Guest Blog: Concussions: The Gender Differences

By Arleigha Cook as a Guest Blogger

“You just have to get back out there.”

“That’s not a concussion headache.  That’s just a hunger headache.”

“Just start exercising.  That helped me.”

These quotes are all from conversations I had regarding concussions.  At a glance, I’m sure you sense a pattern.  Each of the above is a well-intentioned piece of advice, but, characterized by the notorious word “just,” each of these replies is incurably dismissive. In fact, they all tore at something inside me, as if the speaker took a look at me, saw my hope for validation of my concussion symptoms, and then pulled out the carpet from underneath me with an overtly simplistic suggestion of a quick recovery method that I should have seen before.

Interestingly, these people were brain injury survivors themselves.  And they were all male.

Hearing from another concussed individual that I should have been doing something different from the get-go – especially something as simple as beginning to exercise or just “getting back out there” was devastating.  To this day, each time I hear a suggestion of that nature, I sigh and push away an emotional reaction.  It was especially invalidating to hear from one of my friends (a skier and rugby player who had previously sustained three concussions) who said, “That’s not a concussion headache.  That’s just a hunger headache.”  To me, the pain of a “hunger headache” is the same as that of a “concussion headache.”  A hunger headache is a concussion headache.  Likewise, I have not been able to exercise without almost immediately experiencing concussion symptoms for over a year and seven months – I’m sure you can imagine how quickly I dismissed his “advice.”

These interactions got me thinking: men seem to recover from concussions more quickly than women do.  And even when they don’t, they seem to have a dismissive or nonchalant attitude about their recovery. So I started researching that idea, but only came across studies suggesting the contrary.  For example, a recent study published in the journal Radiology suggests that men actually take longer to recover from a concussion than women (see a Huffington Post article about the study here).While I have always thought I sounded like a hypochondriac, my tendency to air on the safe side may actually prove more beneficial than the laissez faire attitudes of concussed males. More than a few times I’ve come across men with concussion experience who think I’m exaggerating my symptoms (hence, “That’s not a concussion headache.  That’s a hunger headache.”).  The study featured in the Huffington Post article above even found, through diffusion tensor imaging (DTI – a form of MRI), that men seem to sustain significantly more abnormalities in a particular area in the white matter of their brains, otherwise known to scientists as the Uncinate Fasciculus.

Is this related to a basic genetic difference between men and women?  Is it the significant change to the Uncinate Fasciculus that causes male concussion patients to underestimate the time, importance, and attention their brains need in order to recover more quickly and effectively?  Presently, it’s hard to say.

My observations – which largely consist of college-age male athletes who receive concussions from football, lacrosse, and soccer – indicate that most men may have an oversimplified idea of the effort and duration involved in a timely and effective recovery.  While many women who have sustained one or moreconcussions seem to doubt their recovery or want to protect themselves through limiting exercise or other potentially dangerous activities, men seem to bear few reservations about returning to physical activity post-injury.  And, research has shown that maintaining a lower level of physical activity – if possible – can aid in the recovery process (see University of Buffalo’s 2013 study “Exercise treatment for postconcussion syndrome: a pilot study of changes in functional magnetic resonance imaging activation, physiology, and symptoms”).

This leads me to consider whether or not one’s cognitions can influence recovery speed.  There are biological differences thatinfluence concussion incurrence rates and recovery in men (such as neck strength, which can affect the damage done to the brain upon impact), but psychological state may be crucial in regards to recovery as well.  My questions: Is a healthy mental state essential for faster recovery?  Do males with concussions tend to have healthier mental states than do females with concussions?  If so, how and to what degree does this impact recovery?  My personal observation dictates that many athletes who have ended their careers as a result of concussion buildup have experienced long-term depression and anxiety because of the sudden life change due to the incurrence of brain injury.  I have especially noticed this in females.  This is not to say that males do not experience these manifestations of psychological distress; rather, it is to insinuate that psychological elements of recovery seem to affect women to a more severe degree and for a longer duration.

For now, we can only hypothesize.  The question of gender influences on concussion recovery is one that is currently being studied, and with the accelerating growth of the concussion field, there is much more to learn about gender, psychology, and outside factors that impact the recovery process.  And of course, with the more that we learn, the more we discover there is to learn.  There may be a large psychological component in recovery, and males may be predisposed to more easilyreframing cognitions surrounding this invisible injury.  Certainly there should be research done on this in the future.

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Arleigha Cook is a brain injury survivor and a former soccer player and sprinter for Trinity’s Womens’ soccer and track and field teams.  After surviving her fourth concussion and receiving a diagnosis of Post-Concussion Syndrome, she has turned her focus to educating others about the effects of concussions.  An English major with a concentration in creative writing, Arleigha started a blog, www.brainmatter4.blogspot.com, on which she posts her thoughts about her own personal experiences with brain injury.  She has also been a guest blogger for B Stigma-Free and has spoken with Elite Sports Medicine at the Connecticut Children’s Medical Center about concussions, using her personal story as an example.  Currently, she is over 1.5 years into her recovery.

The Concussion Conference 2.0: RTL THEN RTP

One Day Concussion Management Training for School Nurses, School Staff and other Professionals who work with Concussed Students

The Concussion Conference 2.0

Wednesday, May 7, 2014  from 8 a.m. to 4 p.m.

Quinnipiac University School of Medicine | 370 Bassett Road | North Haven, CT

Due to the overwhelmingly positive response from 78 School Nurses, 25 MDs, and 25 ATs who attended the Jan 2014 Concussion Conferences and requests for more concussion management training, this new conference includes both:

• Advanced training with case studies for those who attended the 1st conferences to return for a higher level of study
• Basic foundation sessions for new participants

This conference will provide basic and advanced concussion management training for:

• School nurses
• School psychologists
• School guidance counselor/social workers
• School special education directors
• 504 Coordinators
• Athletic Trainers
• Physicians, PAs, and APRNs

See Flyer May2014 Concussion Conf_@QU(4)

Speakers for The May 7 Concussion Conference include nationally known experts and panels of local concussion professionals comprised of pediatricians, physical therapists, neuropsychologists, and advocates of brain injury prevention and athletic training education: Dr. Tricia McDonough-Ryan, Dr. Thomas Trojian, Katherine Snedaker MSW, Dr. David Wang, Dr. Mike Lee and the team of experts from Gaylord Center for Concussion Care, Representative from CATA; Deb Shulansky from Brain Injury Alliance of CT (BIAC); Brain Injury attorney and BIAC Board member Paul A. Slager; Charlie Wund, Founder & President Agency for Student Health Research; and Dr. Karissa Niehoff, The Executive Director at CT Association of Schools and CT Interscholastic Athletic Conference

Register now at TheConcussionConference.com  - Early bird pricing until Monday, April 7

Event produced by Katherine Snedaker, PinkConcussions.com and SportsCAPP.com

Co-sponsored by Gaylord Center for Concussion Care

Each participant will be trained and will leave with a framework and materials needed to create a Concussion Management Team. The purpose of the CMTeam is to handle the 80% of concussions that resolve in the first month, based on research and nationally recognized best practices.  For concussions that last beyond the 4 week period, academic accommodations will be taught which can be created in an IEP or a 504 plan for those students.

Early Morning Sessions are split between:

Foundation for First Time Participants

• Concussion 101 for School Staff and Medical Providers
• Concussion’s Impact on School: Strategies and Adjustments in the First 3 Weeks
• Time to Retire? Factors in a teen’s decision to retire from contact sports

Advanced Case Studies for Participants from 1st conference or Concussion Professionals

• Presentation of Case Study #1: A case from Gaylord Center for Concussion Care
• Presentation of Case Study #2:  A case from Dr. Ryan and Kim Zemo, Social Worker

Late Morning and Afternoon Sessions for All Participants

• Existing Models of Concussion “Return to School” Plans in the USA and CT
• The Timing of Return to Learn (RTL), “Buffalo Protocol,” Return To Play in Student Athletes
• Beyond the Diagnosis: Eyes, Balance and Gait
• Post Concussion Syndrome: Depression, Isolation and Identity Loss, CTE Fact & Fiction
• Post Concussion Syndrome: Academic Modifications After One Month, Home Life Support
• New Research on “Does Concussion Education Work” and Concussion Resources
• The Past: State of CT Concussion Law and Development of Module #15
• The Present: CIAC’s Concussion Policy and Connecticut Law

Continuing Education Credits

• Gaylord Hospital is an Approved Provider of Continuing Nursing Education by The Connecticut Nurses’ Association, an Accredited Approver by the American Nurses’ Credentialing Center’s Commission on Accreditation. CNE application is pending for this program.
• This program has been submitted to The Commission for Case Manager Certification for approval to provide case managers pending clock hours.
• This activity is pending approval from the National Association of Social Workers.
• Program pending CME Activity approval via CT AAP.

Register now at TheConcussionConference.com

To participate as a conference sponsor or exhibitor, please contact Katherine at 203.984.0860 or Katherine@PinkConcussions.com

<May2014 Concussion Conf_@QU(4).pdf>

Guest post: 29 Fatality Cases of American Football Players in 2013

Originally posted at ChaneysBlog.com, currently offline. 29 Death Cases of American Football Players, 2013

Guest re-posting of Matt Chaney's Blog

Posted Sunday, November 17, 2013

Collision deaths of American high-school football players have increased markedly during 2013, suggesting this is not the year, once again, for “behavior modification” of modern ramming players who strike according to natural physics and the techno force of bullet-head helmets.

“Heads Up Football”—the latest version of old “head up” form theory for helmet-less hitting in forward-colliding sport, invalid through application attempts since the 1960s yet promised today by NFL commissioner Roger Goodell—has not prevented the fatal head and neck injuries of at least six high-school players this year, likely more pending further announcements of postmortem findings.

Below are 6 annotated cases of reported collision deaths among preps, followed by 3 possible collision fatalities of teen players for the year thus far, through Sunday, according to this blog’s ongoing review of critical gridiron casualty cases in Google information banks

By comparison, only one prep fatality involving collision was reported last year for tackle football, 2012 online: Dana Payne, 15, Tennessee, a running back drilled in a scrimmage, unable to rise afterward, whose cause of death was bronchial asthma with torso impact contributing, according to the Shelby County Medical Examiner’s Office.

An additional 7 cases below are apparently game-related player deaths during 2013, with no link to impact injuries per information available at this time; the fatal conditions apparently originated from physical exertion and more bodily stress during football-specific activities.

Finally, 13 cases of active player deaths reported during 2013 can neither be verified nor nullified for hard link to football, for a total collection below of 29 cases.

As usual, for electronic reviews since 2011, ChaneysBlog makes no scientific claim of case listings beyond raw information and disavows any qualification as football epidemiology.

Several limitations restrict injury reporting in vast American football, if not outright nullifying reliable collecting among millions of players mostly juvenile, particularly regarding the worst cases.

These annotated casualty cases of American football players are compiled strictly of information available in Google, primarily news reports, and require highly specialized follow-up for sound medical qualification.

These cases do not include 2013 deaths of active football players such as suicides, drug overdoses and more dangerous behavior outside competition and training. No deaths of coaches, referees and other field officials are included.

My heartfelt condolences to every one of the families below.

Deaths of Football Injuries Reportedly Involving Collisions

May 13:  Jaleel Gipson, 17, Louisiana, a running back for Union Parish High School, sustained a fractured cervical vertebra while colliding in the head-on “Oklahoma Drill” during spring football practice on May 9. Four days later, Gipson was removed from life support and pronounced dead at hospital. “The injury occurred during a tackling drill,” reports Monroe sportswriter Cody Futrell. “Gipson was the ball carrier, and the coaching staff said he and the tackler used proper technique.” The school principal, David Gray, also contends that Heads Up theoretical technique, headless hitting, avoiding initial contact even by facemask, ruled a collision between players charging head-on that left one with a fatal broken neck. “Jaleel was carrying the football. He was head up in the exact position he needs to be,” Gray says. “The tackler led with shoulder as textbook, as taught and just an extremely unfortunate circumstance occurred. Tragic, a very tragic situation.” No video of the injury in practice was available online at time of this posting.

Aug. 16:  De’Antre Turman, 16, Georgia, defensive back/receiver for Creekside High School, suffered fracture of the C3 vertebra while making a tackle during a scrimmage. “Tre broke on [the ball carrier], dislodged the ball and his body just went limp,” says witness Glenn Ford, who coached Turman in offseason training. The teenager, a recruit of the University of Kentucky, was later pronounced dead at hospital. “It was a fundamental tackle,” Ford says. “[Turman’s] head was up. It was a clean tackle. It was a clean tackle. He went down. Only God knows. You know, only God knows what happened.” No video of the scrimmage tackle was available online at time of this posting.

Aug. 28:  Tyler Lewellen, 16, California, collapsed on sidelines during a scrimmage on Aug. 22, suffering a severe brain bleed. A CT scan revealed trauma and cerebral swelling and Lewellen remained comatose in ICU for five days, until life support was removed and he died soon after. Family members say doctors speculated whether the injury was a “second impact” from a previous undiagnosed concussion. Coaches say no clear evidence of a fatal head impact exists on video of the scrimmage, and on his last play Lewellen struck a ball carrier “with what appeared to be a glancing blow of the shoulder,” reports The New York Times. Autopsy results or video of the full scrimmage were not available online at time of this posting.

Sept. 16:  Damon Janes, 16, New York, running back for the Westfield-Brocton “combined” team between two small high schools, suffered severe brain bleeding during a game on Sept. 13 and died three days later at hospital. Teammates, family members, other parents and news media say Janes was injured by a helmet-to-helmet hit in the game’s third quarter. Meanwhile, Gary Swetland, coach of the opposing team, Portville High, said his review of game video found “no obvious play that would lend one to think that a catastrophic injury was occurring or would occur,” reports The Buffalo News. The Westfield-Brocton team’s remaining football season was cancelled following the tragedy. Final autopsy results and complete game video involving the injury were not available in Google at time of this posting.

Oct. 6:  Dylan Jeffries, 17, West Virginia, a running back/defensive back for South Harrison High School, suffered a “massive blood clot” of the brain during contact in a football game on Sept. 27. Emergency surgery relieved pressure and Jeffries was placed in a medically induced coma, but he died after nine days hospitalized. Family friend Mileena Beety wrote online: “To the Lincoln football team: Dylan knew many of you and was very excited about this game. Please do not blame yourselves if you tackled him or came in any contact with him throughout the game. He would have done the same to you if you were carrying the ball.”

Nov. 11:  Charles Youvella, teenager, Arizona, a senior running back/defensive back for Keams Canyon Hopi High School, suffered severe brain bleeding during a game and died two days later at hospital. “Midway through the fourth quarter [with his team trailing 60-6], Youvella caught a pass followed by what officials said appeared to be a typical football tackle. On the way down, the back of Youvella’s head hit the ground hard,” report Chris Williams and Richard Obert for AZCentral.com. Autopsy results were unavailable on Google at time of this posting.

Football Deaths Possibly Involving Collision, American Football 2013

Oct. 12:  Dodi Soza, 16, a running back for Downey High School, collapsed during a football game on Oct. 10 and died two days later at hospital. Soza had just scored a touchdown when he fell stricken, and initial reports of the casualty were of a possible cardiac arrest; later, Soza was reported to have sustained a brain injury. No confirmation or video of a collision injury was available in Google at time of this posting, nor were final autopsy results.

Oct. 29:  Jacob Vick, 15, Virginia, a linebacker for New Kent High School, collapsed during football practice and later died at hospital. New Kent coach Dan Rounds said the starting varsity linebacker had just returned to play following diagnosed brain trauma: “Rounds said Vick recently sat out a game after sustaining a concussion, but received medical clearance to play in [the Oct. 25] game against Lafayette. Rounds said that after consulting with Vick’s parents, he did not play Vick in the game against Lafayette,” reports Marty O’Brien for The Newport News Daily Press. Autopsy results were unavailable in Google at time of this posting.

Nov. 14:  Chad Stover, 17, Missouri, a football player for Tipton High School, suffered severe brain bleeding during a game on Oct. 31. Emergency surgery was performed and Stover remained comatose until dying two weeks after the injury. Autopsy results were publicly unavailable at time of this posting, and any evidence of football’s causing the brain hemorrhage remains unclear. An anonymous news source says Stover “had an undiagnosed preexisting medical condition, which may have been triggered by his participation in a contact sport,” reports KRCG-TV.

Player Deaths Involving Exertion or Stress of Football-Specific Activity

Jan. 5:  Chandler Williams, 27, wide receiver for the Tampa Bay Storm, of the Arena Football League, collapsed while competing in a flag-football tournament, dying of cardiac arrest. Williams formerly played in the National Football League.

Aug. 3:  Evan Raines, 16, North Carolina, a lineman for Seventy-First High School, experienced breathing problems after sprints to end football practice. Responders treated Raines for possible heat illness before he was transported to a hospital, where he later suffered cardiac arrest and died.

Aug. 7:  Mitchell Cook, 14, California, a football player at Canyon High School, collapsed during warm-up drills at practice and was pronounced dead at hospital, apparently of cardiac arrest. Family members said Cook had a pre-existing heart condition that wasn’t considered life-threatening.

Aug. 16:  Kaylan Carter, 16, California, a running back/defensive back for Enochs High School, collapsed of cardiac arrest during a weight-training session at the school on June 24. Carter remained comatose in ICU until life support was removed seven weeks later, and he died soon after.

Sept. 25:  Jake West, 17, Indiana, a linebacker for LaPorte High School, suffered cardiac arrest during football practice and was later pronounced dead at hospital. An autopsy revealed “right ventricular cardiomyopathy,” reports WNDU-TV.

Oct. 4:  Andre Maloney, 17, Kansas, a defensive back/receiver for Shawnee Mission West High School, suffered a cerebral stroke during a game on Oct. 3 and died the next day at hospital. Maloney, a recruit of the University of Kansas, had just scored a touchdown when he collapsed along a sideline.

Nov. 1:  Caleb Allridge, 16, Louisiana, a lineman for Covenant Christian Academy, collapsed at home and later died at hospital, of a pulmonary embolism. His brother, Wilfred “PJ” Allridge III, said Caleb had been sidelined for weeks because of a knee injury in football: “Caleb was recovering from a dislocated knee injury that forced him to miss several football games this season, and PJ said swelling from the injury ended up causing an undetected blot in his heart and lungs,” reports Chris Singleton for HoumaToday.com.

Additional Deaths of American Football Players, 2013 To-Date

Jan. 15:  Toron Murphy Jr., 17, Michigan, an offensive lineman for Martin Luther King Jr. Senior High School, collapsed after arriving at school in the morning and was pronounced dead at hospital, of cardiac arrest, dilated cardiomyopathy.

Jan. 21:  Serxho Guraleci, 22, Michigan, senior defensive lineman for Wayne State University, collapsed during a weight-lifting session with teammates, dying of a heart attack “caused by a blood clot or hardening of the arteries typically from high cholesterol that a doctor says more than likely was genetic,” reports The Macomb Daily News. Guraleci had recently completed four seasons of football for Wayne State.

Feb. 2:  Parker Allred, 16, Utah, football player and water polo player for Timpview High School, died of complications from staph infection and influenza.

Feb. 14:  Xavier Walton, 20, Indiana, defensive lineman for Anderson University, collapsed while playing intramural basketball, suffering loss of heartbeat, and was pronounced dead at hospital. No autopsy results were available online at time of this posting.

Feb. 27:  Falobi Akanbi, 17, Texas, an offensive lineman recruit for Montana State University, collapsed while playing pickup basketball and later died at hospital. Akanbi was a senior at Dawson High School in training for college football.

March 23:  Michael Raybourn, 16, Missouri, a lineman for Excelsior Springs High School, died during sleep at his home.

June 26:  Chad Stamper, 15, Minnesota, a football player and wrestler in training for Mora High School, died “of heart failure attributed to a pre-existing heart defect,” reports The Kanabec County Times.

Aug. 10:  Sam Woodruff, 15, Utah, an offensive lineman for Grand County High School, died at home in the afternoon, during summer two-a-day practices. The team had practiced the previous night and that morning, and Woodruff was readying to attend evening practice when family members found him in a bathtub of running water, unresponsive. Woodruff had expressed concern for his weight and health to teammates, and family members suspected a heart problem affected him. No autopsy results were available online at time of this posting.

Sept. 15:  Cameron Espinosa, 13, Texas, a lineman for Haas Middle School, suffered allergic reaction to ant bites during a game on Sept. 11, with the insects occupying mounds across the field of the Corpus Christi Independent School District. Espinosa died after four days hospitalized. Such casualties as the Espinoza tragedy are sometimes qualified as football-related, like the death of 11-year-old Jesse Watlington last year in Florida, caused by a lightning strike before team practice at Southwest Florida Christian Academy.

Sept. 27:  Cameron Smith, 13, Kentucky, a lineman for Campbellsville Middle School, died suddenly at his home. “The Kentucky Middle School Football Association said Cameron Smith just stopped breathing,” reports WHAS-TV.

Oct. 22:  Elijah Allen, 11, California, collapsed while playing football during recess at Vista Heights Middle School and later died at hospital. Some students say Allen was tackled as he went down, but teachers and school administrators say only a game of touch football was in progress. A pre-existing medical condition might have contributed to the death.

Oct. 23:  Chase Watson, 15, Ohio, a receiver for Marlington High School, collapsed while jogging with a friend after football practice that afternoon. Watson was pronounced dead at hospital. Final autopsy results were not available in Google at time of this posting.

Nov. 5:  Kylin Polhill, 14, New Jersey, a lineman for Marist High School, collapsed while playing pickup basketball on Nov. 4, having “stopped breathing,” and died the next day. Autopsy results were unavailable in Google at time of this posting.

Launch of International Study of Male Athletes and Concussions

Press Release: Monday, November 2, 2013 

Launch of International Study of Male Athletes and Concussions

Study of Female Concussions Launches 2nd Study, to explore Male Athletes’ Experiences with Concussions

Contact:

Katherine Snedaker, MSW, PinkConcussions.com / 203-984-0860 PinkConcussions@gmail.com

Dr. Jimmy Sanderson, Clemson University / 864-656-3996 jsande6@clemson.edu

Norwalk, CT – Media attention and public interest in sports concussion injuries has been increasing at a rapid rate. As a result, it is important for researchers and concussion advocates to enhance research efforts on this very important topic. To provide some insight on female concussions, we launched a research study in October 2013, which focused on female athletes from all sports, and their past and present experiences with concussions. Via social media tweets & posts about the study, 652 women contacted us to participate. Of the 597 women who were eligible to participate and sent a link to the survey, 538 women completed the forty question online survey. This research study was also was designed to explore female verses male athletes' experiences with reporting concussions, another salient avenue in the concussions dialogue, as many athletes do not report concussions willingly or are mis-diagnosed.

Now we are recruiting for a NEW IBR approved study of male athletes and their experiences with concussions in conjunction with our recent efforts to recruit female athletes to discuss their concussion experiences.

This research aims to explore reasons why male/female athletes would report or not report concussions and examine potential gender differences that can inform the athletic, medical, and academic communities.

Current and former male athletes are eligible for this study which will be conducted by researchers from Clemson University with the advocacy group, Pink Concussions. For this study, male athletes, age 18 and over, who are willing to participate can sign up now at PinkConcussions.com or click here. Participants will be emailed a link to a twenty-minute online survey about their experiences with sports and non-sport concussions and reporting concussions.

The research also will investigate male/female athletes' willingness to have genetic testing that may show links to the repair and recovery of brain cells after concussion. After finishing the survey, participants in the study can opt for an additional study and consider submitting DNA collected by a cheek swab to be tested for variants at the Apolipoprotein E (APOE) gene.  Testing for certain genes has previously documented an association between specific genetic factors and outcomes from injuries such as concussion.

Apolipoprotein E is a protein that is important in the repair and recovery of brain cells that have been damaged due to concussion. The clinical studies point to a relationship between certain genetic signatures and poorer overall concussion response. While additional evidence is needed to better understand the relationship between APOE status and concussion outcomes, the American Academy of Neurology introduced APOE testing into concussion management guidelines this year.

This research will be beneficial in shedding light on and male female athletes’ experiences with concussions and reporting concussions. We hope the results of this research will help further concussion research by focusing on the communicative element present in this issue, and the results of the study will be helpful for athletes, parents, administrators, physicians, and advocates.

Co-Researchers in this study are Dr. Jimmy Sanderson and Dr. Melinda Weathers in the Department of Communication Studies at Clemson University, along with Ms. Katherine Snedaker, MSW, of PinkConcussions.com.

# # #

For more information about this study, help in recruiting athletes or to participate in the study, please fill the contact form at PinkConcussions.com or contact:

Dr. Jimmy Sanderson

Clemson University

jsande6@clemson.edu

864-656-3996

Katherine Snedaker

PinkConcussions.com

PinkConcussions@gmail.com

203-984-0860