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.
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?
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?
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.
Posted by Dr Abhimanyu Kaura, PGYIII (Medicine), Monmouth Medical Center
Kuru disease is one of the five human spongioform encephalopathies caused by prions. This group also includes Creutzfeldt-Jakob disease (CJD), variant CJD, Gerstmann-Straussler Scheinker syndrome and fatal familial insomnia.
Bovine spongiform encephalopathy also known as “mad cow disease”, is another prion disease that affects cattle, and was responsible for bringing more attention to all of these disorders in the 1990s.
Kuru is confined the Fore tribes of Papua, New Guinea.
In the 1950s there were 2100 cases of Kuru in these tribes leading to about 1000 deaths per year.
As per the culture of the Fore tribe, if a person in a family dies his meat is eaten by his family members, especially the wife and children, as a mark of respect to him. 90% of people affected by the disease were women and children.
Between 1996 to 2004 only 11 new cases of Kuru were identified in the region. Currently with the ban of cannibalism in the Farah tribes the disease had become virtually non existent.
Kuru first presents with tremors, then unsteady gait and progresses to leg weakness, ataxia, incoherent speech, sporadic laughter finally. In later stages, affected patients become demented, bed bound and unable to swallow.
Death occurs most commonly from respiratory distress and pneumonia or infection of pressure sores. The disease is fatal within 1-2 years of the onset of symptoms and had no known cure.
Here’s a video introduction
Watch the full story here:
The causative organism is a prion, a mutated protein which replicates itself like a virus, and is spread by eating the neuronal tissue of infected people.
The precise incubation period of the disease is unknown, but can be up to fifty years.
The detailed studies of theses cases of Kuru has helped us understand other prion diseases such as variant CJD, sporadic CJD whose clinical features and course is similar to this condition.
And maybe another link between Zombies and neurology?
The term concussion is derived from the Latin word “concutere” which means “to shake violently”:
This term is used to describe a head injury associated with a temporary loss of brain function, including impaired consciousness, cognitive dysfunction and/or emotional problems.
To fully understand Concussion’s Axis of Evil, one need look no further than the brutal world of professional boxing and it’s neurological complications.
One of the most savage beatings any fighter every received occurred on July 4, 1919 in Toledo, Ohio, when 24 year old Jack Dempsey destroyed 37 year old Jess Willard to become the Heavyweight Champion of the World.
One can easily spot the effects of concussion in Willard as he sustains blow after blow to the head, and he develops unsteady gait, erratic behavior (failing to avoid punches and protect himself) and ultimately unconsciousness.
New Jersey’s own Harrison S. Martland MD (1883-1954) was the first to report in 1928 that repeated beatings of this kind could lead to a delayed permanent neurologic syndrome referred to as punch drunk syndrome.
His observations went largely unheeded.
Muhammad Ali (born as Cassius Marcellus Clay in 1942) was only 22 when he became word heavyweight champion in 1964, almost 40 years after Martland’s paper was published.
Here is with Liberace in 1964:
Almost 10 years after that performance, Prof Corsellis reported further clinical and pathological features of punch drunk syndrome in his 1973 paper “The Aftermath of Boxing”.
Here’s data from one of his cases:
By 1983, Muhammad Ali was retired from professional boxing,
Obviously, repeated head trauma, and it’s consequences, is not unique to boxing:
His brain was examined as part of an ongoing study by Boston University’s Study of Traumatic Encephalopathy.
His brain showed the same pathologic changes as the Punch Drunk boxers.
This syndrome, more commonly referred to as Chronic Traumatic Encephalopathy, is now known to have occurred as a consequence of repeated head trauma in many other sports, including soccer, hockey, horse-racing and wrestling.
Then, there’s the Second Impact Syndrome (SIS).
SIS is said to be a rare, often fatal, traumatic brain injury that occurs when a repeat injury is sustained before symptoms of a previous head injury have resolved.
Although limited to single case reports, and disputed as a discrete syndrome in the scientific literature, SIS cases are young athletes and have become high profile in the media:
Click here to find out more about this case.
This data, as well as SIS cases, has led to a concern that the presence of ongoing concussive symptoms are a significant risk factor for further injury to occur, and that any residual symptoms should mandate restriction for further contact sport in young athletes.
Finally, it is know that concussions are under-reported by high school players.
A 2004 survey of 1500 varsity football payers in Milwaukee disclosed that although 15% had sustained a concussion during the season only 50% reported it to their coach or trainer.
So there we have it, Concussion’s Axis of Evil:
And the solution?
The Allies Against Concussion:
Click here to find out more about the Matthew J. Morahan III Health Assessment Center for athletes at Barnabas Heath.
Preventing, evaluating and managing sports related concussions is a hot topic right now.
For example, Monmouth Neuroscience Institute, in association with the Matthew J. Morahan III Health Assessment Program, offers baseline cognitive screening events and concussion evaluations for local school and college athletes.
Like most programs around the country, we use the ImPACT computerized testing to measure reaction times and assess concussions. However, this type of computer testing requires specialized equipment and staff training.
Investigators are still looking for a more simple and cost effective assessment tool that can be used to asses athletes’ reaction times right on the side lines, to allow immediate return to play decisions during the actual game.
Sports medicine physicians from the University of Michigan have developed a homemade device that could be used in this way.
They stuck a hockey puck to then end of a long wooden dowel marked with centimeter spaced lines along its length.
The evaluator holds it in front of the athlete who is seated with one arm resting on a table. The evaluator lines up the puck with the bottom of the athlete’s hand and lets go. Once the athlete has caught the falling stick, the evaluator marks where his hand lands, which gives a quantitative measure of reaction time.
A concussed athlete will have a slower reaction time and take longer to catch the stick (catching it further down) than a healthy athlete.
In a study published last year these investigators first used their homemade device to measure pre-season reaction times of football, soccer and hockey players. Then they waited for these same athletes to get injured with concussions, and had them to re-take the test within at least 48 hours of the head injury. They found that the concussed athletes took significantly longer (sometimes as much as a full second) to catch the rod than before the head trauma.
The catch? You still need a baseline measure for each athlete – but it might be easier to get high school and college kids to do this simple 5min test before the first game of the season than have them go to specialized testing center for a computer based test. Then, with those baseline test results recorded, any coach can repeat the test on the side-lines after an injury and decide if they should be worried.
I am sure the use of a hockey puck was no accident!