Posted on

Tragedies propel Iowa Athletic Trainer to take leading role in concussion research

Article reposted from The Des Moines Register
Author: 

Mike Hadden couldn’t comprehend what was happening to his beloved niece.

Alex Hermstad was 12 years old when she started experiencing weakness in her hand, leading to an alarming diagnosis — amyotrophic lateral sclerosis, commonly known as ALS, a disorder that typically doesn’t strike people until their mid-50s. Her identical twin sister, Jaci, had no such symptoms. On Valentine’s Day in 2011, Alex died at her Storm Lake home. She was 17.

Hadden, a scientist and a health care professional who is one of The Des Moines Register’s People to Watch in 2017, restlessly probed for an explanation. As director of athletic training at Simpson College, he was also troubled by seeing the damage young athletes were suffering from concussions. He searched for a link, theorizing there had to be something in the environment making young people more susceptible to such trauma.

He devoured some 15,000 scholarly articles, and took a sabbatical year from Simpson to conduct his own research.

Hadden returned to work only to confront another family’s grief over another incomprehensible death to someone far too young. Zac Easter was 24 years old when he took his own life Dec. 19, 2015, driven to despair after six diagnosed concussions left his brain ravaged by chronic traumatic encephalopathy, also known as CTE. Repeated concussive blows to the head have been shown to lead to CTE. Hadden had known the Easters for years, from the time Zac’s father, Myles, was the football coach at Simpson.

That was when Hadden — with assistance from Jill Wilson, who was the athletic trainer at Indianola High School when Easter played football there — embarked on a potentially game-changing research project on concussions from his modest office at Simpson College, a liberal  arts school in Indianola with fewer than 2,000 students.

‘Something’s going on’

Hadden immediately reached out to a family that wanted the same thing he did — for something positive to emerge from tragedy.

“I had experience with a severe loss like that, and I knew the terminology. I knew how to get things moving. I knew what had to be done. We made sure to save tissue from Zac in case we wanted to do further tests,” Hadden said.

“There’s obviously something going on. ALS in a 12-year-old? CTE in a 24-year-old? That kind of stuff doesn’t happen.”

Hadden sent tissue and fluids from Easter to Dr. Bennet Omalu in California. The forensic pathologist — famously played by Will Smith in the movie “Concussion” — confirmed that Easter suffered from CTE.

The Easter family enlisted Hadden’s help in establishing a nonprofit organization called CTE Hope. The goal is to fulfill Zac Easter’s dying wish of making football a safer sport and to establish a reliable return-to-play protocol for athletes who have been concussed.

MORE: Zac Easter’s battle with CTE

Hadden obtained saliva samples from three Simpson football players who suffered concussions, carefully storing the samples in minus-80 degree temperatures. Hadden and others hope that doctors and sports trainers worldwide will be able to use a simple test to determine when an athlete has a concussion and, more importantly, when it is safe for him or her to return to the sport.

All from a simple spit test.

“That’s our missing link in all of this. Because we can’t evaluate the brain like we can a knee, shoulder, ankle,” said Wilson, who is also an adjunct professor at Simpson. “It’s going to take the discussions out and the questions out from parents, coaches and athletic trainers. Because it’s not fun to be that person on the sideline to release them to play and every time they take a hit, you cringe, because you don’t know what’s going to happen.”

The spit test

It is estimated that 1.5 million athletes suffer concussions each year. But experts fear 60 percent of concussions — potentially an additional 2.5 million — go undiagnosed under the current protocols. Also of concern is that the current five-step protocol for allowing an athlete to return to his or her sport — the so-called Zurich guidelines developed in 2008 — is imperfect. Those guidelines call for the gradual increase of physical activity before a concussion-sufferer returns to play.

The idea for a solution came to Hadden last March, when he read an article by David Walt, a professor in the chemistry department at Tufts University in Boston. Walt’s group is at the forefront of efforts to diagnose illnesses from saliva rather than blood using a “single molecule analysis.”

Concussions have long been linked to a spike in certain protein levels in the brain. If those “biomarkers” can be detected through a patient’s saliva, in theory doctors and athletic trainers could keep collecting samples until they knew those proteins had returned to the normal range, taking the guesswork out of the diagnosis.

To start, Hadden collected saliva samples from 93 of Simpson’s 130 football players this fall, plus another dozen from women’s soccer competitors, all of whom volunteered to be part of the project. These were stored to establish a baseline of the protein levels that were present in the saliva of the healthy athletes.

The sports seasons unfolded with relatively few concussions — great news, Hadden is quick to point out — but he did diagnose three football players who suffered concussions at home games. The initial saliva sample needed to be gathered in the first 20 minutes after the injury, then stored at minus-80 degree temperatures while transported to the freezer being used by Hadden. He kept a cooler and a supply of dry ice in his office, to be prepared.

Hadden kept gathering saliva from the injured players — 24 hours out, again at three days, at one week and, ultimately, after they were pronounced symptom-free. All of the telltale spit will be shipped to Tufts this winter, when Walt and his crew have some room in their schedule of tens of thousands of analyses they conduct each year. Walt said the tests take about four hours, and he hopes to have results within two days. He’ll be looking for elevated protein levels and how quickly those moved back to the athlete’s “baseline” stage.

Hadden said two of the football players progressed normally from their concussions, but the third had a relapse. He is curious to see what the difference was in their saliva.

If successful, Hadden envisions a time when trainers like himself can diagnose concussions armed with not much more than a cotton swab.

Hadden hopes to be able to release the results to the medical community by the next CTE Hope fundraising gala on April 21 in Indianola. He’s also hopeful that his studies can be broadened to include other universities in Iowa, so that the sample sizes can be much larger going forward.

Providing ‘Hope’

It’s this kind of work that drew the Easter family to Hadden when they started the nonprofit. Brenda Easter — Zac’s mother — said Hadden provides the scientific mastery while she handles public relations for CTE Hope.

“I have all the confidence in Mike and the work that he has started. If the saliva testing isn’t the right method to evaluate a trauma to an athlete, then we go to blood or we go to urine. He’s going to pave the way. He’s that committed and he’s got that kind of energy,” Easter said.

“We do have a bond. He lost his niece to a horrible disease. And while they’re a little further ahead with ALS testing, CTE is in the same boat. Neither one has a whole lot of firm treatment programs or protocols to follow when people are diagnosed,” she said.

Now Hadden’s work with CTE Hope, a mission that arose out of the deaths of Alex Hermstad and Zac Easter, may put Hadden on a national stage. If so, it would be their legacy, not his, Hadden said.

But he’s already fulfilled Brenda Easter’s late son’s dying wish.

“If something like (CTE Hope) existed when my son started to have the symptoms, I would have just been so blessed to know that there is a place and they know how to treat it. Zac said to me more than once, ‘Mom, there is no hope for me.’ And he wasn’t wrong,” Brenda Easter said.

“This work was Zac’s wish. It’s not like you can buy a gift for him any longer, and so the only gift I can give him now is to carry out his wishes. And we’re so blessed to have someone as compassionate as Mike to lead the way.”

MIKE HADDEN

AGE: 50

LIVES: Indianola

EDUCATION: Bachelor’s in biology/physical education at Buena Vista, 1990; master’s in sports administration/biomechanics at Kansas, 1997.

CAREER: Director of athletic training and professor in department of Sports Science & Health Education since 1997; head athletic trainer at Mercy-Des Moines Sports Medicine and athletic trainer at Des Moines Roosevelt High School, 1991-97

Posted on

NAU researchers receive grant to study concussion reporting

The long-term impact of concussions is widely known but many athletes still fear opening up about head injuries.

NAU interdisciplinary researchers have been awarded a $400,000 grant to study how organizational culture relates to concussion reporting among athletes, coaches and staff.

Research team members Debbie Craigand Monica Lininger, athletic training education professors, and Ann Huffman and Heidi Wayment, psychological science professors, have been awarded the national Mind Matters Challenge grant for their proposal, “Changing the Culture of Concussion Reporting: A Cultural Analysis and Implementation Model.”

“Concussions are unique in the field of athletic injuries because the decision whether to keep playing is less clear,” said Craig, who is director of NAU’s athletic training education program. “Everyone must believe that it is OK to report concussions. This will be a significant cultural shift from the current American football culture. Our goal is to facilitate that shift.”

Wayment said this project is a tremendous opportunity given how rapidly public awareness on head trauma and chronic traumatic encephalopathy, also known as CTE, is increasing.

“As we know from research in health psychology, just ‘knowing’ that a behavior can negatively impact one’s health is not sufficient for change,” she said. “I am especially excited about our interdisciplinary approach: we will be looking very specifically at multiple factors that impact athletes’ decision-making processes. My colleagues and I each bring a different theoretical perspective to the research, and we are excited to be working together.”

The objective of the project is to investigate the organizational, athletic, individual and interpersonal factors that affect concussion-reporting behavior and develop intervention strategies that increase student-athlete safety and well-being. The research study, funded by the NCAA and the U.S. Department of Defense, will be conducted over two and a half years and involve four different NCAA Division I football programs.

CLICK HERE FOR ORIGINAL ARTICLE

Posted on

Concussions in women’s soccer closing the gap on football

Olivia Homer always knew whom she’d defend whenever her Monmouth Academy soccer team stepped on the field.

“The biggest and the fastest,” said Homer, 16, a junior.

Fearless yet standing just 5-foot-2, Homer embraced that challenge.

But after suffering two concussions in a little less than two years, she had to give up the sport she’d loved since kindergarten out of fear for what a third would do to her quality of life.

“Right now, I guess I’m a little worried,” said Homer, who still experiences migraine headaches she attributes to the concussions. “But I’m not as scared as I would be. I think that I’d be more scared if I was playing.”

• • •

Homer says her decision to not play soccer this season was difficult. She and teammate Haley Fletcher dreamed of being team captains for their senior years.

Yet doctors and athletic trainers say athletes who decide not to play a sport after suffering a concussion are making the correct decision if they can’t overcome fears of another one.

But are these fears founded?

A recent High School Sports-Related Injury Surveillance Study shows that concussions are more common in soccer, particularly in the girls game. Furthermore, the data also shows the gap between girls soccer and football is not as wide as commonly perceived.

The survey collected information on 20 sports from 100 American high schools between 2005 and 2014 and found that for every 10,000 “athlete exposures” (times a student-athlete played soccer in a game or in practice), 4.5 girls and 2.8 boys suffered a concussion.

Only football (6.4), boys hockey (5.4) and boys lacrosse (4.0) had higher rates.

In all gender-comparable sports, such as soccer and lacrosse, girls had a higher rate (1.7) than boys (1.0).

Another study from the National Athletic Trainers Association also showed concussions in girls soccer are more prevalent. The national study, which was based on information from the 2005-06 high school sports seasons, showed girls soccer had a concussion rate of 51 (out of 1,000 exposures). Boys soccer, meanwhile, had just 33 while football came in at 201.

Experts say a number of factors could account for the high rate in girls soccer, from physiological and playing style differences to girls possibly being more likely to report a head injury.

Furthermore, athletes who’ve suffered a concussion at any time in their lives have an increased risk of suffering another, according to the Centers for Disease Control.

In soccer, the greatest risk comes from collisions resulting from trying to head the ball and not — as commonly believed — from head-to-ball contact.

“The real problem we’re seeing is athlete-to-athlete contact and, particularly in women’s sports, head-to-head contact, head-to-shoulder, head-to-body contact,” said Tim Weston, head athletic trainer at Colby College and District One director for the National Athletic Trainers Association.

According to a 2007 report by some of the same Sports-Related Injury Survey authors, only motor vehicle accidents trump athletics as the leading cause of concussions among individuals 15 to 24 years old.

Homer suffered her first concussion in a July 2013 car accident, just days before she was to start soccer practice as a freshman. She missed a couple of games due to headaches but she was mostly symptom-free once school started. She wore headgear through the season with the hopes of preventing another concussion.

She made it through that season and last fall without incident and earned the trust of coach Gary Trafton, who assigned her to mark St. Dominic’s Faith Grady, Madison’s Kayla Bess and other top players in the Mountain Valley Conference.

While playing indoor soccer last March, Homer got knocked down. She got back up and started playing again, only to be knocked down a second time. This time, she fell on her shoulder and her head snapped toward the ground. She remained conscious, but immediately felt dizzy and confused when she got back on her feet.

A doctor in attendance examined Homer. He told her and Susan Norton, Homer’s mother, that he didn’t think she needed to go to the hospital immediately, but recommended they see their primary care physician the next day. He also reminded them to keep a close eye on any symptoms.

Homer’s symptoms worsened overnight and she was diagnosed with a mild concussion the next day.

The symptoms continued to get worse and left Homer confined to her bedroom.

“I had to be in a dark room,” she said. “The lights were so sensitive. It was hard to see. It was hard to think. I just had to lay and do nothing.”

It took her two weeks to get back to school. Even then she could only do half-days at first, and she would spend most of that time alone in a dimly-lit conference room because she was still sensitive to light and noise.

“That’s when I started to realize that sports would be different, school would be different,” Homer said. “The second one hit me so hard. It was diagnosed as moderate, but it felt severe. It took me a while to fully feel better. And I still get headaches. I think from the concussion I got migraines.”

“I just never really came back the same,” Homer added.

Homer’s story mirrors some of the ones told by pro and amateur football players. Athletic trainers and doctors credit the publicity surrounding brain injuries in American football with raising the public’s consciousnesses of concussions in general. But they believe public perceptions of other sports can end up skewed by football’s high-profile battle with concussions and possible long-term consequences, such as chronic traumatic encephalopathy (CTE).

“The focus on football, I think, has done wonders in terms of saying concussions are important and it’s provided media coverage and resources to the science. But what it really has done is skewed to say football is bad and everything else is good,” said Dr. Paul Berkner, director of the Maine Concussion Management Initiative (MCMI) at Colby College. “We have parents making decisions about concussion risks that are not informed.”

Added Dr. Chris Lutrzykowski, who specializes in non-operative medicine, including concussion management, for Maine General Health in Augusta: “The pendulum has swung from blowing off a possible concussion, and I think it has swung a little too far with parents making choices for kids (out of fear of injuries).”

Nevertheless, coaches, parents and the athletes who’ve suffered concussions are asking questions.

“I see a lot of coaches who are much more educated with regard to concussion management, and parents are as well,” Weston said. “I certainly get more questions from parents like ‘What are the long-term effects for my son or daughter. What is going to happen down the road?’”

Medicine has made great strides in concussion management in just the last decade, and Maine high schools — spurred by a 2012 state law that required them to have a concussion management program — are now more equipped than ever to determine if and when an athlete can return to action.

Many Maine high schools use the program ImPACT, a computerized neurocognitive test that establishes a baseline score for athletes who have been diagnosed with a concussion to match before they can play again. MCMI partners with schools to collect the data, and, with the help of a federal grant, hopes to work with more schools in launching the Head Injury Trauma program, which it says will make it easier for athletic trainers and school officials to record and track concussions.

Baseline testing has its flaws, chief among them being that there is no way of knowing whether test-takers tried their best or simply slacked off to establish a lower baseline score and improve their chances of returning if they do suffer a concussion.

“Pre-concussion testing can be a useful tool, but it’s nowhere near a panacea,” said Chris Sementelli, an athletic trainer for 29 years and program director for Maine General Sports Medicine.

Athletic trainers work closely with schools and sports medicine physicians to help manage concussions, a relationship that has become more common in the state since the 2012 legislation. Public education and media coverage of concussions has athletes, coaches and parents more aware of concussion signs and symptoms, which in turn gives the medical professionals critical information to help the athlete.

“The difference in concussion management has been the improvement in recognizing the signs and symptoms,” Lutrzykowski said. “One of the key pieces of managing concussions is now we’re better able to recognize them.”

Even with access to more information, there is still much medicine does not know about the repercussions of and recovery from concussions. There are many questions a doctor or athletic trainer can’t answer, such as what will happen if an athlete suffers another concussion.

That can cause a lot of uncertainty in a young athlete, and uncertainty doesn’t translate well to the field.

“A key to getting an athlete back to playing after a concussion is working through that piece of fear,” Sementelli said. “I will not let an athlete back on the field unless they have full confidence in themselves.”

Homer didn’t step near Monmouth’s soccer field when the preseason started and might have avoided it altogether if her coach, Gary Trafton, and her teammates didn’t encourage her to come back as the team’s scorekeeper. She was worried about the temptation to play again.

“I was really close, I think (to trying to play again). At the first game, I started to think, ‘Well, I can be out there. I can play,’” Homer said.

Homer hasn’t missed any school time this year due to her concussion. Without any noticeable symptoms, other students sometimes have a hard time accepting that she has given up her favorite sport.

“She’s had to develop a thick skin,” said Norton, her mother. “She feels like she’s constantly had to defend herself.”

“They think that they would play, but they don’t know exactly what goes on in my head. The headaches I still get sometimes will still feel like I have a concussion,” Homer said.

Norton and Homer said they understand too well how much perceptions about concussions still need to be changed.

“They haven’t had to face their future. You don’t think about it until you’ve had a concussion so bad that it took you out of school,” Homer said. “I’ve had a lot to learn.”

ORIGINAL ARTICLE:

Heads up: Concussions in soccer, particularly in girls game, a concern

Posted on

NFL and GE announce prize-winning concussion research

Six innovative studies on identifying concussions, the severity of brain trauma injuries and speed of the healing process have been named winners of the GE & NFL Head Health Challenge.
Some practical applications from the researchers, who each received a $500,000 award to advance their work, could be seen within the next two years, said Jeff Miller, the NFL senior vice president of the league’s Health and Safety Policy.
“It’s not too far in the future,” Miller told Reuters in an interview.
“This partnership has proven to be all that we had hoped and vastly more in terms of being able to advance the neuro sciences in ways that will lead to better protection and the health and safety of our players.
“And have significant impacts beyond the football field, other sports and throughout our community and the military.”
Head injuries have become a high priority for the NFL in recent years.
The issue of concussion and the effects of chronic traumatic encephalopathy (CTE) on former players was intensified following the suicide deaths of Junior Seau and Dave Duerson, who shot themselves in the chest to preserve their brains for study.
In April, the league also reached a final settlement of a lawsuit brought by former players over concussions that could cost the NFL $1 billion.
Three of the winning projects, Banyan Biomarkers Inc. of San Diego, University of Montana, Missoula, and Quanterix of Lexington, Massachusetts, study blood for biomarkers that inform different aspects of concussion.
The other three, BrainScope Company Inc. of Bethesda, Maryland, Medical College of Wisconsin, Milwaukee and the University of California, Santa Barbara, focus on neuroimaging tools and EEG-based traumatic brain injury detection to analyse and understand concussions.
“The lessons we are learning and the innovations we are helping to accelerate are not only going to help us and society overall around mild traumatic brain injury and the safety of the game, and improve safety for athletes across other platforms,” Alan Gilbert, director GE’s Global Government and NGO Strategy, told Reuters.
“We’re going to learn and be able to apply those lessons to things like ALS (Amyotrophic lateral sclerosis or Lou Gehrig’s disease), Alzheimer’s and Parkinson’s.
“We feel that it’s already happening — partnerships we’re doing right now with ALS are a direct result around this multiplier effect because we partnered with the NFL.”
Miller envisioned tests being administered on NFL sidelines or at the stadium to quickly diagnose concussions and their severity.
“Blood tests on the sideline, better imaging to identify a concussion — that’s the sort of transcendant science we were hoping to capture and encourage by running this challenge,” he said.
Two other NFL Head Health Challenge projects to protect the brain and to find materials that better absorb or dissipate energy in protective equipment are also ongoing in conjunction with GE and equipment manufacturer Under Armour.

More from: http://www.gmanetwork.com/news/story/527558/sports/othersports/nfl-league-and-ge-announce-prize-winning-concussion-research

ORIGINAL ARTICLE:

http://www.reuters.com/article/2015/07/23/us-nfl-concussions-idUSKCN0PX1CB20150723