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UCSF Researchers Advocate Prioritizing Teens for Education and Prevention

by Scott Maier (August 17, 2016) — The number of Americans diagnosed with concussions is growing, most significantly in adolescents, according to researchers at UC San Francisco. They recommend that adolescents be prioritized for ongoing work in concussion education, diagnosis, treatment and prevention.

The findings appear online August 16, 2016, in the Orthopaedic Journal of Sports Medicine.

“Our study evaluated a large cross-section of the U.S. population,” said lead author Alan Zhang, MD, UCSF Health orthopaedic surgeon. “We were surprised to see that the increase in concussion cases over the past few years mainly were from adolescent patients aged 10 to 19.”

Concussions are a form of mild traumatic brain injury resulting in transient functional and biochemical changes in the brain. They can lead to time lost from sports, work and school, as well as significant medical costs.

Though symptoms resolve in most concussion patients within weeks, some patients’ symptoms last for months, including depression, headache, dizziness and fogginess. Neuroimaging and neuropathological studies also suggest there may be chronic structural abnormalities in the brain following multiple concussions.

Recent studies have shown an increase in traumatic brain injuries diagnosed in many U.S. emergency departments. Smaller cohort studies of pediatric and high school athletes also have indicated a rise in concussions for certain sports, such as football and girls’ soccer. However, this is the first study to assess trends in concussion diagnoses across the general U.S. population in various age groups.

In this study, Zhang and his colleagues evaluated the health records of 8,828,248 members of Humana Inc., a large private payer insurance group. Patients under age 65 who were diagnosed with a concussion between 2007-2014 were categorized by year of diagnosis, age group, sex, concussion classification, and health care setting of diagnosis (emergency department or physician’s office).

Overall, 43,884 patients were diagnosed with a concussion, with 55 percent being male. The highest incidence was in the 15-19 age group at 16.5 concussions per 1,000 patients, followed by ages 10-14 at 10.5, 20-24 at 5.2 and 5-9 at 3.5.

The study found that 56 percent of concussions were diagnosed in the emergency department, 29 percent in a physician’s office, and the remainder in urgent care or inpatient settings. As such, outpatient clinicians should have the same confidence and competence to manage concussion cases as emergency physicians, Zhang said.

A 60 percent increase in concussions occurred from 2007 to 2014 (3,529 to 8,217), with the largest growth in ages 10-14 at 143 percent and 15-19 at 87 percent. Based on classification, 29 percent of concussions were associated with some loss of consciousness.

A possible explanation for the significant number of adolescent concussions is increased participation in sports, said Zhang, MD, who is also assistant professor of orthopaedic surgery at UCSF. It also may be reflective of an improved awareness for the injury by patients, parents, coaches, sports medical staff and treating physicians.

For example, the U.S. Centers for Disease Control and Prevention “HEADS UP” initiative has caused numerous states such as California to alter guidelines for youth concussion treatment.

Many medical centers also are establishing specialty clinics to address this, which could be contributing to the increased awareness. At UCSF, the Sports Concussion Program evaluates and treats athletes who have suffered a sports-related concussion. The team includes experts from sports medicine, physical medicine and rehabilitation, neuropsychology and neurology. Their combined expertise allows for evaluation, diagnosis and management of athletes with sports concussions, helping them safely recover and return to sports.

Other UCSF orthopaedic surgery contributors to the Orthopaedic Journal of Sports Medicine study were senior author Carlin Senter, MD, associate professor; Brian Feeley, MD, associate professor; Caitlin Rugg, MD, resident; and David Sing, clinical research associate.

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco, and other partner and affiliated hospitals and healthcare providers throughout the Bay Area.

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Award recognizes outstanding work in the area of human intelligence

ARLINGTON, TEXAS (July 5, 2016) — The Mensa Foundation presented its Laura Joyner Award to the San Diego Brain Injury Foundation for their work in improving the quality of life for brain injury survivors and their families living in San Diego County. The award was presented at The Foundation’s annual Colloquium held at the Town and Country Resort and Convention Center.

According to the SDBIF’s website, every 23 seconds someone suffers a brain injury in the United States. In San Diego, 11,000 people annually are affected by traumatic brain injury. Although there are many medical facilities that help with the initial diagnosis and treatment, SDBIF addresses long-term needs by providing resources including free educational meetings, a brain injury guide, and a hotline with referral and support group information. Foundation Trustee Eldon Romney presented the award to SDBIF’s executive staff members, Stephanie Bidegain and Susan Hansen at the event.
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For more than 40 years, the Mensa Education and Research Foundation has been a strong voice in supporting intelligence. The Foundation fosters the best and brightest through scholarships and awards, and encourages research and intellectual inquiry through the Mensa Research Journal and various Colloquiums. Governed by a volunteer Board of Trustees, the Mensa Foundation is a 501(c)(3) organization and is funded by American Mensa, Mensa members and other charitable donations. To learn more about the Foundation, visit mensafoundation.org.

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LOUDON, N.H. (AP), (July 16, 2016) – He was one of NASCAR’s first superstars, but Fred Lorenzen’s memories of his Hall of Fame career have dimmed as he battles dementia. His Daytona 500 victory, the wins he piled up to become NASCAR’s first $100,000 driver, his life on the road, all have been largely extinguished.

Lorenzen still has flickering moments when he remembers the days when he was NASCAR’s “Golden Boy” for his rugged, movie-star looks. Like in recent years, when he visits Chicago Speedway, not far from his assisted living facility.

“His face just lights up when he’s there,” said his daughter, Amanda Lorenzen Gardstrom.

Nearly 45 years after his last Cup race, Lorenzen hoped he would still make his mark on the NASCAR community. Inspired by Dale Earnhardt Jr.’s decision to pledge his brain to the Concussion Legacy Foundation, Lorenzen became the second known driver to make the same decision.

Gardstrom made it official Friday with a pledge to Legacy co-founder Chris Nowinski. As auto racing grapples with the issue of concussions and head trauma, one of NASCAR’s pioneers is now alongside Earnhardt in the donation queue.

“As a family, we decided we wanted to support Dale Junior and all work together toward a healthy future for these drivers,” she told The Associated Press.

Earnhardt’s concussion history – he missed two races in 2012 – spurred his decision to pledge his brain to the Legacy, a group that works with Boston University on research into chronic traumatic encephalopathy, or CTE, a degenerative disease that doctors believe is caused by repeated blows to the head.

Gardstrom is convinced the 81-year-old Lorenzen has CTE as a result from years of brutal wrecks and hits from the 1960s, one of the most dangerous eras in racing history. Lorenzen won the Daytona 500 in 1965.

“He never stopped to heal,” she said.

She wants to help, and knows her father does, too, and advance the understanding of concussions and their treatment in NASCAR.

“It’s the younger generation that we really need to educate,” she said. “They’re young, they’re hungry, but when they get in a wreck and get a concussion, they know if they don’t get back in the car, someone else is going to take it. We want to change the culture of the sport.”

Earnhardt has become the face of concussion awareness in sports and will skip Sunday’s Sprint Cup race at New Hampshire Motor Speedway because of concussion symptoms. There is no timetable on when NASCAR’s most popular driver might return.

The 41-year-old Earnhardt had already intended to be an organ donor, so he said in April that giving up his brain made sense. Earnhardt said he was motivated by reading about three former Oakland Raiders who donated their brains in honor of teammate Ken Stabler. The quarterback’s brain showed signs of CTE.

“I think the protocols and the advances that we have made in trying to protect ourselves are great things,” Earnhardt said at his pledge announcement. “I’m excited about what NASCAR has done. They have really taken this head on.”

Gardstrom felt the same sense of motivation when she read about Earnhardt’s pledge. She said Lorenzen, inducted into the NASCAR Hall of Fame in 2015, first showed signs of dementia about a decade ago. He has memory loss and uses a wheelchair at Oak Brook Healthcare in Illinois.

The Elmhurst, Illinois, native was one of NASCAR’s first stars to hail from outside the sport’s Southern roots.

“The hardest part right now is that his racing memories are starting to go,” Gardstrom said. “That was the one thing that was really wonderful, to connect and see him light up when he talked about racing.”

She’d like to see others in the sport talk more about concussions.

“That hasn’t necessarily been a hot topic of conversation in any of our meetings,” Sprint Cup champion Kyle Busch said.

Six-time NASCAR champion Jimmie Johnson was part of a 54-member panel that picked Lorenzen for induction into the hall. Johnson has yet to consider donating his brain to the Legacy.

“I am an organ donor so it wouldn’t bother me to do that, but it’s something I’ve not taken steps in and have not discussed at all,” he said.

In the 15 years since Dale Earnhardt’s death at the 2001 Daytona 500, NASCAR introduced a series of measures designed to keep drivers safe, from helmet and restraint systems to impact-absorbing barriers along concrete walls, all designed to cushion high-impact blows.

NASCAR also mandated in 2013 that drivers submit to baseline neurocognitive assessment. When a driver in NASCAR can’t return his damaged car to the garage, a trip to the care center is required. Under a new three-step process, a driver showing any indication of a head injury must go immediately to a hospital. Concussed drivers must be cleared by an independent neurologist or neurosurgeon before they can get back in a race car.

Gardstrom wants NASCAR to take even more steps.

“We don’t have to wait until more drivers’ brains are studied to make a better concussion protocol,” she said.

Former athletes in other sports have sued their leagues, contending the risks of concussions were hidden from them so they could return to competition. Gardstrom has no interest in a lawsuit.

“No money is going to bring my dad back, but what my goal now is, is to make sure the NASCAR family doesn’t have to go through the similar things we’re going through now,” she said.

Lorenzen hasn’t been forgotten by today’s racing stars – they appreciate a driver who won 26 times in the Cup series. Tony Stewart introduced Lorenzen at his hall induction. Jeff Gordon leaned in for a chat with “Fearless Freddie” last year at Chicagoland before the race.

“He was such a humble guy, that I don’t think he ever realized what an impact he had on the sport,” Gardstrom said.

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