Heads in the Game
This is farewell.
Just a song before I go? Nah, but imagine Crosby, Stills & Nash as background music. . . .
Let's close out the Heads in the Game series, and this accompanying blog, with some web portals that may well prove useful for parents, players, coaches, anyone who already has experienced concussions or brain injuries in sports, or, alas, is concerned they may someday deal with them.
> The Center for Disease Control contains a sub-site with a wealth of information available. Experts at UPMC Sports Medicine assisted in formulating much of that information.
The CDC's signs and symptoms card was posted here a few days ago, but here's another form of it.
Like everyone else, they're also on Facebook. . . but it's part of their http://www.facebook.com/cdcheadsup , where some folks have shared their stories and other links. (Though nobody has made them aware of our series.)
"A concussion is a brain injury, and all are serious" -- a CDC quote that should appear in every locker room, preseason physical-examination form and coaching credential.
> UPMC Sports Medicine's sites for head injuries and the concussion program that attracts professional and amateur athletes from all over.
The ImPACT test, founded by program director Dr. Mark Lovell and co-director Dr. Michael "Micky" Collins, already contains millions of tests for young athletes in Western Pennsylvania and throughout America. The majority of Pennsylvania high schools are expected to be subscribers by the end of 2011. Youth teams and associations also can get their players tested, for a nominal fee. As Shawn McCall -- a president, coach and father in the Peters Township Youth Football Association -- put it in the main story of the Heads in the Games first installment, "How much is your kid's brain worth? Come on.
"No pun intended, it's a no-brainer."
> West Penn Allegheny Health System/Allegheny General Hospital sports medicine, while less widely publicized as its counterparts, also performs considerable work with concussions -- as detailed in Part I on this page of PDF presentations and slideshows. The sports medicine director, Dr. Patrick DeMeo, is also the Pirates' medical director. And Dr. Edward Snell, who assists DeMeo with the Pirates, is so well versed in concussions that he has spent the past decade helping the National Federation of High School Associations to rewrite its concussion guidelines.
> The state of Washington's interscholastic sports, the first to come under the Lystedt law being adopted in much the same form in states across the country -- though Pennsylvania's attempt (see below) is stalled in the senate.
> Keep an eye on the U.S. military, for that's the likely genesis of the next breakthroughs in concussion research. You can find some discussion on that front at this site and this one. Anywhere from 40 percent to 75 percent of all military injuries in Afghanistan and Iraq are concussion-related, experts say. Post-concussion symptoms may even be confused for post-traumatic stress disorder in some soldiers.
> Some supplementary reading, all found in these pages in the past:
Mike Webster's tale (circa 2005-06)--
His family's fight against the NFL, which helped to pry open the door that lead to today's awareness of Chronic Traumatic Encephelopathy, concussion dangers, later-life difficulties. Interesting to look back that the findings the NFL at long last accepted last year were intially found in 2005 amid concussion and retired-players research at the University of North Carolina, long before Kevin Guskiewicz of Latrobe deservedly became a nationally known expert in the field. And here's a story I'll never forget: fomer NFL player Curt Marsh, whose leg got amputated as a result of injuries, had an annual physical to retain his disability payments, "So every year I go back [to an NFL-selected physician] to see if my leg has grown back, or I have a new hip, or whatever."
2010, what some people call The Year of the Concussion, from the Post-Gazette --
Brain experts call for plans for concussion management. (Me, March 13)
Experts contend hockey is next. (Me, March 14)
Chris Henry's brain shows chronic disease. (Me, June 28)
-- Column on those concussion findings. (Ron Cook, June 29)
Column on Ryan Clark's concussions. (Ron Cook, Aug. 8)
Young-athlete trips to ERs on rise. (Jack Kelly, Aug. 31)
Brain trauma rises in youth basketball. (Jack Kelly, Sept. 15)
State committee approves proposed bill. (Tracie Mauriello, Sept. 20)
Editorial about the bill. (Sept. 26)
Pa. House passes concussion bill. (Me, Sept. 29)
Mixed reaction to the bill. (Me, Sept. 30)
Spinal injury is concussion-like (Jack Kelly, Oct. 4)
UPMC gets NFL grant to study youth concussions. (Me, Dec. 22)
George Visger's story, first published on this blog, then in the newspaper (Dec. 26)
And, of course, this Heads in the Game Series --
The links to Parts I through III are located at the left on his blog page.
Here, from Part IV, is the Preston Plevretes story.
Here is Dr. Julian Bailes' seven points to curtail and prevent concussions.
One final note: My heartfelt thanks to everyone involved in the series -- the doctors, the nurses, the clinics, the parents, the players, the certified athletic trainers, the public-relations folks, the families and athletes who shared through emails and calls their past tales of concussions and brain injuries, . . . . The list is long. Each one had a significant impact, for which I am eternally grateful. Hopefully, we opened some eyes and minds, raised some awareness, with videos, photographs and words.
Hear ye, hear ye:
With the Heads in the Game series having come to a close last Sunday, we're officially going dark on the Heads in the Game blog tomorrow.
Sorry, no Heads in the Game cologne, lunchboxes or action figures are planned.
But the existing threads will remain open, and you'll be more than welcome to post in the Comments section. . . of any of the items from the beginning to tomorrow's final post.
The head of Heads in the Game
You can't get more "upper-body" than the brain.
Well, there is the lid of the skull, the scalp and his mop of hair.
Still and all, that's barely 1 inch total, leaving another 5 feet, 10 inches as Sidney Crosby's "lower body" by that definition, eh?
The NHL opens itself for not only levity, but criticism in such matters due to its hazy identification policy on injuries. Concussions, as we all know now, are serious ailments. Penguins coach Dan Bylsma said the team's captain and All-Star vote-getting leader likely will miss a week. (You can read more at the PG+ site, which I believe once you sign up is still free for the first few views.) To many experts in the concussion business, a week is the bare minimum, the industry standard.
The question is: Would that be a week from Tuesday, truly a week and three days from this past Saturday, or longer?
Here comes the criticism part. In Canada, where Crosby is idolized, if not held in greater esteem, there already is considerable eyebrow raising and jaw jutting over the lingering questions. Cam Cole, one of that nation's foremost hockey voices, opined here that the Penguins did a disservice by allowing Crosby to play against Tampa Bay and failing to identify when the injury happened. That's because, Cole wrote, it was apparent to the 6-plus millions watching the Winter Classic that the concussion came in the Dave Steckel hit in Heinz Field Saturday night against the Washington Capitals rather than when the Lightning's Victor Hedmen clouted him -- into the boards? -- three nights later.
This much remains certain: The Penguins and the white coats around them know concussions. Team doctor Chip Burke was a key figure in a league study about concussions years ago and helped the NHL to launch its policy about handling such injuries. UPMC Sports Medicine is their medical provider, so the ImPACT test assuredly will be the prime tool used in opening the bench door and, in the end, ultimately allowing Crosby to return to the ice. Because of Crosby's star status, you would think even greater will be exercised. . . especially if post-concussion symptoms dragged into a 2 1/2- to 3-week window, where missing the Jan. 30 All-Star Game and taking that break could conceivably prove to be a boon. That's a much longer period than what Bylsma offered. . . but that's the thing with concussions: You never know. It's case by case, individual by individual, "mild concussion" by "mild concussion."
The focus far too often falls upon sports.
But concussions can happen anywhere.
This one came on a school playground, and it claimed the life of a 9-year-old Oklahoma girl.
Alyssa Avila of Wyandotte, Okla., died Aug. 19 after falling off a teeter-totter contraption at her elementary school. Even though she landed on wood-chip mulch, as the playground surface was described, she fell on her head and back with such apparent force that Oklahoma medical examiner's office ruled -- and announced just this week -- that she sustained a severe concussion that killed her.
Our children cannot wear headgear every moment of every day. Then again, headgear such as football helmets are designed to prevent traumatic brain injury, not the mild brain trauma of a concussion. As experts contend, you cannot wrap a helmet around a brain suspended in liquid inside the skull.
Yet there might be better safety precautions to be exercised in the places where children play games as well as sports.
In other news:
> Sen. Tom Udall, D-New Mexico, officially asked the federal government -- in the form of the Federal Trade Commission -- to investigate manufacturers whom he said "falsely advertise" concussion-safety claims about their football helmets, particularly ones sold for wear by children.
The story and the text of his letter are linked here.
If you have an athlete or child who is prone to concussion or involved in an activity where he/she could suffer one -- that's not just football, but skateboarding, bicycling, soccer and, yes, even cross-country (one local girl was concussed by a buck at the state championships) -- don't leave home without this card.
The Center for Disease Control, which on these topics gets assistance from UPMC Sports Medicine concussion specialists, put together this list of concussion signs and symptoms.
A variation of it was handed out to football coaches and referees in Pennsylvania this past fall and elsewhere across America, under the new guidlines of the National Federation of State High School Associations.
It looks something like this:
Appears dazed or stunned
Is confused about assignment
Is unsure of game, score, opponent
Answers questions slowly
Loses consciousness (even briefly)
Shows behavior or personality changes
Can't recall events prior to hit or fall (retrograde amnesia)
Can't recall events after hit or fall (anterograde amnesia)
SYMPTOMS REPORTED BY ATHLETE
Headache or "pressure" in head (Editor's note: In one examination session, I remember a 14-year-old high-school student recalling how his felt like it was a tomato being squeezed; it hurt that much even AFTER he removed his helmet.)
Balance problems or dizziness
Double or fuzzy vision
Sensitivity to light and/or noise
Feeling sluggish or slowed down (physical)
Feeling foggy or groggy (mental)
Does not "feel right"
Change in sleep pattern (Editor's note: Here is where the UPMC Sports Medicine concussion program handy card differs slightly from the CDC's.)
Concentration or memory problems