Ready for more bad news? A recently–published study by Toronto’s Centre for Research on Inner City Health, shows that traumatic brain injuries cause homelessness.

In 2004 and 2005, they interviewed 904 people at homeless shelters, and meal programs, and found that 53% had traumatic brain injuries. Worse, is that 70% of those injuries occurred, before the person became homeless.

Stephen Hwang, co–author of The effect of traumatic brain injury on the health of homeless people cautiously said:

“I think that this article doesn’t make the link definitively, but it is hypothesis generating. It raises a possibility which has not been discussed by researchers before.”

In a recent interview, co–author Angela Conatonio, said traumatic brain injuries, are the leading cause of death, among people under 45 in Canada, and added:

“Cognitive rehab [may be beneficial to those who have suffered traumatic brain injuries] for example, or they might benefit from some assisted technology, such as help with their memory”

The Worst Part

If it took Dr. Conatonio three years to figure out that homeless people, with a TBI “might benefit” from “help with their memory” — how long it will take for Canada to actually help these people?

Photo

Photo of woman, is by Spirited Angel from her Toronto Life collection.

On August 22^nd, the Department of Labor launched America’s Heroes at Work which focuses on the challenges, faced by these injured veterans, when they look for a job. Neil Romano, Assistant Secretary for Disability Employment Policy, said:

“An initiative like this is terribly important, because if you’re going to have one in five veterans coming home with this, they’re just not people we can afford to forget or lose”

Romano said DOL spent $500,000 developing this impressive site.

Visit: www.americasheroesatwork.gov

The program was announced by Illinois Governor Rod R. Blagojevich, and Tammy Duckworth, director of the Illinois Department of Veterans Affairs.

The New York Times, in Screening for Brain Injury Is Set for Illinois Veterans, by Libby Sander, quoted Dr. Felise S. Zollman, medical director of the brain injury program at the Rehabilitation Institute of Chicago, who described the program:

“The mandatory screening would consist of a written questionnaire, an assessment by a medical professional, and a professional interpretation of the results. Service members believed to show symptoms of a brain injury would be referred for assessment and further treatment at a veterans’ center.”

In Illinois Unveils Mental Health Services for Returning Guardsmen, Veterans, by Donna Miles, reporting for American Forces Press Service, quoted Dr. Samuel Ward Casscells, assistant secretary of defense for health affairs, who explained why mandatory testing is necessary:

“We’ve got these post-deployment questionnaires that you fill out when you leave theater.

When I left Iraq, I filled out a questionnaire that said: ‘Were you near an (improvised explosive device) that went off? Are you having trouble sleeping? Are you having trouble controlling your feelings?’ And so forth, and so on.

A lot of people check ‘no’ because they want to get home.

[Questionnaires have been retooled so that] even if they check ‘yes,’ they’re going to get home and get the care when they get home, he said, adding that this will help promote more honest responses.”

The Defense and Veterans Brain Injury Center, says that:

In prior conflicts, TBI was present in at least 14–20% of surviving combat casualties; preliminary information from the current conflict in the Middle East suggests that this number is now much higher.

It is about time that someone is taking some steps to identify this problem.

“I’m not sure if we, as athletes, know what a concussion is just listening to these doctors and researchers talk. Outside of me being knocked out, asleep, I went back in the game on all the other occasions. And 50 or 60 times, I’m in the huddle, I don’t know where I’m at, don’t know the call, and I’ve got a player holding me up. I’m not sure if athletes really know what a concussion is — get some smelling salts and back in the game.”

These words of wisdom came at a “Concussion Conference”, held by the league, on June 19^th in Rosemont, Illinois.

Each NFL team sent a physician and two trainers to discuss ways of limiting brain injuries from concussions. All attendees received a package filled with concussion research.

What Is A Concussion?

Princeton’s Wordnet defines it as: “injury to the brain caused by a blow; usually resulting in loss of consciousness”.

NFL’s Opinion

That sounds pretty serious to me, but not to the NFL, which seems to be more concerned about profits, than the welfare of its players. The NFL, founded in 1902, formed the “Mild Traumatic Brain Injury” (MTBI) Committee in 1994, which finally began to study concussions.

So, they did not consider concussions to be of any consequence for their first 92 years, and not serious enough to formulate any sort of policy on them since they began studying them, in 1994.

The main difference in this conference, was that the NFL invited Dr. Kevin M. Guskiewicz who as reported here, had previously conducted a study of 2,559 retired players, linking concussions to depression, despite the fact that Henry Feuer, a Neurosurgical Consultant to the Indianapolis Colts, called the study “essentially worthless.” However Henry is the same fellow, who was commissioned by the NFL in 2005, to conduct a study of concussions on High School football players, and concluded that “it might be safe” for players who suffer concussions to return to play in the same game, so in my opinion, his opinion is worthless to anyone but the NFL.

On June 10, 2007, Alan Schwarz reported in N.F.L. Study Authors Dispute Concussion Finding that Dr. Feuer had changed his mind, and high school (not professional) players should not return to a game after suffering a concussion. Quoting Mr. Schwarz’s excellent article:

Feuer said that he “would change that sentence; I’d eliminate it.” Regarding high school players, he added: “It’s been shown that they don’t seem to recover as fast. Period.”

Another one of the authors, Cynthia Arfken, a Ph.D. employed by Wayne State University, went even further. Arfken, who co-authored another gem, Decreasing Unnecessary Care in a Psychiatric Emergency Service, as well as my favorite, a study of 48 cocaine dependent adults with ADD, claimed that she was unaware of the contents of the study and claimed that it was published without her permission, and was given a proof to review, but, as Mr. Schwarz reported, ”did not examine it carefully.”

Less carefully than the check she received for contributing to the report?

Another author, the Co–Chairman of the MTBI committee, Dr. Ira Casson, had the best comment:

“The fact that someone may misinterpret what we wrote in that paper does not mean that what we wrote in that paper was inaccurate, incorrect or shouldn’t have been done. This paper was aimed at scientists and physicians. If people who are not scientists or physicians are misunderstanding it, then that is not the responsibility of those of us who wrote it.”

Curiously, Dr. Joseph Waeckerle, the emergency doctor for the Kansas City Chiefs said, “My recommendation is that we write an editorial, or we write a piece, that explains very clearly that there is no external validity to this paper.”

The semi–eminent Dr. Feuer, countered with:

“I’m happy that more is coming of this. We set out to study a finite period of time. Look at what’s coming from it — continuous arguments. That’s what’s important. We’re getting people’s ire up. That’s how you get good studies done. When people get critical of something, you look into it more.”

The NFL’s commissioner, Roger Goodell, was on the same wave length as Dr. Feuer, saying:

“Vigorous debate is part of advancing that agenda.”

Unfortunately, debates don’t accomplish anything.

What Will The NFL Do?

Players will be checked prior to the season for head injuries. A physician will measure their reaction times, and other data, which will then be used to determine if they are hurt badly enough during the season to be considered ”injured.”

Referees will make sure players are wearing their helmets correctly, and that their chin straps are secured.

The biggest change will be the introduction and implementation of an anonymous system for players and personnel to inform the NFL if they feel that a Coach is forcing a player, who might have a head injury to play.

Personally, I think that proposal is idiotic, because nobody likes a stool pigeon, and nobody wants to ruin their career.

What Do Players Say?

Joe Theismann was the starting Quarterback for the Washington Redskins, from 1978 through 1985. Lawrence Taylor ended his career by sacking him on a busted play, and accidentally falling on his leg, shattering it.

Jayne and I were at that game, and you could hear his bone snap in the stands.

In a recent interview, Theismann said he suffered between five and ten concussions.

“If you could identify fingers the trainer was holding up, you went back into the game. Our education on concussions was nonexistent, but what we did know was if you sat down and didn’t play, and another guy did well, your career was gone.”

If you’e career is “gone” by sitting down, imagine what will happen when you (anonymously?) complain about your coach. And how can it be anonymous if you are the subject of the complaint?

What Does The Commissioner Say?

This is how NFL Commissioner Roger Goodell, summarized his position, and lack of action:

“No one has all the answers in this area so I don’t think anybody is being irresponsible. I think they want to be extremely responsible in trying to bring awareness and proper medical care to not only our players but to people who suffer concussions, which happens increasingly outside the NFL.”

My Opinion

1. Anyone who complains about their coach will never play again.
2. Nothing will happen until a player with a concussion returns to a game, gets hit in the head again, and is permanently disabled on the spot.

3,683 surveys were sent to retired players and 69% (2,552) were returned. The New York Times, in Concussions Tied to Depression in Ex-N.F.L. Players by Alan Schwarz, described the study as “the most comprehensive study of football players to date.“

Whom Can You Trust?

The NFL has billions of reasons to discount the results of this study, even though it was conducted by The Center for the Study of Retired Athletes, at The University of North Carolina, which is partly funded by the league.

The NFL’s Opinions

The NFL version of the study, quoted Dr. Kevin M. Guskiewicz, the lead author of the study, which was published by The American College of Sports Medicine in Medicine and Science in Sports and Excercise, who said:

“The findings of this study are not simply relevant to 50-, 55-year-old, 60-year-old retired athletes” [but to those currently playing].

Other NFL “experts” also discounted the results:

Dr. Amparo Guiterrez, professor of clinical neurology at LSU did not say when the survey was done (the CSRA said 2001), but according to the league’s version, “Gutierrez said he has been collecting data since about 2001.” Dr. Gutierrez said:

“the study’s biggest problem is that it relies on athletes’ memory, unverified by doctors’ records.”

If that is true, then why has he been working on this since 2001?

Two members of the NFL’s mild traumatic brain injury committee also downplayed the results.

Dr. Henry Feuer, a neurological consultant for the Indianapolis Colts, said the findings were “virtually worthless.”

Dr. Ira Casson, co-chairman of the MTBI committee, said:

“They had no objective evaluations to determine whether or not what the people told them in the surveys was correct or not. They didn’t have information from doctors confirming it, they didn’t have tests, they didn’t have examinations. They didn’t have anything. They just kind of took people’s words for it.”

The CSRA reported it differently than The National Football League, and The New York Times, saying:

“Retired NFL players who sustained three or more concussions during their professional playing years had a nearly three-fold risk of being diagnosed with Mild Cognitive Impairment (one precursor to Alzheimer’s disease).”

They didn’t even mention depression! And the NFL never said anything about “impairment” or “Alzheimer’s!”

Another View

The Times article gave a more balanced perspective, quoting Dr. John Whyte, director of the Moss Rehabilitation Research Institute, who has no ties to the National Football League, or the CSRA:

“To the person who says this is worthless, let’s just discard a third of the medical literature that we trust and go by today.”

“Here, the response rate was good and not a relevant issue to the findings. We have some pretty solid data that multiple concussions caused cumulative brain damage and increased risk of depression, and that is not in conflict with the growing literature.”

“Do I think this one study proves the point beyond doubt? No. Does it contribute in a meaningful way? You bet.”

My Opinion

• The results would have been higher if more than 69% of the retired players responded.
• The NFL needs to quit pretending that, when two 300 pound football players, running at full speed, collide, the worst that can happen, is a mild traumatic brain injury. This MTBI committee is a joke. Football is a rough game, and it should be rough, but it’s time that the league came up with some guidelines to at least place players with concussions, or MTBI, on an injured reserved list as soon as they are taken out of a game.

Senator Durbin described this legislation as:

“A bill to ensure that the Department of Defense and the Department of Veterans Affairs provide to members of the Armed Forces and veterans with traumatic brain injury the services that best meet their individual needs, and for other purposes; to the Committee on Armed Services.”

How Will It Help?

• The Department of Defense will screen military personnel for traumatic brain injuries before and after they are deployed. It is not clear if recruits will be affected by a TBI diagnosis.
• “Traumatic Brain Injury Program” which will be jointly administered by DOD and VA which will establish guidelines for the treatment and care of military personnel with traumatic brain injuries. This will allow patients with traumatic brain injuries to be treated at facilities run by the DOD, and VA, as well as private facilities. This is a huge improvement over the current system which places patients at one of four polytrauma centers. Additionally, patients will have a standardized appeals process to complain about their treatment, and will be guaranteed a referral to a physician in the private sector. However patients will be limited to one outside referral every three months.
• The DOD and VA will also develop a training program for medical personnel at public and private centers, “to ensure that such personnel are consistently using the most up-to-date and best practices and procedures for the screening, treatment, and rehabilitation of members of the Armed Forces and veterans with traumatic brain injury.” Medical records will be transferred “expeditiously” between these agencies.

My favorite portion of this bill is:

“The Secretary of Defense shall, upon the request of any former member of the Armed Forces who served in the Armed Forces after October 6, 2001, and has been discharged from the Armed Forces under other than honorable conditions, conduct a review (including a medical evaluation) to determine whether a traumatic brain injury was a cause of the actions of the member that precipitated the discharge under other than honorable conditions. Such request may also be made by an authorized representative of the member.”

Where Did My Brain Go? will be following this legislation, and I hope it is ratified.