Patrick Eng
An Aspiring Rooster Teeth Employee

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Week 19 - What I Needed to Know About Football and Brain Injuries

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Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that has commonly afflicted war veterans and football players. This disease has Alzheimers-like symptoms and is now definitively linked to recurring hits to the head.

While CTE has previously been linked to repetitive hits, this most recent study reaffirms the stance that those repetitive hits, and not necessarily concussions, are the main cause of the disease.

This study focused on the brains of 4 deceased teenage athletes who had all died soon after receiving brain injuries.

Scientists found that all 4 brains had early flags for CTE, like "leaky blood vessels and abnormal buildups of the protein tau." These 4 brains were then compared to ones of similar status (age and athleticism) and showed scientists the quick change in the pathology of the affected brains.

Since this is science, it wouldn't be a true experiment if we didn't subject mice to everything as well.

This study created a "mouse-model" that put the subjects through repeated and one-off traumatic head events to mimic the human experiences.

Scientists found that their mouse subjects experienced similar brain pathologies like those of the deceased teenage athletes.

Scientists were then able to use their mouse-models, computer models, and findings of the earlier brain autopsies to track the progression of the disease through the brain. This progression was facilitated through the buildup of the tau protein that was mentioned earlier.

As of now, CTE can only be diagnosed in an autopsy and finding the specific indicators in the living is something that this study and ones to come will hopefully help find.

Even former football players, like Nick Buoniconti, are speaking out over the dangers of CTE and its connection to tackle football. Advocates have started the Concussion Legacy Foundation's Flag Football Under 14 initiative that is aimed at raising awareness of the risks of football.

This study is commended for reinforcing the idea that repeated head injuries, not concussions, are the main issue.

Problems still remain though as scientists try to connect and identify all the variables that influence this disease, like genetics, how early the trauma occurred, and length of exposure.

Lee Goldstein, one of the leading researchers in this study, wants this study to be a warning to everyone that "CTE develops early, soon after injury. It doesn't take years or decades. It starts early. It persists. And all of our evidence to date shows it's progressive." He wants people to know that while the focus and efforts to reduce concussions is admirable, that doing so isn't solving the problem.

When players get hit in the head multiple times, it only becomes a big deal if they say it's a concussion. But according to this study, those repetitive hits should be a giant flashing warning sign that should not be ignored.

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One study found that out of 111 deceased football players, 110 of them had CTE.

The first question you should be asking yourself when you see how high these numbers are though is "how biased is this study?" And to that, I commend you for thinking at least a little bit.

A large majority of these 111 test subjects had all experienced early symptoms of CTE, think memory loss, fits of rage, and mood swings. So, as you should with all studies, take it with a grain of salt and look deeper than the conclusion.

While CTE is nothing new, the link between it and football is only recently being acknowledged. This disease, which is prevalent throughout the sport due to recurring traumatic brain injury, is known to cause suicidal behavior, dementia, memory loss, and changes in mood and function.

A different study of CTE, done on the brains of 202 deceased football players at different levels, found that 87% of them had CTE. These two studies provide the strongest connection between the sport and the disease and that CTE is more common than we think.

These studies found that the longer someone played football, the higher the severity of their symptoms. For example, those who only played in high school only exhibited mild symptoms, while those who played in college or semi-professionally showed severe symptoms.

Like I said earlier, these studies are not without their biases.

As CTE becomes are a more common household term used by families tied to football, the number of brains donated to these studies tends to also mostly come from people who displayed the common symptoms. Meaning, these studies don't necessarily have a large healthy pool of athletes to pull from.

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So now that we have at least a general understanding of traumatic brain injuries and what causes them, let's take a brief look at how to diagnose and treat it.

Glasgow Coma Scale

The Glasgow Coma Scale is a basic test that is used to evaluate the severity of a brain injury. This scale goes from three (unconscious) to 15 (fully aware), with a higher score evaluating to less severe injuries. The GCS tests three areas to assess someone's injury:

Eye Response - open spontaneously, open to sound, open to pressure, or are not open

Verbal Response - oriented, confused, inappropriate words, random sounds, or no response

Motor Response - obeys commands, localises pain, withdraws from pain, abnormal flexion, abnormal extension, or no response

On top of the GCS, various questions need to be asked to anyone who witnessed the injury so medical personnel can better understand the situation and make a more accurate diagnosis.

If you ever witness a traumatic brain injury, make sure you think about:

  1. How the injury occurred

  2. If the victim lost consciousness

    1. If so, how long were they unconscious

  3. What part of the head was hit

  4. How hard was the hit (from a punch to the head to getting hit by a linebacker)

  5. How did they're body react, i.e. was it jarred or whipped around

Getting a Picture

There are two main imaging tests that can be used to help understand the severity of the injury and help treat it:

  1. Computed tomography (CT) scan - uses a series of x-ray slices to create a cross-sectional view of a part of the body. This would be done soon after the brain injury to check for hemorrhaging or hematomas.

  2. Magnetic resonance imaging (MRI) - uses magnetic fields and radio waves to create a detailed view of your body. This would be done after the patient had stabilized or hasn't improved after some time.

Under Pressure

As you've probably experienced with other injuries, there tends to be swelling after the event. While it's not so much a problem with a broken ankle or sprained wrist, the brain only has so much room to expand when sitting inside your skull.

In cases of brain injury, it's important to monitor the pressure inside the skull, and drain any extra fluid that might be taking up much-needed real-estate within the skull.

Treatment

For those with mild brain injuries, the best you can do is rest and take some pain relief medication. While they still need to be monitored for worsening symptoms and go for follow-up doctor appointments, they mostly just need to make sure they aren't exerting themselves mentally or physically until approved by their doctor. A gradual return to normalcy is usually expected.

For those who aren't so lucky, emergency medical care is required to ensure that the brain has an adequate amount of oxygen, a large enough blood supply, and careful monitoring of internal cranial pressure. Internal bleeding and pressure must be resolved so that secondary injuries do not occur.

Medication

Because secondary brain injury is such a dangerous part of head injuries, there are a few medications that can be used to help reduce risk and aid in recovery. Three basic medications include:

  1. Diuretics: these drugs help "reduce the amount of fluid in your blood vessels" which in turn reduce the amount of pressure inside the skull

  2. Anti-seizure: since brain injuries have the high chance of causing internal bleeding or pressure within the skull, disruption to the brain's natural electrical impulses is not uncommon. Anti-seizure drugs are used to ensure that the brain does not experience a seizure and sustain even more damage.

  3. Coma-inducing: since the brain is already in a fragile state, a medically-induced coma might be used to alleviate blood flow to the brain and put it in a deep sleep. This deep sleep is used to reduce the amount of energy the brain needs to expend to continue to function and helps reduce swelling.

In critical situations, surgery may be required to help save the patient. Common surgeries include hematoma removal, skull repair, or opening up the skull to drain unnecessary fluids.

Rehab

Depending on the severity of the injury, basic human functions might have to be re-learned. As everyone and every injury is different, the length and type of rehab will vary.

Treatments for recovery could involve a handful of different specialists, each focusing on a different area. Some common specialists include:

  • Physiatrist - oversees the whole rehabilitation process and makes sure the patient has or can get what they need

  • Occupational and Physical therapists - helps the patient relearn basic functionality

  • Speech/language pathologist - helps the patient relearn any communication skills or learn new ones (in cases where communication abilities are lost completely)

  • Neuropsychologist - provides emotional and psychological assistance

  • Social workers

  • Nurses

When it comes to brain injuries, the best way to help yourself is to just take it slow. Don't push yourself too far, and when your body starts to protest, listen to it. Sure, doing nothing might not seem like it's helping, but every little thing that takes pressure off your brain helps.

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Too Long; Didn't Read

The brain is a powerful and fragile instrument, and when you pit it against 1,600 pounds of force, issues are bound to happen.

Football players are constantly at risk of head injuries, and while helmets are there to reduce that risk, the recurring hits add up in the form of chronic traumatic encephalopathy (CTE). This brain disease causes memory loss, mood swings, and dementia among others. To make things worse, CTE can only be diagnosed post-mortem, though doctors can have strong hunches that certain brains will have CTE based on how the patient was while still alive.

In essence, CTE is caused by the buildup of a certain protein within the brain (tau). This buildup is caused by recurring hits to the head, not necessarily concussions. So while the movements to reduce concussions with football are admirable, the real culprit is just the number of recurring hits that players receive.

Due to the complexity of brain injuries, it's also critical to understand the context of each one so you or medical personnel are able to treat it properly. While most mild injuries can just be treated with some rest and basic medication, more severe injuries could require surgery or an induced coma. A common way to assess the severity of an injury is the Glasgow Coma Scale, which is a simple test that scores someone's verbal and motor ability on a scale from three to 15 (the higher the number, the healthier the person).

With severe brain injuries, it's also vital to monitor the pressure within the skull, as it can easily cause seizures or hemorrhages if unchecked.

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Patrick Eng