Monthly Archives: July 2013
Tom Robenalt, a Chicago traumatic brain injury attorney, pointed recently to a study in the journal JAMA Psychiatry, which suggested that multiple traumatic brain injuries or concussions, may be the precursor to military suicides, just as it is with sports-related suicides.
The study goes further than just suggesting there may be a link between military suicides and TBI and sports-related suicides and multiple concussions, according to Robenalt. It offers the speculation that many of the men in military service played sports before they enlisted. Many suffered head injuries while playing those sports, a state of affairs further exacerbated by concussive shock waves that buffeted their heads when an improvised explosive device (IED) was triggered while on a tour of duty overseas.
“What this speculation gives rise to is that those servicemen who enlisted with pre-existing TBI, but still functioning well enough to enlist, were even more prone to suicidal thoughts,” said Robenalt. “More prone than someone who had not sustained concussions while playing sports or someone that had never had a head injury.”
Depression and post-traumatic stress disorder (PTSD) are noted factors in suicides, according to Robenalt. If these conditions existed prior to an individual enlisting in the military, they would be aggravated by combat conditions, which may explain the higher levels of suicides in the Armed Forces, he added
The study was conducted by an Air Force psychologist and included 161 individuals sent to his clinic for suspected concussions. Those interviewed were asked about any history of head trauma, any battles with depression, PTSD or struggling with suicidal thoughts.
“The major conclusion drawn from the study was that many of the head injuries the men talked about were sustained before they joined the military. Some former service personnel indicated they had received as many as six head injuries prior to reporting for duty. Additionally, roughly 20 percent suffered further concussions during basic training,” said Robenalt. “The implication of the report is that sustaining earlier head trauma may create a pre-existing disposition activated by further head trauma in combat. Some military members reported they had sustained up to 15 brain injuries while on a tour of duty.”
If these findings gain more credence over time, Robenalt theorized, the military may face a similar situation to the National Football League.
Browns QB Colt McCoy was knocked silly two years ago and still allowed to get back in the game. It’s a different story for Browns’ offensive lineman Ryan Miller—a 6-foot-7, 320-pound behemoth. Game time or practice, times have changed.
It was a routine blocking drill that knocked Miller into next week. One-on-one blocking dropped Miller after he made contact with his helmet, rendering him motionless for several minutes. He was surrounded by teammates as he “was immobilized and strapped to a backboard. The Browns initially feared Miller had suffered a devastating injury, and were relieved to learn he was responsive and moving his limbs.”
It was a scary scene as players and coaches looked on. Said Browns linebacker D’Qwell Jackson, ”I’ve only witnessed it a few times and anytime that happens you just pray and just hope for the best and hope everything is OK…’I’ll tell you what, it made everyone realize that at any moment anything can happen.”
The indoor workout came to a standstill as Miller “was rushed to the Cleveland Clinic on Saturday.” After a few hours, he was released from the hospital, but now “will be monitored by the medical staff and must pass a series of tests before he can return to the field.”
With new targeting rules in effect in college football and the NFL’s long overdue concussion protocols, the game’s landscape is definitely being altered. The big question is, how much? Losing your QB for four games could cost you a playoff spot, or in the case of the NCAA, a BCS bowl berth.
The International Rugby Board (IRB) and its Member Unions have “reaffirmed their commitment to ensure best-practice concussion management procedure delivery by undertaking a full review of the first year of the application of the Pitchside Suspected Concussion Assessment (PSCA) protocols.”
The PSCA is designed to give teams and match doctors time to assess cases in which concussion is not immediately apparent. The IRB believes that “since its introduction as a global trial in 2012, (it) has proven highly successful, leading to 25 percent more players being removed from the field of play permanently following a head impact.”
The review will be overseen by the PSCA Working Group, which will assess the protocol’s “functionality and compliance, obtain feedback from team doctors and collectively ensure that the correct procedures are followed to ensure clear and consistent management of suspected concussion cases and further enhance best-practice delivery.”
Specifically, the PSCA allows team doctors to make an assessment in a quiet situation within a five minute interval. This calm environment away from the field of play and the pressures that come with operating in the middle of an incredibly noisy and often pressurized on-field situation hopefully will contribute to more accurate assessments, according to the IRB.
“The PSCA is intended to be a supportive tool for physicians in the elite Game,” said IRB Chief Medical Officer Martin Raftery. “If a player is clearly displaying the signs of concussion, that player must be removed from the field of play and should not return to play.
“Concussion management is at the very heart of the IRB’s player welfare strategies and the message to players, coaches and parents is clear – if in doubt, sit it out.
“Our Member Unions have supported the PSCA process and recognize the enormous benefits that the PSCA process delivers in this important area of player welfare,” he added.
“All head injury incidents occurring within the PSCA trial are logged by the IRB Game Analysis unit for assessment. This review one year on from implementation will enable us to work with the physicians to review all the cases, identify practice learnings and reinforce the importance of following the correct procedures.”
Raftery continued: “The area of concussion is highly emotive and diagnosis is complex, especially in the heat of the battle, and the PSCA was developed in line with international best practice to assist doctors and give them the best possible platform to assess their players when it is unclear whether concussion is apparent.
“All the evidence suggests that the PSCA is proving to be a very effective tool to protect our players and team physicians are twice as likely to remove players from the field of play than independent medics, but we can and will continue to review and improve our practices to ensure that we are collectively doing all we can.”