Friday, April 27, 2018
Health

Sports medicine still has a long way to go on brain injuries

Football season was a very big deal in my home. Both my parents loved the Steelers, but my mother was in her own league.

She didn't hang Terrible Towels in the powder room. What she did was cheer and yell at the games on TV louder than anyone I've heard before or since.

But when my brother went out for the high school team, she objected almost as loudly as she rooted for Franco Harris. Eventually, reluctantly, she gave in.

As it turned out, my brother was not much of a football player. While my mother sympathized with her bench-warming son, she was relieved not to see him buried beneath a pile of large bodies every Friday night.

I suspect many football fans both love the game and fear what it can do to its players.

I thought about all this recently when I read about a Largo High player who took a hard hit during a game against Dunedin and was later diagnosed with a severe concussion. His parents, saying the ambulance took too long to arrive, started a petition to require paramedics at every Pinellas high school football game.

However that effort ends, it's clear it will take more than ambulances to really protect players.

For several years, sport-related brain injuries have been in the news and on research agendas. Parents, players and coaches are learning the importance of recognizing and respecting the signs of concussion.

Last week, the National Football League agreed to pay $765 million to settle thousands of player lawsuits over head injuries linked with terrible disabilities including dementia, and even suicide.

That sum is paltry compared with NFL revenues, many have noted. Just $10 million of the settlement is for research. It's a small fraction of funds the NFL and others, including the National Institutes of Health, are spending in this area, yet it's an investment that needs to keep growing.

Scientists are finding that it isn't just major game-day injuries, but also the accumulated impact of many smaller hits, during games and practice, that should worry us.

Last spring, I heard a lecture from a leader in this field, Robert A. Stern. He is a professor of neurology at Boston University School of Medicine and co-founder of the Center for the Study of Traumatic Encephalopathy. You may have heard about its collection of brains contributed by deceased athletes, used to study the impact of repeated hits to the head.

Stern talked about "subconcussive blows'' — hits that leave no symptoms but are connected with a progressive brain disease, chronic traumatic encephalopathy. CTE's hallmarks are cognitive declines, mood and behavior problems such as aggression.

Football is getting much of the attention in this arena, for good reason. Stern told us that football linemen may take more than a thousand subconcussive hits a season, each with a g-force similar to a car hitting a brick wall at 35 miles per hour.

But CTE also has been found in hockey and soccer players, military veterans, domestic abuse victims, even a circus clown who'd been shot out of a cannon.

For all that has been learned, Stern said, questions still outnumber answers. It isn't known how many blows over what period of time it takes to cause CTE. Nor is it known why some people can take a lot of head trauma and never develop CTE. Perhaps, Stern said, genetics could make one more vulnerable. Another line of inquiry is discovering whether learning to detect CTE early — rather than at autopsy — might make treatment possible.

This work also offers clues about Alzheimer's disease and other forms of dementia.

Stern spoke movingly of the dozens of athletes and their families who have made this research possible. His center's first was John Grimsley, the Houston Oilers linebacker who died in 2008 of an accidental gunshot wound at age 45 after five years of worsening memory and mood problems. His widow donated his brain for research, and it — like most of the brains in the project — revealed extensive CTE. You can see the tissue slides on the center's website, with the tell-tale proteins stained dark brown; they are startling.

Numerous athletes who are still living have signed up to donate their brains after their deaths. More than ever, they deserve the cheers of their fans — and all of us.

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