TBI News

Pathologist says Waters' brain tissue had deteriorated

ESPN.com news services

NEW YORK -- A leading forensic pathologist told The New York Times that brain damage suffered by former NFL defensive back Andre Waters may have led to his depression and ultimately his suicide. The forensic pathologist, Dr. Bennet Omalu of the University of Pittsburgh, told The Times that the condition of Waters' brain tissue was what would be expected in an 85-year-old man, and there were characteristics of someone being in the early stages of Alzheimer's. The doctor said he believes the brain damage had come from or had been quickened by successive concussions.

Waters was 44 and a father of three when he died of a self-inflicted gunshot wound on Nov. 20 in Tampa, Fla., three days before Thanksgiving. "No matter how you look at it, distort it, bend it," Omalu told The Times in a telephone interview, "it's the significant forensic factor given the global scenario." If Waters had lived another 10 to 15 years, Omalu told The Times he believes "Andre Waters would have been fully incapacitated."

"Whatever its cause, Andre Waters' suicide is a tragic incident and our hearts go out to his family," the NFL said in a statement released to the media Thursday afternoon. "The subject of concussions is complex. We are devoting substantial resources to independent medical research of current and retired players, strict enforcement of enhanced player safety rules, development and testing of better equipment, and comprehensive medical management of this injury. This work over the past decade has contributed significantly to the understanding of concussions and advancement of player safety. We will continue with all these efforts and maintain our focus on player health and safety."

The league has a traumatic brian injury committee that will begin studying retired players later this year regarding concussions and depression. "The connection between depression and head injuries is likely but not proven," Leszek Christowski, the Hillsborough County medical examiner, told ESPN.com's Tom Farrey on Wednesday. "Scientifically, there is no [cause-and-effect] connection. Could it play a role? Yes. But the statistical studies do not show a clear-cut connection between concussion and depression."

The Times cited a study by the Center for the Study of Retired Athletes, based at the University of North Carolina, of 2,500 former NFL players that found that cognitive impairment, Alzheimer's-like symptoms and depression rose in direct proportion to the number of concussions a player had sustained. The same group conducted a 2003 study which found a link between multiple concussions and depression among former pro players with histories of concussions. Then 2005 study was a follow up to the one two years prior.

According to The Times story, written by Alan Schwarz, Chris Nowinski, a former Harvard football player and professional wrestler who has suffered a number of concussions, initiated the inquiry. He called the Waters family to request permission to use remaining parts of Waters' brain for testing. The family agreed and signed release forms in mid-December. Four pieces of Waters' brain were sent from the Hillsborough County, Fla., medical examiner's office to Pittsburgh for testing by Omalu. On Jan. 4, tests came back and Omalu said the results were similar to that of an 80-plus-year-old Alzheimer's patient. "It strikes me as pretty reasonable," Dr. Brent Masel, board member for the Brain Injury Association of America, said in reference to the quality of Omalu's analysis. Referring to studies that have likened head trauma in the NFL to that found in boxers, Masel added, "When you look at boxers and the problems they've had, it makes sense that you might find this in a football player, based on what we know." Waters was signed in 1984 by the Eagles as an undrafted free agent out of Cheyney State and played 10 seasons in Philadelphia. He finished his career with the Arizona Cardinals, whom he played for in 1994 and '95. Tom Farrey is a senior writer for ESPN.com and ESPN The Magazine.

 

THE SIGNATURE WOUND OF THE IRAQ

WAR

Posted by Robert Bazell, Chief Science & Health Correspondent (06:34 pm ET, 04/26/06)

Many troops in Iraq with brain injuries may be returning to duty. That’s right -– they’re  not getting treatment –- not even getting a break –- but going right back into the field. We've been reporting on the enormous numbers of brain injuries among Iraq vets for the past two nights. I'll reiterate the numbers and the reasons below. We could not fit this aspect of the story in these two reports, so I want to point it out here. 

According to the VA doctors who run the rehabilitation programs for brain injuries, when troops are wounded in the field they are evacuated immediately if they have any obvious wounds. But the signature enemy weapon of this war has been the roadside bomb – the IED.  The human brain is the consistency of gelatin and the force from the explosion shakes it ferociously. Many thousands of troops in Iraq have felt the blast of an IED. If they are knocked unconscious, according the VA docs, they too are evacuated to a field hospital for evaluation. But if they are not and if they do not complain of a problem, they remain on duty.

Specialists in brain injury know all too well that people can suffer brain problems without losing consciousness. One of the most frightening aspects of brain injury is that brain-injured people often lose the ability to know something is wrong.

Dr. Harriet Zeiner, a VA psychologist and brain injury specialist, was recently on a conference call with medical officials at several military  treatment facilities including hospitals in Iraq. "One of the things commanders are trying to determine," she says, "is that after someone has been exposed to five and six concussive blasts are they still battle ready? Frankly, that floored us. You could have very significant effects from one exposure, and now they're trying to figure out if people who've been exposed five and six times should be going back into battle."

To follow up on those comments, I called the Pentagon several times to request an interview with someone who would explain the policy of what field commanders do to determine if troops are suffering brain injury, and what is the policy for returning them to duty. My requests were denied repeatedly.

But beyond that problem, as we have been reporting, the toll of brain injury in this war is enormous. Almost 18,000 troops have been wounded according the Department of Defense. The VA doctors say that two-thirds of them have been injured by IED blasts and two-thirds of those exposed to blasts suffer some brain injury -- ranging from a mild concussion to permanent damage. Brain injuries -– thousands of them –- could be the legacy of this war just as much as post-traumatic stress and problems from exposure to Agent Orange persisted among many of the troops who served in Vietnam.

Jan 9, 2007 — Bob Woodruff's ABC Special Moved Up Because of Fast Recovery, Has Nothing to Do With Sweeps Week

Bob Woodruff's To Iraq and Back hour-long special – where he recounts the horrifying IED attack (and shrapnel injuries) he and cameraman Doug Vogt survived in Iraq nearly a year ago – was supposed to air in the spring. Then came word that his special was being moved up to a Feb. 27 air date. The official reason? Something about Woodruff recovering much faster than expected.

From helmet to sideline, device measures impacts to head

Football teams are studying applications

By Jessica Sidman | Jul 27, 2006 |

The latest football helmet innovation not only protects the head -- it can read the mind. Or at least what's happening to it. The Head Impact Telemetry System measures and records impacts to the head and sends a wireless signal to the sideline in real time. The device, which is being tested by several high school and college teams, is a tool to learn more about head injuries, and researchers hope it eventually will lead to safer helmet designs. Football is responsible for about 250,000 head injuries a year, according to the Brain Injury Association of America. Although the HIT System is not intended to be used to diagnose concussions, medical personnel can use it to better assess a player after a potentially damaging impact, says Rick Greenwald, inventor of the device and president of Simbex, a research and development company in Lebanon, N.H. The system also can be used with video footage as a coaching tool to demonstrate proper tackling, Greenwald says. "It's a tool for the doctor, it's a tool for the coach, and I think it can maintain the highest level of performance for players on the field," he says.

Head injury help is here now for NASCAR

Dale Earnhardt Jr., right, hid his concussion from fellow drivers Dale Jarrett, left, and Elliott Sadler for months

By Chris Jenkins, USA TODAY

If NASCAR officials are serious about improving the way they monitor drivers' head injuries, they can look to relatively new technology already used by other series. CART and the Indy Racing League are using the "ImPACT" program to make sure their drivers have fully recovered before they get back in the race car.

Developed at the University of Pittsburgh, ImPACT uses a computer program to test an injured athlete and compare results to a baseline test administered before the season. Drivers involved in a serious crash must pass the test before they can race again.

Although the system has been around only two years, it already is used by several hundred high school and college sports programs plus nine NFL teams. Mark Lovell, the system's co-developer, says diagnosing concussions usually is the easy part.

"It's determining when somebody is in good enough shape to go out and play, whether that's playing football or racing a car, that's the tricky decision," he says. "Athletes being athletes, they want to compete and aren't always honest about the way they feel."

NASCAR policies regarding head injuries have come under scrutiny after Dale Earnhardt Jr. said last week that a concussion he sustained in April hurt his ability to drive for months, but he kept the injury a secret. Other drivers, including Jeff Burton and Ricky Rudd, have admitted to hiding past head injuries so they could keep driving. In response, NASCAR announced that it will empower trackside doctors to order drivers involved in a wreck to get a CT scan.

Earnhardt said Tuesday that his decision to hide the injury was blown out of proportion by the media. Earnhardt says, in hindsight, he should have told NASCAR President Mike Helton: "I kind of hurt the trust between me and Mike a little bit," Earnhardt says.

Steve Olvey, CART's director of medical affairs, says a concussion can affect a driver weeks after the headaches and wooziness disappear. "A lot of times, they'll think they're OK," he says. "They're not really trying to hide anything."

If a driver with a concussion sustains another head injury, there is a slight risk of death from "second-impact syndrome."

ImPACT — Immediate Post-concussion Assessment and Cognitive Testing — can identify the lingering effects of a concussion. An athlete sits at a laptop for about 20 minutes, performing tasks that measure reaction time, concentration ability and short-term memory. The results are sent over the Internet to Lovell's office, where they are instantly compared to the athlete's baseline score from before the season. If the score is too low, the driver can't race.

Lovell says that NASCAR could implement the system next season for less than $100,000. NASCAR spokesman Jim Hunter wasn't familiar with the system but said the series' five-member medical advisory board likely would be interested in taking a look.

NASCAR has taken a more active approach to safety since the death of Dale Earnhardt, but it still relies primarily on racetracks to provide medical care. CART and the IRL have a medical director with final say on whether a driver is fit to race. The IRL's Gil de Ferran, a championship contender, sat out the season finale because doctors determined he had not recovered from a previous head injury.

"It's a tough decision because it's not a popular decision," says IRL director of medical services Henry Bock. "But as a doctor, you make those decisions every day."

Although this is ImPACT's first season in racing, CART and the IRL traditionally have been cautious about allowing drivers with head injuries to race. CART driver Christian Fittipaldi felt better two weeks after a serious accident in 1999, but eight hours of neurological testing revealed that Fittipaldi hadn't recovered. Olvey sat him down for another month. "They do all the rules," Fittipaldi says. "I had to listen to them."

Fittipaldi, who will be driving in NASCAR next season, says he believes ImPACT works. "I think every racing series should have something to make sure we're 100% OK," he says.

ABC News anchor Woodruff visits newsroom

 

NEW YORK June 16, 2006 (AP) — ABC News anchor Bob Woodruff on Tuesday paid his first visit to the network's New York newsroom since he was seriously hurt by a roadside bomb in Iraq on Jan. 29.

Woodruff's visit was a surprise, much like President Bush's trip to Iraq on Tuesday, and a crowd quickly gathered around him, said Jon Banner, World News Tonight executive producer.

"It's the first time many here had seen him, and he was greeted by a spontaneous round of applause," Banner wrote in the World News Tonight Web log. "You could literally see the emotion in each hug. There was barely a dry eye."

Woodruff talked about his rehabilitation, how he wanted to get back to work and how wonderful it was to spend time with his four children, Banner wrote.

"There are a lot of happy faces around the newsroom today," he said.

Woodruff has been recovering from serious head injuries and broken bones suffered in the attack. It's unclear when Woodruff will return to work and what he will be able to do: he was World News Tonight co-anchor with Elizabeth Vargas at the time of his injury, and Charles Gibson is now the sole anchor of the broadcast.

 

Troops risk undetected brain injury

Researchers: Concussions from blasts often missed

By Gregg Zoroya | Jun 7, 2006

Thousands of troops in Iraq and Afghanistan may be risking permanent brain damage by returning to combat with relatively minor but undiagnosed concussions, often caused by bomb blasts, military researchers say.

Doctors say they are only now understanding the scope of the problem. Researchers screening returning soldiers and Marines at four military bases found that about 10% suffered at least a minor brain injury during combat. About 20% of troops in front-line infantry units suffered such injuries.

The injuries frequently go undiagnosed because troops have no visible wounds or may not know they suffered a concussion, doctors say. Medics and field doctors often aren't aware of what happened during fighting.

More than 500,000 soldiers and Marines have served in or near Iraq and Afghanistan since Sept. 11, 2001, sometimes more than once.

"This blast group is going to be potentially huge," says Angela Drake, a neuropsychologist with the Defense and Veterans Brain Injury Center, a research arm of the Department of Veterans Affairs and the Pentagon. "We're looking at thousands of potential patients."

Military doctors describe brain injuries as a signature wound of these wars. That's because advances in body armor save soldiers who might have died in previous conflicts, but blast waves from roadside bombs can cause brain damage.

U.S. troops in Iraq are exposed to hundreds of bombings each month. "We've seen patients who have had three deployments and have had some (head) injury on every single one," Drake says.

The damage from multiple concussions can be irreversible. "Repeated concussions can be quite serious and even lethal," says Air Force Maj. Gerald Grant, a neurosurgeon who treated troops in Iraq.

The Brain Injury Center is urging the military to track the number of concussions troops suffer. A handful of military bases use the screening procedures developed by the center, but the Pentagon has declined to mandate the survey.

Pentagon health official Michael Kilpatrick questioned the accuracy of the screening and whether soldiers even remember information they're asked for: "Most people, when they get knocked out, don't really know it."

Military researchers, however, say the two-question survey has proved highly accurate.

"I think they're afraid," Drake says of the Pentagon's decision not to screen for concussions. "The sheer numbers are overwhelming. This is a worrisome thing. It's like opening a can of worms."

The Pentagon is developing a simple mental exam that medics can use on troops who may have suffered a brain injury. If the test shows evidence of a mild concussion, a servicemember could be kept from combat until the injury heals. Kilpatrick says this test could be used in Iraq within a few months.

Bob Woodruff recovering, able to speak

NEW YORK (AP) — Five weeks after ABC anchorman Bob Woodruff was seriously injured in an Iraqi explosion, he remains hospitalized but is able to say a few words and is starting to walk, his brother said Tuesday.

"In the last couple of days, he's taken a lot of great leaps forward," David Woodruff said. "He's definitely doing so much better."

Bob Woodruff and ABC cameraman Doug Vogt were standing in the hatch of an Iraqi mechanized vehicle, reporting on the war from the Iraqi troops' perspective, when the roadside bomb exploded Jan. 29. Both were wearing body armor, which doctors say likely saved their lives.

The men underwent surgery in Germany before being flown to the National Naval Medical Center in Bethesda, Md.

Woodruff, 44, still is on heavy pain medication as his body recovers from the serious head injuries and other wounds. But he recognizes people, he can tell his daughter he loves her, and the multilingual journalist has even said a few words in Chinese and German, his brother David Woodruff told ABC's Good Morning America.

The first response David Woodruff recalls getting from his brother in the hospital was a smile when he told him: I hate to tell you this, but you still have a face for TV.

"My brother's been an overachiever his entire life. I think none of us expected him to do anything less in this whole process," David Woodruff said. "We know that top on his mind is getting back to his family, to his kids and getting back to doing what he loves to do."

Bob Woodruff grew up near Detroit in Oakland County's Bloomfield Township and is a 1979 graduate of Cranbrook Schools in Bloomfield Hills.

Vogt left Bethesda Medical Center in late February and returned home to France, where he is undergoing rehabilitation, the network said.

Charles Gibson and Diane Sawyer have been substituting for Woodruff, who started as co-anchor of ABC's World News Tonight with Elizabeth Vargas earlier this year.

Seattle's Wistrom to Wear Innovative Helmet in Sunday's Big Game

Designed With Insights From NFL-Sponsored Study on Brain Injuries, Schutt DNA Helmet to Make Championship Game Debut

Jan 30, 2006

DETROIT, Jan. 30 -- As billion-dollar companies unleash major marketing campaigns this week during the buildup to Sunday's championship game, Litchfield, Ill.-based Schutt(R) Sports is tackling the spotlight with a unique, state-of-the-art helmet that will make its big-game debut on the head of Seattle's defensive end Grant Wistrom. Designed with insights from an ongoing, NFL-sponsored study that is providing new information about mild traumatic brain injuries, the Schutt DNA(TM) helmet exclusively features military-developed technology: new-to-the-game SKYDEX(TM) technology developed for Army paratrooper helmets and Navy SEAL boats. "Without a question it's the most comfortable, best-fitting helmet that I've ever put on," said Wistrom, who will be playing this Sunday in his third league title game. "I'm not even aware I have it on -- and in that way it does enhance my game." The Schutt DNA's spherical shell is designed to make for a more glancing blow, particularly on helmet-to-helmet contact. The helmet's SKYDEX lining attenuates shock and dissipates energy better than foam. And, because SKYDEX is thinner and lighter than traditional foam, it allows for more comfort cushioning inside the helmet.

 

Clinical Trial to Test Stem Cell Approach for Children with Brain Injury

HOUSTON—(Dec. 20, 2005)—A unique clinical trial will gauge the safety and potential of treating children suffering traumatic brain injury with stem cells derived from their own bone marrow starting early next year at The University of Texas Medical School at Houston and Memorial Hermann Children’s Hospital. 

The clinical trial is the first to apply stem cells to treat traumatic brain injury. It does not involve embryonic stem cells.

Studies Suggest 10% of Arizona High School Football Players Will Suffer a Concussion During This Coming Season

Aug 23, 2005

PHOENIX, Aug. 23 -- With the high school football season just around the corner, coaches, parents and athletes need to focus on one of the most overlooked, misdiagnosed and least understood injuries that is sure to affect some of the 18,000 student-athletes in Arizona who will strap on the pads this year: sport-related concussion, or mild traumatic brain injury (TBI).

"The biggest problem in managing sports-related concussion is recognizing the injury, especially in athletes with no obvious signs that a concussion has actually occurred," says Tamara McLeod, Ph.D., ATC, assistant professor, Sports Health Care Program, Arizona School of Health Sciences in Mesa. "Traditional neurological and radiologic procedures such as CT, MRI and EEG, although helpful in ruling out other causes of neurologic symptoms, are not useful in identifying the effects of mild TBI (concussions)."

Recent studies show that more than 62,000 concussions occur each year in high school sports, with football accounting for two of every three, according to the Brain Injury Association of Arizona. However, many mild concussions likely go undiagnosed and unreported. Studies estimate that approximately 10 percent of all athletes involved in contact sports such as football have a concussion each year. In addition, close to 6 percent of concussions may go unreported because athletes are not aware of the signs and symptoms and do not think the injury is serious enough to report to medical personnel.

Allowing enough healing and recovery time following a concussion is crucial in preventing further damage to the athlete. Most athletes who experience an initial concussion can recover completely, as long as they are not returned to contact sports too soon. Following a concussion, there is a period of change in brain function that usually lasts anywhere from 24 hours to 10 days but may last weeks or even months. During this time the brain is vulnerable to more severe or permanent injury. If the athlete sustains a second concussion during this period, the risk of permanent brain injury increases.

"Let's face it," adds Dr. McLeod, "the typical high school athlete is competitive and wants to return to the game despite any minor symptoms. The concern is that before an athlete is fully recovered from an initial concussion, he or she is more susceptible to a second concussion and is at higher risk for further, more serious damage."

Keeping an athlete out of contact play until he or she is fully recovered is absolutely essential to preventing further injury, explains Dr. McLeod. "No athlete should ever return to contact sports before it's determined his or her recovery is complete," she emphasizes.

The problem of the lack of a simple, objective identification method is compounded by the fact that too many Arizona high schools do not have qualified full-time sports medicine staff trained in sports concussion. Fortunately, there is hope on the horizon. Recent career-ending concussions suffered by high-profile athletes such as Steve Young of the San Francisco 49ers have increased awareness. In addition, new objective concussion assessment tools now make it easier to identify deficits caused by injury and to monitor post-injury recovery.

One tool is a computer-based neurocognitive testing program designed to aid in the management of sports-related concussion. The program uses baseline and post-injury neurocognitive testing to track recovery for safe return to play.

The Brain Injury Association of Arizona is a non-profit membership organization of people with brain injuries and their families, friends, and service providers working together since 1983 to provide information & referrals, education, advocacy and support for those affected by brain injury. BIAAZ is the only statewide organization in Arizona dedicated to enhancing the quality of life for people with brain injuries and their families and preventing brain injuries. BIAAZ is a chartered state affiliate of the Brain Injury Association of America.

 

Key Iraq wound: Brain trauma

Body armor prevents death, not damage

By Gregg Zoroya | Mar 4, 2005 |

A growing number of U.S. troops whose body armor helped them survive bomb and rocket attacks are suffering brain damage as a result of the blasts. It's a type of injury some military doctors say has become the signature wound of the Iraq war. Known as traumatic brain injury (TBI), the wound is of the sort that many soldiers in previous wars never lived long enough to suffer. The explosions often cause brain damage similar to "shaken-baby syndrome," says Warren Lux, a neurologist at Walter Reed Army Medical Center in Washington. "You've got great body armor on, and you don't die," says Louis French, a neuropsychologist at Walter Reed. "But there's a whole other set of possible consequences. It's sort of like when they started putting airbags in cars and started seeing all these orthopedic injuries." The injury is often hard to recognize -- for doctors, for families and for the troops themselves. Months after being hurt, many soldiers may look fully recovered, but their brain functions remain labored. "They struggle much more than you think just from talking to them, so there is that sort of hidden quality to it," Lux says.

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