Updated approach to brain trauma, reporting culture needed

By Lou Fancher Correspondent Contra Costa Times

Former UC Berkeley Golden Bear and San Francisco 49er Ben Lynch can't recall the last time he picked up a sports magazine or newspaper without seeing an article about concussions.

No, he hasn't suffered memory loss from Chronic Traumatic Encephalopathy (CTE), the debilitating result of repeated head trauma that leads to dementia, depression and even death. But the possibility had been there.

"There were two things I was praised for when I was playing, a big hit and playing through injuries -- something that should never be encouraged, especially when it comes to head injuries," Lynch said, to parents, coaches, educators and health professionals gathered at Miramonte High School on May 9.

Presented jointly by the Sports Legacy Institute, a Boston-based nonprofit, and the affiliated SLI California Concussion Coalition, the free, 90-minute presentation was aimed at education.

That repeated hard hits to the head have long-term consequences is no surprise, said Lynch and his co-presenters, Dr. Eric Freitag of the Mt. Diablo Memory Center and UC Berkeley Head Team Physician Dr. Casey Batten. Concussions and other head trauma are in the news every day. from military veterans to accident victims to professional and student athletes, the nation is in the midst of what some call "a concussion crisis."

And worse, the people in charge of concussion-vulnerable populations are often misinformed, or operating with outdated information.

"We started this because we found coaches, athletes, parents and even care providers were mishandling these cases," Freitag said, in comments before the May 9 presentation.

Beginning with 10-second videos pulled from YouTube, Freitag allowed audience members to assess the likelihood of concussion. Two helmeted tikes collided in the first video, but by the final clips, Lacrosse players clocked foreheads, a bike rider was run over by an antelope and athletes staggered after multiple "dings."

Rhett Ridolfi's case was offered as a tragic tale of lawsuits and a 22-year old with severe paralysis and permanent cognitive deficits following a 2008 football practice in Trinidad, Colo. Despite slurred words, headaches and other symptoms, he was allowed to return to the football field and suffered irreversible injury.

"I wish I could say this was an unusual case," Freitag said, "but in 2013, this kind of poor management is still the norm."

Despite AB 1451 -- a California law requiring concussion training for all high school coaches, and more peer-review literature in the last 10 years than in the 50 years prior -- Freitag said reporting and assessing head trauma is only still "evolving."

Batten was ambitious, telling the audience, "If all of you can walk out of here and understand how to identify and hold back an athlete suffering a concussion, it's a big win."

The takeaway of the next hour was knowing the less-familiar symptoms, not just the obviousness of loss of consciousness (fewer than 10 percent of concussions involve it), but sensitivity to light and behavioral changes. The "window of opportunity" was also crucial; abnormalities can manifest themselves over a 36-hour period and recovery takes 10 days or more. In the end, the more familiar a parent, coach or health care provider is with a head trauma sufferer, the better.

"Half the people I pull from the field are pulled because I know them," Batten said. He suggested coaches use a card with simple test questions to ask, but cautioned that adrenaline and delayed symptoms would mean some athletes pass the test, despite being injured.

Audience questions centered on finding knowledgeable medical practitioners -- a group receiving considerable criticism from both Freitag and Batten. Freitag said "cookbook approaches" don't take into account the myriad symptoms of a concussion. Batten said, bluntly, "If they're grading concussions, they're probably not up to date." Because physical and cognitive rest is really the only "cure," a multidisciplinary approach involving trained medical providers, parents, coaches and educators is imperative.

Batten spoke of preventive practices, remaining skeptical of claims about special helmets and mouth guards, and about enforcing the rules.

"Football helmets were designed to do one thing -- prevent skull fractures," he said. "They don't prevent concussions."

Lynch suggested the main thing that will create change is a new culture, one that doesn't downplay the "invisible injury" of a concussion.

Batten said, "Remove the athlete from play, document what happens, ensure a professional health care evaluation is performed, and keep them out until the doctor signs off that they're OK. It's rare, but a second concussion can lead to permanent brain damage and even death."