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Tuesday, September 24, 2019

Mild Head Trauma and Brain Damage

     The brain’s most obvious protection is the is our approximately one-quarter inch thick skull, but the brain is also surrounded by protective cerebrospinal fluid and a protective membrane called the meninges. Both provide further defense against physical injury.
     Another protective element is the blood–brain barrier. As the name suggests, this is a barrier between the brain’s blood vessels and the cells and other components that make up brain tissue.
     Whereas the skull, meninges and cerebrospinal fluid protect against physical damage, the blood–brain barrier provides a defense against disease-causing pathogens and toxins that may be present in our blood. 
     The link between repeated head trauma and neuro-degenerative disease continues. According to researchers at Stanford University School of Medicine and Trinity College in Dublin even mild head trauma in adolescents and adults who participate in contact sports damages the barrier that protects the brain from pathogens and toxins. 
     In the study, scientists scanned the brains of teenage and adult rugby players and found damage to the protective barrier that separates the brain from blood borne pathogens and toxins in roughly half of adolescent rugby players after a full season. And, that was even in athletes who didn’t report taking a shot to the head. 
     Even mild blows to the head may temporarily weaken the blood–brain barrier and affect normal brain function even if only temporarily. The temporary changes are in the form of awareness and responsiveness, short-term amnesia, headache and difficulty thinking clearly which can be difficult to spot.
     Researchers wondered if mild head trauma damaged the blood-brain barrier and scanned brains rugby players to see if the blood-brain barrier was intact. Ten of 19 teen players showed signs of damage by the end of the season. Of eight college rugby players, two had damage. Their injuries were not serious enough to be considered a concussion. 
     Scientists recruited five professional mixed martial arts fighters, who wore the mouth guards during fights and had their brains scanned before and after fights. After fight scans showed increased blood-brain barrier damage. Surprisingly, not all blows that looked bad, like an early knockout, caused damage. 
     It used to be thought that the brain bouncing around and slamming into the skull caused the damage, but recent evidence suggest the damage goes much deeper than just on the surface. Researchers are unsure how long recovery from he blood-brain barrier takes. Bottom line: research has raised questions that it’s too soon to answer. 
     The dangers of American professional football is a hot topic because studies have found high rates of concussions, traumatic brain injuries and a serious brain disorder called chronic traumatic encephalopathy (CTE) in former players. These injuries can have terribly debilitating effects and as a result, the NFL changed rules designed to make play safer. 

Concussion: Occurs when a collision causes the brain to hit the inside of the skull. The greater the force of the impact, the more severe the concussion. Symptoms can include disorientation, memory problems, headaches, fogginess, and loss of consciousness. After suffering from one concussion, a person is much more likely to suffer from a second one after another injury. Having more than one concussion can cause depression, anxiety, aggression, personality changes, and an increased risk of Alzheimer’s, Parkinson’s, CTE, and other brain disorders. 
CTE: A brain disorder that is caused by repeated head injuries. These brain changes progress and worsen over time, and may not be noticed for months, years, or decades after the last brain injury. There is no cure. Common symptoms include memory loss, impaired judgment, aggression, and depression. 

     Some of former athletes with CTE have committed suicide or murder. CTE is most often found in athletes who have experienced repeated head injuries, such as former boxers, hockey players, and football players. 
     Former pro football player Aaron Hernandez committed suicide in prison where he was serving time for murder. The autopsy results revealed that he had the worst case of CTE ever reported on such a young man (Hernandez was 27 years old). 
     In September 2017, President Trump tweeted that the NFL is ruining the game because the league’s safety restrictions and rules make the game less enjoyable to watch. Apparently, like back in the days of the gladiators, some football fans want to watch violent games, regardless of players’ safety and health. 
     A study published in the Journal of American Medical Association in 2017 found that among 202 deceased former football players almost 88 percent of them were diagnosed with CTE. However, it needs to be pointed out that these results are not typical because their bodies were donated by family members who wanted to know if they had CTE when they died. 
     Researchers at Virginia Tech found that football risks start at an early age when young children take high-force hits to the head. The researchers observed 9- to 12-year-old players and found that about 8 percent of head impacts were high magnitude (40 times the force of gravity). Quarterbacks, running backs, and linebackers were at the greatest risk. 
     Another study found that dangers are much greater when players start before the age of 12, because they are twice as likely to develop mood and behavior problems later in life. 

The NFL has changed several rules. 
* They have moved kickoffs from the 30 yard line to the 35 yard line and touchbacks from the 20 yard line to the 25 yard line. This rule shortens the distance between the kicking team and the receiving team. Since players gain a lot of speed as they run at each other from across the field, the shorter distances are less dangerous. 
* The NFL plans to also reduce injuries by continuing to disqualify players who exhibit poor sportsmanship and dangerous conduct. 
* Crown-of-the-helmet rule penalizes defensive players or offensive ball carriers who initiate contact with the top of their helmet. This type of play happens when a player uses his head to hit another player’s head, which is very dangerous for both players. It reduces the probability of all head and neck injuries by 34 percent. The downside of this rule is that players are more likely to tackle the lower body, which increases risk of serious lower body injuries. 
* The NFL has made several changes to its concussion protocol. Prior to the change, if a player left the field with a possible concussion, he had to stay out of the game while he was being evaluated. If he was diagnosed with a concussion, he would continue to be benched for the rest of the game and for as long as it took for a doctor to clear him for play. 
*After the rule change an unaffiliated neurotrauma consultant must be present for all games to evaluate any player who seems to lack motor stability or balance, and re-evaluating any player who had been evaluated for a concussion during a game within 24 hours of the initial evaluation. Having the decision made by an expert who is not working for either team is a good way to try to better protect player safety. 

     With several high school and collegiate athletes dying from head injuries sustained during football games in recent seasons, concern over head injuries and concussions has become more prevalent. 
     Part of the renewed focus on athletic head injuries is a better understanding of the symptoms and ability to diagnose the condition. 

Signs of a Concussion: 
It is often assumed that athletes suffer concussions when they lose consciousness or have difficulty remember or repeating things. However, according to doctors at the Mayo Clinic, most people who have a concussion do not lose consciousness or black out; some people will have a concussion and not even realize it. 

Symptoms of a concussion include: 
* Headache 
* Fatigue 
* Ringing in the ear
* Vomiting 
* Nausea 
* Difficulty speaking 

     There are also symptoms that may not appear until well after the injury initially occurs, including irritability, difficulty sleeping and memory or concentration problems. 
     Parents, friends and teammates should not only be aware of these symptoms, but also watch the athlete closely in the hours following a hard hit in a game. 
     According to a recent study by the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, over 40 percent of high school athletes return to action prematurely after suffering a concussion. These statistics include 16 percent of football players who play the same day after losing consciousness. According to a report in the Chicago Tribune, nearly half of concussions in high school football go unreported. 

    Second Impact Syndrome - SIS is a condition that reflects the compound effect of head injuries and can results in a serious permanent brain injury or even death. Younger, less developed brains are at a much higher risk of SIS according to the Ohio Children’s Hospital Study. 
     In an effort to alleviate pressure on high school athletes to return to games following a hard hit, the Illinois High School Association has adopted a rule concerning concussions.  The rule states that if an official, coach or trainer suspects that a player has suffered a concussion, that player can be removed from the game and can only return if cleared by a medical professional. This rule applies to all sports and players. 
     When a young athlete receives a head injury in a game, the first person they generally come in to contact with is the school’s athletic trainer. The primary responsibility of the trainer is to properly diagnose the condition, inform the student and parents of the assessment and any potential risks. When a trainer fails to properly diagnose a condition and an injury is caused by that act, the trainer may be held liable.

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