Closed Brain Injury (Concussions) The Subtle Incapacitator

Dale Earnhardt, Jr.

(WOMR file photo)

Dale Earnhardt, Jr. came out front on Thursday, with his admission that he has suffered two concussions within the last six weeks.

What is a concussion?

Concussions are traumatic head injuries that occur from both mild and severe blows to the head. Some head injuries may appear to be mild but research is finding that concussions can have serious, long-term effects, especially repeat head injuries or cumulative concussions.

A concussion is typically caused by a severe head trauma during which the brain moves violently within the skull. The brain cells all fire at once, much like a seizure. Some studies show that patients who suffer a concussion appear to have the brain activity of people in a coma.

A concussion may result from a fall in which the head strikes against an object or a moving object strikes the head. A suddenly induced turning movement such as a blow that twists the head (like a punch to the side of the face) is more likely to produce unconsciousness. However, significant jarring in any direction can produce unconsciousness.

Early Concussion Symptoms May Include

  • Confusion
  • Disorientation
  • Memory loss
  • Unconsciousness
  • Unequal size pupils
  • Headache
  • Dizziness
  • Tinnitus
  • Nausea
  • Vomiting
  • Vision changes

Late Concussion Symptoms May Include

  • Memory disturbances
  • Poor concentration
  • Irritability
  • Sleep disturbances
  • Personality changes
  • Fatigue

Sports Concussions Linked to Depression and Cognitive Deficits

Depression is one of the many symptoms experienced by athletes following concussion. In fact, some research finds the prevalence of depression in head trauma patients can be as high as 40 percent. Several studies have also shown a link between a history of brain injury and a higher probability of developing major depression later in life.

  • One study on concussion in athletes from the Montreal Neurological Institute of McGill University identified a neurological basis of depression in athletes who have had concussions. Imaging tests done with functional MRI on athletes who had depression following a concussion showed the same pattern of brain activation as patients with major depression.
  • Another study found that of 2,552 retired pro-football players, over 11 percent of those with a history of multiple concussions also had a diagnosis of clinical depression. Players reporting three or more previous concussions were three times more likely to be diagnosed with depression than those with no history of concussion.
  • A study by researchers at the University of Illinois at Chicago College of Medicine reported finding structural changes in the white matter of the brains of patients with head injuries, with the most severe head injuries showing the most structural change. These structural changes correlate to cognitive deficits in thinking, memory and attention.They also found that some mild head injuries caused damage only to the outer surface of the nerve (the myelin sheath of an axon), which may be able to be repaired, but more severe head injuries caused damage to the axon itself, which may not be as easily repaired. If an axon is severed, it is unlikely that it can repair itself.

    Concussion Assessment and Testing in Athletes

    Deciding when an athlete should return to sports after a concussion remains a matter of controversy within the medical community. However, various research projects continue to learn more about concussion assessment and evaluation.

    In 2010 researchers at the University of Michigan’s Department of Physical Medicine and Rehabilitation developed a simple and inexpensive reaction time test that may help identify athletes who have a head injury that is serious enough to require time off from sports.

    Researchers at the University of Pittsburgh’s Sports Medicine Center developed a computer program, Immediate Post-Concussion Assessment and Cognitive Testing system, or ImPACT, which measures an athlete’s memory, reaction time and processing speed in order to help determine when an athlete can safely return to sports after a head injury.

    The test measures an athlete’s baseline results at the start of a season. They retest any athlete who sustains a head injury or concussion. The results of the testing provide an objective assessment of whether the athlete is healthy enough to return to play. The ImPACT program is currently used at many high schools and colleges, as well as the National Football League and National Hockey League.  (sportsmedicine.com)

These closed head injuries, better known as concussions are very subtle, but may have very serious and long-lasting results.  Witness NASCAR drivers Ricky Craven, Ernie Irvan, Bobby Allison, Sam Ard, and Jerry Nadeau, just to name a few.

Twelve drivers have been diagnosed with concussions in the past five years. The last was Nationwide Series driver Eric McClure, who drove head-first into the inside wall at the Talladega Superspeedway in April. He wasn’t cleared to return until June 22.

Doctors gave McClure extra time to recover since it was the third time he’s been diagnosed with a concussion.

“I think that will probably not necessarily pay dividends now, but it will 10 years from now,” McClure said.

Others, however, may spend a lifetime trying to find answers for the blurry vision, headaches, depression and lapses of memory that comes with too many blows to the head.

RICKY CRAVEN

Craven’s impact with the fourth turn wall in practice for the 1998 race at the Texas Motor Speedway was so hard his eyes couldn’t focus for months.

Now a racing commentator for ESPN’s “NASCAR Now,” Craven sometimes wonders if his degenerating eyesight and memory lapses are related to a series of crashes or being 46 years old.

“I guess I’ll never know exactly what causes it, but I am a little concerned with how quickly my eyesight is getting worse,” Craven said.

The crash at Texas was his third hard impact in three weeks. Craven called it “compound concussions” and it created a rare problem that made it difficult for him to have any depth of focus.

“That crash affected me more than I realized,” he said.

He attempted a couple of comebacks, highlighted by his stirring side-by-side battle with Kurt Busch at the Darlington Raceway in 2003, a finish that remains the closest since NASCAR switched to electronic scoring in 1993.

He eventually retired to become an analyst at ESPN.

“There’s a fine line between playing hurt and prolonging an injury,” Craven said. “Things make a lot more sense the older you get, but you still have questions. I’ve come to realize I may never know. I want to blame it on getting older, but you don’t know.”

BOBBY ALLISON

No matter how many times he watches the replays, Allison can’t remember the day he beat son Davey Allison to the finish line to win the 1988 Daytona 500.

He can remember the set-ups on dirt cars from 30 years ago, but often forgets what day it is. Despite the holes in his memory and the struggles to understand some things, he knows he’s fortunate to be alive.

Allison crashed hard at Pocono Raceway four months after winning the 1988 Daytona 500. He spent months in hospitals, often clinging to life. He still has a stint in his brain to drain fluid. He also walks with a limp and sometimes struggles with his speech.

But nothing can bring back his proudest day.

“I just keep thinking, ‘Maybe somebody will say the right thing and that will help that memory come back.’ There were times I recognized the kids, but I didn’t know what state I was in.”

Allison’s injuries led to a forced retirement. He toyed with the idea of making a return in 1990, only to have it struck down by NASCAR before it got out of hand.

His medical bills, added with a failed attempt as a car owner, left Allison separated from his wife, Judy, and eventually living in his old bedroom at his mother’s house.

“It’s really hard to quit on somebody else’s terms,” he said.

Bobby and Judy Allison are back together. Despite the death of sons Clifford in 1992 and Davey in 1993, Allison has slowly put some of the pieces back together.

The day he and Davey finished one-two, however, is gone. Every time he watches a replay, he gets frustrated.

“I get up and turn it off,” he said. “It does nothing for me.”

ERNIE IRVAN

Irvan almost died in a practice crash at the Michigan International Speedway in 1994. Five years later — and almost at the same spot on the race track — he had another life-threatening crash there.

And in the middle, he came back to beat Michigan for one of NASCAR’s all-time feel-good victories in 1997.

He beat the odds after suffering a traumatic brain injury in 1994, so when he escaped with his life after the same kind of injuries in 1999, Irvan finally made a tearful exit from the sport.

Irvan still has bouts of blurred vision. And since then, he’s committed to making sure everyone, especially children, know about the benefits of wearing helmets to prevent injuries.

“This is something that I treasure,” he said. “I don’t want to retire, but I knew it was the right thing to do. The doctors didn’t tell me I needed to retire. He told me there was a lot of things that can hinder me from being able to carry on a regular life.

“Being able to sit with my son, my girl and my wife, everything is worthwhile.”

Irvan escaped with his life, but he’s left to deal with the damage – most notably his vision.

“There’s no question I could get out there and perform,” Irvan said.

But there’s no chance he could survive a third trauma to his brain, his doctors said.

SAM ARD

Ard was a pioneer who helped build what’s become the Nationwide Series. He won 22 races and two championships in the first three years after the series was created in 1982.

But everything came to a crashing halt, literally, when he hit his head in a crash during the final race of the 1984 season at Rockingham, N.C. Although he won the championship, that crash wound up being his final race — and the beginning of medical problems that continue 29 years later.

Now 73, Ard has been diagnosed with Alzheimer’s and Parkinson’s disease — both probably accelerated by his career-ending crash.

Ard suffers with bouts of dementia, memory loss and mood swings. Ashley Kent, Ard’s neurologist in Florence, S.C., believes the diseases were magnified by Ard’s final crash.

“I think that the head trauma certainly made it occur at a younger age for Mr. Ard,” Kent posted on Ard’s website, samard.com. “We don’t know exactly how, but [a head injury] certainly is one of the risk factors for Alzheimer’s dementia. I don’t know exactly what the mechanism behind it is, but [Ard] probably already had some damage from the head trauma. Then, that probably sets up a degenerative process.”

Kevin Harvick, Dale Earnhardt Jr., Kyle Busch and Tony Stewart have helped generate money to offset Ard’s bills.

Some days he recalls enough to remember other drivers and his championships. Other days he struggles to dress himself.

JERRY NADEAU

So much of Jerry Nadeau’s short racing career is tucked away at an empty shop near Charlotte, N.C.

Not long ago he had a luxury motorhome parked at the private shop, as well as a racing simulator, trophies and cars.

Now all that’s left are huge holes in his memory and personal life following a hard collision with the first-turn wall at the Richmond International Raceway in 2003.

His impact was so hard, county rescue personnel originally said over their two-way radios the driver was dead inside the car.

He wasn’t, but it was close. Nadeau spent months in rehabilitation, and his recovery isn’t over yet. He still can’t remember the crash.

It took him three weeks to regain consciousness. He still has memory lapses, bouts of depression and numbness in the left side of his body.

He thought about making a comeback in the ARCA Racing Series, but that ended when his father, Gerard, died of cancer.

He pain is as much emotional as physical. He feels betrayed by a body that can’t do what it used to, and by a mind that can’t make sense of it all.

“It’s not the kind of memories you want to keep,” he said.

While he remains troubled by the way he left the sport, he knows any real comeback is impossible. He still deals with the pain of a crash that happened nine years ago, and deep down he never wants to go through that again.

“I don’t need to take that chance,” he said. “What if I bumped my head again? That’s in the back of your head.” (jacksonville.com)

So what is Dale Earnhardt, Jr.’s future?

Does he, in fact, just stay out the his race car for just the two races that he, his doctor, and Rick Hendrick have announced?  That would give Junior a two-week break, and allow his brain to try to recover from the back-to-back concussions.  Could we have seen Earnhardt drive his last Sprint Cup race?  Having NASCAR’s most popular driver come out front and into the open about his concussions, doing the right thing for his long-term health, and take himself out of the line of further danger in the short-term, notwithstanding the implications to his race team regarding the Sprint Cup championship in 2012, is quite brave and remarkable!

This could have far-reaching implications, not only in NASCAR, but it may flow into other sports, as well!

What are your thoughts?

(references sportsmedicine.com and jacksonville.com)

TIL NEXT TIME, I AM STILL WORKING ON MY REDNECK!

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