Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

I was reviewing Feeds from the Center for Disease Control and came across this "Return to Play Progression."  Young athletes, as well as professional athletes, need protection while in the heat of the moment.  Coaches and Health Care providers can control crucial decisions as discussed below.

 Baseline (Step 0): As the baseline step of the Return to Play Progression, the athlete needs to have completed physical and cognitive rest and not be experiencing concussion symptoms for a minimum of 24 hours. Keep in mind, the younger the athlete, the more conservative the treatment.

Step 1: Light Aerobic Exercise
The Goal: only to increase an athlete’s heart rate.
The Time: 5 to 10 minutes.
The Activities: exercise bike, walking, or light jogging.
Absolutely no weight lifting, jumping or hard running.

Step 2: Moderate Exercise
The Goal: limited body and head movement.
The Time: Reduced from typical routine
The Activities: moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting

Step 3: Non-contact Exercise
The Goal: more intense but non-contact
The Time: Close to Typical Routine
The Activities: running, high-intensity stationary biking, the player’s regular weightlifting routine, and non-contact sport-specific drills. This stage may add some cognitive component to practice in addition to the aerobic and movement components introduced in Steps 1 and 2.

Step 4: Practice
The Goal: Reintegrate in full contact practice.

Step 5: Play
The Goal: Return to competition

The Center for Disease Control espouses that an athlete should be free of symptoms prior to being put back into play.  If symptoms are present, the athlete should not be put back into play for at least 24 hours.  A health care provider should carefully monitor the athlete after injury.

Online training for Health Care Professionals can be accessed here.  Health Care Professionals can access state, league, or sports governing body’s laws or policies on concussion.

Protecting our kids and teens from concussions should be a priority. Check out An International Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008.

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 When children have been exposed to family violence, their brains become increasingly "tuned" for processing possible sources of threat, a new study reports. The findings, reported in the Dec. 6 issue of Current Biology, reveal the same pattern of brain activity in these children as seen previously in soldiers exposed to combat.

This sheds new information on the Shaken Baby Syndrome in infants and all the way through childhood.  The changes don't reflect damage to the brain. Rather, the patterns represent the brain's way of adapting to a challenging or dangerous environment. Still, those shifts may come at the cost of increased vulnerability to later stress.

Violence against women in a family also has serious consequences for the children's growth, health, and survival. There are several possible explanations for why violence against a mother can affect her children's health. During pregnancy the fetus grows less, and after birth the mother's mental health is crucial both for her emotional contact with the children and for her ability to care for the children. What's more, women who have been subjected to violence often have weaker social networks and often lack economic resources to seek medical care for their children, for example. This means that the children's health is dependent on the economic resources and the protection that the environment can offer.

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 Derek Boogaard's brain was preserved.  Although the Hockey player was dead, a request came to the family to not cremate Boogaard until they could carve his brain out of his skull to study it.  That was May 2011.  The results came in October.

Boogaard had chronic traumatic encephalopathy, commonly known as C.T.E., a close relative of Alzheimer’s disease. It is believed to be caused by repeated blows to the head. It can be diagnosed only posthumously, but scientists say it shows itself in symptoms like memory loss, impulsiveness, mood swings, even addiction.

More than 20 dead former N.F.L. players and many boxers have had C.T.E. diagnosed.  Typically they are left in a permanently scarred state in later life.

The issue of repeated trauma is explained in a video.  To read more about this particular case you can read the New York Times Article.

The Center for the Study of Chronic Traumatic Encephalopathy states the following:

Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head. CTE has been known to affect boxers since the 1920s. However, recent reports have been published of neuropathologically confirmed CTE in retired professional football players and other athletes who have a history of repetitive brain trauma. This trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau. These changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement. The brain degeneration is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia.

 A new paper published in the Journal of Neuropathology and Experimental Neurology suggests head trauma may also lead to a neurodegenerative disorder mimicking ALS.  This paper adds to literature suggesting an elevated risk of ALS in veterans and professional soccer players who have suffered head injuries, and is certain to contribute to the controversy regarding the link between head trauma and ALS. A recent article in the New York Times points out that Lou Gehrig himself may have had this entity rather than ALS.

Researchers at Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, the University Hospital and academic medical center for Einstein, used diffusion tensor imaging, an advanced type of MRI-based imaging technique, as well as cognitive tests, to assess brain function in amateur football players. Their findings indicate the possibility of brain injury from frequently heading the ball.

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The Journal of Cognitive Neuroscience published a study by the U.S. Department of Energy's Brookhaven National Laboratory concluding that the more gray matter you have in the decision-making, thought-processing part of your brain, the better your ability to evaluate rewards and consequences. The study shows this link between structure and function in healthy people -- and the impairment of both structure and function in people addicted to cocaine.

Differences in gray matter volume -- the amount of brain matter made up of nerve cell bodies, as opposed to the "white matter" axons that form the connections between cells -- have been observed in a range of neuropsychiatric diseases when compared with healthy states.

The test utilized MRI, EEG and P300 studies. To explore this structure-function relationship, the scientists performed magnetic resonance imaging (MRI) brain scans to measure brain volume in 17 healthy people and 22 cocaine users.

The implications are important for understanding the potential loss of control and disadvantageous decision-making that can occur in people suffering from drug addiction.  There are still questions about whether these changes in brain structure and function are a cause or a consequence of addiction. But the use of multimodal imaging techniques, as illustrated by this study, may open new ways to address these and other questions relevant to understanding human motivation in both health and disease states, with particular relevance to treating drug addiction.

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 The 10th Annual Pacific Northwest Brain Injury Conference 2012.  Living with Brain/Spinal Cord Injury & Disease: Striving for Excellence.

The Brain Injury Alliance of Oregon is sponsoring  a conference on March 1 to 3, 2012 at the Sheraton Portland Airport Hotel.

I have been involved with this conference and recommend it to those who can attend.

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