Brain Injury in Football More Common in Practice

By Gordon Johnson

In the 9th grade, I was 5’11” tall and weighed 185 pounds. I ran a 24 second 200 meters. I played running back and safety. Back then, 9th graders were in junior high school, not middle school. Our team was terrible. I played running back for three years on a team that won one game in the three years. I got tackled a lot and never was the player I always believed I would become. Games were rough. We lost by scores like 30-0, 44-0, week after week. But worse than the games, were the scrimmages.

Today, another young man went from the football field to the emergency room, where he is reportedly having seizures: http://www.clarionledger.com/story/prepsreport/2014/08/23/jackson-prep-football-player-critical-condition/14490017/ .   As I write this it is not known if  Walker Wilbanks collapse was related to football hits or the conditions under which this game is played in August. Perhaps neither. But a day after my brother in law got a concussion in practice, this story appears.

I first started on the 9th grade team as an 8th grader because my coach was impressed by my ability to lay crushing hits on my teammates in passing drills. I played safety even though all of the running back carries in games were limited to 9th graders. My 9th grade year I was going to get all the carries. Careful what you wish for.

My first concussion? It was a scrimmage between the 9th graders and the high school Junior Varsity. Once a year, the 10th graders, who were winning no more than the 9th graders, got to take out their revenge on the 9th graders. The scrimmage was an annual slaughter. As the only player on my team who had experience playing with the 10th graders (from the year before) I was given the privilege of being the one who got hit. Over and over, smothered, hammered on every play. Defense wasn’t much better. The 10th graders scored on every play that I wasn’t in position to make a tackle.

By the end of the practice, I was wobbly and sick to my stomach. Was it a concussion? No one on my sideline would have had a clue. I played one more year of football, but never with the relish I had as an 8th grader.

We spend so much time worrying about concussions in those who play this game long enough to be on the field with trainers and neurologists. Now the NFL limits tackling and hitting in practice. But each day of August I see a field of 10 year olds playing football. Practicing football. They are tackling, the coaches trying to sort out the kids who like to hit from those who don’t.

I worry about the kids who are too small or weak to make it an even contest. I worry as much about the kids who stand out at that level. Being good means you will get hit and get hit more, for more years. Perhaps, you will start to hate the game and move on like I did after my 10th grade year.  But if you don’t, your ability will make you a target and it doesn’t matter how well you play the game, your brain will pay the price.

Football Concussions Strike Again

By Gordon Johnson

I make my living representing brain injury survivors. I have been doing that for more than 20 years. Since I first became a brain injury lawyer, I have been concerned about what seems to be the contagious nature of concussions.

I know that concussions are not a communicable disease. They are caused by traumatic, not infectious sources. Yet as they say, Karma is a bitch. As a survivor myself of a significant brain injury, my superstitious side doesn’t worry about an injury to myself. What I worry about is injury to those I care about.

I spent the summer writing a book about CTE (chronic traumatic encephalopathy). I live in an asymmetrical family, which means my brother in law is still young enough to be playing high school football. He is a big, athletic and very bright young man. He is so bright I am confident there is a place for him at a great university like my alma mater, Northwestern University. He also might have a future as an athlete. His middle school team won the state championship last year by a score of something like 42-0. He scored two touchdowns. His whole family is excited about his football career, my wife included.

As I wrote my CTE book, my wife was required to read every word. Payback. LOL. As she did, I kept pointing out to her that perhaps her brother ought to consider not playing football. She understood the book, understood the risks, but repeatedly said something to the effect that I am not going to tell him that he can’t play football. It was not my role to intervene. When he needed $150 for football fees last week that money came out of my pocket.

On my way back from a brain injury conference in Des Moines on Friday I got the text: My brother got a concussion in his first scrimmage.

I am a rational person. I do not believe in a higher purpose for people getting hurt. I have spent my life seeking justice from those whose mistakes hurt my clients. I know that my brother in law getting hurt is just fate being fate. My writing a book about CTE is not the reason he got a concussion. My being a brain injury lawyer is not why brain injury seems to jump from family member to family member like Ebola.

The reason TBI continues to impact my family is that brain injury is that common. 2 million diagnosed concussions a year, double that number with the undiagnosed. Playing football is one of those activities which will almost assuredly mean that you will at some point have a concussion.

I have not despaired of my brother in laws chances of going to Northwestern. If he is kept out of the game long enough, allowed to rest, to recover, his brain will get past this insult. This time. Probably. But I also wish that this would be a lesson to the rest of my family, that this young man’s brain is too valuable to waste any part of it, even if it is just his reserves.

Football wastes the brains of young people. Don’t let your young people play it. My child would not play football. Sadly, I have no control beyond that.

What is Wrong with Children Playing Football?

By Gordon S. Johnson, Jr.

In an excellent article in Arizona Central by Nathan Brown, the movement towards baseline concussion testing for children in Pop Warner football is addressed. See http://www.azcentral.com/story/sports/2014/08/16/pop-warner-partners-mayo-clinic-concussions/14176461/

Note to Parents. If the experts believe that your child needs baseline testing for brain function to engage in a sport, perhaps they should be playing that sport.

The concept of baseline testing for those participating in sports was originally introduced as a part of research models on sport and concussion to aid in measuring the extent of brain injury in the activity. From a research standpoint, it is a great concept. But the reason it is a great concept is that football and other contact sports are a great laboratory to study concussion, because we can predict that there will concussions. Would you volunteer your children for any other activity where they are likely to be a research subject in a potentially life threatening activity?

Football is dangerous, even to highly trained professionals. But it is far more dangerous to children. Research is indicating that those who begin playing tackle football (with helmets) before 12 are at more risk for not only concussions, but also CTE than those who begin to play later. Bourlas, et. al, IBIA, 2014. Children are also at risk because the interplay of the following variables:

• Imbalance Between Ability Levels. In youth leagues, even when selected by weight, the potential for difference in ability levels is drastic. We have all seen the movies portraying the kid who didn’t want to be playing being outclassed by the superstar kids. That is the reality of youth leagues, particularly because the differential rates upon which children mature physically. Dramatically different levels of coaching make this problem worse. The good teams often slaughter the bad. he good teams often slaughter the bad. That doesn’t just show up in the final score, but in the relative beating the children take. I played on a high school team that was severely outclassed by our competition, and we just were pummeled in every game.
• Vulnerability of Growing Brains and Bodies. During developmental years, people are more vulnerable to injury than during adulthood. Brain injury is usually not just a function of a head impact, but the degree to which the head is set in motion and or stopped by the blow. Higher level athletes spend considerable training time strengthening their neck muscles. Children’s necks lack the strength to limit this acceleration/deceleration of the head, adding to the risk of injury.
• Difficulty in Identifying Brain Injury Symptomatology. The sense of concussion is that it is a predominantly cognitive injury. Measuring the cognitive changes is the reason for baseline neuropsychological testing for children playing football. Yet, the cognitive domain is only one of four potential areas in which a concussion can impact anyone, but especially a child. The four areas are cognitive, behavioral, mood and motor (muscles and coordination.) With children as young as 10, it is very difficult to determine what is normal, and thus be able to identify dysfunction. Behavior and mood are particularly unpredictable in children between 10 and 18. How would you know if your child was having long term symptoms from concussion or CTE, when we dismiss most moods and behavior during such periods as related to adolescence?
• Takes Years to Assess Degree of Frontal Lobe Injury in Pediatric Patients. We learn to become adults in our frontal lobes. As our frontal lobes change during the years leading to adulthood, behavior, manners, mood, depression, sexuality all grow. Likewise, an injury to areas of the brain that may not be primary to a person’s current age, may not show up for years. Damage to the frontal lobes may not manifest itself for years after an injury to a child. Your child may be cognitively cleared from a brain injury playing sports, but have significant injury to the frontal lobes and the axonal tracts which connect the frontal lobes, without it showing up until the appropriate point in the maturation process.

Football is a dangerous sport for brains, period. One might argue that there is a cost benefit analysis that a professional athlete will engage in. We hear lots of famous retired players talking about how good the game was to them. How ridiculous all the lawsuits are. Yet to those athletes, the benefit analysis, in hindsight, was great. They got a career, fame from the risks they took. “Statistically of the 100,000 high school seniors who play football every year, only 215 will ever make an NFL roster. ” See NFLPA .  If  you know your child is going to be one of those who not only plays, but plays long enough for it to be a meaningful career option, maybe you should take that risk. For the other 99,900 parents, maybe you should rethink this.

Remember: With concussion time may reverse; CTE only gets worse.

For more on frontal lobe injuries, click here. 

Braininjuryhelp.com

If I were going to write an amnesia questionnaire?

By Gordon S. Johnson, Jr.

Overall considerations in assessing amnesia:

Ask open-ended questions where you can get a feel as to the communication skills of the person injured. While amnesia is the most sensitive test and most significant test of post concussion dysfunction in the brain, an open-ended question will tell you far more than a yes or no question. Does the injured person seem capable of complicated and logical thought and communication? If not, this is evidence of confusion and possibly amnesia. But confusion and amnesia are not the same thing. A person can be amnestic without being confused.

A clear memory of the event does not mean that the person does not have amnesia as brain injury is a process, not an event and the dysfunction can get worse over time. While it is always helpful to start with the event when checking a person for failure to encode continuous memory (amnesia) the amnesia may not show up until later. A number of factors could contribute to this, but keep in mind that adrenaline improves memory, so memory of the event may be an island of clarity in a sea amnesia. Keep in mind the possibility of “Swiss cheese” memory. Holes in memory can occur without any ability to predict when and where such holes will occur. The advantage of open-ended questions is you are more likely to spot the holes in memory if you demand complicated answers.

A period of amnesia does not end until the return of “continuous” memory. So remembering something of what is going on, but not all of it, is evidence of amnesia. At this point you are looking to include, rather than exclude the role of concussion in behavior and cognitive function. More evidence is better than less.

Amnesia Questions to ask of Eye Witnesses to Concussion:

1. Was he/she repeating himself?
2. How long did it take before he/she knew what was going on?

Amnesia Questions for Injured Person

1. What is the last thing you remember before you got hurt?
2. What is the next thing you remember?
3. How did you get hurt?
4. Do you remember the ambulance ride? Describe.
5. Tell me about the intake person/process when you got the ER?
6. Did you have to wait in the ER? If so describe the most unusual thing your saw there?
7. Who else have you seen in the ER? Tell me about what you talked about.

Amnesia Questions for the next day.

You are trying to establish continuous memory from just before the injury up to the moment of the inquiry on the next day. If there is evidence of amnesia, it is critical that it be documented. If you are not a medical provider, video tape the discussion and show to a provider if abnormal.

1. What do you remember about yesterday after your concussion?
2. Do you remember the rest of the game/day?
3. Do you remember any part of the game/day before you got hurt?
4. Do you remember the treatment you got yesterday?
5. What did you eat this morning, yesterday evening, etc.
6. How did you sleep?
7. Describe the worst symptoms you had yesterday?
8. Describe the worst symptoms you are having right now?

Amnesia Questionnaire Needs to be in Treatment Records

If this questionaire is abnormal, missing memories, it is critical that such be made part of the official treatment record of the injured person. While most people get better quickly after a concussion, for those that don’t it needs to be clear to subsequent medical diagnosticians that this easiest and most significant symptom, is documented.

For more on amnesia: