Time for a comprehensive national sports injury surveillance monitoring system

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Letter to the editor of the Hill Times from Harry Zarins, BIAC Executive Director

Re: “If Sidney Crosby isn’t immune, neither are Canada’s youth” (The Hill Times, Feb. 7, p. 24). NDP MP Glenn Thibeault’s article is an excellent article opening the door to a national debate on creating awareness on Canada’s silent epidemic: acquired brain injury and its future pressures on the health, social, economic, educational and justice systems.

In all of the discussions surrounding concussions it must be strongly noted that a concussion is a brain injury and a concussion must be referred to as a mild traumatic brain injury, mTBI.
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If Sidney Crosby isn’t immune, neither are Canada’s youth

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Hilltimes.com

February 7, 2011 – http://hilltimes.com/page/printpage/crosby-02-07-2011

By NDP MP GLENN THIBEAULT
Our nation has a storied history of amateur sporting achievements, with the record breaking gold medal performance by Canada’s athletes at the 2010 Vancouver Olympics serving as a unifying force in fostering the Canadian national identity. For years to come, Canadians across the country will remember where they were when Sidney Crosby scored the “Golden Goal” in the men’s hockey final.
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Brain injuries: Wake-up call for hockey

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We’ve long known that hits to the head can cause devastating concussions affecting memory, judgment, behaviour, reflexes and coordination. Now a new study of junior hockey players suggests the incidence of brain injury is seven times higher than previously reported.
The study of two junior hockey teams found that one-quarter of the players suffered a concussion during the last season — 80 per cent of them caused by intentional hits. Nearly a third of the victims also suffered a second concussion. An estimated 15,000 to 20,000 younger players suffer needless concussions every season.

This groundbreaking study is called the Hockey Education Concussion Project — a signal from its authors that concussions are a public health issue that requires action from hockey officials, but also increased awareness at all levels of society. Players, parents and coaches must recognize that when a concussion is suspected, the player be seen by a doctor before returning to the ice.
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Protect young athletes from brain injury

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Recent moves to study contact sports’ effects on brain health could help protect the next generation of athletes.

Pro athletes, current and past National Football League players, doctors and researchers have formed the Mackey-White Traumatic Brain Injury Committee, and began meeting in January. They are exploring football-related brain injuries and examining research with an eye toward recommending changes to enhance player safety.

And in Boston, former Harvard football player and World Wrestling Entertainment wrestler Chris Nowinski is heading up the Sports Legacy Institute. SLI works with Boston University Medical School to explore the effects of concussion on the brain. The institute is enlisting athletes to register for annual testing and asking them to donate their brains after death for further research.
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Traumatic Brain Injury in Professional Football – An Evidence-Based Perspective

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Released: 6/11/2010 5:25 PM EDT Source: Johns Hopkins Medicine

Newswise — Experts from Johns Hopkins Medicine hosted a press conference following a continuing medical education program on the epidemiology of head injury in professional football. The program was an evidence-based review of traumatic brain injury in the sport.

The objectives of the conference on Traumatic Brain Injury in Professional Football: An Evidence-Base Perspective was to assess the current scientific knowledge on this subject and to make recommendations for the future research needed to answer the remaining questions regarding the diagnosis and treatment of traumatic brain injury (TBI).
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A rich and varied portfolio in brain bank

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By MARK KRAM
Philadelphia Daily News

kramm@phillynews.com

BEDFORD, Mass. – Up on a shelf at the Boston University Brain Bank at the Veterans Administration Hospital are a row of large jars, each with a human brain that has been set in a liquid fixative. To the casual observer, the inert matter on display looks like something on the order of strawberry yogurt. None of them is the same size or shape.

“Every one of them is different,” says Dr. Ann McKee, a neuropathologist who oversees the BU Brain Bank. “In fact, brains are like faces in that no two are ever alike.”

The BU Brain Bank is one of 40 or so in the United States – approximately 30 of which are dedicated to the study of Alzheimer’s disease, and another 10 of which specialize in the investigation of other diseases. But McKee says the BU Brain Bank is the only one that has undertaken a longitudinal assessment of athletes. In conjunction with the Sports Legacy Institute, founded by former Harvard football player Chris Nowinski and neurosurgeon Dr. Robert Cantu to study the effects of concussion, the Center for the Study of Traumatic Encephalopathy operates out of here under the supervision of McKee, who has teamed with Nowinski, Cantu and BU associate neurology professor Dr. Robert Stern as co-directors of CSTE.

Located in an unassuming brick building, which houses a staff that includes McKee and four others, the BU Brain Bank is the repository of 1,000 brains: 400 are kept as “fixed specimens” while 600 or so are stored in freezers at a minus-80 degrees. McKee says that when the brains come in, they are photographed, weighed and bisected. One part is flash frozen with dry ice and transferred to a freezer, which is jammed with plastic bags full of brain specimens that have been carefully inventoried.

“Storage is a continual problem,” McKee says. “We keep having to buy new freezers. We had some problem with one being temperamental and we had to do some juggling. But they are back up now.”

So how long are the brains preserved?

McKee says, “Indefinitely. Researchers will have access to these brains years from now.”

Seventy percent of the donated brains were afflicted with Alzheimer’s disease, 20 percent had other diseases and 10 percent are “control specimens,” which is to say they came from a person who died while considered still cognitively intact. McKee says “controls” are especially valuable, if only because they are generally so hard to come by.

“We need ‘controls’ to compare them with the diseases we see,” McKee says. “The problem is that you have to be studied during life, you have to come in periodically and be evaluated to be certain that you are functionally normally. So that takes an altruistic person.”

Up in the hallway are enlarged photographs of some of the cases McKee has worked on: One is of the brain of a boxer, another the brain of a football player and still another shows just how far brain science has come in 50 years. It is the photograph of a brain that had been savaged by a prefrontal lobotomy, a hideous procedure developed for the treatment of mental health issues and for which neurosurgeon Egas Moniz won a Nobel Prize in 1949.

“So that was where we were just 50 years ago,” McKee says. “Think of where we will be in another 50.” *

A look inside the brain

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A look inside the brain(pdf-1.5MB)

Special Report: Deadly Aftershocks: Donor List

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By Daily News

The Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine has lined up a number of professional and amateur athletes who have agreed to donate their brains upon their death. Currently, there are 116 donors (68 pro athletes, 48 amateurs). These are the names of the athletes who have allowed their names to be used publicly.

NFL
Ted Johnson
Joe DeLamielleure
Isaiah Kacyvenski
Ben Lynch
Bernie Parrish
Ralph Wenzel
Frank Wycheck
Bruce Laird
Brent Boyd
Mel Owens
Dan Pastorini
Billy Ray Smith
Ken Gray
Barry “J.B.” Brown
James Houston
Chad Levitt
David Long
Harry Jacobs

NHL
Keith Primeau
Noah Welch
Steve Heinze
Ryan Vandenbussche

NBA
Paul Grant
Malcolm Huckaby

Soccer
Cindy Parlow

Pro wrestling
Rob Van Dam
Lance Storm
Chris Nowinski
Tom Materas

Swimming -
Jenny Thompson

Boxing
Termite Watkins

Special Report: Deadly Aftershocks: NFL’s Concussion Study

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by Daily News

The NFL MTBI (mild-traumatic brain injury) Committee, which was established in 1994, is studying to determine if there are any long-term effects of concussions on retired NFL players. NFL-funded concussion research directed by the MTBI Committee has led to the publication of peer-reviewed scientific papers and helped advance the understanding of concussions and player safety. Including:

* Analysis and definition of concussions: Using 3-D analysis of game video to define the velocity and orientation of impacts that cause concussion. Reconstructing game concussions to determine the head acceleration and forces causing injury. Determining game-actual impacts that cause concussion.

* Development and enforcement of rules to promote player safety: Assisting the league in developing rules to prevent unnecessary helmet impacts and spearing of players with head-down tackles. Defining the positions and impacts most vulnerable to concussion and emphasizing the need for protecting quarterbacks, receivers and defensive backs.

* Improved testing and other helmet-related developments: Defining standardized test procedures to evaluate new helmet design and providing information to the National Operating Committee on Standards for Athletic Equipment (NOCSAE) that led it to revise and update its testing standards. Developing test equipment and protocols for evaluating the safety performance of helmets for concussion. Encouraging objective evaluation of new helmets designed to lower the risk of concussion and encouraging research to further improve helmets in the future. Sharing testing information with helmet manufacturers and NOCSAE for use in their efforts to improve helmet design and safety.

* Understanding effects and management of concussions: Evaluating injury data to determine risks and treatment for concussion, repeat injury, player return to play, and other epidemiology of concussion. Defining post-concussion syndrome as well as investigating the recovery from the injury over time. Recommending that the management and evaluation of concussions be based upon the scientific medical assessment of physicians and not on arbitrary guidelines.

Special report: Deadly aftershocks: NFL concussion management

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by Daily News

In May 2007, the NFL outlined the standards (below) for concussion management, based on consensus medical recommentations. The standards were recommended by the NFL’s independent committee on mild-traumatic brain injury (MTBI) chaired by Dr. Ira Casson, of the Long Island Jewish Medical Center and the Albert Einstein School of Medicine, and Dr. David Viano, of Wayne State University.

* Medical decisions must always override competitive considerations.

* Neuropsychological baseline testing will be required for all NFL players, using a standardized test to establish an individual functional baseline. Neuropsychological testing cannot be used by itself to make clinical decisions. For players removed from games due to concussions, repeat testing will be done during the season to track recovery and to help decide when they can return to play. These players also will be re-tested against their baseline performance the following season at training camp.

* NFL team physicians and athletic trainers are to share the most up-to-date information on state-of-the-art care and management of concussions.

* The MTBI Committee will continue to operate as an independent group. The goal of the committee remains the advancement of scientific knowledge through well-conceived research to protect the health of NFL players and improve the safety of the game.

* A brochure will be distributed to help educate players and their families about concussions, including how to recognize symptoms and recommended treatment.

* Return-to-play decisions should continue to be made by team medical personnel using their expertise and professional judgment.

* The NFL rule requiring every player to wear a chin strap that is completely and properly buckled to the helmet will be strictly enforced.

* The NFL will establish a “whistle blower” system so that anyone may anonymously report any incident in which a doctor is pressured to return a player to play from a concussion or that a player with a concussion is pressured to play.

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