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Concussion a Good Opening Gambit
Shana and I attended an advance screening of the movie Concussion, with a group of sports writers and newscasters. Will Smith gave a compelling performance as Bennet Omalu, and his quest to determine and understand the cause of a specific type of brain damage, later named CTE, first discovered in the brain of former Pittsburgh Steeler, Mike Webster. This was Omalu’s movie and his story, based on the 2009 GQ exposé, Game Brain by Jeanne Marie Laskas. This was not a documentary.
The title for the film, “Concussion” is misleading. The film is not about concussions and the failure on the part of the league to inform players about the signs and symptoms of concussions, the need to refrain from returning to play before a player is healed, or the potential life-long consequences of a concussion. It is a film about the work of Bennet Omalu and his efforts to understand Chronic Traumatic Encephalopathy (CTE).
Importantly the film is based upon a true story, but is not a complete story. It is an excellent presentation of the path Omalu took and the painstaking investigation into the cause Mike Webster’s death. Omalu’s dogged pursuit of answers led to the discovery of the connection between football and brain damage and opened the door to further research. The movie indicated his conflict with the NFL in accepting this information, which the NFL still disputes.
This movie opens the door to a more important conversation, about trauma and brain damage that must continue. The cinematic decisions about the portrayals of different characters and the complete omission of any reference to the Concussion Legacy Foundation in Boston, the past and current role of Commissioner Goodell and the NFL marketing department in deflecting criticism were interesting choices made by the film’s writer and director.
It was a compelling introduction for the public to the health issues generated by trauma in football. This theme must be expanded. If this movie provokes a national conversation about the larger issues associated with all types of brain damage, from football, other sports and everyday accidents, then it has been a great public service. It would be misleading, if however, it leaves the impression that the problems have been remedied or that the only public health concern is CTE. This is the tip of the iceberg of the full-range of chronic life-altering effects of concussions.
Brain injury is a chronic condition with life-long consequences. According to the Centers for Disease Control (CDC), each year there are over 200,000 visits to emergency departments by children under the age of 19 suffering concussion related problems from organized sports. Omitted from these statistics are visits to urgent care facilities, physicians’ offices, and cases where concussion is not the principal diagnosis. The CDC estimates that the accurate number is between 1.6 million to 3.8 million sports related concussions documented each year! This is a true public health crisis. Labeling a condition does not address treatment issues and how we, as a society, address the impact of a chronic condition that has consequences for families and society.
We applaud the efforts of all those involved in making this important film, and hope it engenders continued investigation and research into not only prevention, but improved identification and treatment options that will assist this vulnerable population.
SHANA DE CARO, ESQ. is a member of the Board of Directors of the Brain Injury Association of America and immediate past chair of the American Association for Justice Traumatic Brain Injury Litigation Group.
MICHAEL V. KAPLEN, ESQ. is a Professorial Lecturer in Law teaching the only course in traumatic brain injury law at The George Washington University Law School, a member and immediate past chair of the New York State Traumatic Brain Injury Coordinating Council, three term president of the Brain Injury Association of New York State and a past chair of the American Association for Justice Traumatic Brain Injury Litigation Group.
DE CARO & KAPLEN, LLP is a New York based law firm with a focus on representing victims of traumatic brain injury throughout the nation. Shana and Michael are frequently invited to lecture attorneys and public advocacy groups nationwide on the legal issues pertaining to brain injury, public health concerns and the impact of brain injury on the lives of its victims.
Shana and Michael authored the New York Law Journal expert column on brain injury law and the chapter on brain injury law in the special issue of Psychiatric Clinics of North America.
Brain Injury Prevention, Brain Injury Publications, Current Affairs
CDC Updates on Traumatic Brain Injury
The Journal of Head Trauma Rehabilitation released a special issue highlighting work from CDC and CDC’s partners to prevent traumatic brain injury (TBI) and to help people better recognize, respond, and recover if a TBI occurs. These studies present a clearer picture of TBI in the United States and the progress in the field.
Some key findings include:
• Online Training Effectiveness: CDC and the National Federation of State High School Association’s concussion course online was effective in increasing concussion-related knowledge across a wide range of individuals.
• Sports and Recreation TBI: About 7% of all sports and recreation-related injuries treated in United States emergency departments were TBIs.
• Data Sources: New sources of TBI-related data on emergency department visits and hospitalizations will improve the ability to examine subpopulations most at risk for TBI.
• Unemployment: About 60% of people (ages 16 to 60) who were discharged from inpatient rehabilitation following a TBI between 2001 and 2010 were still unemployed two years after their injury.
• Motorcycle TBI death: Motorcycle crash patients with a TBI were 3 times more likely to die in the emergency department compared to those without a TBI.
You can review the special issue of the Journal by clicking here .
Brain Injury Publications
Concussion App Review
Apparently, not all concussion apps that are currently available from I Tunes are up to date or provide comprehensive information according to a new article Comprehensive review of concussion screening apps for the sidelines which can be accessed by clicking here.
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VA develops concussion app to assist in concussion management
The Veterans Administration has developed a new mobile app that provides information on concussion symptoms and the self-management of the common symptoms following a concussion.
The concussion app’s main goals are:
- To provide education about a concussion
- To provide a 22 question inventory about symptoms that may develop following a concussion including dizziness, balance problems, headaches, memory and concentration impairments,
- To provide tools to assist individuals properly manage the symptoms of mild traumatic brain injury when they develop
- To provide resources and support for professional care and web sites with information about traumatic brain injury.
- The app can be used by anyone and is not restricted to veterans.
More information is available by clicking here
Brain Injury and Sports, Brain Injury Prevention, Brain Injury Publications
Centers for Disease Control Concussion App
CDC's Heads Up app helps parents and others learn how to spot the signs and symptoms of a concussion and explains what to do if they think their child or teen has a concussion or other serious brain injury. The app also includes information on selecting the right helmet for an activity and other detailed helmet safety information.
Download the CDC Heads Up Concussion App by clicking here
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The Crash Reel-An important message on the life long consequences of traumatic brain injury
I had the pleasure of viewing in preview, a new HBO documentary, The Crash Reel exploring the life and brain injury sustained by American snowboarding champion, Kevin Pearce which will debut on Monday, July
15th at 9 PM eastern time, 8 c on HBO.
As an advocate for persons with a brain injury, I appreciated the compassionate approach to the subject matter. The treatment of Kevin as a person with a brain injury, rather than a brain injured person is a very important message for members of the public. Kevin does not allow his brain injury to define who he is. He is an inspiration to anyone who has sustained a traumatic brain injury.
The stages of the film depicting Kevin’s journey are quite helpful to an understanding of the transitions that an individual and their family members go through following profound brain trauma.
This film will make a very important contribution to the understanding of traumatic brain injury in the minds of the public.
The filmmakers have launched a comprehensive traumatic brain injury awareness and outreach campaign called #LoveYourBrain and the Pearce family has started the Kevin Pearce Fund to support families and individuals
affected by traumatic brain injury and other challenges.
For more information on the documentary, visit their face book site.
Brain Injury Publications
Brain injury in the elderly
Traumatic brain injury in the elderly is explored in a special edition of NeuroRehabilitation: An Interdisciplinary Journal. The guest editor of this collection of articles is the well-known expert in the field of neuropsychology and traumatic brain injury, Wayne A. Gordon, PhD., Vice Chair of the Department of Rehabilitation Medicine at Mount Sinai School of Medicine in New York.
The articles in this special edition address the following subject matters:
A comparison of cognitive function of individuals diagnosed with dementia and a history of TBI with those with dementia and no history of TBI;
Factors related to death following TBI in the elderly based upon medical chart review of individuals 55 years and older who died one to four years after moderate or severe TBI, and compared these to matched living patients;
Characteristics of the inpatient rehabilitation treatments received by individuals with a TBI who were above the age of 65 when they received their injury;
Use of The Brief Test of Adult Cognition by Telephone (BTACT) to screen elderly patients for TBI;
Review of the literature on age-specific factors that are related to successful outcomes in the elderly who sustain a TBI.
Brain Injury & Concussions, Brain Injury Legislative News, Brain Injury Publications
Seeking Comments on the Pediatric Mild TBI Guideline Protocol
Between March 7 and April 7, the Pediatric Mild Traumatic Brain Injury (TBI) Guideline Workgroup is seeking public comment on a guideline protocol on diagnosing and treating pediatric mild TBI (among patients age 18 and under).
Comprised of leading experts in the field of TBI, CDC Injury Center’s Board of Scientific Counselors established the Pediatric Mild TBI Guideline Workgroup to create a clinical guideline for health care professionals working in the acute care and primary care setting.
The Workgroup is using the American Academy of Neurology’s (AAN) guideline development process to develop a multidisciplinary, evidence-based guideline. You can access the guideline protocol for review and comment by clicking here
Public comment on the guideline protocol is one of the first steps in the evidence-based clinical guideline development process. To learn more about the Pediatric Mild TBI Guideline Workgroup and next steps for the project, click here
Brain Injury Legislative News, Brain Injury Prevention, Brain Injury Publications, Brain Injury Rehabilitation
National Brain Injury Survey from Sarah Jane Brain Foundation
The Sarah Jane Brain Foundation (SJBF) and CE Outcomes have announced a national survey to identify gaps in services and research dealing with brain injury.
This is a joint effort during Brain Injury Awareness Month to understand the current state of brain injury across the country and across two different clinical populations (youth/developing brain and adult/developed brain).
The survey will investigate the differences in services between “Mild” TBI/concussions and moderate to severe brain injury. In addition, the assessment will analyze across the continuum of care from prevention to acute care/rehabilitation services to reintegration/long-term care. The online survey is being hosted by CE Outcomes and can be accessed by clicking here.
“This survey will include physicians, psychologists, educators, allied health professionals, and most importantly families and brain injury survivors across this country,” said Dr. Ron Savage, President of SJBF and author of the survey. “We will have data from thousands of voices to better understand the gaps in services that impact the lives of millions of people. Those voices will be heard.”
Brain Injury & Concussions, Brain Injury and Sports, Brain Injury Publications
New government sponsored concussion study reported
Reuters News Service reports that a new sports concussion study has been initated by the United State Institute of Medicine, which is part of the National Academies of Science to investigate sports related concussions among our nation’s youth. The study will look at concussions in children from elementary school through early adulthood and will also include military personnel and their dependants.
The government study will review concussions and risk factors pertaining to this type of brain injury.
The study is being headed by Robert Graham, a public health expert at the George Washington University School of Public Health. According to Reuters, the study panel will likely submit its findings to the Institute of Medicine in the middle of the summer, with publication expected in late 2013.
Sponsors of the study include the Department of Defense, the CDC and the National Institutes of Health. The panel will also examine studies being done by the CDC and the American Academy of Neurology.