion rates. The research that will be presented is showing that no helmet on the market today is actual effective in preventing concussions. However, it appears that the helmet this study rated as number 1, was rated last in a study at Virginia-Tech Wake Forest University School of Biomedical Engineering and Sciences. Obviously this shows that our testing of how effective helmets work isn’t standardized yet or up to par. As mentioned above, the sport of football itself has advanced so now helmets need to advance and the testing of the efficacy of these new helmets need to advance as well.

Should we encourage children to stop playing football to prevent them harm? As an avid football lover myself, I think that this is not the solution. We need to continue to raise media attention in order to expedite the process of creating these newer, safer helmets. Education about concussions need to be taught to young athletes as well as appropriate tackling measures to ensure safety. The NFL association has been good about updating the rules and regulations of the game to ensure player safety with fines and penalties for unnecessary roughness and hits. Lets hope they continue this way and it continues to trickle down all the way to the peewee leagues.

CLick here to link to the LA times article.

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Neurology and Skiing

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We’re mostly talking about orthopedic, spinal cord and head injuries.

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Spinal Cord Injuries:

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The incidence of spinal cord injury (SCI) is around 1 per 100,000 visits (mostly thoracolumbar spine), usually caused  caused by a simple fall, followed by hitting a tree.

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The incidence of SCI for snow boarders is higher, around 4 per 100,000 visits (mostly cervical), and usually caused by a backward fall during a jump (>75%) or other tick.

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Most SCIs in skiers and snow boarders occur in 15-25 years olds.

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Head trauma:

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The incidence of head trauma is 3.8 per 100,000 ski visits, usually from direct collision with trees.  The incidence of head trauma is higher for snow boarding, around 6.5 per 100,000 visits, more often caused by falling backwards.  Most head traumas result in concussions, but 14% are severe head trauma, and 4% are fatal.

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Others

I came across this case report of another unusual neurologic skiing complication: 
A 45-year old woman first developed distorted vision in the left eye, like looking through a kaleidoscope while skiing.  Soon afterwards, her right leg started jerking, causing her to fall. 
It turned out that she had sustained a left carotid artery dissection causing high grade stenosis during skiing.
There are a few other reports of cervical artery dissection from skiing.

Musher Medicine


While I am lucky enough to be spending a few days this week dog sledding in Maine, I got to thinking about the neurology (or at least the medicine) of mushing.

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I guess most people have already heard of the famous annual Iditarod dog sled race which has become Alaska’s most popular sporting event.

However, many are unaware of the historical importance of dog sledding, and in particular the 1925  Serum run to Nome  (sometimes referred to as the “Great Race of Mercy”).

In the winter of 1925 there was a diphtheria epidemic in the isolated Alaskan city of Nome.  The city had 8,000 units of diphtheria antitoxin on hand, but it had all expired the previous summer. They had ordered a new supply, but the port had closed for the winter before the serum arrived.  The doctors were afraid to use the expired medicine.  The nearest supply of antitoxin was in Anchorage, but it might as well have been a million miles away, as the only available planes were water cooled WW1 that could not be flown in winter.  A deadly epidemic was expected.

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Sepalla in Nome, 1925

However, in a daring plan, the antioxin was moved by train from Anchorage to Nenana, and then carried another 630 miles to Nome by dog sled teams running in relay.   Gunnar Kaasen and his lead dog Balto arrived on Front Street in Nome with the antitoxin on February 2 at 5:30 a.m., just five and a half days later. The two became media celebrities, and a statue of Balto was erected in Central Park in New York City in 1925.  However, most mushers consider Leonhard Seppala and his lead dog Togo to be the true heroes of the run – they covered the most hazardous stretch of the route, and carried the serum 91 miles, the single farthest of any team.


A reenactment of the serum run was held in 1975 to mark the 50th anniversary of the “Great Race of Mercy,” and participants included descendants of many of the original mushers.  Since 1997, the event been commemorated by bi-annual “Serum Run” from Nenana to Nome, which includes stops at villages along the way to promote childhood inoculations.

Updated – Concussion Management

NEW Updated Concussion Guidelines

from the American Academy of Neurology

Background information:

Concussion is a mild traumatic brain injury that occurs when a blow or jolt to the head disrupts the normal functioning of the brain.

Symptoms include persistent headache, problems with memory and communication, personality changes, and depression.

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Concussion can occur from a blow to the head/body, such as helmet to helmet contact, or contact with the ground or another object.

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More than a million Americans sustain a concussion each year.

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A concussion does not always “knock you out”.

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Symptoms of a concussion can last, hours, days, weeks, or even months.

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Why is this important?

Repeated concussion can lead to permanent brain damage, affecting academics, internships, social interactions, and athletics.

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Athletes who continue to play after sustaining a concussion, may take longer to recover and are at an increased risk for developing Second Impact Syndrome or a more prolonged Post-Concussion Syndrome.

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Numerous studies in professional boxers have shown that repeated brain injury can lead to permanent brain damage (dementia), sometimes referred to as “punch drunk” syndrome or dementia pugilistica.

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Autopsy studies have shown similar brain changes in former professional football players who experienced multiple concussions.

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Recent studies of college football players showed an association between multiple concussions and reduced cognitive performance.

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Guidelines for concussion evaluation and management

New American Academy of Neurology guidelines suggest the following management of concussion:

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Suspected Concussion:

Any athlete with suspected concussion should be closely observed and undergo repeated “side line assessments” for at least 30 minutes:

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The presence of one or more of these symptoms and signs indicates concussion, that athlete should be removed from play, and referred to an emergency room or experienced concussion program for more detailed assessment.

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Brain Imaging Studies

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Any athlete who sustains a head injury who has unconsciousness, persistently altered mentation, or progressive deterioration on the screening tool (above) over time should be sent to the emergency room for a brain imaging study to rule out a skull fracture or intracerberbral hemorrhage.

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Follow-up Care at a Concussion Center

All athletes with concussion, whether they did not need to go the emergency room, or whether seen in the emergency room and sent home, should be evaluated by a health care provider experienced in managing concussion or a concussion center.  They should be prohibited from return to play or practice (contact risk activity) until the concussion has resolved and they are asymptomatic off medications.

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The concussion center uses clinical assessment of symptoms, computerized cognitive testing and balance testing to follow an athlete’s concussion, and determine when it has resolved.

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Computerized testing:

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Immediate Post-Concussion Assessment and Cognitive Testing (or ImPACT ) is used at many centers to help assess the severity of concussive brain injury and determine when it safe for athletes to resume sporting activities.

The test is computerized and lasts approximately twenty minutes.

Ideally, athletes should take a baseline test at the beginning of the season.

The test should then be repeated within 24-72 hrs after a concussion. The scores are compared to that athlete’s baseline to identify any residual change in verbal and visual memory, processing speed, and reaction time.

ImPACT testing can then be repeated to look for improvement, once the symptoms have cleared, or 7-10 days after the first post-concussion test.

This information can assist with decisions regarding when a player may return to action.

It should be noted that the widespread application of ImPACT testing has been criticized by some authorities.

ImPACT testing can be helpful, but is only part of the neurologic evaluation of athletes with concussion, and should not be the only factor used to determine when that athlete can return to sporting activities.

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Balance Testing:

The Balance error scoring system (BESS) is a clinical assessment of postural stability that is administered in the concussion center and contributes to the diagnosis of concussion.

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Recovery from concussion

Most athletes recover fully from a concussion, but it can take weeks, months, and even years.

School attendance, student work load and other activities may need to be modified according to the individual’s symptoms.

The athlete’s symptoms should be closely monitored until they feel symptom free.

Once the athlete is symptom free, and they have been cleared through ImPACT, they may begin a progressive return to their sport.

A progressive return involves gradually increasing the level and intensity of the activity, while closely monitoring the athlete for any return of symptoms

Day 1: Walking or easy biking for 20-30 min.

Day 2: Jogging or moderate biking for 20-30 min.

Day 3: Running or heavy biking for 20-30 min.

Day 4: Sport specific drills/practice (non-contact)

Day 5: Return to contact sports

If symptoms return at any point during the progression the activity should be stopped. The athlete should return to rest and must be symptom free for at least 24 hrs before starting the progression again.

Recovery may take longer in those with a previous history of concussion, learning disability, or attention disorder.

It must be stressed to athletes, parents and athletic trainers that these guideline are important, and must be followed to minimize the risk of permanent brain injury.

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Retirement from play

Health care professionals in a concussion center may suggest that athletes who have experienced multiple concussions and have persistent neurobehavioral problems permanently retire from contact sports.

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Download the AAN Concussion App

Download a concussion quick check app specially developed for coaches and parents directly to your ipad or droid device.