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Image Source: Wikimedia Commons/U.S. Army

Former professional wrestler, Olympian, and powerlifter Mark Henry has earned his title as the World’s Strongest Man time and time again throughout his career. Now that he is retired, though, he says he is working to leave an even larger impact on the world.

This week, the former World Heavyweight champion revealed that he has pledged to donate his brain for CTE research while talking with former wrestler and Concussion Legacy Foundation co-founder Chris Nowinski.

The conversation arose on Nowinski’s SiriusXM show Busted Open, as the host discussed the recent milestones hit by the CLF and the brain bank it operates with the US Department of Veterans Affairs and Boston University.

“The best way to study the brain is after they pass away, so you can know on a cellular level what’s happening,” Nowinski said. “We just got our 700th brain donation and we’re constantly getting athletes to pledge [their brains], so we can build awareness and do studies while they are still alive. We have 5,000 athletes that have pledged their name and it’s important to get famous athletes [to spotlight the issue].”

This motivated Henry to chime in and announce his own plans to donate his brain to the research center.

“I definitely want to go on record that I’m donating my brain to the brain bank, and I hope that something good can come out of y’all having my brain,” Henry said. “Maybe it will help with figuring out how things work in the future that will benefit my kids and everyone else’s kids…. We always want the future to be better for our families and your families, speaking of the fans out there that have kids playing sports. And some of you parents, you weekend warriors. Like, you get a ding, get some help.”

In addition to hoping his brain will be useful for investigating the effects of repeated brain trauma, Henry says he hopes donations like his will help de-stigmatize donating organs for research.

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Image Source: Dr. Ann McKee/Boston University

One of the biggest hurdles in identifying chronic traumatic encephalopathy (CTE) in living people has always been distinguishing the condition from Alzheimer’s disease.

Both conditions are characterized by large numbers of tangled tau proteins or plaques which are seemingly indistinguishable between CTE and Alzheimer’s. However, a new breakthrough may have uncovered a subtle difference which could differentiate the protein tangles in these conditions and could potentially lead to effective diagnostic methods for people living with CTE.

Using cryogenic electron microscopy (cryo-EM), an international team of researchers examined the tau tangles from three individuals who have been neuropathologically recognized as living with CTE.

Two of these individuals were professional boxers, while the other was a professional football player.

While experts believe they can accurately predict whether a person is living with CTE based on symptoms and past head injury history, the only widely recognized objective method of diagnosing the condition remains through autopsy examination of the brain tissue.

When examined at the microscopic level, the researchers observed that tau proteins in CTE had a distinct “fold” compared to those observed in Alzheimer’s disease, according to their report in the journal Nature.

The same team were also the first to observe a fold in the abnormal tau proteins in Alzheimer’s in 2017.

Distinguished Professor of neuropathology at Indiana University School of Medicine, Bernardino Ghetti, MD, explained the importance of the findings, saying:

“The use of Cryo-EM has allowed us to determine the 3D structure of tau and facilitated our understanding of how it functions and interacts. Understanding these differences will accelerate the discovery of substances that may prevent the formation of abnormal tau in the brain cells of people suffering from either of these two distinct neurodegenerative diseases.”

In addition to finding the unique fold, the researchers say they also observed a unique unidentified element adjacent to the tau of CTE which is not seen in tau tangles related to CTE.

Ruben Vidal, Ph.D., professor of Pathology and Laboratory Medicine at IU School of Medicine emphasized just how important the findings could be, saying: “These two new discoveries provide more insights into CTE than had previously existed. The information will be incredibly valuable for the development of novel agents to help in diagnosis and therapeutics specifically designed for individuals fighting CTE.”

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New research from the University of Pittsburgh suggests that concussions in veterans can cause neuromuscular changes which could leave military personnel at risk for physical injuries after a brain injury.

“Similar to findings of research in athletes, neuromuscular differences are detectable in military personnel following concussion compared to those with no concussion history,” Shawn R. Eagle, a doctoral research fellow at the University of Pittsburgh, in Pennsylvania, told Reuters Health by email.

“Military personnel suffer an exceptionally high rate of musculoskeletal injuries, as well as concussions,” he noted. “If these neuromuscular deficits following concussion are in fact related to increased musculoskeletal injury risk, finding a test (or a series of tests) that is valid and reliable and can be used in clinics can improve our understanding of when it is appropriate to return a recently concussed athlete to play or a concussed soldier to duty.”

The findings come from a small study of 24 concussed male Air Force and Naval Special Warfare Operators between the ages of 19 and 34, as well as 24 control participants. According to the report published in the journal Medicine & Science, the concussed individuals had experienced a brain injury between one month and two years before the study.

Based on the findings, the concussed participants showed faster time to peak knee flexion angle during single-leg standing, compared to control participants. They also had a longer time to peak torque in knee extension isokinetic strength testing, and larger knee flexion angle at initial contact.

“Concussion may influence some athletes’ biomechanics in a way that might increase musculoskeletal injury risk,” co-author Dr. Anthony P. Kontos, also at the University of Pittsburgh, told Reuters Health by email. “In short, their movement may become more protective in nature following concussion, which paradoxically may increase their injury risk.”

“These findings emphasize the importance of assessing athletes’ responses to dynamic physical movements prior to clearing them for return to play following a concussion,” he advised. “We still need to connect changes in movement timing and muscular activation to subsequent injury risk. We also need to develop systematic and clinically feasible dynamic exertion tests to use with concussed athletes before clearing them for return to play.”

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Source: Stuart Seeger/Flickr

Nearly 2 million American children and teenagers were treated for traumatic brain injuries and concussions in emergency rooms between 2010 and 2016, according to a new Centers for Disease Control and Prevention (CDC) report. That averages to 283,000 every year.

Sports and recreational activities were the leading causes for childhood brain injuries, with football, bicycling, basketball, playground activities, and soccer being the leading causes for TBI-related emergency room visits.

The most recent Morbidity and Mortality Weekly Report says that childhood traumatic brain injury rates have largely leveled off since 2012, although sports continue to drive hundreds of thousands of brain injuries every year.

Notably, the report shows that boys are being treated for concussions twice as often as girls. TBI rates also increased with age, with children between 10 and 17 being most likely to experience a concussion.

According to the authors, both of these findings are likely related to boys and older children being more likely to participate in contact sports compared to girls or younger children.

This is supported by the finding that contact sports like football, soccer, basketball, lacrosse, ice hockey, and wrestling led to twice as many TBI-related emergency room visits compared to non-contact sports. Compared to recreational activities like playing on a playground, contact sports were more than four times as likely to result in a brain injury.

However, the report notes that playground activities did contribute to a significant proportion of TBI-related emergency room visits in children under 9.

With these findings in mind, the report’s authors suggest a number of preventative measures parents and children can take to prevent brain injuries in children.

“Limiting player-to-player contact and rule changes that reduce risk for collisions are critical to preventing TBI in contact and limited-contact sports,” the authors wrote.

When an injury does occur, the authors stress it the importance of a fast diagnosis and treatment plan.

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Kelly Catlin (left) at the UCI Track World Championships 2018
Source: Wikimedia Commons/Nicola

Last week, Olympic cyclist Kelly Catlin – who helped lead the U.S. women’s pursuit team to win the silver medal at the 2016 Rio de Janeiro Games – committed suicide just months after experiencing a debilitating concussion.

Now, her family says they are donating her brain to the Veterans Affairs-Boston University-Concussion Legacy Foundation Brain Bank in the hope of getting answers about the brain injury they believe led to her death.

“Our family decided to have a neuropathologic examination performed on Kelly’s brain to investigate any possible damage caused by her recent head injury and seek explanations for recent neurologic symptoms,” her father, Mark, told The Washington Post.

Kelly was not only a leading athlete but a promising student who was studying computational and mathematical engineering at Stanford University. Until recently, her family says she had always been a whiz in almost everything she did.

“[Kelly] had such a bright future. She was so multi-talented,” Mark described to PEOPLE. “There was so much about life that she enjoyed and [her recent concussion] was such as temporary setback that she couldn’t see through.”

The brain injury occurred during a race in December, and her family says they immediately saw changes in her personality and behavior.

“My wife and I talked to her weekly on the phone and she started to express apathy about cycling, which she’d never done before,” Mark said. “She had a lack of enthusiasm for the Olympic team, for training, for everything in life. We were concerned. She ran herself down. She had these mental issues and she started to feel trapped.”

In January, Kelly attempted suicide for the first time and entered physical and mental health treatment for two weeks before returning to Stanford. Still, the symptoms, depression, and personality changes persisted.

“Everything was open to her, but somehow her thinking was changed and she couldn’t see beyond, I guess, her depression,” Mark described to The Post. “After her concussion, she started embracing nihilism. Life was meaningless. There was no purpose. This was a person with depression. For her, she could no longer concentrate on her studies or train as hard. She couldn’t fulfill what she felt were her obligations to herself, she couldn’t live up to her own standards. She couldn’t realize that what she needed to do was get away and rest, heal. We were all searching for the magic words, that life was worth living.”

While Dr. Ann McKee, leading brain injury pathologist at Boston University’s brain bank, says it could take up to a year to have conclusive findings of what led to Kelly Catlin’s death, she says Catlin’s story lines up with many other cases of brain injury-related suicide.

“Those are unfortunately common symptoms of a brain injury such as concussion, although the symptoms can have many other causes,” she wrote. “The goal of our research is to enable novel insights into concussive and sub-concussive injury in a way no other research can. By understanding the ways that the human brain reacts to concussive injury, we are hoping to discover new ways to diagnose concussion during life and develop effective treatments.”

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Research coordinator Sarah Randall assesses a child after concussion.
Credit: McMaster University

The developers of new comprehensive guidelines for helping children recover from a concussion got inspiration from a surprising place – a famous childhood board game.

“For children, recovering from a concussion is like a snakes and ladders game, as there are times where they may have rapid improvement and climb through the steps more quickly, and other times where returning symptoms mean they have to take a slide back,” said author Carol DeMatteo, professor of rehabilitation science and a researcher at CanChild.

CanChild is a research institute which is part of McMaster University in Ontario, Canada and is where the new guidelines were developed.

“Our new research, along with our review of studies from all over the world, has led us to update the guidelines for recovery, and we have different but compatible guidelines for returning to school and for returning to activity including sport.
“Families have always felt the recovery instructions were too restrictive and difficult to follow. We now know that too much rest after concussion is not a good thing, and children can begin some activity sooner as long as they don’t overdo it and make their symptoms worse.”

According to these new guidelines, children are recommended to mainly rest during the first 24 hours after injury. However, some home and leisure activities can be enjoyed for up to five minutes at a time – so long as symptoms do not worsen.

From there, the guidelines lay out three distinct courses for concussions. One path is for those who are symptom-free within 48 hours of their injury, while the second is for those who are symptom-free or much decreased within one to four weeks. The last group is for those who continue to have symptoms for more than four weeks.

As DeMatteo explains, each path is broken into stages which clear goals and allowed activities for each stage. The guidelines also describe what changes to look for before moving onto the next stage.

For example, those who have reached stage two in the path to returning to school, children with concussions are allowed to walk, enjoy 15 minutes of screen time or school work twice a day, and can socialize with one or two friends for up to 30 minutes.

While the guidelines try to account for a wide range of symptoms and recovery speeds, DeMatteo urges health professionals and caretakers to remember that every child and every concussion is different. As such, each child has to go at their own pace on the road to recovery.

You can read the full guidelines from CanChild here.

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One of the most difficult parts of treating concussions is predicting how long it will take an individual to recover after their injury. While most people will recover from a concussion within approximately seven-to-ten days, others can take several weeks or even a couple months before they are ready to fully return to school and sports.

This is particularly tough for athletes, who tend to be strongly focused on how soon they can return to the game after a concussion.

Now, a team of researchers from Florida Atlantic University’s College of Engineering and Computer Science and SIOTEC Analytics believes they are developing an objective way to accurately predict an individual’s recovery time after sports-related concussions using machine-learning.

By feeding a wealth of data about sports-related concussion and their symptoms – such as headaches, dizziness, and fatigue – the researchers are developing a system to accurately estimate concussion recovery times.

As the team explains in a report published in the journal Medicine & Science in Sports & Exercise, the tool isn’t intended to be a definitive estimate of recovery times. Instead, they believe it can be used as a foundation for evaluating and developing personalized recovery plans for injured athletes.

For the project, the researchers used data from the National Athletic Treatment, Injury and Outcomes Network (NATION), which is an injury surveillance program monitoring injuries in high-school student athletes. It included data on 2,004 concussion incidents across 22 sports, including football, wrestling, field hockey, soccer, and basketball.

The team then used this data to create two datasets. One included 922 concussions in football, while the other was comprised of 689 concussions from other contact sports – for a total of 1,611 concussion incidents in all contact sports.

The data sets also included data on the most common symptoms following sports-related concussions, including headache (94.4%), dizziness (74.3%), and difficulty concentrating (61.1%%).

Using all this information, the team developed a machine learning-based model which estimated recovery times for concussion-related symptoms within seven, 14, and 28 days, using 10 classification algorithms.

“We have introduced a cutting-edge approach and new clinical tool to manage sports-related concussions, which will measurably improve with more and more inclusive data,” said Taghi Khoshgoftaar, Ph.D., co-author and Motorola professor in FAU’s Department of Computer and Electrical Engineering and Computer Science, who collaborated with lead author Michael F. Bergeron, Ph.D., senior vice president of development and applications at SIVOTEC Analytics, and Sara Landset, co-author and a Ph.D. student at FAU. “Our supervised machine learning method has demonstrated efficacy and warrants further exploration.”

“It is really important to be able to promptly identify those athletes who are going to need more time to recover after incurring their concussion,” said Bergeron. “The ability to predict recovery time using machine learning will help to augment an effective stratified approach to care. This also can help with realistic expectations of the student-athlete, as well as provide important insight and perspective for parents, coaches and teachers.”

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A history of repeated concussions has long been tied to an increased risk of developing depression, but a new study suggests the relationship may not be so simple.

Instead, researchers from the Vanderbilt Sports Concussions Center and Medical College of Wisconsin (MCW) say physical symptoms after concussions may be the key indicator of whether a person is likely to develop depression after a brain injury.

“While it often gets portrayed that sustaining sport-related concussions while playing contact sports at any level will increase the risk of future mental health problems in former athletes, clinicians who are in the field treating these individuals know that it is a much more complex process and the source of psychiatric symptoms can be multifaceted,” explained study authors Scott L. Zuckerman from Vanderbilt and Benjamin Brett from MCW to PsyPost.

“In other words, not all former athletes who sustained a sport-related concussion (or multiple) will inevitably develop mood symptoms, such as depression, later in life and other factors likely play a role in this process. In that light, we wanted to further investigate the relationship between the number of self-reported concussions and depression symptoms in former NFL athletes, examining additional factors (i.e., somatic or physical symptoms) that may have an influence or moderate this relationship.”

For the study, the researchers surveyed 43 former NFL players to measure clinical depression and symptomatology – such as dizziness, chronic pain, and shortness of breath.

The researchers also collected a detailed record of every participants’ head injury and concussion history.

According to the report, the athletes reported an average of 8.7 sports-related concussions. However, not all players experienced the same concussion risk. Those who experienced the highest rate or severity of somatic symptoms were significantly more likely to experience depression symptoms.

Notably, those with the highest number of concussions were also more likely to experience increased somatic symptoms.

“We hope the average person takes away that the discussion of whether participation in contact sports can lead to later-life mental health and neurocognitive problems is complex, with many more questions than answers,” Zuckerman and Brett said.

“As our paper showed, the association between concussion history and depression, which is often portrayed as a causal relationship, was influenced by additional factors. In reality, the amount of bodily or somatic complaints had a larger effect than the number of concussions sustained by former NFL athletes.”

“Further, the amount of bodily or somatic symptoms endorsed moderated the relationship between sport-related concussion history (number of concussions) and depressive symptoms. If you had minimal to no bodily/physical symptoms, there was virtually no relationship between the number concussions that an individual sustained while playing contact sports and depression symptoms later in life. The more bodily/physical symptoms were endorsed, the stronger the association between self-reported concussion history and depression symptoms.”

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Every day, approximately 153 people in America die from injuries related to traumatic brain injury (TBI). Yearly, brain injuries account for more than 2,500,000 emergency room visits and 282,000 hospitalizations.

While many will quickly recover from the most common form of TBI – frequently referred to as a concussion – millions each year experience long-term symptoms and even disability from injuries or complications relating to their brain injuries.

To help raise awareness of these injuries, the Brain Injury Association of America has observed Brain Injury Awareness Month in March for more than three decades.

This year’s campaign is called #ChangeYourMind, as the group focuses on the stigma surrounding brain injuries and the disenfranchisement experienced by many living with brain injuries.

Specifically, the group says they are hoping to accomplish three things this year:

  • De-stigmatizing brain injury through outreach within the brain injury community
  • Empowering those who have survived brain injury and their caregivers
  • Promoting the many types of support that are available to people living with brain injury

While we work every day to raise awareness and support for brain injuries – along with providing treatment and rehabilitation services – NRI will be observing Brain Injury Awareness Month with news and articles focusing on the daily lives of those with brain injuries and the stigma surrounding living with long-term brain injury.

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Image Source: Chris Humphreys/USA TODAY Sports

Chris Borland is a former NFL player who retired in 2015 after his rookie season because of concerns about the risk for long-term brain trauma and chronic traumatic encephalopathy. Since then, he has been an outspoken critic of the NFL and NCAA’s handling of brain injuries in football.

This week, he was invited to speak to the U.S. House Committee on Natural Resources’ Subcommittee on Oversight Investigations as one of four witnesses to discuss how large corporations can use disinformation to mislead the public about issues of significant public interest such as public health. Specifically, Borland spoke on the way the major football leagues manipulate not only the public’s perception of brain injuries but also the scientific research into brain injuries and CTE.

Below, we are sharing the statement he prepared and read to the subcommittee, which has been released into public record:

To the members of this committee, thank you for the privilege to testify today to discuss the nature of industry’s manipulation of science and policy as it pertains to brain injury in football.

My name is Chris Borland. I was an All-American linebacker at the University of Wisconsin. In 2014, my first year in the National Football League, I led the San Francisco 49ers in tackles.

I decided to walk away from the game of football after my rookie season in the NFL.

While an active player in the NFL, I spent six months studying the available research on the ramifications of repetitive brain trauma. In relating what I found in the research to my own past experience with brain injury and to the demands of my job, I felt it was in the best interest of my personal health to stop playing football immediately.

Per a 2014 NFL actuary, 28 percent of the league’s players will suffer from cognitive impairment. I had a history of brain injury and played an especially dangerous position as a middle linebacker. Personal experience is important in deciphering such data.

Since leaving football in 2015, I have advocated for players and families that live with the consequences of brain injury.

I’ve gained a keen insight into the failings of industry-funded research. Today, we continue to see industry-funded science misrepresenting the reality of what football players (as well as athletes in other violent games) experience in their sport.

While much of the focus with brain injury research in football has been on the NFL, I would like to highlight how NCAA research into concussion is inherently flawed and why the NCAA fails to portray an accurate risk of brain damage for athletes competing under their organization.

In 2014, the Department of Defense and NCAA collaborated to create what they call “The Grand Alliance,” a $30 million initiative to study concussion. Under the Grand Alliance, a program was launched dubbed the CARE Consortium. CARE is an acronym for concussion assessment, research, and education. In the words of the NCAA and Department of Defense, the Care Consortium “serves as the scientific and operational framework for the Concussion Research Initiative of the Grand Alliance.”

To date, $64 million has been poured into The Care Consortium. There have been 40,000 athletes studied, and the NCAA and Department of Defense report to have captured 3,300 concussions.

Due to disincentivization in reporting concussions that I understand well as a former Big Ten linebacker, I believe the figure of 3,300 concussions flawed to the point of being unusable. My intimate relationship with this research further bolsters my personal experience.

The University of Wisconsin is a member institution in the Care Consortium. I have played with many men that were participants in the study. I know that most of these men appear in the research as having never sustained a concussion. That is, they have never reported sustaining a concussion.

In my experience in football (which is not unique to that of my friends and teammates) symptoms of concussion, whether it be dizziness, tinnitus, imbalance, or others, were weekly occurrences during the season.

The NCAA and Department of Defense routinely fail to acknowledge when sharing Care Consortium data, that an estimated 1/8 to 1/20 concussions is actually reported.

A second glaring omission is that concussion is not believed by neuropathologists to be solely instrumental in brain diseases like Chronic Traumatic Encephalopathy. Focusing only on concussion ignores the repetitive subconcussive hits to the head that football players experience, and that are believed to contribute to neurodegeneration.

To be clear, I feel The Care Consortium does tremendous work researching concussion and developing protocols for those that have been diagnosed.

My concern is that most of us athletes fall through the cracks. The Care Consortium data fails to take into account that the vast majority of concussions go undiagnosed.

The Care Consortium focus on concussion does not capture what may be at the heart of the problem with brain injury in football, repetitive subconcussive hits.

A true scientific and operational framework for concussion would include explicit acknowledgment that players so rarely report the injury.

A genuine inquiry into brain damage from football must include mention of subconcussive hits.

With The Care Consortium, the NCAA and Department of Defense have done a good job studying reported concussions. The Care Consortium has done a better job at distracting athletes and the public by excluding vital information and appropriate context.

I deeply appreciate the opportunity to share my experience in football, with research, and as an advocate for former players. I’ll eagerly and happily answer any and all questions. Thank you!

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