More must be done to find, treat serious brain injuries

This season the National Football League is responding to increasing concerns over traumatic brain injuries suffered during play.

The NFL commissioner recently announced a $100 million initiative intended for medical and neuroscience research to prevent, diagnose and treat head injuries. In addition, 32 club owners will contribute to funding for engineering advancements and medical research. The “Play Smart. Play Safe.” initiative also requires the NFL to hire a chief medical officer to work with each team’s medical staff and to establish an independent scientific advisory board to ensure the safety of players.

More than 40 percent of retired NFL players have signs of traumatic brain injury, or TBI, based on specialized MRI scans, according to recent study results announced by the American Academy of Neurology.

The movie “Concussion,” starring Will Smith, who many argued should have won an Academy Award, was produced not only to increase public awareness of the high frequency of head trauma among football players, but also to highlight the controversy over the NFL’s handling of the issue.

Football is not the only sport associated with traumatic brain injuries. Soccer injuries are also sending more children to the emergency room. As a 6-year-old, running full speed while playing soccer, my head crashed into my coach’s hip, throwing me quite a distance. It resulted in a head injury and a broken collarbone.

With the growing popularity of soccer, more American children are being seen in urgent care and emergency facilities — a trend driven by concussions, according to another study. Nearly 3 million players under age 18 received ER treatment for soccer-related injuries from 2000 to 2014. Studies have also shown that it is not only impacts with the ground or other players that cause brain injury; “heading” the ball also can result in cumulative brain damage.

Our lead physical therapist notes that the rules have changed. His 9-year-old daughter plays competitive club soccer. Heading is now penalized until a certain age.

It is well established that multiple injuries to the brain can result in cumulative changes also called chronic traumatic encephalopathy. It is far more worrisome when someone suffers a second or third concussion, especially if there has been a loss of consciousness and if the events occur in close succession.

Manakai O Malama continues to see many cases of TBI suffered by military veterans, those in motor vehicle or work-related accidents as well as athletes. Over the years, we have continued to expand our services to diagnose and treat this growing problem. Medical providers, occupational therapists and psychologists utilize multiple screening tools to identify those likely to have sustained a brain injury. Those with a positive screen may proceed with imaging and a comprehensive evaluation by our neuropsychologist to more clearly evaluate the nature and the extent of the diagnosis.

While the most severe TBIs typically involve a bleed inside the brain, the vast majority are mild or moderate in nature and do not involve a bleed. Although the brain is suspended and cushioned by cerebrospinal fluid, with a significant impact or even a whiplash without impact, the fragile tissue bangs against the inside of the skull and becomes damaged.

A bleed results in severe symptoms and is readily diagnosed with imaging. Less-severe TBIs often go undiagnosed but not without troubling symptoms that range from forgetfulness to emotional complaints, irritability, impatience and anxiety. Other common symptoms include fatigue and lack of concentration or mental stamina, especially at the computer workstation.

Symptom duration ranges from quite transient to permanent. Unlike a flesh wound or fracture which is visible to the naked eye or on an X-ray, TBIs are less easy to discern, causing many to simply say, “I just don’t know what is wrong with me.”

Pugilistic sports such as boxing and mixed martial arts are not going to go away anytime soon, but some now take more care to protect the brain. I am a martial artist, practicing taekwondo for 41 years, and still train actively. Our studio does not condone head shots. However, whether as the result of team sports, blunt trauma from transportation or intentional violence, people will continue to suffer from traumatic brain injury.

The best course of action is to continue to engage in best efforts to prevent these injuries and, when they occur, execute concussion protocols in the field. When these protocols result in red flags, proceed to more comprehensive screening, diagnostic imaging, and neuropsychological evaluation and treatment.

Ira “Kawika” Zunin, MD, MPH, MBA, is a practicing physician. He is medical director of Manakai O Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.