The Mechanics of Concussion

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A new study from a research team at Ohio State University provides insight into how concussions work. The research is based on a laboratory experiment with mouse tissue, but the effects are quite similar to what is seen with human patients with neurological disorders.

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Source: Washington Univ.

Cells contain axons, which transmit signals (messages) to other parts of the body and brain through the nerve system.

Concussions activate a protein “called TRPV4, which causes a chain reaction that prompts a pause in content exchange along the axon.” (1) When the pause occurs, the axon swells, which is the physical sign of the problem. Similar swelling occurs in patients with Alzheimer’s and Parkinson’s.

This research also indicates that the swelling can be reversed with prompt reduction of stress to the brain. Further, if the protein is suppressed, the swelling does not occur. However, we don’t know exactly what that means for humans, at least not yet.

Knowing how something works is key to developing fixes for problems.


Sources:

  1. Yuanzheng Gu, Peter Jukkola, Qian Wang, Thomas Esparza, Yi Zhao, David Brody, Chen Gu. Polarity of varicosity initiation in central neuron mechanosensation. The Journal of Cell Biology, 2017; jcb.201606065 DOI: 10.1083/jcb.201606065
  2. Picture source: https://faculty.washington.edu/chudler/cells.html

Concussion: When in doubt, out!

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An international medical conference in Berlin has issued a consensus recommendation on the treatment of concussion in sports: When in doubt, take the player out.

According to a report in Medscape, there are a variety of diagnostic criteria for concussion, some more clearly objective and easier to ascertain than others:

 

  • Somatic symptoms (eg, headache), cognitive (eg, feeling as if in a fog), and/or emotional symptoms (eg, lability);
  • Physical signs (eg, loss of consciousness, amnesia, neurologic deficit);
  • Balance impairment (eg, gait unsteadiness);
  • Behavioral changes (eg, irritability);
  • Cognitive impairment (eg, slowed reaction times); and
  • Sleep/wake disturbance (eg, somnolence, drowsiness).

We know that concussions can have effects that range from very short duration to permanent, and that repeated concussions can magnify effects. We also know that a full recovery can take more than a year, if it is even possible. We know that children can suffer concussions whose effects last into adulthood.

What isn’t stated: what to do about non-sports concussions. How soon can a victim return to driving, if at all. If a pilot, a first responder or in some other occupation involving obvious risk, how soon should a victim return to work? How about someone responsible for stock or bond trading — if impaired reaction times can affect clients? Since most people don’t carry disability insurance, who pays them when they can’t work? (Social Security Disability only starts after one is out of work for two years.)

What’s the legal liability for forcing someone with a concussion back to work, when someone else is hurt as a result? Now that we know that forcing a truck driver of police officer back to work with a concussion could result in someone’s death, there should be a liability.  I guess the courts will sort that out.


Sources:

  1. Bert R. Mandelbaum, MD, “Concussion Consensus Calls for Caution,” MEDSCAPE, 23 MY 2017. http://www.medscape.com/viewarticle/880146?nlid=115245_1521&src=WNL_mdplsfeat_170530_mscpedit_wir&uac=153634BV&spon=17&impID=1357880&faf=1

 

 

How Long Concussion Effects Last

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A new study from researchers at the University of Washington Medical School 20150317_CDC_Concussionestablishes that even mild concussions can have effects on mental functioning and quality of live as long as five years after the injury.

The study looked at soldiers who had received mild concussions from explosions during tours in Iraq and Afghanistan.

“This is one of the first studies to connect the dots from injury to longer-term outcomes and it shows that even mild concussions can lead to long-term impairment and continued decline in satisfaction with life,” said lead author Christine L. Mac Donald, Ph.D., an associate professor in the Department of Neurological Surgery at the University of Washington School of Medicine in Seattle. “Most physicians believe that patients will stabilize 6-12 months post-injury, but this study challenges that, showing progression of post-concussive symptoms well after this time frame.”

It’s important to understand the length of impairment in terms of providing adequate services for veterans. That’s why NIH and DoD funded this work.

However, it’s also important to remember that civilians, athletes and First Responders suffer concussions — sometimes quite similar to what soldiers experience.

Forcing people to return to work before they are recovered can have unintended and unfortunate consequences. In fact, that was the explanation for a police shooting of an unarmed civilian in Seattle last year, discussed in an earlier post, and the deaths of high school and college football players as recently as 2016.

Arguably, the current health insurance system isn’t set up to meet the needs of people who may require care for 3-5 years as they recover from TBI. The US healthcare and health insurance system was designed long before we understood the nature of the problem and the length of recovery. The system hasn’t changed with the growth of knowledge.


Sources:

  1. Mac Donald CL et al. “Early clinical predictors of 5-year outcome following concussive blast traumatic brain injury.” JAMA Neurology. May 1, 2017.
  2. Alan Neuhauser, “Sudden Death,” US News, 11 August 2016. https://www.usnews.com/news/articles/2016-08-11/sudden-death-the-mysterious-brain-injury-killing-young-football-players
  3. “Brain-injury deaths in high school football players rising,” Fox News Health, 6 January 2017. http://www.foxnews.com/health/2017/01/06/brain-injury-deaths-in-high-school-football-players-rising.html

Brain Injury: New Developments

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imagesA brain protein, tau, may be an indicator of the length of time required for recovery from a concussion.

A research team from the National Institutes of Health and the University of Rochester Medical Center conducted a study of college athletes (NCAA Div. I and III) from a mix of sports.  Tau levels were measured preseason and within six hours following a concussion.

Tau was already a suspect in brain illnesses, having been identified as a factor in the development of chronic traumatic encephalopathy or CTE, frontotemporal dementia and Alzheimer’s disease.

Tau levels jump after concussion, and higher levels are linked statistically to longer recovery time requirements.

The research focused strictly on athletes and on defining an objective measure of when a player should be allowed to go back into play.  The report calls for follow-on studies including the capture of blood samples on the sidelines of games to assess how quickly tau levels change and whether that could be used as an immediate indicator.

However there are potential applications of tau to other situations and occupations, for example, people involved in traffic accidents and in law enforcement.  Is tau a potential measure of long term injury?  Could the metric be used to assess how long a worker should be out after a work-related injury?  Frankly, if tau works for athletes, it’s hard to see why it wouldn‘t work in these other situations.


Sources:

  • Jessica Gill, Kian Merchant-Borna, Andreas Jeromin, Whitney Livingston, Jeffrey Bazarian. Acute plasma tau relates to prolonged return to play after concussion. Neurology, 2017; 10.1212/WNL.0000000000003587 DOI: 10.1212/WNL.0000000000003587
  • University of Rochester Medical Center. “Brain protein predicts recovery time following concussion.” ScienceDaily. ScienceDaily, 6 January 2017. <www.sciencedaily.com/releases/2017/01/170106192001.htm>.

 

Sex and Health

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There is a large volume of recent research on the benefits of sex for the human body.  Most of this work is based on health and behavioral records, but some research is starting to explain the mechanics of how sex and orgasms affect the body.

There were reports in the media over the last three years that breast manipulation or massage might reduce the risk of breast cancer.  Maybe, maybe not.  The reports suggest this might be true but there is no conclusive evidence.

Masturbation may also be good for older males  (age 50+) by removing toxins from the prostate gland.  This may reduce the risk of prostate cancer.  Masturbation among older men is also associated with reduced risk of cystitis and diabetes.

There is a key difference between the findings regarding breast and prostate cancer.  We have a logical hypothesis about how an orgasm might reduce the risk of prostate cancer, but we don’t know how breast massage might affect the growth of breast cancer.  It is reasonable to think that frequent massage will increase the chance of detecting cancer at an early stage, when it is most easily treatable, but that’s not the same thing as prevention.

For medical research findings to be taken seriously, there are two requirements:  (1) a statistical finding that a relationship exists between a personal characteristic or behavior and a disease; AND (2) a logical theory about how the behavior or characteristic could impact the disease.  Having one part without the other is useless.

The new finding is that orgasms reduce stress, and stress is related to cancer risk as well as to vulnerability to a host of other physical problems.  What’s important in this new research is the identification of how this can work — a process known as brainwave or neural “entrainment.”

Entrainment is the process of bringing neurons into coordination or alignment.  This allows the mind to focus on a single idea or sensation.  There’s no reason for orgasm to be the only path to alignment.  In theory one could get to entrainment via music, meditation or massage as well.   Many people probably already do.

Maybe someday we’ll have home devices that will help us monitor and achieve entrainment.  Biofeedback is being used for this purpose today.

The ease of achieving entrainment may also explain why some people have an easier time achieving orgasm than others.  If that’s true, it might suggest meditation and/or biofeedback as paths to facilitate sexual bliss.  Can we train the brain to be more orgasmic by making entrainment easier to achieve?  Does entrainment explain how background music can be conducive to sex?

There are Canadian clinics using entrainment in treatment of concussion/brain injuries (e.g., Canada Concussion Clinic in London, Ontario).  Here, again, the mechanics of how entrainment might affect concussion aren’t obvious.

It’s funny how folk wisdom can speak to scientific concepts.  Phrase one hears among older Americans include “calming the mind” and “peace of mind.”  Both may just be lay references to entrainment, which benefits both mind and body.

 


Sources

  1. “Beast Massages May Prevent Cancer, Study Says,”  Huffington Post, 7 June 2013. http://www.huffingtonpost.com/2013/06/07/breast-massage-cancer-prevention_n_3404250.html
  2. Borreli, Lizette, “Why Sex Feels Good: Neuroscientist Finds Orgasms Enhance Brain Activity, Leading To Altered State Of Consciousness,” Medical Daily, 3 Nov. 2016.  http://www.medicaldaily.com/why-sex-feels-good-neuroscientist-finds-orgasms-enhance-brain-activity-leading-403322
  3. “Masturbation Prevents Cystitis, Diabetes and Prostate Cancer, Study,” University Herald, 6 Dec. 2013.  http://www.universityherald.com/articles/6033/20131206/masturbation-prevents-cystitis-diabetes-prostate-cancer-study.htm
  4. “Squeezing breasts could stop growth of cancer cells,” The Daily Mail, 18 December 2012. http://www.huffingtonpost.com/2013/06/07/breast-massage-cancer-prevention_n_3404250.html
  5. Transparent Corporation, “Biofeedback and Brainwave Entrainment”.  https://www.transparentcorp.com/special/biofeedback.php

The NFL, Concussions and Life Expectancy –the right to “informed decisions”

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My wife and I met a young man on a plane recently.  He was charming and well-spoken, and as we talked we learned he plays high school football.

We also learned that no one is telling him the full truth about what he’s doing or the risks involved.

Now, I don’t have a problem with someone engaging in risky behavior — as long as doing so doesn’t put a third party at risk.  If you want to talk your sailboat out in a hurricane, go for it.  Just don’t expect anyone to come to rescue you.  They shouldn’t have to do that.  You need to accept responsibility for your actions.

However, risk-taking should be informed.  The sailor has weather reports.  If he chooses to ignore them, that’s his problem.  At least the information is available.

This young man had heard about the risk of concussions, but knew nothing about the debate over life expectancy.  He had never been knocked out of a game, and didn’t know he still could be at risk for long term damage without that happening.

What really shocked him was the length of a career in the NFL.  For players able to make the roster, the NFL says the average length of career is 6 years.  The Players Association says its 3.2 years.  Third party analysts have estimates that fall in between these numbers.  Bottom line, if you make a good college team, get drafted, and make starting spot on the team, the odds are your career will end by age 29.  Then what?

The young man was shocked.  That’s a lot of risk for not so much money.  And the risk may be understated.

First there’s the question of life expectancy.  Various reports suggest that pro football players have a life expectancy that is 20 years shorter than typical adult American males.  Various critics and apologists for the sport have been trying to discredit those numbers.  That’s where the debate over football and the health of players becomes similar to the 1970s debate over cigarettes and cancer or the current debate over global warming — the sides are more interested in “winning” the debate than in finding out what’s true.

(There’s a huge hole in the critics’ argument having to do with the relationship between life expectancy and income — see below.)

Then there’s the matter of “Health Life Expectancy”, a metric developed in Europe and calculated by the World Health Organization.  It appears that nobody in the US likes to talk about that metric, because it reflects badly on the US government and US medical community.

You see, Americans give up an average of roughly  9 years of their life to illness and injury.  That’s everyone, not just those playing football.  Life expectancy from birth for US residents is 78.8 years; Healthy Life Expectancy is 70 years.

However, sports stars are highly paid, and the life expectancy for affluent Americans is much longer than for everyone else.  A high income male in the US can expect to reach 89 years of age — and almost no one in pro sports is doing that.  Adjusted for income, sports stars actually do sacrifice life expectancy.

The truth is that a lot of pro sports stars die young, often from drug or alcohol behavior that may be concussion-related.  The ones who live longer (Frank Gifford comes to mind) have their lives affected materially by brain damage from concussions.  Their “Healthy Life” is much shorter than the number of years they lived.  Hopefully the Harvard study will tell us how much shorter Healthy Life Expectancy is for pro footballers.

So, the young man had been fed only a small fraction of the truth.  That’s  not right.  How can anyone make an intelligent decision about their future if they don’t know what the choices really mean?

College programs and the NFL have no more right to hide information on risks from prospective players than homeowners have to hide information about defects from prospective buyers.  People are entitled to know.

What they do once they are informed is up to them.  If they want to accept the risks and play, go for it.  If they decide to do something else, that’s fine as well.  I’m sure there will always be a line of candidates at the door.

[Sources:  CDC, New York Times, Atlantic Monthly, NFL, Boston.com]