Proposed bill could help understand brain injuries

SAFE PLAY legislation would establish national system to track traumatic head trauma

By Christopher Lang and Jennifer Vazquez, April 9, 2015 | Northern Valley Suburbanite

North Jersey health experts believe a proposed bill could help with further understanding traumatic brain injuries like concussions. The legislation, called the National Traumatic Brain Injury Research and Treatment Improvement Act of 2015, was introduced by Reps. Bill Pascrell, D-9, and Thomas J. Rooney, R-Fla., on March 10, the annual day of Brain Injury Awareness.

If approved, it would require the Centers for Disease Control and Prevention to “establish a national system to track the occurrence of traumatic brain injuries and collect data to assist research, prevention, and treatment development efforts.”

Top neurologists from Englewood Hospital and Medical Center and HackensackUMC called the bill “important” in understanding these injuries, which are classified as minor or major.

The proposal came just days before 24-year-old Chris Borland, a rising star for the San Francisco 49ers as a linebacker, announced his retirement after one season, citing concerns from repetitive head trauma. Borland, who led the 49ers in tackles this past season, had two concussions before joining the NFL. He joined fellow teammate Patrick Willis, 30, and others this past season who retired early because of concerns about the long-term effects of head trauma.

Concern over sports-related head injuries continues to grow in the sports world, including at the youth level, and health experts are taking notice.

Understanding Concussions

“I think it’s extremely important,” said Dr. Patrick Roth, chairman of Neurosurgery at HackensackUMC, about the proposed bill. “One of the main sources of brain injury is through sports.”

A concussion is a mild, traumatic brain injury that causes “transient alteration in your level of conciseness,” said Englewood Hospital and Medical Center’s chief of Neurology, Gary Alweiss, adding that it does not require a loss of consciousness, though that can happen.

“One of the main sources of brain injury is sports,” said Roth.

According to the CDC, in 2009, there were 248,418 individuals 19 years old and younger who were diagnosed with a concussion or traumatic brain injury. And from 2001 to 2009, the number of concussion cases in that age group from sports and other injuries increased 57 percent.

“A lot was known [about concussions], but not always spoken about,” said Roth. “Even the literature is still very, very poor.”

In sports, the past practice, Alweiss said, was to get the athlete back onto the field, whether amateur, youth, or professional.

“The pendulum is really swaying,” said Alweiss. “It used to be get back out there.”

But time is changing, in part, according to Alweiss because of more high-profile cases.

“Like most diseases, it kind of has to happen to a famous person. Muhammad Ali is an example,” Alweiss said. Ali has lived with Parkinson’s for more than 30 years. And more recently, Alweiss notes there have been well-known athletes like Pittsburgh Penguins’ Sidney Crosby who have had concussions.

In 2011, Crosby was hit in the head during an NHL game. A few days later, he was again injured. He would return to the ice in November after missing the remainder of the 2010-2011 season. However, he would be sidelined again until a return in 2012.

“What happens is when people just have minor injuries and they get better, and then they turn 40, 45 years old and then all of a sudden they are becoming demented,” said Alweiss. “They are losing their memory well before they should. There is growing evidence that, that’s from having small, multiple concussions.”

Establishing databases to study these types of injuries, Alweiss said, will benefit the efforts to help those who have had concussions.

It’s Expensive

According to the CDC, 5.3 million Americans live with a disability that derived from a traumatic brain injury. It also reports that 2.5 million traumatic brain injuries happen each year. Aside from the physical toll of these injuries, the CDC reports “the cost to society for medical care and lost wages associated with TBI is $76.3 billion annually.”

According to the Medical Expenditure Panel Survey 2011 Full Year Consolidated, Events, and Medical Conditions file, the average U.S. cost to treat a concussion is $18,454.

Rehab, said Roth, is a key to the future when dealing with concussions because “it extends for such a long time and is so potentially expensive.”

He said it will be important to find a way for patients “to transition to the community. For example, teaching families how to continue the process and rehab over time or the patients themselves. It is a long-time deal and expensive.”

At HackensackUMC, Roth said they developed a program called Think First.

“It involves us going to high school or younger settings and talking to kids about head injuries,” he said. “The idea is to scare them into thinking before they behave. Adolescents have shown to be impulsive. A lot of these things occur because of impulsive behavior at that age.”

That program ties into the overall goal of prevention at the hospital, he noted.

In treating a concussion, Roth said “we have a bunch of tricks we use in the ICU [intensive care unit] to maximize a good outcome.” Part of that is “making sure oxygenation in blood flow are maintained. The worst thing that could happen to a brain after an injury is being deprived of oxygen.”

However, Roth noted, “Our tools are definitely limited once an injury has occurred.”

Along that line, Alweiss noted there is no approved method to treat a concussion, only recommendations.

“There are a lot of people that try, a lot of people out there are doing testing biofeedback and other modalities,” Alweiss said, “but the American Academy of Neurology just issued their practice parameters and there is no clear proven treatment, which makes avoidance even that much more important because if there was a known treatment you still wouldn’t want to have one [concussion], but at least you could cure it.”

For many health officials, rest is recommended after an individual is diagnosed with a concussion. However, the length of time is unknown because each concussion and patient is unique.

“For example,” said Roth, “you take a concussion, we don’t know what the proper amount of time away from after a concussion is. What we do know, if we come back too quickly and get a second concussion it could be devastating. But we don’t know when the curve of danger is low enough to go back.”

The American Academy of Neurology guidelines found that depending on specific variables, such as the athlete’s age and the individual having the foggy symptom, leads to a longer recovery period—but no definitive timeframe. The guidelines, which are endorsed by the NFL, can be found at aan.com.

“The last thing one wants to do when one has a concussion and is having active symptoms is sustain another concussion,” Alweiss said.