Dr. Conidi is the Chairman for Seeing Stars Foundation and is currently the Director of the Florida Center for Headache and Sports Neurology, a tertiary headache center which specializes in the treatment Sports Related neurological disorders with an emphasis on sports related mild traumatic brain injury as well as refractory headache patients and patients with facial pain. He is the team neurologist for the NHL’s Florida Panthers and a member of their medical team; as well as consulting neurologist for the Miami Dolphins and NY Mets (major and minor league teams).
Concussion risk for football players may not be reduced by helmet add-ons designed to reduce injury
Scientists are always looking for new ways to prevent concussions — a particular concern for athletes. Some of the most recent innovations, however, may not work as well as hoped.
Companies have been developing football helmet add-ons designed to offer more protection against concussions. But a new study found that these latest innovations may not lower the risk of head injury.
Every year, emergency rooms deal with hundreds of thousands of sports- or recreation-related head injuries, according to the Centers for Disease Control and Prevention (CDC). Many of those injuries come from football.
John Lloyd, PhD, a brain injury specialist in San Antonio, FL, and a member of the American Academy of Neurology, wrote this research with Francis Conidi, DO, at the Florida Center for Headache & Sports Neurology in Port St. Lucie.
“Our study suggests that despite many products targeted at reducing concussions in players, there is no magic concussion prevention product on the market at this time,” Dr. Lloyd said in a press release.
Drs. Lloyd and Conidi tested football helmet add-ons like outer soft-shell layers, spray treatments, helmet pads and fiber sheets. The specific products were Guardian Cap, UnEqual Technologies’ Concussion Reduction Technology, Shockstrips and Helmet Glide.
Crash test dummy heads were outfitted with football helmets featuring these add-ons. These researchers hit these dummies' heads five times from heights of 1 meter (about 3 feet), 1.5 meters (about 5 feet) and 2 meters (6.5 feet). Drs. Lloyd and Conidi measured linear acceleration, angular velocity and angular accelerations.
Linear acceleration is the rate of change of the position of the head (or speed of the head) over time as it moves in a straight line, according to Dr. Conidi. Angular velocity (sometimes called rotational velocity) is the speed at which the head rotates. Angular acceleration is the change in speed of the head as it rotates.
These researchers found that the Guardian Cap, Concussion Reduction Technology and Shockstrips reduced linear accelerations by about 11 percent — compared to helmets without add-ons. Angular accelerations were decreased by only 2 percent. Helmet Glide appeared to have no effect.
Dr. Lloyd stressed that angular accelerations are believed to be the major forces behind concussions.
Dr. Conidi told dailyRx News that one way to protect against concussion is to learn the proper way to tackle and absorb a tackle. He also advised that athletes perform pre- and in-season strengthening exercises.
“Stronger neck muscles can reduce angular and rotational acceleration of the head which is felt to be the mechanism of concussion,” Dr. Conidi said.
It’s important to limit tackling in younger athletes and teach athletes and coaches to recognize the signs and symptoms of concussion and the need for immediate removal from play of anyone suspected of suffering a concussion, Dr. Conidi said.
The CDC estimates that 1.6 to 3.8 million concussions occur in the US each year. Brain injuries from sports or recreation send more than 170,000 children and teens to the ER each year.
This study was released online Feb. 25 and will be presented at the American Academy of Neurology’s 67th Annual Meeting in Washington, DC, April 18 to 25.
BRAINS, Inc., and the Seeing Stars Foundation funded this research. Dr. Lloyd and his company, BRAINS, Inc., are working to develop sports helmets that provide advanced protection against concussion and brain injury.
One of the first projects undertaken by the Seeing Stars Foundation is to fund a multi-center research project to test a concussion specific neurological exam which has been designed by members of our medical board. Although the military currently uses the Military Acute Concussion Evaluation (MACE) which consists of standardized testing of cognition, neurologic functions including balance, and a symptom screen. And many professional and amateur sports organizations use the Sideline Concussion Assessment Tool (SCAT 3). Neither has been validated. A validated neurological exam can then be applied to the sideline evaluation of concussed athletes and can be administered in the battlefield to a concussed soldier. It can also be used serially to return athletes and soldiers to play and battle.
Other possible crossover applications would include evidence based studies into the treatment of post traumatic headache, depression, vestibular dysfunction and longitudinal diffusion tensor magnetic resonance imaging (MRI). Initial Diffusion Tensor Imaging and Susceptibility Weighted Imaging studies have already shown evidence of nerve damage in 30-40 percent of service members who are symptomatic from a concussion. The military has begun initial studies where an image of the soldier’s brain is taken prior to deployment to create a baseline that can then be compared with an image after combat.
Another one of the initial projects of The Seeing Stars Foundation is the funding of a longitudinal diffusion tensor magnetic resonance imaging study, where an athlete is screened prior to the season and then followed if he or she experiences a concussion. This type of imaging is essentially objective, using numeric values which appear to change over time as the brain recovers. Our medical advisory board sees DTI MRI as “The” future objective measure for diagnosis and recovery from concussion. Along with the Department of Defense they also see parallels for application in the battlefield.
Other Facts on military concussion.
Individuals who sustain a concussion often do not seek out medical attention. The reasons for this are that the symptoms of concussion quickly subside in most subjects within seconds or minutes after the injury. Also it is the culture among service members and athletes to ignore signs and symptoms of concussion and return to the fight or play as quickly as possible. Thus, caregivers and coaches must be vigilant for the signs and symptoms of TBI in any service member or athlete who may have sustained a blow to the head.
In 2011 the DoD instituted a requirement that all service members exposed to a blast event (within 50 meters), or who were inside a vehicle or building exposed to a blast, must be removed from combat for at least 24 hours and be medically evaluated prior to return to duty. Likewise, the National Football League instituted rigid new requirements that state, in part: "Once removed for the duration of a practice or game, the player should not be considered for return-to-football activities until he is fully asymptomatic, both at rest and after exertion, has a normal neurological examination, normal neuropsychological testing, and has been cleared to return by both his team physician(s) and the independent neurological consultant." These new policies were instituted in direct response to the culture of the service members and players wanting to return to combat/play too soon and not being forthcoming about their symptoms.
Those individuals who remain symptomatic 24-48 hours after the injury are often referred for further testing. In-theater service members will often be referred to a concussion care center and will likely have more detailed cognitive testing with the Automated Neuropsychological Assessment Metric (ANAM). Post-injury test results can be compared with pre-deployment tests, and serial studies can be done to follow recovery from the cognitive deficits sustained from the concussion. Increasingly high school, collegiate and professional sports teams are obtaining pre-season neurocognitive baseline testing so that cognitive deficits can be detected more easily after a concussion.
Brain injury symptoms include severe headaches, memory problems, impulsivity or impaired judgment, and even depression. Taken as a group, these symptoms are often called post-concussive syndrome. At least 253,000 American servicemen and women were diagnosed with brain injuries in the last twelve years.
Study’s Results Show Bad News For Brain Injury Victims. The new study looked at symptoms of post-concussive syndrome over a period of time. Researchers evaluated veterans with brain injuries during the first four years after a brain injury and then again in the next four years after that. Over the course of eight years, the researchers found that symptoms still had not diminished. Almost 50 percent of the surveyed veterans reported continuing headaches. Forty-six percent said that their headaches were still “severe” up to four years after an injury. Fast forward another four years and the numbers were even worse: 51 percent of respondents said that they suffered from severe headaches.
Researchers also said that a similar pattern appeared in other brain injury symptom categories like depression, impulsive decision-making, and coordination. Because brain injuries can be cumulative, veterans who suffered multiple concussions also seemed to experience even worse symptoms. Although the study concludes worsening symptoms over time, some experts believe that most if not the vast majority of the TBI’s in the study were not handled/managed correctly. If you go back eight years the treatment of this injury was way wrong, and often never allowed the brain to fully heal. Concussions/TBI’s are often forgot after the fact because they are invisible to everyone, except for the person suffering from them.
This study really hammers home the need for proper management, remember that the elephant in the room is not the injury, rather the mismanagement of the injury. It is the opinion of some neurologists that in 2004 concussions were mismanaged and now we are seeing some results of this. Moreover, this should justify removing anyone with a TBI/concussion from activity until fully recovered; sports, military or life in general.
In addition to being a major issue in sport, concussion is one of the most common injuries seen in the battlefield. In fact mild traumatic brain injury is considered the signature wound among US soldiers in the Middle East with more than 33,000 TBI’s diagnosed since 2000. Research is showing that war veterans from Iraq and Afghanistan are not showing improvement of traumatic brain injury (TBI) symptoms. A recent study of traumatic brain injury looked at 500 veterans of the Iraq and Afghanistan wars. The research concluded that brain injury symptoms did not subside over the course of eight years. Instead, the veterans reported slightly worse conditions over the course of time. More specifically almost 50 percent of the surveyed veterans reported continuing headaches. Forty-six percent said that their headaches were still “severe” up to four years after an injury. Four years later the results were even worse with 51 percent of respondents noting that they suffered from severe headaches. Sadly very little is known about post traumatic headache from any cause and one of the major goals of our foundation is research into the possible mechanism and treatment of post traumatic headache. In addition to the above the researchers also noted a similar pattern in other brain injury symptom categories like depression, impulsive decision-making, and coordination. Because brain injuries can be cumulative, veterans who suffered multiple concussions also seemed to experience even worse symptoms. This research draws more attention to traumatic brain injuries as invisible wounds. Even though veterans with brain injuries may look completely whole and healthy on the outside, painful and frustrating consequences can continue to make post-service life extremely difficult.
Furthermore, many more of our heroes go undiagnosed, mainly due to similarities among soldiers and athletes in which fierce competitiveness can allow injuries such as concussions to be ignored for sake of winning or completing a mission. Perhaps one of the greatest issues facing the military and professional sports is the aforementioned warrior culture. The only real way to change attitudes is through education. This of course is one of the two major goals of our foundation. We envision developing dual programs where athletes and wounded warriors get together and speak to athletes (at all levels) about the dangers of not reporting concussion immediately when it occurs. We are also planning of producing a video that we will post on our website which brings athletes and wounded warriors together to discuss their experiences with concussion.
Although the mechanism appears to be different the symptoms of concussion and athletes are nearly identical. In fact there is no clear evidence that the types of combat-related concussion are significantly different for blast or blunt trauma from sports and neuropsychological studies have found no measurable differences in cognitive performance between blast and blunt injuries. Research into the evaluation and treatment of concussed athletes can also be applied to our wounded warriors. In fact the NFL and U.S. Army have already teamed up on a long-term program to care for and prevent concussions and head trauma. However, given the enormous task at hand significant additional funding is going to be needed.
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