Singer Jimmy Buffett Cancels Concert After Sustaining A Concussion From Stage Fall

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Posted on 28th January 2011 by gjohnson in Uncategorized

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After singer Jimmy Buffett fell off a stage during a concert in Sydney, one pundit joked that “maybe he blew out a flipflop,” referring to Buffett’s hit “Margaritaville.” But the accident is no laughing matter.

http://latimesblogs.latimes.com/gossip/2011/01/jimmy-buffett-fall-out-of-hospital-doing-well.html

Buffett, 64, appeared to just walk off the front of the stage, falling head first into the crowd at the Hordern Pavillion Wednesday. One account said that Buffett had been blinded by a spotlight that a lighting person had put on him, and fell.    

http://www.tmz.com/2011/01/26/jimmy-buffett-fall-stage-australia-video-pictures-margaritaville-welcome/?nci00=webmail

When he fell Buffett’s head hit a piece of metal and then he cracked his head on the venue’s floor. Witnesses said that he had a huge cut on his forehead, and that he was unconscious for five to 10 minutes before paramedics came. That means Buffett sustained a concussion. 

http://www.foxnews.com/entertainment/2011/01/27/jimmy-buffett-released-hospital-reportedly-cancels-concert/#

At first it appeared that Buffett, or his management, wasn’t taking his concussion very seriously.

On Wednesday his website said, ”As you probably already know, Jimmy had an accident while performing in Sydney last night and was taken to the hospital. The doctors say he is doing well and will be released tomorrow. More info as we get it, and thank you for all of your well-wishes!”

http://www.margaritaville.com/news.html

But the site posted a new update Thursday.

“Jimmy was scheduled to perform at the Auckland Viaduct on Te Wero Island this Saturday night but unfortunately, he will be cancelling the New Zealand show to allow himself time to recover from his injuriesm” the site said. ”Jimmy would like to thank all of his fans for their support, and wants them all to know that he will return.”

Let’s hope he doesn’t return too soon. He needs adequate time to recover from his concussion.

New York Giant Manningham Shows Belated Concussion Symptoms

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Posted on 30th September 2010 by gjohnson in Uncategorized

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Here’s another case illustrating the difficulty of recognizing concussions in the National Football League. 

The New York Giants’  No. 3 receiver, Mario Manningham, seemed normal after Sunday’s game and was OK Monday morning, according to the New York Daily News. 

http://www.nydailynews.com/sports/football/giants/2010/09/30/2010-09-30_manningham_tested_after_concussion.html

 But on Wednesday, Manningham began to show symptoms of a concussion. It turns out that the football player had informed the Giants late Sunday night, after the New York team were crushed 29-10 by the Titans, that he was having some issues.

But Giants’ coach Tom Coughlin didn’t see Manningham having any difficulty Monday morning, and was taken off-guard when the player started to show signs of a concussion.

Manningham is undergoing concussion-related tests. 

      

College Football Player’s Suicide Raises New Issues On Link Between Concussions, Brain Disease

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Posted on 14th September 2010 by gjohnson in Uncategorized

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The suicides and evidence keep piling up. And the latest development should be terrifying for any football player and his parents, from Pee Wee Football to an NFL linebacker. 

 In what has been stellar ongoing reporting on concussions and football, The New York Times Tuesday had a Page One story on yet another football player, Owen Thomas of the University of Pennsylvania, taking his own life. Its headline was “In College Player’s Suicide, Signs of Disease that Haunts the NFL.”

http://www.nytimes.com/2010/09/14/sports/14football.html?_r=1&ref=sports

The 21-year-old, a popular kid who never had a problem with depression, hung himself in April. His family allowed brain-injury researchers to examine his brain tissue, and the results of those tests are in. And the results are disturbing.

It turns out out that this young man already had the same brain-trauma induced disease — chronic traumatic encephalopathy, or CTE — that has been discovered in the brains of 20 deceased National Football League players. As The Times notes CTE, linked to concussions, has caused depression and impulse issues in pro football players, who have had lost two colleagues who committed suicide, like young Thomas.

What’s unnerving about the Thomas case was that he apparently developed CTE even though he had never  been diagnosed with a  concussion.  So his doctors believe that his CTE ”must have developed from concussions he dismissed or from the thousands of subconcussive collisions he withstood in his dozen years of football, most of them while his brain was developing,” according to The Times.

For football, and particularly parents who allow their young sons to play the sport, the news that CTE can develop when a player suffers hard-to-detect-brain damage below the concussion level should be frightening. I’d suggest that you think twice before allowing your son to play the game.

The Times said that Thomas is the youngest non-pro football player to be diagnosed with full-blown CTE.

His parents, the Rev. Tom Thomas and the Rev, Kathy Brearley, deserve credit for going public with their son’s case, as painful as it must be to have the spotlight put on his suicide again. But they wanted Americans, and parents, to be aware of the news regarding the damage that non-concussive brain injury can inflict, starting at an early age.

Coincidentally, last Saturday the Palm Beach post published a story about another football players who committed suicide, and whose brain was later studied and found to have CTE, which is also known as ”gridiron dementia” and “concussion-drunk syndrome.”

http://www.palmbeachpost.com/sports/football-killed-him-the-legacy-of-pahokees-andre-910250.html

That article was about former Philadelphia Eagles safety Andre Waters, who was nicknamed Dirty Waters because of his aggressive on-field behavior. Roughly four years ago Waters took his own life, shooting himself with a Smith & Wesson when he was only 44.  

When he was alive, Waters had stopped counting his concussions at No. 15, according to the Palm Beach Post.

But Thomas didn’t have to sustain that many, or perhaps any, concussions to get CTE just like Waters. 

  

 

 

      

 

 

 

 

 

Using Neuroscience To Explain A Linebacker’s Subtle Brain Injury

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Posted on 23rd August 2010 by gjohnson in Uncategorized

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In a well-done story, Discover Magazine describes in clear, concise detail the consequences of  our brains getting repeatedly banged around. The article is headlined “The Brain: What Happens To A Linebackers Neurons?”

http://discovermagazine.com/2010/jul-aug/18-brain-what-happens-to-a-linebackers-neurons

The piece opens by describing the new battery of cognitive tests that the National Football League gives to players in the college draft, brainteasers such as trying to remember where different “Xs” and “Os” were positioned a page. 

The idea is to have a baseline to compare to a player’s answers after they sustain a head injury. If a player gets a concussion in a future game, he can be retested to compare his pre-concussion answers to his post-concussion ones, to gauge how badly his brain was injured. 

As our brains float around in the cerebrospinal fluid in our skulls, they get knocked around quite a bit. So how do our brains usually escape getting damaged?   

Discover Magazine illustrates that by citing research by Douglas Smith, director of the Center for Brain Injury and Repair at the University of Pennsylvania. We won’t go into all the detail, but Smith set up rat neurons on a stretchable membrane, and they developed axons, appendages that connect one neuron to another, transmitting electric signals.

When Smith directed a “controlled puff of air’” at  his “brain,” the axons were elastic and stretched, then went back to their old position.  But if he subjected his “brain” to a quick, big shot of air, the axons developed “kinks,” according to Discover Magazine. They wind up permanently damaged.

This type of damage can lead to diffuse axonal injury, which is when proteins “pile up”  on an axon, and can even burst it, Discover Magazine said. Diffuse axonal injury happens when a person’s brain is suddenly acclerated, as when someone gets whiplash.

This is apparently what happened to New York Mets outfielder Jason Bay recently. He crashed into a wall to catch a fly ball, and hurt his back and legs. He never hit his head, so a concussion was ruled out. But two days later Bay came down with a nagging headache. Team doctors now believe that Bay sustained a concussion from whiplash, from his head snapping back when he hit the wall. 

The type of mild brain injury that football players sustain again and again over the years has a cumulative effect, and the repeated stretching that axons undergo can essentially kill them “like a shorted-out circuit,” according to Discover Magazine.

There is some hope of finding drugs that can stop brain damage on the molecular level.

But at the present time, “Once a person does sustain a brain injury, there is not a lot doctors can do,” the magazine article says.  And that is the sad truth at the moment.  

Post-Concussion Sufferers May Get Relief From Moderate Exercise

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Posted on 4th March 2010 by gjohnson in Uncategorized

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A new study has found that moderate exercise may help those who suffer from post-concussion syndrome (PCS), according to the National Post.

http://www.nationalpost.com/life/story.html?id=2628799

Those with PCS continue to suffer from the symptoms of traumatic brain injury (TBI), such as dizziness, headaches, insomnia and irritability. These PCS patients haven’t gotten much attention or focus, with the standard treatment for their condition just being rest.

But in a new study reported in the Clinical Journal of Sports Medicine, researchers had athletes with PCS work out on a treadmill, moderately. The goal was to create relief from PCS by working on the assumption that it is caused by an imbalanced flow of blood in the brain.

It’s known that rigorous exercise interferes with the flow of blood to the brain and can make concussion symptoms worse. So in the study, the patients with PCS were put on an exercise routine that ramped up slowly, and wasn’t very intense.

Researchers found that people in that group became better able to exercise after just a few weeks.

Luger Who Sustained A Concussion On Olympic Luge Track Warned Officials Of Its Dangers

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Posted on 20th February 2010 by gjohnson in Uncategorized

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Much has been written about the luge track at the Winter Olympics in Vancouver where a Geogian luger was killed last week. And The New York Times has a worthy follow-up story in its sports section Friday.
http://www.nytimes.com/2010/02/19/sports/olympics/19luge.html?hp

An article headlined “Luger Warned of Track Before the Games” reports that luger Werner Hoeger lost consciousness and suffered a concussion during a trial run at the Whistler Sliding Centre in November.

That’s the same luger track where Nodar Kumaritashvili was killed last Friday, after slamming his back into a steel pillar.

Hoeger after his Nov. 13 accident repeatedly wrote and e-mailed international luge and Canadian officials, telling them that the track wasn’t safe, according to The Times. Obviously, officials didn’t heed Hoeger’s warning.

The International Luge Federation said Thursday that it will issue a report on the Georgian luger’s death at the end of next month. Changes were made to the luge track after last week’s fatal accident.

For a very detailed account of Hoeger’s back and forth with officials over the dangerous track, read The Times’ piece.

Notice is a major element to any claim for negligence or wrongful death. Looks like the Canadian officials had that.

Evolution in the Understanding of Concussion – Length of Amnesia Correlates to Severity of Brain Damage

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Posted on 19th January 2010 by gjohnson in Uncategorized

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Continuing on with the discussion of my Concussion Clinic videos, today’s topic is The Length of Amnesia is the Best Predictor of Severity of Injury. Today’s video is here:http://www.youtube.com/profile?user=braininjuryattorney#p/u/8/WB9ErwpKnXk

Brain injury is one of those things that everyone feels the need to classify, typically into categories of mild, moderate and severe. A severe brain injury is one that involves extended coma. I don’t have any trouble with that definition for severe brain injury.

The controversy in classifying brain injuries revolves primarily around whether there was a brain injury at all and where the break point is between mild and moderate brain injury. The problem with all classification battles in the mild to moderate category is too much is based upon the identification of symptoms in the first hour, where it is not how symptomatic a person is at two hours, but how long the symptoms last that is significant. This is especially true with the most predictive symptom, amnesia.

With respect to severe brain injury, the Glasgow Coma Scale is a reasonably accurate indicator of severity. It also has the benefit of nearly universal adoption, making outcome studies based upon it reliable because of the large number of patients studied. But when the brain injury is below the severity level that loss of consciousness or a change in mental state is witnessed by a medical professional, the GCS has little validity. Most concussed individuals will get the highest score of 15, regardless of how significant the concussion is and how symptomatic they are at the time given the score. The GCS score at the mild end is only a test for confusion, not amnesia. To get a “perfect” GCS score, a patient needs only have his eyes open, be able to carry on a conversation demonstrating orientation (he knows who he is and where he is) and that he can follow simple commands. Compare that to how oriented a quarterback must be to continue to play in the game.

In contrast, basing outcome on the length of amnesia not only correlates well with the GCS score in the severely brain injured population, it is sensitive enough to provide meaningful diagnostic guidance in the less severely injured. According to Lezak, Neuropsychological Assessment, citing Bigler 1990, the length of amnesia predicts as follows:

  • Less that five minutes, very mild.
  • 5 minutes to 60 minutes, mild.
  • 1 to 24 hours, moderate.
  • 1- 7 days, severe.
  • 1-4 weeks, very severe.
  • More than 4 weeks, extremely severe.
With

But the key to applying this score is first understanding what amnesia is and then assuring that the diagnostician, asks and records the right questions. Amnesia is not like the Hollywood head injury myth, where the main character does not remember who he is until he magically flashes on something, or gets that second blow to the head. According to Lezak as amnesia “does not end when the patient begins to register experience again, but only when registrations is continuous.” Lezak, 4th Edition, page 160.

The problem is that distinguishing between some imprinting of memory and “continuous” imprinting of memory does not lend itself to established tests which primarily focus on confusion. One standardized test for amnesia, the GOAT, (“Galveston Orientation and Amnesia Test”) has only one good question out of 10. The best question on the GOAT is “can you describe in detail the first event you remember after the accident.” But because this is the “subjective” question, it is the one researchers pay the least attention to. But even this best question, doesn’t account for the fact that amnesia may begin after the period for which this question is being asked. It is not what the person remembers about the first 10 minutes post-accident, it is what they continuously remember the next hours and days that is significant.

Evolution in the Understanding of Concussion – Non-Athletes are At Much Higher Risk of Disability

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Posted on 13th January 2010 by gjohnson in Uncategorized

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Continuing on with the discussion of my Concussion Clinic videos, today’s topic is Non-Athletes are at Far Greater Risk of Disability. Today’s video is here: http://www.youtube.com/profile?user=braininjuryattorney#p/u/5/Z3QvSHrWykI

Sport is an ideal laboratory to study concussion. First, almost all sport concussions get witnessed and in today’s world, most get videotaped. Second, a very significant percentage of them happen on university campuses where scientists and medical researchers are looking around for things to study. Three, they are predictable, happen in a confined space and to a subset of people who we can control. The predictability and control means we can actually study and test their cognitive abilities before they have the concussion. And then because we know they will have repeated concussions, we can study that as well.

The problem with sports as the laboratory is that we are studying those people who tell us the least about what might happen to average people who suffer accidental concussions. In the sport laboratory we are studying those people who are most likely to get better, to have an “apparent full recovery”. Thus, the sport and concussion literature has done an excellent job of dealing with the primary issue which they care about, determining when it is safe to expose our football players to another concussion. But the truly important issue, of what disability is likely to come from a concussion and how can we best diagnose and treat that disability, the sport laboratory tells us very little.

In fact, the dark side of neuropsychology is trying to use sports concussion research as evidence that concussion does not cause permanent damage. Anyone who has worked with Post Concussion Syndrome survivors knows that concussion or mild traumatic brain injury, can disable. The young male athlete’s apparent full recovery does not tell us very much about how someone older, someone not in extraordinary shape, someone who was not expecting to get hit, will recover.

Here is the reality of the real world of concussions: If you are significant at 24 hours, and you are female and you are over 40, you need to go see the doctor every couple of days until you get better. You need to see a doctor who is going to test your memory. You need a doctor who is not just to test your memory for things you know about your life, but what you have been doing in the 24 hours before that examination. And you need a doctor who is not going to just ask you those questions, but also ask the people you live with.

Obviously, disability happens to those who are not 40, not female, but the more vulnerable your brain is because of age, because of prior concussions, because of emotional challengers you have had in your life, the more likely you will have a bad result. If you are at risk for a bad result, you must be followed and diagnosed in that first week. If you don’t get that type of evaluation we will have no way of predicting whether this concussion will give you a few bad days, a few bad weeks or keep you disabled the rest of your life.

Evolution in the Understanding of Concussion: The Need for Periodic Followups

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Posted on 12th January 2010 by gjohnson in Uncategorized

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Continuing on with the discussion of my Concussion Clinic videos, today’s topic is the Need for Periodic Follow-ups. Today’s video is here: http://www.youtube.com/profile?user=braininjuryattorney#p/u/11/dEWHgwRywtY

When the sport and concussion guidelines are applied properly there is a 15 minute post-injury evaluation to determine whether this concussion or “ding” was serious enough to require further follow-ups. An injured player is not supposed to return for at least 15 minutes. At 15 minutes, if they continue to be symptomatic, they are not to return to play in that game and not until the expiration of 7 days from the date they cease to be symptomatic.

While the 15 minute rule is not quite good enough, it is important that an athlete is at least required to wait that long before he or she returns. As brain injury is a process not an event that can take 72 hours to manifest itself, the 15 minute rule isn’t perfect. Yet I realize that 15 minutes is a compromise, that generally protects the player. While there are exceptions, the concussion that is completely asymptomatic at 15 minutes is probably not going to be serious. But keep in mind, that Natasha Richardson could likely have passed a superficial orientation test at 15 minutes and she died before they could get her to a hospital. Also with non-professional sports, there is a strong movement to not allow any return to play.

The truly important part of guidelines is the “no play for seven days” if the concussion continues to be symptomatic at 15 minutes. Thus if there is symptomotology of brain injury at 15 minutes, the professional team’s medical staff will do follow-up testing each day to determine whether the athlete continues to be symptomatic. (What happens in amateur sports may be entirely different but is a topic for a different blog.)

If we could take that model of periodic follow-ups and apply that to the brain injuries that happen in accidents, we would then likely identify almost all concussions that are likely to be disabling. Add two more levels of inquiry to that process and we could have an excellent concussion diagnosis system.

Distinguish between Confusion and Amnesia. I have discussed this issue in depth earlier in this series, but absence of confusion does not mean absence of amnesia. Amnesia is the real litmus test for concussion. Remember that amnesia is not a black curtain of memory, but the inability to remember the amount of information we would normally remember. What does “normal memory” mean? Take this an example.

At a real world hospital, if you aren’t bleeding when you get to the Emergency Room, you start your time there with a 20 minute conversation with the billing department. Then you sit in the ER waiting room for a while, normally too long. A normal person’s memory might not include the name of the person who was taking their insurance information. But a normal person would remember the process. They would remember filling out a form, even if they didn’t remember what the form said. A normal person would remember fishing the insurance card out of their wallet. Likewise, a normal person would very clearly remember how long they waited in the ER. A normal person would remember the most seriously hurt person who was waiting with them. People tend to remember blood, etc. If the doctor or other ER person would ask these kind of questions, evidence of amnesia would likely be clear.

Next Day Follow-up. Even more important than asking better questions on the day of the accident, is to have a medical professional ask them something about their memory the next day. Amnesia at 24 hours is far easier to spot. How much they remember of the pervious 24 hours events will show how severe this particular concussion is. With all of the momentum for better diagnosis for NFL and amateur football players, we must also clearly recognize that the care they are getting is infinitely better than the million plus other people a year who suffer a concussion, most who are at much higher risk of a bad outcome. See http://www.tbilaw.com/blog/2010/01/nfl-football-concussions-versus-real.html

Evolution in the Understanding of Concussion: Distinguish Between Confusion and Amnesia in Diagnosing Concussion

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Posted on 11th January 2010 by gjohnson in Uncategorized

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Continuing on with the topic “The Evolution of Our Understanding of Concussion, Otherwise Called Mild Traumatic Brain Injury,” our next point of emphasis is the importance of distinguishing between confusion and amnesia after a brain injury. The video on this topic is at: http://www.youtube.com/profile?user=braininjuryattorney#p/u/6/xuO69e9Vv_c

You can have significant amnesia and not be confused. How do we know that? On this specific issue, the sports arena is the ideal laboratory – NFL quarterbacks the perfect test subject. We know from hundreds of reported cases that a football player can finish the game, a quarterback can finish the game, and have no memory for the game when asked about it later. Thus, we know they were amnestic.

We also know that they were not confused while they were playing the game because football, especially quarterbacking, is not something someone can do while confused. Think of all the sequential, memory and processing intensive things an NFL quarterback must do on every single play. If he were confused, he wouldn’t survive a single play. While one can argue that a boxer can fight on auto-pilot, a quarterback cannot. A quarterback must remember the plays and make differential decisions under high stress, with instant processing.

The reason I make this point over and over is that in the vast majority of cases, the inquiry at the scene, in the Emergency Room is an inquiry only to determine whether a person is confused. If a person is not confused, they are presumed not to have suffered a brain injury. If the inquiry does not include a test for amnesia as well as confusion, then the diagnosis of brain injury will likely be missed.

The diagnostician, be it an EMT, an ER doctor or primary care doctor must put on the sports writer hat and ask about the events since the injury, not just about what happened before the injury or what is happening now. What we want to know about is what happened “during the game” – the period of time between the concussion and now. Tell me about the ambulance ride. Tell me about who else was in the Emergency Room.

And doctors, don’t be in such a hurry to decide there was no concussion. Amnesia often materializes in the hours after an accident – not the minutes – because brain injury is a process, not an event. For more on that topic, see the general treatment of that topic found on my website http://subtlebraininjury.com/ and the specific treatment at http://subtlebraininjury.com/tbiprocess1.html

At times the world of sport is a useful laboratory for us to learn about concussion, such as with this issue, but we must remember that the average person with an accidental concussion, is not an extraordinary physical specimen, who expected to get hit. More on the distinction between real world brain injury and sport concussions on my Brain Damage Blog, http://tbilaw.com/blog