Even though there has been considerable attention put on sports-related brain injury recently, undiagnosed brain injuries are still putting athletes back on the field too soon.

In one recent study comparing football players without a diagnosed concussion to football players with a diagnosed concussion, researchers found some who had no clinical signs of injury, but showed signs of impairment both in neuropsychological testing and from a functional MRI.

Additionally, both the type of cognitive impairment and the location of brain impairment were related to visual working memory—that is, the ability to keep in mind what you’ve recently seen. The most commonly damaged brain area was the dorsolateral prefrontal cortex (located on the top front of skull), where—not surprisingly—helmet-to-helmet contact is often made.

Talavage TM, Nauman EA, Breedlove EL, et al. Functionally-detected cognitive impairment in high school football players without clinically-diagnosed concussion. Journal of Neurotrauma. (October 2010).

On May 20, 2010, The House Education and Labor Committee held a hearing to investigate the impact of concussions on student athletes and their academic performance.  BIAA was contacted by the Committee early in the planning stages for general guidance of the issue including expertise regarding appropriate witnesses.

In conjunction with the hearing, a Government Accountability Office (GAO) report was released finding that concussions in high school athletes are widely unreported and under-diagnosed suggesting a gross underestimate of the overall national occurrence of concussion in high school sports.

BIAA has and will continue to be a frontrunner on this issue and will sustain efforts with state affiliates to promote state laws regarding return to play guidelines for student athletes.

Hyperventilation (with a mechanical ventilator or a manual bag valve mask, for instance) can be a life-saving treatment in the early stages of traumatic brain injury. Although hyperventilation can reduce intracranial pressure and reduce mortality rates, improper ventilation can lead to adverse outcomes.

A recent study considered the hyperventilation guidelines from the Brain Trauma Foundation and determined how much improper use could affect in-hospital mortality. They found the following:

1. Hypocarbia/hyperventiliation and hypercarbia/hypoventilation administered after traumatic brain injury increased the risk of in-hospital mortality.
2. Normocarbia administered after traumatic brain injury decreased the risk of in-hospital mortality.

Hypo- and hypercarbia (carbon dioxide pressure that is too low or too high) that occurs early in treatment (pre-hospital trauma care) can actually induce secondary brain damage. Normocarbia (normalized carbon dioxide pressure) should therefore be the goal in early trauma management. It was suggested that, rather than indiscriminate administration of hyperventilation, only patients with signs of brainstem herniation and elevated intracranial pressure should be treated.

Dumont DM, Visioni AJ, Rughani AI, et al. Inappropriate prehospital ventilation in severe traumatic brain injury increases in-hospital mortality. Journal of Neurotrauma. (April 2010).

A ketogenic diet (high fat, low protein and carbohydrates) can make significant changes to the way the brain metabolizes energy. It is well known that the ketogenic diet can reduce seizure activity, and more recent research has suggested that it also increases neuroprotective effects in brain injury.

In one animal study, the administration of a ketogenic diet after traumatic brain injury showed a reduction in secondary brain injuries such as neuronal death and brain edema (swelling). Secondary brain injuries can often cause more damage than the primary injury, and much brain injury research has focused on the reduction of these secondary processes.

A research review of the relationship between the ketogenic diet, the protein adenosine, and brain activity illustrated the metabolic process in which ketosis may effectively treat brain disorders. Ketosis can increase ATP and adenosine, both of which are important elements of brain activity. This change in brain activity could not only increase neuroprotective factors and decrease seizure activity, but also improve sleep quality, alleviate pain, and reduce rates of diabetes.

Although we still need clinical research in humans to verify the benefits of a ketogenic diet for traumatic brain injury, there is potential for a wide-range of benefits from a relatively simple therapy.

Hu Z-G, Wang H-D, Qiao L, et al. The protective effects of the ketogenic diet on traumatic brain injury-induced cell death in juvenile rats. Brain Injury. (May 2009).

Masino SA, Kawamura Jr. M, Wasser CA, Pomeroy LT, & Ruskin DN. Adenosine, ketogenic diet and epilepsy: The emerging therapeutic relationship between metabolism and brain activity. Current Neuropharmacology. (September 2009).

This week, Congress continued to push forward towards the goal of completing health care reform. Congressional Democratic leaders are attempting to move forward using the simple majority process known as “reconciliation” and are expected to release a package of amendments that would first move through the House Budget and Rules Committee before coming to the House floor for a vote. However, many House members are hesitant to vote on the package before gaining assurance from the Senate that they will also pass the package.

On March 11, 2010, the Congressional Budget Office released an updated version of their score for the Senate-passed healthcare reform measure finding that the bill would reduce federal deficits by $118 billion between from 2010 through 2019. CBO said that the new score differs from their December 19, 2010 estimate because it accounts for all of the amendments adopted by the Senate throughout the course of their debate, reflects a new expected enactment date and “incorporates some technical revisions.” (Powers, Pyles, Sutter & Verville, PC)

BIAA will continue to monitor the situation closely and alert grassroots if action becomes necessary.

SPORTS & CONCUSSIONS

What is a Concussion?

Concussions are a type of traumatic brain injury (TBI) caused by a blow or jolt to the head. The injury can range from mild to severe and can disrupt the way the brain normally works.

An athlete does not need to lose consciousness to sustain a concussion.

You cannot see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up days or weeks after the injury. It is best to see a health care professional if you think you might have a concussion. An undiagnosed concussion can affect your abilities at school or work and in everyday activities.

Signs and Symptoms of Concussions

• Nausea (feeling that you might vomit)
• Dizziness or balance problems
• Double or fuzzy vision
• Sensitivity to light or noise
• Headache
• Feeling sluggish or tired
• Feeling foggy or groggy
• Confusion
• Trouble concentrating
• Trouble remembering

If you’ve had a concussion

• Never ignore a bump to the head
• Tell your coach or teammates
• Ask to be taken out of the game
• Pay attention to physical changes
• Watch out for thinking problems
• Talk to your parents or teachers about the troubles you are having
• See a health care professional
• Get plenty of rest
• Return to practice and play only after your brain is healed and your health care professional says it’s okay

When Will I Get Better?

Your concussion symptoms can begin to decrease in the first few weeks/months depending on the severity of your injury. You may notice more difficulty in some situations than others. You might get tired after reading, studying or watching TV. It may be harder to do two things at once, such as talking on the phone and working on the computer.

Take things slow and be patient with yourself. Do not participate in contact sports until your health care professional says it is okay.

Did You Know?

• A concussion is the most common type of brain injury sustained in sports.
• Most concussions do NOT involve loss of consciousness.
• You can sustain a concussion even if you do NOT hit your head. An indirect blow elsewhere on the body can transmit an “impulsive” force to the head and cause a concussion to the brain.
• Multiple concussions can have cumulative and long lasting life changes.
• Concussions typically do NOT appear in neuroimaging studies such as MRI or CAT Scans.
• An estimated 1.6-3.8 million sports- and recreation-related concussions occur in the United States each year.
• During 2001-2005, children and youth ages 5–18 years accounted for 2.4 million sports-related emergency department (ED) visits annually, of which 6% (135,000) involved a concussion.
• Of the 1.4 million traumatic brain injuries sustained by children and adults in the United States each year, at least 75% are mild and/or concussions.
• Among children and youth ages 5–18 years, the five leading sports or recreational activities, which account for concussions, include bicycling, football, basketball, playground activities, and soccer.

In the coming days the Senate will consider S. 252, the Veterans Health Care Authorization Act of 2009. Among the provisions of the bill, the legislation authorizes the Department of Veterans Affairs(VA) to provide care to veterans with traumatic brain injury through contracts with non-VA providers when necessary.

Call your Senators today to encourage passage of S. 252! Click the “call now” button below this message to get started, then type your zip code in the “call now” box and click go to access phone numbers and talking points for your call!

This week the Senate Health, Education, Labor and Pensions Committee has been continuing to consider its version of the health care overhaul, while the Finance Committee has yet to begin formal markups, but continues to discuss policy behind closed doors.

In the House, The chairmen of the Energy and Commerce, Education and Labor, and Ways and Means Committees are working on a final draft of a bill that could be released at any time. The House committees plan to mark up the legislation next week.

On July 2, 2009, BIAA circulated comments to the House Committees of Jurisdiction applauding their “efforts to design health care reform that will improve the accessibility, quality, effectiveness, and efficiency of patient care.”

More specifically, the comments expressed BIAA’s support of the protections and standards for qualified health plans included in the draft, such as no imposition of pre-existing condition exclusions, guaranteed access to essential benefits (including rehabilitation services), guaranteed issue and renewal, adequacy of provider networks, limits on cost sharing, no annual or lifetime limits on coverage, and consumer protections.

To see a full copy of the comments, click on the following link:

http://www.biausa.org/elements/policy/2009/biaa_house_tri_committee_health_reform_comments.pdf

BIAA will continue to follow the health care reform considerations carefully and advocate on behalf of the brain injury community.

Today, July 10, 2009, the House Appropriations Subcommittee on Labor, Health and Human Services and Education will begin considering the Fiscal Year 2010 spending bill that will provide the funding allocation for programs authorized through the TBI Act and for NIDRR’s TBI-related research programs, including TBI Model Systems of Care.

BIAA and other stakeholders authored a letter that was circulated today on Capitol Hill urging increased funding for TBI programs. Specifically:

• $11 million for the Centers for Disease Control and Prevention TBI Registries and Surveillance, Prevention and National Public Education/Awareness
• $20 million for the Health Resources and Services Administration (HRSA) Federal TBI State Grant Program
• $6 million for the HRSA Federal TBI Protection & Advocacy (P&A) Systems Grant Program
• $13.3 million for NIDRR’s TBI Model Systems of Care Program

For further reading, a copy of the letter can be found on our web site by clicking on the following link:

http://www.biausa.org/elements/policy/2009/tbi_act_appropriations_2010_support_letter.pdf

If you would like to take action and encourage your Congressman to support increased funding for TBI programs, click on the link below to be directed to our legislative action center!

http://capwiz.com/bia/home/

BIAA will continue to monitor the Appropriations proceedings and alert grassroots advocates to take action when needed.

Leading medical experts at the Sports Legacy Institute (SLI), a nonprofit educational and research organization dedicated to advancing understanding of the long-term effects of brain trauma, announced Tuesday, June 23, 2009, that they have launched the SLI Military Living Donor Registry, a brain and spinal cord donation registry for active and veteran members of the United States military.

In conjunction with The Boston University Center, the Sports Legacy Institute will compare findings from the brains of military personnel with those from their athlete program, which has signed up more than 120 donors in less than a year, and other brain banks around the world.

Col. Michael S. Jaffee, national director of the Defense and Veterans Brain Injury Center, said the Defense Department supported the spirit of the research and could assist in approaching active and retired soldiers to register for brain donation.

BIAA enthusiastically supports this initiative and will continue to advocate on its behalf. For further reading, click on the link below to view the New York Times article: (The official press release will be available shortly on BIAA’s web site: www.biausa.org )