Soccer 'Headers' Linked to Brain Injury

The ‘non-contact sport’ of soccer may now be linked to traumatic brain injuries (TBI) for certain players.

A study by the Albert Einstein College of Medicine of Yeshiva University in New York of 38 amateur soccer players found that frequent and repeated ‘heading’ of soccer balls may cause TBI.  The study established a threshold of 1000-1500 headings a year as the point where injury was most likely to occur.

"Heading a soccer ball is not an impact of a magnitude that will lacerate nerve fibres in the brain," said Michael Lipton, M.D., Ph.D., director of radiology research at the Albert Einstein College and lead author of the study.  "But repetitive heading may set off a cascade of responses that can lead to degeneration of brain cells."

Researchers used diffusion tensor imaging (DTI) to study the effects of soccer 'heading' and found that players who met the threshold number of headings have abnormalities similar to those found in TBI patients.  The researchers identified five areas, in the frontal lobe (behind the forehead) and in the temporo-occipital region (the bottom-rear areas) of the brain that were affected by frequent heading.  Those areas are responsible for attention, memory, executive functioning, and higher-order visual functions.

Dr. Lipton and colleagues also gave the same 38 amateur soccer players tests designed to assess their neuropsychological function.  Players with the highest annual heading frequency performed worse on tests of verbal memory and psychomotor speed (activities that require mind-body coordination) relative to the other players.

"These two studies present compelling evidence that brain injury and cognitive impairment can result from heading a soccer ball with high frequency," Dr. Lipton said.  "These are findings that should be taken into consideration in planning future research to develop approaches to protect soccer players."

Heading is currently an essential part of the game and the focus of many training drills.  However, Dr. Lipton hopes his team’s findings will be used to create safe guidelines for play, especially for younger players, in the future.  The American Academy of Pediatrics currently recommends that adults who supervise participants in youth soccer should minimize the use of heading the ball until the potential for permanent cognitive impairment is further studied.

Gabby Giffords' Road to Recovery Is Simply Remarkable

Congresswoman Gabby Giffords is certainly an inspiration for those who suffer from a traumatic brain injury (TBI).  Her remarkable road to recovery was well documented and shown on the recent ABC 20/20 Episode. 

Statistically, only about 10% of those who are shot in the head even survive.  Severe brain injuries, such as from gunshot wounds, can leave the victim with physical disabilities, cognitive problems, and behavioral symptoms. The potential physical symptoms can run from total or partial paralysis to things like vision and speech problems, and general fatigue. Cognitive and behavioral disabilities from a severe brain injury can pose devastating problems for the victim too. There are innumerable cognitive and behavioral issues that a TBI victim may have to deal with, including attention, concentration, learning, and memory issues, as well as depression, irritability, and inappropriate behavior issues. Recovery from such a devastating injury is very slow, and improvements can continue to be seen months up to several years later. Some of the recovery is attributable to rewiring of neurons in the brain, sprouting new connections to attempt to regain their former functions and take over functions of the neurons that were lost.

As shown with Congresswoman Giffords, one of the most important parts of the rehabilitation process is family understanding and support for the TBI victim. Dealing with the effects of TBI is a lifelong issue for the family, as well as the victim.

Public Documents Need Not Be Automatically Disclosed in Litigation in Colorado

Today I'm changing my post's focus from traumatic brain injury ("TBI") issues, to legal issues from the Colorado Supreme Court's opinion that came out today in Averyt v. Wal-Mart, because of the significance it has to cases filed in Colorado, including TBI injury cases.  The Court in Averyt essentially carved out an exception to a party in a lawsuit's mandatory automatic disclosure of documents obligation under the Colorado Rules of Civil Procedure for "public documents."  Rule 26(a)(1)(B) states, "[e]xcept to the extent otherwise directed by the court, a party (to a lawsuit) shall, without awaiting a discovery request, provide to other parties: . . . [a] listing, together with a copy of, or a description by category and location of, all documents, data, compilations, and tangible things in the possession, custody, or control of the party that are relevant to disputed facts alleged with particularity in the pleadings. . ." C.R.C.P. 26(a)(1)(B)(parentheses added). 

In summary, the court in Averyt ruled that a City of Greeley public document - a document that could have been located equally by either the plaintiff or defendant in the lawsuit - did not have to be disclosed by the party that actually found the document after the trial that already started.

This is a very significant ruling in Colorado because now, each party in a lawsuit must be diligent in doing their own research into finding public documents that are relevant to their specific case.  The court in Averyt specifically mentioned a few public documents that do not have to be automatically produced under Rule 26(a)(1)(B): newspaper articles, minutes from meetings of governmental bodies, customer reviews, reports of health and safety inspections, complaints lodged with business rating agencies, grievances filed with professional licensing authorities, and even legal documents filed in other cases.  But the court did not foreclose the possibility that a party could still obtain, either through written discovery or depositions, information about another party's knowledge or possession of a public document. 

With this new ruling, victims of accidents should be even more diligent in finding a personal injury attorney to represent them who is knowlegable and who is going to work hard to find all the relevant public documents that could affect their case.  At Nelson Law Offices, we are dedicated to doing just that - building strong personal injury cases for all persons who are the victim of the negligence of others. 

Cholesterol Drugs Studied for Traumatic Brain Injury Patients

A Johns Hopkins study reported in the Journal of Trauma found that cholesterol-lowering statin drugs may have a role in the treatment of traumatic brain injuries (“TBI”).  Older adult TBI victims, who had previously been on cholesterol-lowering statin drugs such as Lipitor and Mevacor, when hospitalized with serious head injuries, were 76 percent more likely to survive than those not taking the drugs.  The prior use of statin cholesterol drugs was also associated with improved functional recovery at 12 months post-injury for those older patients.  However, those TBI victims with heart disease did not benefit from the prior statin drug use.

Eric B. Schneider, an epidemiologist at Johns Hopkins University, believes that it is not the lowering of cholesterol that’s helping the brain recover, but that there are other, less well-known properties of statins that are causing these results.  Statins also have an anti-inflammatory effect, and they also are known to modulate the body’s immune response.  Schneider wants to now do a clinical trial administering statins to brain-injured patients, not already on the cholesterol-lowering statin drugs, immediately upon arrival in a hospital emergency department to see if the same effect is achieved.

The researchers have cautioned that they cannot recommend that statins be used as a blanket treatment for TBI patients at this time, because there are unknowns and downsides to the drugs, including the risk that some people may develop serious muscle disorders.  But if a significant benefit in patients treated with statins after a TBI were found, it would open up a wide variety of possibilities for its use, including giving statins people who are likely to be exposed to mild TBI, such as football players or soldiers in combat.

October 5th Free Lecture on Sports Concussion at Boulder High School

Hits to the head are almost unavoidable in contact sports. But with any bump to the head, caution should be the name of the game. That bump could cause a concussion. Concussions are brain injuries that can lead to long-term problems — memory loss, chronic headaches, concentration difficulties — and, in some cases, death. Getting medical help quickly offers the best chance for avoiding serious consequences. Unfortunately, concussions can be difficult to spot. Learn the warning signs of concussion and when a hit to the head should mean a trip to the doctor or emergency room. Then get a review of treatment options and rehabilitation for concussions. Speakers Jason Glowney, MD, board-certified sports medicine physician Julie Stapleton, MD, board-certified physiatrist specializing in neuro-trauma When Wednesday, Oct. 5, from 7 to 8 p.m. Where Boulder High School (Performing Arts Auditorium) 1604 Arapahoe Ave., Boulder RSVP Reservations required. Call 303-441-0580 or visit bchlectures.org/concussion to register.

http://www.bchlectures.org/1011/images/concussion.pdf

Blood Protein Test May Help Diagnose Concussions

Doctors in Cleveland, Ohio are currently conducting a study on local college football players, testing their blood for a protein that could indicate they’ve sustained a concussion.  The blood samples are being screened to see if they contain a protein that's known to leak into the blood after sustaining a head injury.

If the study confirms the predictive value of the protein, it could lead to simple blood tests to confirm concussions.  Traumatic brain injury (TBI) accounts for more than 1 million emergency room visits each year throughout the US. 

 

The test could also help track the long-term effects of high-impact sports like football or boxing, and it could be valuable to the military, as soldiers often face head injuries caused by the pressure wave from bomb explosions.

Higher Risk for Dementia for TBI Victims

A new study revealed that Traumatic Brain Injury (TBI), whether mild, moderate, or severe, has been linked to a doubling of risk for dementia.
 

Presented at this year's Alzheimer's Association International Conference in Paris, France, a seven year study of veterans over 55 found that the veterans with TBI were twice as likely to develop dementia over that 7 year period of time, with 15% of the TBI veterans vs 7% of non-TBI veterans developing dementia.

"[The findings] suggest TBI may predispose people to earlier manifestation of [dementia] symptoms and raises hope that treatment or rehabilitation may have a role in preventing downstream dementia," says Kristine Yaffe, MD, professor of psychiatry and epidemiology, University of California, San Francisco and director of the Memory Disorders Program at the San Francisco Veterans Affairs Medical Center.

According to Dr. Yaffe, the most plausible explanation for the relationship between increased dementia in TBI victims is that diffuse axonal injury, or swelling of the axons that form connections between the neurons, would disrupt neuronal communication.

Clinicians need to recognize TBI as a major risk factor for dementia, and individuals who have sustained a head injury constitute a group that should "probably be followed very carefully as they age and be screened for dementia and other cognitive problems," Dr. Yaffe said.

TBI is a widespread problem, far too common among veterans, as well as car accident victims, athletes, people who experience falls, and many others.  The Centers of Disease Control and Prevention estimates that approximately 1.7 million TBI-related deaths, hospitalizations, and emergency department visits occur in the United States every year.