Has Anybody Seen My Mind?

Recognizing signs and symptoms of brain injury linked to repetitive sports related concussions.

Teresa R. (Hedges) HeadleyM.Ed., AbD., Professional Counselor

Volunteer Ambassador Sports Legacy Institute

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.

Michael Franti

Are you ready for some football?

For clarification- I LOVE THE GAME!

Teamwork, leadership, lessons in winning and losing, physical development.

Licensed Professional Counselor

PhD. Research regarding the experiences of wives whose husbands have died due to chronic traumatic encephalopathy.

Personal Experience

Credentials and Personal Experience

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.

Sports Legacy Institute

Pat White

Tim Tebow

Kevin Kolb

What do you think a concussion is?

What is a Concussion?

60 Minutes Presentation

A Blow to the Brain

“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).

Concussion Defined

How many is too many?

Repetitive Concussions

Implementing standard concussion guidelines

Centers for Disease Control Educating parents/coaches/athletes

Prevention

Proper sideline medical assessment and diagnosis of concussion.

NOT Self-assessment

Proper Assessment

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

Minimum Standards

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).

Shocked?

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.

Utilization of Baseline Data

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)

Consequences of Repetitive Injury

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The Concussion Crisis RevealedIn 2007, pathological evidence was accumulating that brain trauma in sports caused a unique brain disease called Chronic Traumatic Encephalopathy, or CTE, that eventually leads todementia. CTE is preventable, but nothing was being done to prevent it.

Justin Strzelczyk

Andre Waters

Suicide at age 44

Died at 36

Murder/Suicide age 40

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The CSTE Brain BankSLI Legacy DonorsNFLAndre Waters - March 10, 1962 to November 20, 2006Justin Strzelczyk - August 18, 1968 to September 30, 2004John Grimsley -  February 25, 1962 to February 6, 2008Tom McHale - February 25,1963 - May 25, 2008 Wally Hilgenberg - Sept 19, 1942 - Sept 23, 2008Lou Creekmur - January 22, 1927 – July 5, 2009

National Hockey LeagueReggie Fleming - April 21, 1936 - July 11, 2009

Professional WrestlingChris Benoit - May 21, 1967 to June 24, 2007

Amateur FootballMike Borich - December 8, 1962 - February 9, 2009John Doe, died at age 18

Through 2009, CSTE has now studied the brains of over 20 athletes12 of 12 NFL and college football players have tested positive for CTE

Survey of All Pathologically Confirmed CTE cased since 1928

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The first paper from the CSTE found only 48 cases of CTE existed in the medical literature• CSTE quickly added three more, and expects to double the known cases within 3 years

• First described in boxers by Martland in 1928Martland HS: Punch

drunk. JAMA 91:1103–1107, 1928

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John Grimsley1st 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.”

65 yr old healthy control

Grimsley 45 yr old CTE

73 yr old boxer with dementia

and CTE

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.

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Tom McHale6th 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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Tom McHale6th 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

Michael Benoit (Chris’s father) on Larry King Live

Chris Benoit

Video Footage of Impacted Player

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

Chris Henry

Depression Mood Disorder Substance Abuse/Dependency “the brain injury of violence”- mimic

Intermittent Explosive Disorder Suicidal Ideation/Tendencies Impulse Control

Symptoms Mimic Other Disorders

Little research Anectodal stories (Michael Benoit) Lisa McHale

Impacts on Families

“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).

Psychological Consequences

Education/PreventionSLI operates as a though leader and innovator in sports concussion education and sport reform and works with established organizations to execute programs

SLI’s 10 Point Plan for Safer Sports

1. Reevaluate how the game is practiced

2. Encourage mandatory brain trauma and concussion education for coaches, athletic trainers, parents, and athletes

3. Reevaluate protective equipment4. Develop better methods of concussion

detection and diagnosis5. Develop better methods of concussion

management6. Consider minimum medical

resources 7. Reevaluate techniques of play8. Reevaluate the rules9. Reevaluate rule enforcement and

the role of referees10. Reconsider the culture of the game

SLI Concussion Clinics (est. 2008) SLI Community Educators (est. 2009)

HELPS Screening Tool (Hux et al, 2009).

Role of Healthcare and Mental Health Care workers

Chris Nowenski

HEAD GAMES- Football’s Concussion Crisis (2007)

How we can support the research

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Analog - Smoking and Lung CancerWith 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

Smoking and Lung Cancer Timeline1984 -

American Association for Cancer Research accepts the evidence gathered by cancer scientists

1950 – first small study finds smokers twice as likely to die from lung cancer

1997: US tobacco firms agree a multi-billion-dollar settlement to cover healthcare costs incurred by treating people with smoking-related illnesses

1953 - Big Tobacco forms Tobacco Institute Research Committee ("TIRC"),

10 years 20 years 30 years 40 years 50 years

1965 – Surgeon General warning added to packaging

1994: Seven Dwarves testify before Congress

2007 – Andre Waters suicide linked to brain damage from concussions

2007 – SLI founded2007 – Benoit tragedy

2008 – SLI/BU Center for the Study of Traumatic Encephalopathy – Brain Bank and clinical research program establishedConcussions and CTE Timeline

2009 – NFL admits a link between brain trauma and CTE and begins to support CSTE research

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…and Inspired Real Change

Jan. 2007 July 2007 Jan 2008 July 2008 Jan 2009 July 2009

Andre Waters suicide - 3rd NFL

CTE Case

Ted Johnson speaksout on eve of

Super Bowl

SLI members profiled on HBO Real Sports

Justin Strzelczyk4th NFL case

SLI incorporated

NFL issues concussion management guidelines

NFL tells referees to eject players for

helmet-to-helmet hits

WWE wrestler Chris Benoit5th CTE case

NFL wives Mackey, Perfetto speak out

NFL holds “Concussion

Summit”

WWE implements concussion program

NHL warns teams ofstiffer penalties and fines for head shots

John Grimsley5th NFL CTE case

Living Donor Registry reaches 100 brains

NFL announces 4 new rule changes to protect heads

Study finds NHL players out 41%

longer per concussionthan 1 year ago

SLI and Boston UniversitySchool of Medicine partner to found Center for the Study of

Traumatic Encephalopathy

Tom McHale6th NFL CTE case

NHLPA seeks ban on hits to head

NFL/NFLPA Acknowledge Link,

Support BU Research

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The CSTE Brain Donation Registry

• National Football League (81)• Ted Johnson• Joe DeLamielleure• Isaiah Kacyvenski • Ben Lynch• Bernie Parrish• Kyle Turley• Frank Wycheck• Bruce Laird• Brent Boyd• Mel Owens• Dan Pastorini• Billy Ray Smith• Ken Gray • Harry Jacobs (more)

• NBA• Paul Grant• Malcolm Huckaby

• National Hockey League (6)• Keith Primeau• Noah Welch• Steve Heinze• Ryan Vandenbussche

• Pro Wrestling (25)• Rob Van Dam• Lance Storm• Chris Nowinski• Spike Dudley• Molly Holly• April Hunter• Al Snow

• Boxing• Micky Ward

• Soccer• Cindy Parlow

Swimming• Jenny Thompson• As of Sept 2009

Living athletes are lining up to be part of this groundbreaking research. They haveagreed to be studied throughout their lives as part of the IRB approved CONTACT study

Level Donors

Pro 150Amateur 150Total 300+

Active NFL Players Sign Up – September 14, 2009

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Sean MoreyArizona Cardinals

Lofa TatupuSeattle Seahawks

Matt BirkMinnesota Vikings

3 active NFL players promise their brains for concussion research: 'The culture has to change'

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).  

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. 

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.

Moser, R., & Schatz, P. (2002). Enduring effects of concussion in youth athletes. Neuropsychol, 17(1).

References

Moser, R., Schatz, P., & Jordan, B. (2005). Prolonged effects of concussions in high school athletes. Neurosurgery, 57(2).

Nowenski, C. (2007). Head Games: Footballs’ Concussion Crisis. East Bridgewater, MA: Drummond Publishing.

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).

References Continued