How new science is changing the way we think about traumatic brain injuries
TBI quick facts
• Traumatic brain injuries impact 3 million Americans annually, at a rate of roughly one TBI every three minutes.
• TBI are the No. 1 trauma injury in Summit County.
• Skiing and snowboarding are the No. 1 cause of TBI in Summit County, followed by falls, motor vehicle collisions and bike collisions.
• Roughly 2,000 TBI patients are treated annually at St. Anthony Summit Medical Center and local mountain clinics (Breckenridge, Keystone and Copper).
• Roughly 15 percent of Summit County ER patients are diagnosed with TBI.
• The TBI rate in Summit County is 17 times higher per capita than the national average.
• Just 10 percent of TBI patients experience a loss of consciousness.
• Roughly 35 percent of TBI patients show psychiatric conditions within the first year of injury, including depression, anxiety and mood swings.
Sources: Kim Ramey and Melissa Volkert, Avalanche Physical Therapy; Dr. Tara Kane, Centura Health Neuroscience and Spine; Centers for Disease Control and Prevention.
Are you struggling with the effects and symptoms of TBI? You’re not alone. St. Anthony Summit Medical Center partners with Avalanche Physical Therapy to host two free groups for TBI survivors, family and caretakers. No registration is required — simply show up.
The young adult and high school group meets the third Thursday of every month at various locations across Summit. For more info, contact occupational therapist Melissa Volkert at (970) 668-0888.
The adult group meets the fourth Thursday of every month from 5:30-6:30 p.m. at the medical center. For more info, contact physical therapist Kim Ramey at (970) 668-0888.
For statewide information, contact Liz Gerdeman of Brain Injury Alliance of Colorado at (303) 355-9969 or see the website at www.biacolorado.org.
Late in the fourth quarter, Summit High head football coach John Shirkey saw a hit that made his blood boil.
It was homecoming Friday and the Tigers were trying to mount a comeback against Clear Creek. Just before the whistle blew on a play in Clear Creek territory, an opposing defensive tackle blindsided a Summit player, leveling him with a nasty shot from the side that reeked of illegal — and potentially dangerous — contact.
“I lost my mind because it was the second or third time it happened,” Shirkey remembered. He was still livid after the clock hit zero and his team lost, 14-28 in the snow, until he received an email from the officials a few days later. They had reviewed the game tape and admitted the hit was illegal. They also admitted it was a missed call and apologized for potentially putting his players in danger, not once, but maybe several times.
Coach was impressed.
“’It’s about reworking the psyche of football players,” Shirkey said. “For a long time it’s been, ‘Be the most violent you can be.’ Now, the focus really needs to be, ‘How can we be effective and safe at the same time?’”
The science of TBI
For decades, contact has been part and parcel of playing sports at just about any level. Even when direct hits aren’t part of the game — think sports like basketball, softball, baseball and more — simply placing a dozen or more players on the field or court comes with the potential for brutal hits.
“I literally don’t remember the word concussion being part of the vocabulary,” said Shirkey, who played high school and collegiate football from 2000 to 2007. “It was ‘bell rung,’ which doesn’t tell us anything. In the years that I played, even through high school, that wasn’t even part of the conversation.”
In the past 15-some-odd years, though, traumatic brain injuries, or TBI, have come to the forefront. Awareness was spurred by devastating news, like the 2004 death of freshman football player Jake Snakenberg of Grandview High School, and has since been championed by everyone from high school parents and university researchers to pro football players and beyond.
“This is such an emerging science,” said Steve Sedlak, athletic trainer at Summit High School, who remembers smelling salts and other remedies when he played competitive soccer. “We err on the side of caution at the high school now, and it’s so hard to say without a proper screening — an MRI, a CAT scan — to know what’s a concussion. Everyone is going to be treated differently, and the symptoms of similar hits can show differently from athlete to athlete.”
The science might be constantly changing, but doctors still know more now than they did just a decade ago. The most common form of TBI, concussions, are rated on a scale from mild to severe. Mild concussions account for 80 percent of all concussion diagnoses and come with a slew of immediate symptoms: headache, nausea, confusion, slow reaction time and more, including a loss of consciousness no longer than 30 minutes.
These symptoms appear when the brain gets jostled around inside the skull — a frightening image — but neuropsychologist Tara Kane of Centura Health in Lakewood says a concussion is rarely the end of life as an athlete knows it.
“A lot of people have this perception that the brain is permanently damaged after a TBI, and that’s not always the case,” Kane said at the TBI Seminar hosted by St. Anthony Summit Medical Center on Oct. 5 in Frisco. “You have to work through some of the behavioral and emotional issues first to get past that.”
Jennifer Kagan, nurse director for the traumatic brain injury program at the medical center, helped organize the TBI Seminar and brought together experts from across the state. They shared new information about symptoms and treatment, along with answers for questions about the new concussion protocols for youth athletes.
“It wasn’t that there was an increase in concussion, it was more about the realization that we’re seeing so many in our community,” Kagan said. “The acute care — taking care of them initially — is something we have down for serious traumatic brain injury. But in our community, we see so many adults, students and kids struggling with recovery, and they’re returning to the hospital or physical therapy because they weren’t sure how to address depression or struggles in school.”
After the hit
The new science of TBI can make it tough for folks in the field — the coaches, players, trainers and parents — to parse through the symptoms. Should players miss a game after one hard hit? Should they miss a week? More?
“Anything we can do to make this game safe for people is great,” Shirkey said. “I think football is a great game, and I don’t think it needs to be as violent as it has been. On the other hand, there’s a misconception that if you play football at any level you’ll get a concussion and end up with CTE (chronic traumatic encephalopathy) and go crazy. I hear that from parents — they’re afraid.”
For Kane and Kagan, the most important part of emerging TBI science is post-impact care. It starts with the Jake Snakenberg Act, a law put into place in 2011 that requires all Colorado coaches at all levels to take annual TBI training. This training helps them identify the symptoms of TBI and, if needed, get their players help. In other words, ignoring TBI is illegal, not just irresponsible. Coaches are required to bench a player if they suspect TBI, and the player isn’t allowed to return until a doctor clears them after at least two to three days of complete rest: no play, no practice, no school, no screens — nothing that can overload the brain in a fragile state.
“You’re seeing a shift in the sports culture,” Kagan said. “It used to be, ‘Shake it off and you’ll be fine.’ Now, a lot more attention and respect is being given to head injury recovery and prevention.”
Since coming to Summit High in 2010, Sedlak has worked closely with coaches to get everyone up to speed on TBI prevention and treatment. At first it was a struggle.
“There will always be a macho, tough side of sports,” Sedlak said. “There will be athletes who hide symptoms of concussion, so I tell parents and coaches, ‘It takes a village to take care of this epidemic,’ I’ll call it. I can’t be the chief.”
It’s gotten easier over time. Prior to each season, Sedlak meets with coaches for TBI training. This year, he showed a new film from the Summit Medical Center, called “Impact Free,” featuring interviews with Jerry Karl of Team Summit Colorado and Summit rugby players. In just a few years, he’s been impressed with how quickly coaches are adjusting to confusing — and sometimes frustrating — protocols.
“To be honest, this coaching staff at Summit are rock stars,” Sedlak said. “There’s such a bigger picture here when it comes to sports. Winning is important — we wouldn’t be playing if that wasn’t important — but you look at guys like Tommy (Gogolen) with soccer or John with football or Karl Barth with rugby and they get it: the student comes first, health comes first.”
On the slopes
In Summit County, TBI aren’t limited to the ball field. They’re the No. 1 trauma injury at the medical center, according to Kagan, and those diagnoses are led by the county’s No. 1 form of recreation: skiing and snowboarding.
Matt Voegtle, the snowboard program director for Team Summit, has been coaching for 16 years. Like Shirkey, there was no such thing as concussion protocol when he was competing, but he now admits he wouldn’t do anything less for his athletes.
“I think they’re necessary,” Voegtle said. “As I’ve gotten older, personally, when I hit my head now it doesn’t take a lot to put me down … and I think that’s hard for these kids to see. Now we think, ‘When in doubt, sit them out.’ You don’t even have to see them hit their head.”
But, again, Voegtle and his coaches are fighting macho sports culture. Helmets are mandatory for ski club practice and competition — he rarely has to remind an athlete to wear the brain bucket — but he’s noticed pushback off the snow.
“There is a part of the core culture — and this is exclusive to snowboarding — that thinks helmets are uncool,” Voegtle said. “There’s even a bit of revival in that culture. We run into a lot of resistance with skateboarding, but if they’re on my watch they have a helmet.”
Ski club coaches abide by the same Colorado laws as team sports, which means any time a coach suspects TBI they’re required to bench an athlete. Last season, Voegtle removed three snowboarders for multiple weeks due to concussion. When they returned, he eased them back into training, starting first with dryland work in the gym before basic technique on mellow runs. The terrain park only comes after three or four weeks of return-to-play training.
For Sedlak, dryland training is key. It strengthens neck muscles and has been shown to prevent mild concussions. True, he says, coaches and players can’t fully prevent TBI, but he also reminds everyone that concussions are, by nature, a retroactive injury — the worst comes long after that first devastating hit.
“My drive-home point with all this concussion stuff is honesty,” Sedlak said. “I can’t see inside your brain, so unless you tell mom and dad, or coach, or me, we can’t address this injury.”
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