Posts Tagged ‘chronic traumatic encephalopathy’

2017 NFL Pro Bowl Concussion Symposium and Health Screening

Tuesday, February 21st, 2017

Desi Rotenberg
MS, ATC

Posted February 21, 2017

By Desi Rotenberg, MS, ATC

The 2017 NFL Pro Bowl is a tradition that stems back to its inception in 1938. While the teams have changed drastically since then, the NFL Pro Bowl has become a tradition of competitive fun and entertainment for players, NFL front offices and fans. 2017 was the first year since 1980 (minus 2009) that the game was held within the continental United States. This venue change hoped to bring more fans, more attention and enhanced exposure of the game itself.

One of the attention grabbers for me during the Pro Bowl weekend occurred off the field. This year, The University of Central Florida (UCF) hosted the 2017 Pro Bowl Concussion Symposium and Health Screening. The purpose of this symposium was two-fold. First, retired NFL players were invited to partake in health screenings for free to help identify any neurological, cardiovascular or other issues plaguing them due to their playing time in the league. Second, the NFL Players Association partnered with the UCF Psychology Department to present all of the latest research and treatment options related to concussions in the world of sports, and more specifically, the game of football.

Here are a few of the highlights:

Following the U.S. Supreme Court settlement regarding previous NFL players and head injuries, the science has gained a significant amount of traction. As new empirical data emerges and technology continues to develop, more funding is becoming available to allow athletes to have increased access to neurological assessment and professional evaluation following head trauma. Interestingly, the Supreme Court settlement included a 65-year plan that will give retired NFL players and their families financial support if they experience symptoms of amyotrophic lateral sclerosis (ALS), dementia or any other life-altering behaviors or symptoms that may arise secondary to traumatic brain injury.

Furthermore, baseline testing is being made available to all retired NFL players and will be done immediately upon retirement. This will allow the players’ medical teams to identify any behavioral, cognitive or neurological changes that may arise over the remainder of the individual’s life.

The overarching goal is to have every college, high school and middle school offer some form of baseline testing in at least one sport for all student athletes. We are slowly, but surely, making our way towards that goal. However, there still remains room for improvement when it comes to baseline testing.

The areas of deficiency that were identified was a lack of baseline testing within recreational sports and ease of administration within middle schools and high schools. If we want to ensure the safety of all athletes, we must do what we can to have concussion education, a concussion protocol and return to play protocol in place.

At the academic levels, we must also ensure that we have a return to learn protocol in place. The question that acts as a defense for medical professionals responsible for the return to play decision is, “If you cannot learn new information, should you be returning to play?”

Emerging Technology

To this point, there are 2 questions that remain: 1) How do we diagnose Chronic Traumatic Encephalopathy prior to death, and 2) How do we avoid the high cost of imaging when it comes to concussion diagnostics?

There is by no means an answer to the first question as of yet, but I am hopeful due to the emergence of Diffuse Tensor Imaging (DTI). DTI has been around for roughly 20 years and has been mainly used in the diagnosis of strokes and other ischemic disorders of the brain.1 Within the past 10 years, research has shown that DTI can also be used to assess the integrity of the white matter in the brain.2 The goal of physicians at the symposium was to make DTI more streamlined and allow patients access to this form of diagnostic following head trauma.

In the image below, the varying colors represent the orientation of various white matter within the brain. In the second image, neurological specialists have the ability to zoom in on a specific location and can visualize a physical abnormality or disruption in neuronal activation due to a disturbance in neuronal integrity.

Images Obtained from Journal of Neuroradiology

So how do we lower the cost of imaging?

We start by locating private medical companies that offer this type of imaging. There were several speakers at the symposium who owned businesses that focused on the neurological diagnosis and treatment of individuals who suffered traumatic head injuries. The businesses offer consultations and diagnostics at a fraction of the cost of normal imagining techniques.

Cognitive and Behavioral Effects of Head Trauma 

Neuropsychologists want to make one thing very clear to all health practitioners: There is no such thing as the average TBI patient. While there are several concussion treatment protocols, it is paramount that each case be treated on an individual basis according to the needs of the patient and the underlying symptoms present. Cognitive changes following head trauma occur on a varying spectrum, and can include, but are not limited to: changes in vigilance, reaction time, mental tracking, verbal retrieval, mood and information processing.

Common symptoms that can be seen are the emergence of anxiety, depression, inability to focus and difficulty sleeping. Each symptom can lead to frustration, impatience and social disconnect. There is one congruity with all of these cognitive and behavioral changes: a concussion is a physiologic injury of the brain, where normal cerebral flow has been altered and the normal “algorithm” of information input and output has been compromised.

Unfortunately, head injuries cannot be cured; however, there is hope for individuals seeking refuge from this life-alerting injury. There are many clinics that exist, such as the UCF Psychology Clinic that can help patients learn to cope with the inhibiting effects of head trauma. Treatments include consultations with neuropsychologists, who walk patients through cognitive rehabilitative exercises and various forms of talk therapy. These treatments can help an individual compensate for the mental, emotional or physical deficiency that has arisen. The goal of treatment is to help the individual learn how to live within this new reality, and how to improve their overall quality of life.

The central message of the symposium is concussion research and concussion management are constantly changing. Unfortunately, policy change happens at an even slower rate. Due to this constant evolution, this is a topic All medical, fitness and cognitive specialists need to stay up to date on this topic due emerging information and the constant evolution of the topic. This can be accomplished by staying up to date on the latest research and emerging trends, in order to be able to follow “best practices” and avoid liability.

Resources

1. Hagmann, P., Jonasson, L., Maeder, P., Thiran, J. P., Wedeen, V. J., & Meuli, R. (2006). Understanding diffusion MR imaging techniques: from scalar diffusion-weighted imaging to diffusion tensor imaging and beyond 1. Radiographics, 26(suppl_1), S205-S223.

2. Le Bihan, D., Urayama, S. I., Aso, T., Hanakawa, T., & Fukuyama, H. (2006). Direct and fast detection of neuronal activation in the human brain with diffusion MRI. Proceedings of the National Academy of Sciences, 103(21), 8263-8268.

3. Rutgers, D. R., Toulgoat, F., Cazejust, J., Fillard, P., Lasjaunias, P., & Ducreux, D. (2008). White matter abnormalities in mild traumatic brain injury: a diffusion tensor imaging study. American Journal of Neuroradiology, 29(3), 514-519.

About the Author

Desi Rotenberg, originally from Denver, Colorado, graduated with his bachelor's degree in 2012 from the University of Northern Colorado. He has been a BOC Certified Athletic Trainer since 2012 and earned his master's degree in Exercise Physiology from the University of Central Florida in 2014. He currently is a high school teacher, teaching anatomy/physiology and leadership development. Along with being a teacher, he wears many hats, such as basketball coach, curriculum developer and mentor. He has been a contributor to the BOC Blog since the summer of 2015. 

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“Concussion” – A Movie Review from an Athletic Trainer’s Perspective

Friday, February 12th, 2016

Posted February 12, 2016

By Claudia Curtis, MS, LAT, ATC

As a moviegoer, I found “Concussion” to be very well done. The plot flowed well, did not feel too drawn out and the acting was superb. Will Smith did an excellent job portraying the main character, Dr. Bennet Omalu, taking you on his journey and making you feel what he felt.  It gave insight into what was happening behind the scenes for years regarding chronic traumatic encephalopathy (CTE) before the American public was aware of the situation. The movie was produced in a way to keep all kinds of viewers engaged, science for the healthcare professionals, game footage for the sports enthusiasts. The footage shows a lot of big hits, frequently without proper technique. In terms of a cinematic experience, I was pleased with my movie choice.

However, as an Athletic Trainer (AT), how did I feel watching “Concussion?” First and foremost, I was horrified at the way  ATs were portrayed in the movie. This movie focused mainly on the neuroanatomy and the discovery of CTE, not necessarily something  Athletic Trainers have a role in. However, there is one scene where “trainers” are mentioned, and it is done in a rather ignorant way. The scene discusses the fact that the NFL did research prior to Dr. Omalu regarding the presence of CTE.  However, the “researchers” named on the study were a rheumatologist, an equipment manager and a “trainer.” The response to that comment was, “Don’t they just tape knees?” This is a pretty large stage for our profession to be improperly represented, leaving a bitter taste in my mouth that lingers even now.

The impressions I took from this movie span far beyond that one scene though. This movie made me feel a variety of emotions: sympathy, anger, fear and confusion to name a few, alternating throughout the scenes. The person I saw the movie with, a non-healthcare professional, after the movie said, “I wish they had given us more information about what’s been learned since this all started.”

What I realized is that there aren’t a lot more answers right now, but rather that more questions have developed with time and research. How many years of impacts might cause CTE? Does it matter the level of sport played (high school vs. college or professional sports)? Does it matter if consciousness was lost? Are we doing the right thing to prevent this in our concussion recovery programs? Will these concussion return protocols prevent CTE?

I could probably fill an entire page with questions. There is one I’m still asking myself: Is this movie enough to convince high school kids of the real danger that concealing concussions could have long term?