Concussions get a closer look

CINN, in conjunction with the Illinois Athletic Trainers Association, is working hard to raise the awareness of concussions in Chicagoland. We applaud the article in the Chicaogo Tribune highlighting the work being done throughout the area. We urge all parents, coaches, athletic trainers and supporters of youth sports to visit www.cinn.org and order copies of Ahead of the Game, a concussion reference tool that fits in a wallet. Order one for yourself, and one for every family on the team.

chicagotribune.com

Schools increase awareness of injuries that killed 50 young football players in 10 years, and how to diagnose them
By Mike Helfgot

Special to the Tribune

October 7, 2009

Josh Jaremko and a hard-charging linebacker butted helmets during a routine drill of the sophomore football team at Hinsdale Central High School in August — one of hundreds of collisions during that practice session.

He didn’t feel quite right, but returned to the field the following day.

“I especially did not think it was a concussion,” Jaremko said. “I just thought it was a good hit and I would be fine.”

Then he got hit in the same spot again and was diagnosed as having suffered two concussions. He was at risk of what is known as second impact syndrome, a condition where the brain swells rapidly and catastrophically when a second injury occurs before the first one heals.

Jaremko endured headaches for a couple of weeks and doctors’ visits before being cleared to play within a month.

Sports-related concussions have been in the news recently and are the subject of a new effort by athletic trainers in Illinois to make more coaches, parents and athletic directors aware of the symptoms and dangers of playing again too soon.

A 17-year-old, Drew Swank of Valley Christian High School in Spokane, Wash., suffered head injuries in a September game and died two days later. University of Florida star Tim Tebow was knocked out of a recent game with a head injury and it’s unclear when he might return to play.

A New York Times report found that from 1997 to 2007, head injuries caused deaths to at least 50 football players on the high-school level or younger. And another study has found former NFL players are far more likely than the general population to suffer from dementia.

High school players are vulnerable because their younger brains are at greater risk of serious and long-term injury because the brain tissue is less developed and more easily damaged.

The Illinois Athletic Trainers Association is teaming up with the Chicago Institute of Neurosurgery and Neuroresearch to get the word out about how to diagnose a concussion.

Some states are attempting to tackle the issue through legislation. Washington passed a law in May mandating guidelines for treatment and education for coaches and parents. Several other states are considering a similar law.

Michael Sullivan, trainers association president and athletic trainer at Downers Grove North, said State Senator Bill Brady initiated a meeting on concussions with the trainers association and the Illinois High School Association, but those groups did not recommend pursuing legislation. It would be difficult to implement and enforce, Sullivan said, and many schools would not have the resources to comply.

Instead, the trainers association is trying to get the word out through an informal word-of-mouth campaign and the distribution of an educational wallet card it collaborated with the neurosurgery institute to create.

One side of the card lists the symptoms for athletes (headache, sensitivity to light/noise, sluggish, dizzy, double vision, nausea, memory/concentration problem, change in sleep patterns) and the other displays the warning signs for coaches and parents (forgetful, clumsy, irritability, depression, forgetfulness).

The card can be downloaded at CINN.org.

“We’re trying to get the word out any way we can,” Sullivan said. “We’re trying to educate parents, coaches and kids on the identifiers.”

He said Illinois is typical of a national study that showed only 42 percent of the high schools in the nation have an athletic trainer on staff.

“Even within the Chicagoland area, it’s not 100 percent. Many schools hire an outreach trainer, some for game coverage, some for weekly checks. This is not meant to substitute for an athletic trainer or a physician, but at least this gives people an idea.

“There probably are not enough hours in the day for this kind of a campaign, but we can at least distribute literature that get passed on and get the word out to youth groups,” Sullivan said.

Detecting a concussion can be tricky, especially in a sport where playing with pain and discomfort is ingrained. In Brian Connor’s case, the 2009 Hinsdale Central graduate doesn’t remember feeling any — or anything immediately following a helmet-to-helmet hit in a playoff game last season. After seven plays, a teammate realized he was playing erratically and got Connor removed from the game before any more damage could incur.

“I put my head down on top of his, and the next thing I knew it was seven plays later and I’m waking up and talking to our trainers,” Connor said. “I had no idea I was out there.”

More than 3.5 million sports-related concussions occur each year in the United States, according to the U.S. Centers for Disease Control and Prevention and the Brain Injury Association of Washington. Though much is still unknown about concussions, the number continues to rise. Some schools are taking steps to react more quickly and accurately. Barrington senior Tyler Lindroth took a blow to the head in practice in early August, and before he could try to convince anyone he was fine, his coaches forced him off the field. His concussion came with two weeks of short-term memory loss, but by the end of the month, he was cleared and back on the field.

“Our school is pretty good about education on concussions,” Lindroth said. “I wanted to keep playing but they knew something was up.”

Barrington is one of 52 schools in Illinois that uses computer software from a company called ImPACT (Immediate Post-concussion Assessment and Cognitive Testing). Brain injuries don’t necessarily show up on an MRI or CT scan, but this ‘neurocognitive’ testing has proven effective in determining when an athlete with a concussion has returned to normal. The program provides a baseline test to athletes at the start of the season, which serves as a basis for comparison following a head injury. According to Barrington trainer Kevin Stalsberg, the package of 1,000 baseline tests and 100 post-injury tests costs $1,000.

“We see more concussions here,” Stalsberg said. “We’re managing three to five a week. I don’t know why that is. I’m hoping that it’s because of the education.”

Other schools can’t even afford an athletic trainer, let alone cutting-edge computer software. Harlan is among the Chicago Public Schools that does not have one.

“For football games, we have a medic on duty from the Chicago Fire Department,” said Ted Tines, Harlan’s assistant athletic director. “No one has been formally trained to look for at the signs of a concussion. We just have to go with basic common sense — dizziness, blurry vision, lightheaded. We haven’t had any cases this year.

“The board is limited with the amount of funds. I used to go to clinics, but it’s become a financial issue. Are we getting proper training? No. They would tell you they would like to send us, but it is just a financial issue.”

While some schools can’t afford baseline testing, Joseph Reda, the athletic director at Bloom in Chicago Heights, believes the price tag is reasonable enough to pursue with his board.

“I was expecting to hear 30 grand,” Reda said. “Within reason, nothing is too expensive for our kids.”

Real Sports with Bryant Gumbel sheds light on concussions in high school sports

CINN applauds the increasing media attention regarding concussions in high school sports. We continue to urge all parents, coaches and supporters of high school sports, especially those involved in football, soccer (girls and boys), wrestling, hockey and lacrosse to become acquianted with the signs and symptoms of concussion. Visit www.cinn.org to order a free concussion reference tool for yourself, your students, athletes and friends. Help CINN spread the word of the importance of quick and accurate diagnosis of concussions and their treatment.

From Real Sports Website: Description of concussion program that aired in September 2009.

H.S. Concussions

In the violent world of football, helmet-crushing hits that cause concussions are common. While these injuries often make headlines in pro football, few realize that head injuries at other levels of the game, specifically high school, are occurring at an astounding rate and can have deadly consequences. In the last two years alone, eight kids have died from head injuries and many more have suffered catastrophic injuries following a concussion. REAL SPORTS host Bryant Gumbel takes an in-depth look at the disturbing frequency and deadly hazards of concussions in high school football.

Correspondent: Bryant Gumbel
Producer: Tim Walker

New York Times Article Reinforces Need for Concussion Awareness in Youth Sports

In light of more data on the long-term impact of concussions in athletes, the CINN concussion program urges all coaches, trainers, and parents of youth athletes to become more familiar with the signs and symptoms of concussion. Visit www.cinn.org to order CINN’s free concussion reference tool Ahead of the Game. Keep the reference card in your wallet, in your car, and distribute the cards to others involved in youth sports. Let’s work together to not only raise the awareness of concussion in youth sports, but to vigilantly pursue better diagnosis and treatment.

Dementia Risk Seen in Players in N.F.L. Study
By ALAN SCHWARZ
A study commissioned by the National Football League reports that Alzheimer’s disease or similar memory-related diseases appear to have been diagnosed in the league’s former players vastly more often than in the national population — including a rate of 19 times the normal rate for men ages 30 through 49.

The N.F.L. has long denied the existence of reliable data about cognitive decline among its players. These numbers would become the league’s first public affirmation of any connection, though the league pointed to limitations of this study.

The findings could ring loud at the youth and college levels, which often take cues from the N.F.L. on safety policies and whose players emulate the pros. Hundreds of on-field concussions are sustained at every level each week, with many going undiagnosed and untreated.

A detailed summary of the N.F.L. study, which was conducted by the University of Michigan’s Institute for Social Research, was distributed to league officials this month.

The study has not been peer-reviewed, but the findings fall into step with several recent independent studies regarding N.F.L. players and the effects of their occupational head injuries.

“This is a game-changer — the whole debate, the ball’s now in the N.F.L.’s court,” said Dr. Julian Bailes, the chairman of the department of neurosurgery at the West Virginia University School of Medicine, and a former team physician for the Pittsburgh Steelers whose research found similar links four years ago. “They always say, ‘We’re going to do our own studies.’ And now they have.”

Sean Morey, an Arizona Cardinals player who has been vocal in supporting research in this area, said: “This is about more than us — it’s about the high school kid in 2011 who might not die on the field because he ignored the risks of concussions.”

An N.F.L. spokesman, Greg Aiello, said in an e-mail message that the study did not formally diagnose dementia, that it was subject to shortcomings of telephone surveys and that “there are thousands of retired players who do not have memory problems.”

“Memory disorders affect many people who never played football or other sports,” Mr. Aiello said. “We are trying to understand it as it relates to our retired players.”

As scrutiny of brain injuries in football players has escalated the past three years, with prominent professionals reporting cognitive problems and academic studies supporting a link more generally, the N.F.L. and its medical committee on concussions have steadfastly denied the existence of reliable data on the issue. The league pledged to pursue its own studies, including the one at the University of Michigan.

Dr. Ira Casson, a co-chairman of the concussions committee who has been the league’s primary voice denying any evidence connecting N.F.L. football and dementia, said: “What I take from this report is there’s a need for further studies to see whether or not this finding is going to pan out, if it’s really there or not. I can see that the respondents believe they have been diagnosed. But the next step is to determine whether that is so.”

The N.F.L. is conducting its own rigorous study of 120 retired players, with results expected within a few years. All neurological examinations are being conducted by Dr. Casson.

According to a 37-page synopsis of the study furnished to the league, the Michigan researchers conducted a phone survey in late 2008 in which 1,063 retired players — those who participated from an original random list of 1,625 — were asked questions on a variety of health topics. Players had to have played at least three or four seasons to qualify. Questions were derived from the standard National Health Interview Survey so rates could be compared with those previously collected from the general population, the report said.

Some health issues were reported by N.F.L. retirees at normal rates (kidney and prostate problems), while others were higher (sleep apnea and elevated cholesterol) and others lower (heart attacks and ulcers), the summary said.

The researchers also asked players — or a caregiver for those who could not answer — if they had ever been diagnosed with “dementia, Alzheimer’s disease, or other memory-related disease.”

The Michigan researchers found that 6.1 percent of players age 50 and above reported that they had received a dementia-related diagnosis, five times higher than the cited national average, 1.2 percent. Players ages 30 through 49 showed a rate of 1.9 percent, or 19 times that of the national average, 0.1 percent.

The paper itself questioned the reliability of using phone surveys to assess prevalence rates of diagnosed dementia, as did several experts in telephone interviews. For example, some of those affected may not be reachable; then again, N.F.L. players may have greater access to doctors to make the diagnosis. The lead researcher, David R. Weir, said in an interview that proxies might have been handled differently in past studies.

“This suggests something suspicious,” said Dr. Amy Borenstein, professor of epidemiology at the University of South Florida. “But it’s something that must be looked at with a more rigorous study.”

Dr. Daniel P. Perl, the director of neuropathology at the Mount Sinai School of Medicine in New York, agreed with Dr. Borenstein but described the Michigan work as significant. “I think this complements what others have found — there appears to be a problem with cognition in a group of N.F.L. football players at a relatively young age,” he said.

All rates appear small. But if they are accurate, they would have arresting real-life effects when applied across a population as large as living N.F.L. retirees. A normal rate of cognitive disease among N.F.L. retirees age 50 and above (of whom there are about 4,000) would result in 48 of them having the condition; the rate in the Michigan study would lead to 244. Among retirees ages 30 through 49 (of whom there are about 3,000), the normal rate cited by the Michigan researchers would yield about 3 men experiencing problems; the rate reported among N.F.L. retirees leads to an estimate of 57.

So the Michigan findings suggest that although 50 N.F.L. retirees would be expected to have dementia or memory-related disease, the actual number could be more like 300. This would not prove causation in any individual case, but it would support a connection between pro football careers and heightened prevalence of later-life cognitive decline that the league has long disputed.

After the University of North Carolina’s Center for the Study of Retired Athletes published survey-based papers in 2005 through 2007 that found a correlation between N.F.L. football and depression, dementia and other cognitive impairment, a member of the N.F.L. concussion committee called the findings “virtually worthless.”

After initiating a fund in 2007 that provides financial assistance to retirees receiving care for dementia, the league insisted that it was doing so only because the disease “affects many elderly people” well beyond N.F.L. players. And a pamphlet that the league gives every player about concussion risks states, “Research is currently under way to determine if there are any long-term effects of concussion in N.F.L. athletes.”

“It’s time to edit that brochure,” said Kevin Mawae of the Tennessee Titans, the president of the N.F.L. Players Association. “Now it’s in their words and not just other people’s.”

CHICAGO INSTITUTE OF NEUROSURGERY AND NEURORESEARCH TO JOIN NORTHSHORE UNIVERSITY HEALTH SYSTEM

CINN will continue as Chicago’s leader in providing subspecialized neurosurgical
and neuromedical care

CHICAGO, IL, August 19, 2009 – It was announced today that the physicians of the Chicago Institute of Neurosurgery and Neuroresearch Medical Group (CINN) will be joining NorthShore University HealthSystem (NorthShore) headquartered in Evanston, IL. The CINN physicians, including neurosurgeons, physiatrists, neurologists and neurointerventionalist, who have earned this group international recognition, will continue to provide the Chicagoland market with advanced neurosurgical and neuromedical care.

Through its 23-year history, CINN has been widely regarded as one of the region’s leading providers of medical care for patients suffering from brain and spine disorders. CINN physicians are highly experienced in providing innovative treatments for patients with brain tumors, have pioneered innovative surgical spine solutions such as artificial discs, and have championed new treatments for stroke and abnormalities of the blood vessels in the brain.

Recognizing the importance of a robust and stable strategic partner as national health care reform takes shape, CINN chose NorthShore due to its commitment to advancing neurosurgical patient care through investment in new technologies and programs, their excellence in synergistic specialties such as orthopedics, oncology and neurology, as well as the system’s strong network of primary care physicians.

“We look forward to bringing our innovative multidisciplinary patient care model to the NorthShore system,” said Dr. Leonard J. Cerullo, founder and medical director of CINN, “Our goal will remain to provide patients with the most technologically advanced, yet compassionate, care available.”

A hallmark of CINN’s patient care philosophy is the availability of world-class neurosurgical care in close proximity to a patient’s family, friends and support structure, whenever possible. As such, CINN’s commitment to its operations in Elmhurst, Vernon Hills, Harvey, Tinley Park, Skokie, Oak Lawn and downtown Chicago will remain. CINN’s outpatient services and administrative headquarters at the Neurologic & Orthopedic Hospital of Chicago will move to NorthShore’s Glenbrook and Skokie Hospitals.

The agreement is conditioned on obtaining appropriate government approvals, and is expected to close by the end of the year. Medical services at the Neurologic & Orthopedic Hospital of Chicago will continue until that time.

CINN patients with questions about their appointments can email CINN at info@cinn.org or call 773-250-0400.

The Chicago Institute of Neurosurgery and Neuroresearch Medical Group is one of the nation’s leading groups of physicians dedicated to the diagnosis, treatment and rehabilitation of people with brain and spine disorders. Founded in 1987, CINN is one of the Midwest’s largest teams of neurosurgeons, physiatrists and neurologists known for their pioneering treatments in minimally invasive techniques. Through a network of seven locations throughout Chicagoland, CINN is a market leader in treating patients with brain tumors and spine disorders.

NorthShore University HealthSystem, based in Evanston, IL, is an academic health system affiliated with University of Chicago’s Pritzker School of Medicine. Its integrated delivery system includes Evanston, Glenbrook, Highland Park, and Skokie Hospitals as well as the NorthShore Medical Group, Research Institute and Foundation.
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Hormonal? It can help your brain

Research tracks level changes throughout the day
By NESITA KWAN

A lesson in listening to your hormones.

Hormones shouldn’t control anyone’s life. But for those who what to look for, and when, hormones may give their brain an boost for whatever they do.

Harnessing your hormones to boost productivity.

Hormonal? It can help your brain

The latest research is tracking hormonal levels throughout the day, NBC5’s Nesita Kwan reported on Wednesday.

They can be different for every person, but in general, the hours between 7 and 9 a.m. are highest for Oxytocin, which some scientists call the love hormone.

“We probably are feeling very loving, very amorous toward the husband or the boy friend or whoever,” says Chicago neuroscientist Leonard Cerullo. It’s also a time you’ll want to give your kid an extra hug, and kiss the spouse off to work.

After 9 a.m. the stress hormone cortisol kicks in. People are alert, sensitive and at their most creative, which makes it a good time to brainstorm with colleagues. After 11 a.m. people are fully awake, because their sleep hormone, called melatonin, is slowly draining away, which is when it’s best to take on challenging conversations, or tackle that endless list of emails. By 3 p.m., energy levels may be at their peak as melatonin levels bottom out. It’s an ideal time to exercise.

To determine the best mix, health psychologists suggest people keep a diary of moods and energy for at least a couple of weeks, then use their notes to build their own hormonal schedule.

“The most important thing is to become aware of, and sensitive to how you feel, which is a reflection of the total number of hormones reacting in all the cells of the body,” Cerullo said.

Neurosurgeon teaches brain facts, fiction

Pioneer Press, May 21, 2008

More than 165 Roosevelt Middle School fifth-graders learned neurological fact from fiction May 7, as they took part in Dr. Gail Rosseau’s “Fact or Fiction: The Neurosurgery Reality Show.”

Rosseau, a River Forest resident and neurosurgeon with the Neurologic and Orthopedic Hospital of Chicago, and her son, Brendan, a sixth-grader at Roosevelt, presented the animated, interactive Power Point presentation that focused on the brain and spine. Read more

Advances in the treatment of cervical stenosis and chiari malformation

A CME dinner meeting presented by The CINN Foundation in conjunction with the Chicago Medical Society, Illinois Nurses Association and Illinois Chiropractic Society

Until recently, Chiari malformation (CM) was regarded as a rare condition. Current estimates suggest that up to 2 million Americans may have CM. Oftentimes, however, it goes undiagnosed or is misdiagnosed as multiple sclerosis, migraine, fibromyalgia, or psychiatric disturbances. Read more