With kids’ return to sports, a reminder about serious risks of head trauma

cte-300x157With coronavirus cases, hospitalizations, and deaths falling from scary winter highs, the easing of public health measures may see young athletes returning fast to what are supposed to be the fun and educational benefits of organized sports.

But will players, and more importantly grownups, ensure that appropriate practices are followed to ensure kids not only are safe from coronavirus infection but also don’t suffer serious and lasting head injuries?

The Washington Post has posted articles that could provide important reminders about the risks of chronic traumatic encephalopathy or CTE — the degenerative brain disease associated with the repeated blows to the head.

The newspaper has noted that the Nigerian-born doctor, portrayed by actor Will Smith in a 2015 film that helped to focus public attention on this condition and more generally the risks of concussions and other head trauma, has diminished his professional standing by overstating what is known about CTE.

At the same time, reporter Rick Maese has written about the tragic, long decline of Willie Wood, a Washingtonian, a collegiate star, an NFL Hall of Famer for the Green Bay Packers, and a longtime coach in the game.

Wood, with his family’s consent, was diagnosed postmortem by experts in Boston as suffering from a classic case of CTE after a long career of “dingers and stingers,” head blows and injuries that he was especially susceptible to as a light, fleet, and hard-hitting player. His cognitive decline was painful to him and all who knew him, Maese reported:

“[Wood] was retired by the time he began showing signs of decline in his late 60s. He would run an errand and couldn’t find his way home. He would misplace things and get lost in conversations. ‘He was afflicted for so long, I guess you kind of get over that initial pain. But the first year or two was incredibly painful,’ Willie Jr. said.”

Maese reported that Wood and his family followed medical studies that might explain the famed athlete’s problems. The family donated his brain for study after Wood’s death, and the outcomes of the work on him and his family’s concerns help show, Maese wrote, how CTE research has advanced, especially with the publication online in a respected medical journal of new guidelines about subjects suitable for study:

“More than two dozen doctors [have] published the first consensus criteria to diagnose the symptoms of chronic traumatic encephalopathy among living people for research purposes, providing a framework for improved further study of the brain disease caused by repetitive hits to the head and commonly associated with contact sports, especially football. Before the new paper published … there had been no accepted approach for diagnosing CTE or its clinical manifestation during life. While the criteria are not meant for diagnosing individual patients, the paper’s authors believe the findings represent a crucial step for researchers worldwide. The goal for CTE researchers is the discovery of a biomarker that indicates CTE in living people. The new study does not provide that, but in streamlining research it could help achieve that landmark faster.”

Here is what the newspaper reported on the researcher guidelines, again emphasizing that these are not for use in diagnosing nor treating patients:

“Four factors must be present for a traumatic encephalopathy syndrome diagnosis, according to the paper. The patient must have experienced ‘substantial’ repetitive head impacts; show cognitive impairment, such as memory loss or irregular behavior; show a pattern of deterioration; and not have those clinical signs explained by any other conditions. People who meet the criteria will be graded on a 1-5 scale, with 1 meaning the patient is independent and 5 meaning the patient has severe dementia.”

Ouch. In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them by brain and spinal cord injuries, notably through concussion and other head hits in sports, especially if helmets and protective gear are defective and dangerous products.

The pandemic-related constriction, postponement, and cancellation of so many prep and collegiate sports may have had an upside: It apparently added to declines in the need for urgent care for dangerous and damaging head injuries. And public awareness has soared about the risks of such trauma, with preventive measures leading to a sharp dip in the emergency department visits for sports- and recreation-related injuries to children and adolescents, federal researchers have found.

Still, the long, pandemic-related reality of being out of play and away from peers may push over eager young athletes to excessive behaviors. They may want to take out the understandable frustrations they endured during the coronavirus lockdowns and school closures by hitting harder, staying longer in practices, and trying — as a teen mindset might think possible — to make up lost time with misplaced zeal and energy.

Kids too often are not good, long-term thinkers. Grownups need to help, with safety protocols and equipment. They were a growing part of organized sports, pre-pandemic, and they must make a return. As much as we have accomplished in lessening head trauma, we still need to do more, remembering that studies have shown that patients can suffer significant damage not just by big, nasty knocks but also by milder blows to the head, too, especially if they are recurring.

Photo credit: Normal brain vs. advanced CTE, courtesy website of Dr. Anne McKee, Boston University Medical School
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