Transcript Has Anybody Seen My Mind? Recognizing signs and symptoms

Teresa R. (Hedges) Headley
M.Ed., AbD., Professional Counselor
Volunteer Ambassador Sports Legacy Institute
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Personal impact of lyrics.
Personal history and story has led to a
passion to make the voices of those impacted
heard.
Those impacted aren’t only the victims, they
also include wives, children, parents and
partners.
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Are you ready for some
football?
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For clarification- I LOVE
THE GAME!
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Teamwork, leadership,
lessons in winning and
losing, physical
development.
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Licensed Professional Counselor
PhD. Research regarding the experiences of
wives whose husbands have died due to
chronic traumatic encephalopathy.
Personal Experience
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The mission of the Sports Legacy Institute is to
advance the study, treatment and prevention of
the effects of brain trauma in athletes and other
at-risk groups. SLI was founded in 2007 to “Solve
the Sports Concussion Crisis,” and in 2009, SLI
launched programs to also serve our military
veterans. SLI is primarily focused on the study of
the degenerative brain disease Chronic Traumatic
Encephalopathy, or CTE, a condition caused by
repetitive concussive and sub-concussive brain
injuries.
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Pat White
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Tim Tebow
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Kevin Kolb
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What do you think a concussion is?
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60 Minutes Presentation
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“A traumatically induced alteration in brain function
manifested by an alteration of awareness or
consciousness, including but not limited to a loss of
consciousness, “ding”, sensation of being dazed or
stunned, sensation of “wooziness” or “fogginess”
seizure, or amnesic period, and by symptoms
commonly associated with post-concussion syndrome,
including persistent headaches, vertigo (dizziness),
light-headedness, loss of balance, unsteadiness,
syncope (LOC), near-syncope, cognitive dysfunction,
memory disturbances, hearing loss, tinnitus (ringing in
the ears), blurred vision, diplopia (double-vision), visual
loss, personality change, drowsiness, lethargy, fatigue,
and inability to perform usual daily activities.”
Pellman, Viano, & Tucker (2003).
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How many is too many?
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Implementing standard concussion guidelines
Centers for Disease Control
Educating parents/coaches/athletes
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Proper sideline medical assessment and
diagnosis of concussion.
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Self-assessment
NOT
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Preseason Education for Coaches
Preseason Education for Athletes
Preseason Education for Parents
Coaches use CDS’s Head’s Up Clipboard
Sticker
Adopt CDC’s Concussion Action Plan to
Remove a Player from Play
Prevention through neck strengthening
Prevention through overall brain trauma
reduction
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Only 30 – 33 percent of all high schools have a
certified athletic trainer on staff. In poor districts
like those in Chicago’s public school system, just
2 percent of high schools have trainers at
practice, and only 9 percent have them at games.
(Tonino & Bollier, 2004).
“a two to three fold greater impact force is
required to produce clinical symptoms in children
compared to adults…This means that if a child
exhibits clinical symptoms after a head injury,
then it is reasonable to assume that they have
sustained a far greater impact force compared to
an adult with the same post concussive
symptoms.”- (McCrory et al., 2004).
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Most commonly used examination is the
Standardized Assessment of Concussion
(SAC).
Evaluates orientation, immediate memory,
concentration, and delayed recall.
IT IS NOT SENSITIVE ENOUGH TO CATCH ANY
BUT THE MOST SEVERE INJURIES.
Doctors are now advocating not grading the
concussion until symptoms have disappeared
due to the unpredictable nature of the injury.
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At a certain point one doesn’t recover as
quickly or fully from concussions.
“After suffering one concussion, athletes are
three to six times more likely to have a
second one. Plus, additional concussions tend
to be more severe. People with a history of
concussions are between four and seven
times more likely to get knocked
unconscious. The “brain reserve” is
depleted.”- (Collins et al, 1999) (Moser &
Schatz, 2002;2005) (McKee et al, 2009)
In 2007, pathological evidence was accumulating that brain trauma in sports caused a unique
brain disease called Chronic Traumatic Encephalopathy, or CTE, that eventually leads to
dementia. CTE is preventable, but nothing was being done to prevent it.
Justin Strzelczyk
Andre Waters
Died at 36
Suicide at age 44
Murder/Suicide age 40
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Through 2009, CSTE has now studied the brains of over 20 athletes
12 of 12 NFL and college football players have tested positive for CTE
SLI Legacy Donors
NFL
Andre Waters - March 10, 1962 to November 20, 2006
Justin Strzelczyk - August 18, 1968 to September 30, 2004
John Grimsley - February 25, 1962 to February 6, 2008
Tom McHale - February 25,1963 - May 25, 2008
Wally Hilgenberg - Sept 19, 1942 - Sept 23, 2008
Lou Creekmur - January 22, 1927 – July 5, 2009
National Hockey League
Reggie Fleming - April 21, 1936 - July 11, 2009
Professional Wrestling
Chris Benoit - May 21, 1967 to June 24, 2007
Amateur Football
Mike Borich - December 8, 1962 - February 9, 2009
John Doe, died at age 18
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The first paper from the CSTE found only 48 cases of CTE existed in the medical literature
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CSTE quickly added three more, and expects to double the known cases within 3 yea
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First described in
boxers by Martland in
1928
Martland HS: Punch
drunk. JAMA
91:1103–1107,
1928
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1st NFL case studied at BU – 5th overall. Died Feb 2008 of self-inflicted gunshot wound
Houston Oilers 1984-1990
Miami Dolphins 1991-1993
Linebacker; Named to Pro-Bowl, 1988
No history of performance-enhancing drugs
No significant medical history
Concussion history:
• 3 concussions during college football at
Kentucky
• At least 8 concussions during NFL career
• Only one "cerebral concussion“ medically
confirmed
Died of gunshot wound to chest, apparently
while cleaning gun. Police report: no evidence
of suicide, believed to be a “very tragic
accident.”
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John Grimsley Findings
John Grimsley had remarkable brain damage for a 45 year-old man
• For the 5 years
prior to his death
at age 45, he
reportedly was
experiencing
worsening
memory and
cognitive
functioning, as
well as increasing
“short fuse.”
• Although
increasing use of
alcohol, no
evidence of
depression,
sadness,
hopelessness. No
alcohol in blood at
time of death.
65 yr old
healthy control
Grimsley 45 yr
old CTE
73 yr old boxer
with dementia and
CTE
6th NFL Case of CTE. Died of a drug overdose
Defensive lineman at Cornell and Maryland
Offensive lineman in college
Tampa Bay Buc 1987-1992
Philadelphia Eagles 1993-1994
Miami Dolphins 1995
No recorded concussion history, although
teammates have come forward with at least
one story of Tom being unable to remember
plays on the field
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6th NFL Case of CTE
Tom opened and operated multiple
successful restaurants after retiring
Began experiencing problems with
drugs, beginning with painkillers from a
back problem. In and out of rehab in
the last years of his life
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Michael Benoit (Chris’s father) on Larry King
Live
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Chris Henry Had Chronic Brain Injury
The 26-year-old Cincinnati Bengals wide
receiver suffered from chronic traumatic
encephalopathy, which may have influenced
his mental state and behavior before he died
in December.
Chicago Tribune, July, 2010
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Depression
Mood Disorder
Substance Abuse/Dependency
“the brain injury of violence”- mimic
Intermittent Explosive Disorder
Suicidal Ideation/Tendencies
Impulse Control
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Little research
Anectodal stories (Michael Benoit)
Lisa McHale
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“It is common for an athlete to report
significant emotional and somatic responses
to injury, including fear, anger, disbelief,
rage, depression, tension, upset stomach,
fatigue, insomnia, and decreased appetite
which is combined with or directly lead to
anxiety, self-esteem issues, lowered pain
tolerance, and introversion”- (Putikan &
Echemendia, 2003).
SLI operates as a though leader and innovator in sports concussion education and sport reform
and works with established organizations to execute programs
SLI Concussion Clinics (est. 2008)
SLI Community Educators (est. 2009)
SLI’s 10 Point Plan for Safer Sports
1.
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Reevaluate how the game is practiced
Encourage mandatory brain trauma and
concussion education for coaches,
athletic trainers, parents, and athletes
3.
Reevaluate protective equipment
4.
Develop better methods of concussion
detection and diagnosis
5.
Develop better methods of concussion
management
6.
Consider minimum medical resources
7.
Reevaluate techniques of play
8.
Reevaluate the rules
9.
Reevaluate rule enforcement and the
role of referees
10. Reconsider the culture of the game
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HELPS Screening Tool (Hux et al, 2009).
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Chris Nowenski
HEAD GAMES- Football’s Concussion Crisis
(2007)
With smoking, it took 50 years from pathological evidence of the link between smoking
and lung cancer to major policy change. SLI created the change in 3 years
1950 – first
small study
finds
smokers
twice as
likely to die
from lung
cancer
Smoking and Lung Cancer
Timeline
1953 - Big
1965 –
1984 Tobacco forms
Tobacco
Institute
Research
Committee
("TIRC"),
10 years
2007 – Andre
Waters suicide
linked to brain
damage from
concussions
2007 – SLI
founded
2007 – Benoit
tragedy
Surgeon
General
warning
added to
packaging
20 years
2008 – SLI/BU
Center for the
Study of Traumatic
Encephalopathy –
Brain Bank and
clinical research
program
established
American
Association for
Cancer
Research
accepts the
evidence
gathered by
cancer
scientists
30 years
40 years
1994: Seven
Dwarves
testify before
Congress
1997: US tobacco
firms agree a multibillion-dollar
settlement to cover
healthcare costs
incurred by treating
people with
smoking-related
illnesses
50 years
2009 – NFL admits
a link between
brain trauma and
CTE and begins to
support CSTE
research
Concussions and CTE Timeline
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Andre Waters
suicide - 3rd NFL
CTE Case
SLI
incorporated
NFL wives Mackey,
Perfetto speak out
Jan. 2007
WWE wrestler
Chris Benoit
5th CTE case
NFL issues concussion
management guidelines
July 2007
Jan 2008
Ted Johnson speaks
out on eve of
Super Bowl
SLI members profiled
on HBO Real Sports
Study finds NHL
NHL warns teams of
players out 41%
stiffer penalties and
longer per concussion
fines for head shots
than 1 year ago
NFL holds
“Concussion
Summit”
Justin Strzelczyk
4th NFL case
SLI and Boston University
School of Medicine partner to
found Center for the Study of
Traumatic Encephalopathy
July 2008
WWE implements
concussion program
NFL tells referees to
eject players for
helmet-to-helmet hits
Living Donor Registry
reaches 100 brains
Jan 2009
July 2009
NFL/NFLPA
Acknowledge Link,
Support BU Research
John Grimsley
5th NFL CTE case
Tom McHale
6th NFL CTE case
NFL announces 4
new rule changes
to protect heads
NHLPA seeks ban on
hits to head
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Living athletes are lining up to be part of this groundbreaking research. They have
agreed to be studied throughout their lives as part of the IRB approved CONTACT study
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National Football League (81)
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National Hockey League (6)
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Ted Johnson
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Keith Primeau
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Joe DeLamielleure
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Noah Welch
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Isaiah Kacyvenski
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Steve Heinze
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Ben Lynch
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Ryan Vandenbussche
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Bernie Parrish
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Pro Wrestling (25)
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Kyle Turley
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Rob Van Dam
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Frank Wycheck
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Lance Storm
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Bruce Laird
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Chris Nowinski
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Brent Boyd
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Spike Dudley
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Mel Owens
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Molly Holly
•
Dan Pastorini
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April Hunter
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Billy Ray Smith
•
Al Snow
•
Ken Gray
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Boxing
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Harry Jacobs (more)
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Micky Ward
NBA
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Soccer
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Paul Grant
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Cindy Parlow
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Malcolm Huckaby
Swimming
• As of Sept 2009
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Jenny Thompson
Level
Donors
Pro
150
Amateur
150
Total
300+
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3 active NFL players promise their brains for
concussion research: 'The culture has to change'
Sean Morey
Lofa Tatupu
Matt Birk
Arizona Cardinals
Seattle Seahawks
Minnesota Vikings
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Collins, M., Grindel, S., & Lovell, M. (1999). Relationship between concussion and
neuropsychological performance in college football players. JAMA, 282.
Hux, K., Schneider, T., & Bennett, K. (2009). Screening for traumatic brain injury.
Brain Injury, 23(1).
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McKee, A., Cantu, R., Nowinski, C., Hedley-Whyte, E., Gavett, B., Budson, A., Santni, v.
Lee, H., Kubils, C., and Stern, R., (2009). Chronic Traumatic Encephalopathy in Athletes:
Progressive Tauopathy After Repetitive Head Injury. Journal of Neuropathology and
Experimental Neurology, 68,7.
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McCrory, P., Collie, A., Anderson, V., & Davis, G. (2004). Can we manage sport related
concussion in children the same as in adults? Br J Sports Med, 38.
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Moser, R., & Schatz, P. (2002). Enduring effects of concussion in youth athletes.
Neuropsychol, 17(1).
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Moser, R., Schatz, P., & Jordan, B. (2005). Prolonged effects of
concussions in high school athletes. Neurosurgery, 57(2).
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Nowenski, C. (2007). Head Games: Footballs’ Concussion Crisis.
East Bridgewater, MA: Drummond Publishing.
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Pellman, E., Viano, D, Tucker, A., et al. (2003). Concussion in
professional football: Reconstruction of game impacts
and injuries. Neurosurgery, 53(4).
Putukian, M., & Echemendia, R. (2003). Psychological aspects of
serious head injury in the competitive athlete. Clin Sports Med, 22.
Tonino, M., & Bollier, M. (2004). Medical supervision of
high school football in Chicago: Does inadequate staffing
compromise healthcare? The Physician and Sportsmedicine,
32(2).