USA TODAY Monday, December 3, 2012 reported on NFL: WEEK 13, YOUR JOB OR YOUR HEALTH by Gary Mihoces ? Let’s examine some of the voices from stories from page 10 C SPORTS from a concussion research point of view.
“The NFL is stressing a change in the culture when it comes to head injury. A year ago, the league took heat for not checking Cleveland Browns quarterback Colt McCoy on the sideline for a concussion following a brutal helmet-to-helmet hit from Pittsburgh Steelers linebacker James Harrison. It has stepped up systems in place – including an athletic trainer monitoring the action and TV feeds in the press box – to spot potential concussions and make sure players get evaluated.
On NFL sidelines, medical personnel follow a checklist for “obvious signs of disqualification” such as headaches, nausea and dizziness. Since late last season, the league has stationed athletic trainers in the press box to monitor players for possible concussions.
Dr. Hunt Batjer, neurosurgeon and co-chair of the NFL’s Head, Neck & Spine Committee, says the mantra is medical decisions trump competitive ones.
“Let’s say I’m an NFL quarterback and I’ve realized I’ve had a concussion but I’m not so impaired that I can’t continue playing. … The danger of that is I could have another one before I recover from the first one, which is actually going to cost me a lot more time ,” says Batjer.
Late last week Smith wasn’t second-guessing his decision to self-report. “No, I’m not looking back on that,” he said.
He isn’t sure whether his example will make other players more reluctant to follow suit.
“I don’t know. It’s a good question,” said Smith, who was leading the league in completion percentage at the time of his injury. ” … I mean, that’s kind of the deal with all injuries.” ”
Despite leading the NFL in completions Smith does not regret pulling himself from the game. But unfortunately that attitude is still not the norm with players.
“Former 49ers linebacker Bill Romanowski does question whether Smith made the right move. He told Bay Area radio station 95.7 The Game that a “lot of guys still do” play through concussions.
Julian Bailes, Chicago neurosurgeon and co-founder of the Brain Injury Research Institute, heard Romanowski’s take.
“We thought we were making progress on the change in the culture, and now the fact that this guy, Alex Smith, lost his job once again brings up the issue that the culture is still in question,” says Bailes.”
That kind of response is very much the tough culture, as a player says to himself, “Do I play through and just maneuver with it ?” The problem is these players don’t know yet what effect that multiple hits to the head do to their brain’s inner shape integrity. The recently released Boston study with co-author neurosurgeon Robert Cantu is sounding the warning like the canary that falls over at the bottom of a mine. The falling alert is the release of early stage traumatic encephalopathy (cte) seen in a high school football player from Ann McKee, a neuro-pathologist and the lead author from the study. According to McKee, “it’s never been reported in a person without head trauma.” The Boston study was completed at the Boston University for the Study of traumatic Encephalopathy and the Veerans Affairs Healthcare System both in collaboration with Boston’s Sports Legacy Insitute. The young 18-year-old football player, Eric Pelly named in the report was in Stage 1 CTE died 10 days after suffering a concussion in rugby in 2006.
Although it may become harder to hide a concussion especially if the blow is significant. But here is the crux of the still prevalent attitude, ” But there are 22 players on the field. So having individual players take responsibility for themselves remains an factor. “
“During a Nov. 18 game, eighth-year linebacker DeMarcus Ware of the Dallas Cowboys went to the sideline late in the third quarter for a concussion assessment and returned to play in the fourth quarter.Ware says a concussed player is not hard to spot: “You know something is a little bit wrong with a guy when he’s a little foggy, he’s just walking around, his demeanor, how the guy’s acting.” “
Ghamshid Ghajar a neurosurgeon and CEO of the Brain Trauma Foundation has recently started to be able to test for concussion using a simple 5 minute eye test which was reported by his group in September. Working with a large US Army funded grant eye positioning following the stimulus of looking at a small red point tracing a circle has revealed eye positioning errors only in the vertical portions of eye motion saccades. The King-Davick test is another straight forward test to help evaluate potentially concussed players following a concussion. The King-Davick test times the viewer comparing to a previous baseline test to visually scan a bunch of single digit numbers. If the time taken is longer the player is suspected of having suffered a concussion. The Brain Trauma Foundation is using infra-red eye trackers to capture eye motions with a custom-built algorithm that tracks and compares the eye positioning while the eye is following the red dot around a circle. Soldiers have a great risk of jarring their brains within the pressure pulse in proximity to any explosions.
Having a straight forward eye positioning test will help reveal any concussions rather than having solders get back to distant field hospitals for thorough medical evaluation. Also the current practice of self-evaluation would no longer be the norm for reporting potential concussions. But what of sports where concussions may not be appreciated perhaps with only sudden jarring of the head, what are the consequences ? Let’s look at soccer heading.
“Previous studies have investigated how concussions lead to changes in this white matter, but a new study lead by Dr. Inga K. Koerte of Harvard Medical School in Boston, is one of the first to look at how even blows to the head that aren’t considered concussions may lead to traumatic brain injury.”
“In the study, the researchers compared bran scans of 12 male soccer players from German elite-level soccer clubs who had not experienced a concussion, to brain scans of 11 competitive swimmers who had similarly never experienced repetitive brain trauma. The research team used high-resolution diffusion tensor imaging (DTI), which looks at the brain microscopically and is much more effective at catching white matter changes than the standard MRI.”
“The researchers found surprising alterations in the white matter that were “consistent with findings observed in patients with mild TBI, and suggesting possible demyelination [nerve disorder].” Even though the players had no concussions, their brains told a different story of damage, including changes to the myelin sheaths surrounding nerves.”
” “Although our study is small, it is the first to look at soccer players with no symptoms and no diagnoses of concussions,” says Koerte. “We think it is an important finding not just for soccer players, but other athletes of other sports too.” ”
There it is : just head butting soccer balls is shifting the brain tissue.
But what kind of eye and vestibular circuits look like in our brain that control within the eye and the vestibular ocular reflex?
I have reproduced this excellent schematic diagram of the control circuits for pivoting the eye and moving the head at the same time according to University of Western Ontario authors, Tutus Vilus and Douglas Tweed, both from the Department of Physiology. Now without confusing the reader any longer I will write a future cerebrovortex.com article in greater detail of the eye positioning mechanisms outlined here. But for any football players or soccer players who think that concussions are not serious, deal on this . These structures are deep in the middle of the human brain. Do not think that the brain jarring is not doing something to these particular circuits with repeated hits to the head when you might be walking around in the fog after a particular hit. Denying their significance is a huge misunderstanding from the anatomical point of view of the brain’s new shape distension within these apparent vulnerable zones..
If I had to try to help the reader visualize the eye tracking changes I would choose as an example the Archimedes spiral in 3-dimensions to deliver my attempt toward explaining the beginning of eye pivoting changes following a concussion.
Watching the outer green perimeter tracing is the stimulus that forces our eye to track along the 3-dimensional inner red tracing which is projected onto a 2-dimensional surface. According to the recent Weill-Cornell study findings through the Brain Trauma Foundation US Army study only the vertical component within eye saccade positioning is selectively vulnerable following a concussion impact. So the Archimedes spiral represents the normal capacity to follow the green outer stimulus accurately as if the red tracing perimeter were to track the edge of the iris. Following a concussion this eye tracking capacity would skew away with position errors overstepping along the smoothness of the red lines. But does this mean that there are two events happening at the same time ? Both an eye positioning vertical error coordination plus the brain moving in spiral patterns upon itself ? From this concussion cerebrovortex theoretical neurophysiology perspective the observations are starting to reveal themselves as at least two specific brain events not linked in a time sequence, within the eyes and within the brain itself.