Tuesday, February 15, 2011

*Guest Post* Head Injuries: Can't Forget About Them

Since this weekend, much of the hockey world (and anyone else who wished to comment) made a lot of out of Mario Lemieux's comments about the incidents that occurred Friday night during the Pittsburgh Penguins/New York Islanders game. A series of fights, brawls, and bench-leaping resulted in a few suspensions and fines from the NHL.

However, the most pressing issue until Friday was the topic of headshots and concussions. While le
Magnifique stresses the safety of players as a result of all-out brawls like Friday's game, the NHL cannot forget that it has this situation to take care of primarily.

So for my second guest post, I had Vinod Venugopalan (We can call him "V"), a medical researcher from the Montreal Neurological Institute and Hospital at McGill University, shed some light from a medical perspective. I thought this was important because we hear too much from people who don't know a thing about concussions, and what better way is there to discuss the real implications of concussions than to hear it from a guy with experience in the field. He's also a Montreal Canadiens fan, so he understands from a fan perspective as well on head injuries.

Hope you enjoy and learn a bit!

First, I’d like to thank Angie for graciously giving me space on her blog to air my opinion on an issue that I feel very strongly about. My name is Vinod Venugopalan. I’m a medical researcher at the Montreal Neurological Institute and Hospital at McGill University in Montreal, Canada. The recent rash of concussions in the NHL is a definite cause for concern.

The loss of Sidney Crosby, Marc Savard and several others due to head injuries has prompted the NHL to re-think its policy regarding hits to the head. However, to date, the NHL’s response to the sharp increases in the number of head-injuries has been woefully inadequate and poorly reasoned. The NHL has determined that the rise in head injuries can be curbed by increasing the severity of disciplinary action against head shot offenders. What seems to be missing in their consideration of this issue is how to limit the concussions from occurring at all.

What Is A Concussion?

I think it’s important to start with a definition of what a concussion is, and what causes them. First, concussions are brain injuries resulting from a force that causes the head to snap violently. This force in turn causes the brain to move within the skull and scrape along its jagged edges to cause a brief (ranging from seconds to minutes) loss of consciousness. More alarming is that it becomes easier to become concussed the next time and the time after that. In other words once concussed, the brain is never the same.

What's wrong with what the NHL does now?

One main issue regarding how the NHL deals with concussions is that the average team medical staff is not trained effectively to recognize symptoms of concussions: Headaches, dizziness, inability to concentrate, vision, hearing sensitivity, anxiety and depressed mood are all signs of a concussion.

Case in point: Sidney Crosby has yet to return to action as a result of two seemingly innocuous hits to the head, the first by Dave Steckel during the Winter Classic and the second by Victor Hedman of the Lightning. What concerns me more as a medical scientist and clinician is not the Steckel hit on Crosby, which appeared to be accidental, but that the Penguins medical and training staff put him back on the ice after appearing dazed during a second period interview. Moreover, he was allowed to play the next game when he was injured again in a collision with Victor Hedman of the Lightning. Did the training staff not recognize that he was concussed? And if not, why not?

One of the great obstacles in evaluating the extent of brain injury following a concussion is that present brain imaging technology lacks the requisite resolution to detect brain damage caused by concussion. One improvement over the years in analyzing head injuries are new brain imaging techniques are making great headway in being able to detect microscopic injury, the type of injury caused by concussions. A recent a study on concussed athletes suffering from post-concussion depression found functional abnormalities in the frontal lobes of the brain. Five years ago this type of information that ago was not available to the medical community.

Most players who have had concussion problems have had them since they were younger. To my knowledge, there are no comprehensive programs in place at the junior and minor hockey levels that test every player for head injury. This is the ideal place to start. Neuropsychological testing (or testing of cognitive functions, such as memory, attention, verbal reasoning and planning) can and should be assessed in every player from Midget onward. This data should be recorded in a medical database and used for future reference. Players should be tested at least twice a year and flagged for more extensive testing if there are performance decrements from one testing period to another. This type of continuous follow-up will help to detect or at the very least manage these head injuries more effectively.

Revisiting the Crosby case, my first impression is that Sidney Crosby was concussed much earlier in his career, perhaps as far back as his days in QMJHL. I suspect that a great percentage of players come to the NHL with un-reported head injuries. Part of the responsibility lies with the player who is reluctant to tell the trainer he’s hurt for of fear of losing ice-time, his job, draftability, or just simply appearing weak. In a game whose very ethos is defined by resilience and toughness, admitting weakness is career suicide.

In an interview with Eric Duhatschek of Globe and Mail, Pierre-Marc Bouchard of the Minnesota Wild who missed more than a year after sustaining back-to-back concussions talked about how difficult it was as a player to overcome the natural urge to compete and block out any obstacle to playing. “As hockey players, we don’t like to miss games,” said Bouchard. “You think you can play through it. You think you’ll be able to get rid of it the next few days - and you might. But if you get hit again, there’s that danger - that you could get an even bigger concussion." That is exactly what happened to Bouchard.

There are ways, however, to prevent or manage head injuries.

Concussion Prevention

In order to prevent and diagnose head injuries, early detection is key. The NHL should make use of new technology to have every individual brain-scanned before entering the league and scanned a minimum of twice a year, and collect data on the incidence of concussion. The more information we have at our disposal, the better we can use this data to inform NHL policy regarding head injuries.

Once we have this information, it is important to educate all NHL players and staff about what concussions are and the real-life implications of head injuries. It is this way that the players will be more aware of the dangers they are subject to on the ice on both the giving and receiving end of hits.

In Conclusion...

Hockey is a game of hitting and contact; that will never change. As a fan, I do not want it to change. It’s a big reason why many of us watch the game in the first place. That said, I think it’s time for the NHL to change tack. Instead of trying to legislate hits to the head, it must shift its priorities to prevention through the methods explained: education, early detection, and technology.

If you would like to contact Vinod directly, feel free to send your questions or comments (or fan mail) to:

Montreal Neurological Insitute Room 276
3801 University #276
Montreal, QC, Canada
H3A 2B4

or you can just simply email him at vinven55@hotmail.com.

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