6/22/2011
Tad Seifert, MD Norton Neuroscience Institute Louisville, KY
Case Presentation
Football player No chr oni c m edi cal i ssues Two documented concussions during current season 1st event ○ Last offensive series of game ○ Cleared to play following week 2nd event ○ Appx 2 months after 1 st event ○ Suffered during 2nd quarter ○ Did not return for remainder of game ○ Held out the following week ○ Started next game 14 days later
1 6/22/2011
Case presentation
3rd event (appx 6 wks after 2nd injury) 4th quarthltter helmet-to-hlhelme thit(flt hit (flagge d as illegal) Appears unsteady Transient “dazed” appearance Not pulled from game RidfRemainder of game iifftiis ineffective Next scheduled game is 2 wks
Case Presentation
Should this player sit? Be retested with ImPACT? Be reinserted in the “gradual RTP protocol?” None of the above?
2 6/22/2011
15 yard penalty assessed Julius Peppers fined $10,000
3 6/22/2011
Aaron Rodgers
“It hurt, I can tell you that. He hit me pretty good. I know what a concussion feels like. I’m just grateful this wasn’t hard enough to give me another one . ”
The Capital Times Madison, Wisconson
Shawn Doherty writes of a “consipiracy of silence” “After all the drama over Rodgers suffering two concussions and getting pulled out of one game and missing the next last fall, why haven’t there been more questions about what most of us saw Sunday, even if some of us don’t want to admit it?”
4 6/22/2011
Shawn Doherty of The Capital Times: “I’m talking about how Rodgers looked and acted right after Bears DE Julius Peppers’ illegal helmet-to-helmet whack to his head. Rodgers was woozy and wobbling about with dazed eyes. If you didn’t notice he was wobbling, surely you noticed his football was. His magic was gone for the rest of the game. He couldn’t even hit the mark with a couple of short passes…”
Aaron Rodgers
3 days postgame: “No t much to t alk ab ou t. I did n ’t have a concussion. I want to dispel that rumor. No concussion. I was fine. Yeah. Helmets are designed to prevent concussions, I think.”
5 6/22/2011
“Helmets are designed to prevent concussions, I think.” -- ARdAaron Rodgers Robert Cantu, MD Boston University Medical School Senior Advisor to NFL Head, Neck, and Spine Medical Committee: ○ “His confidence about helmets preventing concussions is misguided. They are made primarily to prevent skull fractures and subdural hematomas. Do they prevent concussions? Probably they do, but just a small fraction.”
Let’s talk about helmets…..
“That was lucky. As much as the new helmet feels uncomfortable and I’m still getting used to it, I’m really happy I was wearing it on that (Peppers’) hit. ----Aaron Rodgers on his switch to a new model after suffering two known concussions earlier in the season
6 6/22/2011
Schutt AiR XP
“The Schutt AiR XP™ is a traditional shell helmet with that familiar, spherical shape that so many players have grown up with. A unique combination of tradition with state-of-the art technology in a helmet that’s small in appearance but packs the BIGGEST protection of any traditional shell helmet on the field.“
7 6/22/2011
Packers statement: “….wearing a specifically modified helmet with extra padding to reduce the risk of sustaining another concussion….” SI.Com’s Will Carroll: “…it’s neither special or that advanced. The Schutt design is said to be better than the more stddditandard design thtRdthat Rodgers wore previously, but there are a number of players that wear Schutt designs already, as they are available to any player to wear.”
Schutt AiR XP: “Tests Don’t Lie”--- Schutt website
“In head-to-head testing at 105 degree by an independent research lab the TPU cushioning inside the AiR XP dramatically out performed the bonnet system in the Xenith X1 and the foam cushioning in the Riddell Revolution.” “The Xenith X1 helmet absorbed 23% less impact than the AiR XP.” “The Ridd e ll Revo lu tion he lme t a bsor be d 12% less impact then the XP.” “The Riddell VSR-4 absorbed 28% less impact than the XP.”
8 6/22/2011
Spokesmen for the Packers turned down requests for further comments on Rodgers’ new helmet citing respect for “his privacy”
Schutt TPU (Thermoplastic Urethane Cushioning) “TPU remains the best performing padding system in football today. ” “In game conditions, the AiR XP outperform all the other helmets on the field.” “It’s proven superior to traditional foam padding in game-like conditions: better impact absorption, better heat management, and better hygenics”
9 6/22/2011
“TPU cushioning won’ tttakea take a compression set, won’t break down (even after thousands of impacts) and is resistant to mold, mildew, fungus, and bacteria”
Schutt website fine print warning
WARNING: Contact in football may result in Concussion/Brain injury which no helmet can prevent. Symptoms include: loss of consciousness or memory, dizziness, headache, nausea, or confusion. If you have symptoms, immediately stop and report them to your coach, trainer, and parents. NO HELMET SYSTEM CAN PROTECT YOU FROM SERIOUS BRAIN AND/OR NECK INJURIES INCLUDING PARALYSIS OR DEATH. TO AVOID THESE RISKS, DO NOT ENGAGE IN THE SPORT OF FOOTBALL.
10 6/22/2011
NFL Player’s Association Report
“Dangers of the Game” Based on 2010 regular season After week 15, NFL on pace for 269 concussions 21% increase from 2009 34% increase from 2008
Alan Schwarz , October 2010 “As Injuries Rise, Scant Oversight of Helmet Safety”
Reports the lone existing helmet stddtandard was wr itten more than 30 years ago by a volunteer consortium that includes and is largely financed by the helmet makers themselves, that that this standard is aimed at preventing skull fractures, not concussions.
11 6/22/2011
“Helmets both new and used are not – and never have been – formally tested against the forces believed to cause concussions” “…the fact that helmets are held to no standard regarding concussions surppyrised almost every one of dozens of people interviewed for this article, from coaches and parents to doctors and league officials.”
January 2011 Federal Trade Commission Investigation
Looking into marketing claims for some helmets
Including the Schutt Air XP
Prompted by Jan 4 letter by US Rep Tom Udall of New Mexico
12 6/22/2011
FTC Probe
Investigating “the misleading safety claims and deceptive practices” in the industry Takes aim at Ridell claims that its popular Revolution models “decrease concussions by 31%”
Schutt Air XP Youtube.com video advertisement
15 lb bowling ball dropped onto a “poor unsuspecting watermelon” Cushioned by traditional padding used by competitors: the head-sized fruit is squashed Surrounded by the plastic-based padding touted by Schutt for its “impact absorption”: the fruit remains whole
13 6/22/2011
Schutt Air XP Youtube.com video advertisement
Robert Erb, CEO of Schutt Sports: “The video was meant as a parody and Schutt never claims its products are concussion proof.”
Virginia Tech May 2011 Study releases new rating system of adult football helmets
Accepted for publication in upcoming issue of Annals of Biomedical Engineering
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2011 VT Helmet Study
First time comparative test results on football helmets have been made public Assigned 1 to 5 star ratings providing a “prediction of associated concussion risk.” Study based on “analysis of a million impacts we’ve collected” -- lead author and professor of biomedical engineering, Stefan Duma
2011 VT Helmet Study
Performed 120 impacts on each helmet model at multiple locations and impact energies. A total of three new helmets were purchased for each model and tested Utilized over one million measured head impacts to quantify the impact exposure and concussion risk
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2011 VT Helmet Study
Impacts performed replicating on-field football head impacts Each helmet is tested at four impact locations (front, back, side, and top) at five different impact drop heights ranging from 12 inches to 60 inches.
2011 VT Helmet Study
Cost of helmet showed little correlation to the relative protection offered NR (not recommended): Adams A2000 Pro Elite --- $199.95 1 star: Riddell VSR4 --- cost not available
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2011 VT Helmet Study
4 star ShttSchutt ION 4D -- $259. 95 Schutt DNA 4+ -- $169.95 Xenith X1 -- $299.99 Riddell Revolution -- $182.99 Riddell Revolution IQ -- $222.99 5 star Riddell Revolution Speed -- $243.99
2011 VT Helmet Study Criticism
Researchers simulated only head-to- ground impacts, instead of helmet-to- helmet Rotational forces not considered Time duration of impact not considered
17 6/22/2011
“We disagree with the decision, and it was a ccealean hi t.” – Van couv er captain Henrik Sedin
“It seems like four games is pretty excessive in the Stanley Cup finals” – Canucks Keith Ballard
“In my opinion, it’s not the right call. It was a bit late, but anyyybody that’s p pylayed the game knows you have to make a decision in a fraction of a second. I don’t know how the league could come up with that decision really.” – Vancouver coach Alain Vigneault
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“I saw him coming, but t he re i s n othin g you can do. Mine, they say it was late, it’s arbitrary….that is the decision they made and I have to respect that, but I dfiitlddefinitely don ’t agree with it.” -- Aaron Rome, Vancouver Canucks
19 6/22/2011
James Harrison
2008: $20,000 fine for criticizing a roughing the passer penalty 2009: $5, 000 fine for l a te hit on Cinc inna ti Benga l Andrew Whitworth 2010: $5,000 fine for slamming Vince Young to the turf 2010: fined $75,000 for helmet-leading hits knocking Cleveland Browns receivers Josh Cribbs and Mohamed Massaquoi out of same game 2010: fined $20, 000 for late hit on Drew Brees 2010: fined $20,000 for helmet-leading hit on Buffalo QB Ryan Fitzpatrick
James Harrison on Cribbs being briefly knocked unconscious: “"I thought Cribbs was asleep. A hit like that geeks you up , especially when you find out the guy is not really hurt, he's just sleeping. He's knocked out but he's going to be OK."
20 6/22/2011
James Harrison Super Bowl Week
Suggested the league “lay a pillow down where I’m going to tackle them, so they don’t hit the ground too hard.”
Concussions (history) *high school death Oct. 25, 1921
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Traumatic Brain Injuries Remain in Headlines Weekly, if not Daily
Eastern Oregon UUestyniversity WR D yaylan Steigers dies from CHI on May 9, 2010 Boston Celtics Glenn “Big Baby” Davis (concussion) in 2010 Game 5 Eastern Conference Finals vs. Orlando Magic
Marc Savard Boston Bruins center
NHL All-Star 2008 & 2009 March 7th, 2010 concussion vs. Pittsburgh February 8th, 2011 suffers second concussion in 10 months Does not play during Stanley Cup run
22 6/22/2011
Marc Savard
“I’m feeling better. I still have my days. The memory is the biggest thing for me and the mornings are kind of tough. The memory stuff is really terrible and hopefully it gets better.”
23 6/22/2011
Fencing Response
Described by Lifshitz et al @ UK Spinal Cord & Brain Injury Research Center 2009 publication in Medicine and Science in Sports and Exercise
Jahvid Best
Hold multiple Cal records 2008 Pac 10 leading rusher 2008 Emerald Bowl rushing record 2010 NFL draft 30th pick by Detroit (via Minnesota) Signed $9.8 million over 5 year deal on July 30, 2010 CJ Spiller (Clemson) picked 9th by Buffalo signed for $25 million over 5 years Ryan Matthews (Fresno State) picked 12th by San Diego signed for $26 million over 5 years
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Concussions and Suicide
Concussion and depression relationship well-established Prevalence of depression in general population 5% Prevalence in head trauma patients approaches 40% in some studies fMRI with reduced activity in regions known to be implicated in depression Dorsolateral prefrontal cortex and striatum Medial frontal and temporal lobes Same pattern as that seen in non-concussed patients with major depression
25 6/22/2011
Owen Thomas
Suicide April 25th, 2010 21 yo U Penn DE No previous hx of depression or concussion Brain autopsy discovered early stages of CTE Youngest and 1st amateur player to have documented CTE via brain autopsy
Kenny McKinley
Suicide September 20th,,00 2010 23 yo Denver Broncos WR No documented concussions Brain donated to Boston University Center for the Study of Traumatic Encephalopathy
26 6/22/2011
Dave Duerson
Suicide February 17th, 2011 50 yo former Chicago Bears DB Note to family included the request, “Please see that my brain is given to the NFL’ s brain bank.” Neuropathology exam revealed indisputable evidence of CTE
Ricky Bell
Died February 17th, 2011 Suicide suspected 36 yo former Chicago Bear and Canadian Football League DB
27 6/22/2011
Ricky Bell
Harold Nash – current strength & conditioning coach for New England Patriots -- played with Bell in the Winnipeg secondary in 2002 and 2003. Nash recalled a game against Toronto in which Bell took a head shot. The wobbly Bell wanted to go right back in. "Ricky found his helmet," said Nash. “But he wouldn't do any of the (concussion) testing. Rick was just, 'No,,g I'm not doing the test.' He finds his helmet, and he lines up in the box. He's supposed to be out there covering a receiver.”
Derek Boogaard
Found dead May 13th, 2011 “Accidental death due to mixed alcohol and oxycodone toxicity” 28 yoNew York Ranger left wing Concussion suffered December 9th, 2010
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Derek Boogaard
3 documented concussions during playing career Suffered lingering effects consistent with post- concussidive syndrome Told reporter from The Minneapolis Star-Tribune: “I didn’t have people around me. That’s why when (Rangers’ forward Marian Gaborik) got his concussion, I’d call him everyday and say, ‘I want you to call me and we’ll go for lunch and we’ll do something for at least an hour just so you can get out of yypour apartment.’ I didn’t want him ggggoing through the same thing I did.” Brain donated to BU reseach team
Dave Ulinski Kentucky OL
Daniel Noble Oklahoma DT
29 6/22/2011
“…a quest for cures, treatments, and dead men’s brains.”
“I hadn’t buried my son yet, but I finally realized what was going on: There was a competition for his brain” --- Ken McKinley, Sr.
“Coming to a head” Peater Keating of espn.com, December 2010
“It’s a new reality of the NFL. Grieving families can expect two phone calls: one from Morgantown, the other from Boston. “There should be one process, something simple where maybe players check a box to donate their brains,” McKinley says. “Then maybe others won’t have to go through was I went through”
30 6/22/2011
Chris Benoit Michael Benoit --- “What are my thoughts? My thoughts are that the CTE doctors and advocates need their behinds kicked. Everyone loves to be in front of the cameras talking about the latest case of CTE, but no one is talking about the people who are currently suffering. The research world is an old boys’ club. How many more brains do we need to prove that concussions can cause CTE?
WWE Statement:
"It is natural that a father would try to come up with a reason why his son would tragically murder his wife and c hild, an d then comm it su ic ide. Base d on the study by the Sports Legacy Institute that claimed Chris Benoit had the brain of an 85-year- old with dementia, Mr. Benoit asserts that head trauma was the cause of his son's aberrant, criminal behavior. However, common sense would dictate that this is impossible. Someone with the brain of an 85-year-old with dementia would be unable to keep a traveling work schedule, drive himself to arenas, and perform intricate maneuvers in the ring much less commit a methodical murder- suicide over a 48 hour period."
31 6/22/2011
CTE mimicks ALS?
Journal of Neur opath ol ogy an d Experimental Neurology, August 2010 12 brains with dx of CTE examined Of these 12, three also concurrently diagnosed with ALS (ante mortem)
Chronic Traumatic Encephalomyopathy (CTEM) Protein markers in these 3 patients NOT consistent with ALS TDP-43 found in brain and spinal tissue TDP-43 NOT found in ALS New term coined: CTEM
32 6/22/2011
Live game EEG data?
Dr. Hashem Ashrafiuon Mechanical Engineering professor, Villanova University BCILab™ analyzes EEG waveforms recorded by headset in order to predict abnormalities in brain activity Software currently being developed by Brain Compp(),y,uter Interface (BCI), a Yardley, PA firm Publication of research findings expected this summer
Neurology, April 26, 2011
“The King-Devit test as a determinant of head trauma and concussion in boxers and MMA fighters” Measures speed of reading aloud a series of single-digit numbers from left to right on 3 standardized test cards Requires less than 2 minutes to complete Delay on retesting after suspected concussion suggests true injury
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“The King-Devit test as a determinant of head trauma and concussion in boxers and MMA fighters”
Several limitations: Population selected (MMA participants and boxers) likely had prestudy exposure to head trauma Trials were performed ringside – no description given of level of activity around subjjgects or degree to which other environmental factors were controlled Addition factors not accounted for: sleep deprivation, medication use, learning disorders
“Epidemiology of Sudden Death in Young, Competitive Athletes Due To Blunt Trauma”
Published June 21, 2011 Deaths via blunt trauma in athletes 21yo or younger uncommon Estimated at 16 or fewer per year Fourfold less than cardiovascular deaths
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“Epidemiology of Sudden Death in Young, Competitive Athletes Due To Blunt Trauma”
Football accounted for 57% (138) of deaths 12% of the 138 FB deaths involved students who returned to the game after a concussion
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