Bostonia: The Alumni Magazine of Boston University

Fall 2010 Table of Contents

Under the microscope, the tan image with brown splotches resembles a burned map, its edges singed and riddled with dark squiggles that shouldn’t be there. This is a piece of brain from a 45-year-old man: former National Football League linebacker John Grimsley, who suited up for the Houston Oilers for nine years and absorbed at least 11 concussions during professional and college play.

In the years leading up to his death, Grimsley had changed. He became forgetful and scattered, quick to anger, flying into a rage over household garbage, certainly not the man Virginia Grimsley had married. When he forgot about the engagement party for his son and future daughter-in-law, Virginia knew something was gravely wrong. “We’d been talking about the party every day for the past week,” she said at the time. “I was shocked.”

Ann McKee, a School of Medicine associate professor of neurology and pathology, slips the sliver of brain from the microscope and pulls another from a wooden tray of slides. In the viewfinder, there are brown commas, tangled grammar everywhere. “This is his frontal cortex,” she says. “This is the part responsible for insight, judgment, and intellect. It’s completely congested and filled up with tau, an abnormal protein that forms tangles that strangle and destroy brain cells.”

In February 2008, Grimsley, an outdoorsman who’d grown up with guns, shot himself in the chest while cleaning his firearm. Police ruled his death an acci­dent. A week later, when McKee looked at his brain, she found the congestion, evidence of chronic traumatic encephalopathy (CTE). It was her first discovery of the degenerative brain disease in a former professional football player. As an Alzheimer’s researcher based at the Veterans Affairs Medical Center in Bedford, Mass., she had seen CTE in the brains of boxers—she knew the condition as dementia pugilistica, more commonly known as punch-drunk syndrome. She’d also read about it in battered wives. Conventional wisdom held that if you avoided the ring and abusive husbands and always wore a helmet, you’d be OK.

Researcher Ann McKee was invited to discuss her findings with the NFL. “They were polite,” she says. “But it was falling on deaf ears.”

“When I showed the results to my brother, who is also a doctor and played football, he said, ‘You’re going to ruin football,’” recalls McKee, a diehard Green Bay Packers fan, with Brett Favre bobbleheads on her shelf to prove it.

“I definitely felt we were opening a Pandora’s box.”

But far from ruining the sport, McKee and her fellow codirectors of BU’s Center for the Study of Traumatic Encephalopathy (CSTE) are credited with helping make the gridiron safer, not only for exceptionally well-paid athletes, but for the millions of kids who strap on helmets and pads and emulate their idols.

“When I showed the results to my brother, who is also a doctor and played football, he said, ‘You’re going to ruin football,’ I definitely felt we were opening a Pandora’s box.”

“What BU brought to the table was an explanation for some of the bizarre behavior we’d seen in a number of players whose lives were cut short, many because of suicide or what were thought to be accidental injuries,” says Kevin Guskiewicz, chair of the exercise and sport science department at the University of North Carolina and author of a 2003 study linking concussions in retired NFL players to clinical depression.

At the time of McKee’s discovery, Grimsley was the fifth former NFL player diagnosed with CTE. The untimely deaths of the others often followed years of strange behav­ior. “Iron Mike” Webster of the Pittsburgh Steelers, felled by a heart attack at 50, took to living in his truck and at train stations and tazing himself to relieve back pain. Steelers lineman Terry Long, 45, killed himself by drinking anti­freeze. Philadelphia Eagles defender Andre Waters put a gun to his head at age 44. And 36-year-old Steelers lineman Justin Strzelczyk died in a high-speed police chase.

For years, the NFL downplayed the link between head blows on the field and brain damage later in life. The league’s medical advisor had this to say about Guskiewicz’s 2003 findings: “When I look at that study, I don’t believe it.”

Then, in the middle of the 2009–2010 NFL season, the $8 billion-a-year industry appeared to run a single reverse. It publicly acknowledged the link to dementia and instituted return-to-play rules that forced a newly concussed player to sit out the rest of a game or practice and required an OK from an independent neurological expert before he could return to the field.

At the same time, the league began broadcasting public service announcements during games warning young football players about the dangers of head trauma. Off the field, the leaders of the league’s 15-year-old Mild Traumatic Brain Injury (MTBI) Committee, which had assailed studies linking head injury with CTE, were forced out, and the committee’s research was abandoned. In March 2010, it was replaced with the entirely new Head, Neck and Spine Medical Committee, populated with neurosurgeons, retired players, and former critics, including Guskiewicz.

Since April 2010, NFL commissioner Roger Goodell, who took the helm in 2006, has made it his mission to lobby for youth concussion legislation in all 50 states. The same month, the NFL surprised researchers at the Center for the Study of Traumatic Encephalopathy—which had become one of the league’s most persistent critics—with an unrestricted gift of $1 million for further CTE research. It also promised, along with the NFL Players Association, to encourage active and retired players to donate their brains to the BU center. The last time football had seen radical morphing was in 1905, when President Theodore Roosevelt summoned a handful of college presidents to the White House after 18 on-the-field deaths, leading to the invention of the for­ward pass and creation of the National Collegiate Athletic Association (NCAA).

“The culture was markedly different four years ago,” says Peter Keating, a senior writer at ESPN the Magazine and one of the first national reporters to start shining a light on the NFL's concussion issue back in 2006. “Concussions at all levels of play were just ‘dings.’ Hits to the head were just another kind of hit. And players were ‘warriors’ who were supposed to walk it off. People had a sense that there was something different about injuring your brain and injuring your forearm or knee, but they didn’t know how. The culture was to play through it, shrug it off.”

Look closely at a football game this year, and several changes are apparent. Star quarterbacks, who were once considered too valuable (to both the game and the media) to take time off the field, now ride the bench after a head injury. Independent neurological experts, rather than team trainers or NFL doctors, now decide when they can return. Every locker room in the league is hung with new posters that spell out the dangers of brain injuries and the steps to take if symptoms appear. And more changes may be in store. The league is considering eliminating the three-point stance and reducing full-contact practices.

The TV networks, which draw several hundred million viewers a season, have toned it down, too. Punishing hits are not replayed as they once were, and the crunching sound effects are all but gone. Words like “brain trauma” and “dementia” have found their way into the commentators’ lexicon.

Fateful Encounter

A few months before Grimsley shot himself, former professional wrestler Christopher Nowinski was trying to figure out his next move. He had been involved in research about the perils of sports-related head injuries, had just published a book, Head Games: Football’s Concussion Crisis from the NFL to Youth Leagues, and had convinced the families of Waters and Strzelczyk to donate the athletes’ brains to research. But he’d split from the researchers he’d been working with. Nowinski’s own migraines were worsening, the dark clouds in his mind thickening—the result, he was convinced, of head blows he’d clocked under the WWE klieg lights. A Harvard alum and Crimson defen­sive tackle, Nowinski, a.k.a. “Chris Harvard,” was forced to retire at age 24 with post-concussion syndrome. He once trashed a hotel room in his sleep after a concussion.

Christopher Nowinski’s migraines were the result, he was convinced, of head blows he’d suffered as a professional wrestler.

At 29, Nowinski couldn’t help but wonder about his future. He knew all about the force of helmet-to-helmet contact and wrestling moves like the Dudley Death Drop, how the brain smacks against the cranium after the body stops moving. He knew about the stretched nerves and release of proteins that take over healthy cells in the parts of the brain responsible for judgment, impulsivity, memory, mood, and cognition. And he knew about the depression and the dementia. “I assume at some point I’m going to have to deal with this,” he says. “I just use it as motivation to keep working hard and keep working fast.”

A Harvard alum and Crimson defen­sive tackle, Nowinski, a.k.a. “Chris Harvard,” was forced to retire at age 24 with post-concussion syndrome. He once trashed a hotel room in his sleep after a concussion.

Nowinski also knew that to make his most persuasive case about the dangers of head injuries in sports, he needed science with a capital “S.” A handful of case studies wouldn’t cut it. In June 2007, he partnered with the elder statesman of concus­sion research, Robert Cantu, a neuro­surgeon attached to Emerson Hospital and now also a MED clinical professor of neurosurgery, who wrote the original—and largely ignored—return-to-play guidelines in the 1980s. They formed the Sports Legacy Institute, a nonprofit brain trauma research outfit. Then one evening, Nowinski’s roommate returned from a lecture on the link between brain damage and Alzheimer’s. “He said, ‘Chris, you
should check this guy out,’” Nowinski recalls. “So I met Bob
and we sat down for an hour.”

Bob is Robert Stern, a MED associate professor of neurology and codirector of BU’s Alzheimer’s Disease Clinical and Research Program. After hearing Nowinski’s pitch to pair the Sports Legacy Institute with a high-profile university medical school, Stern signed on. Nowinski would supply the brains, literally. BU would supply the science. The University already hosted one of 30 federally funded Alzheimer’s research centers, had several brain banks, and employed one of the world’s foremost experts—McKee—on tau protein, the telltale marker of CTE. Stern didn’t have to ask her twice. The MED dean and several department chairs kicked in start-up money, and the result was CSTE, whose acronym would soon be cited by countless reporters around the country. Stern makes it clear that BU was not the sole agent of change. Outspoken pathologists and doctors, a few dogged sportswriters, a self-critical NFL-sponsored study, and elected officials all started to push in the same direction, and things began to move with the inevitability of a freight train. But CSTE was shoveling some serious coal in the engine room.

In 2009 researchers announced they had found evidence of the degenerative brain disease CTE in a high school football player.

More Worrisome Findings

Once Stern, Nowinski, McKee, and Cantu, who jointly codirect CSTE, joined forces in September 2008, headlines soon followed. News about the damage found in John Grimsley’s brain was accompanied by the announcement at a press conference of a brain donation program, led by pledges from such notables as troubled former New England Patriots linebacker Ted Johnson, whose struggle with post-traumatic concussion syndrome has been painfully public, and female soccer star Cindy Parlow, who retired early with the syndrome.

Robert Cantu wrote the original, and largely ignored, return-to-play guidelines in the 1980s.

By that time, the NFL’s MTBI Committee had backed off some of its rhetoric from the mid-2000s, when it described the first worrying studies as “purely speculative” and “seriously flawed.” But it still expressed doubts about the credibility of the brain research. In response to BU’s findings of a link between concussions and CTE, NFL spokesman Greg Aiello told the New York Times, “Hundreds of thousands of people have played football and other sports without experiencing any problem of this type, and there continues to be considerable debate in the medical community on the precise long-term effects of concussions and how they relate to other risk factors.”

Three months later, the CSTE team held another news conference, this time in Tampa, Fla., against the backdrop of the 2009 Super Bowl. McKee had found CTE in the brains of two more athletes. The first was former Tampa Bay Buccaneers offensive lineman and successful restaurateur Tom McHale, who had died of a drug overdose at 45. As Virginia Grimsley had done earlier, McHale’s widow, Lisa, now the single mother of three young boys, took part in the announcement.

The second case described at the news conference was even more disturbing: the early signs of CTE had been found in the brain of an 18-year-old high school athlete, a football player who had suffered multiple concussions.

“This was earth-shattering,” Cantu says. “To see initial-stage chronic traumatic encephalopathy at that age is hugely worrisome. It’s something no 18-year-old should have.”

With more than 1.2 million teenagers playing football every fall, many through the independent, nonprofit USA Football, and several million preteens playing at the Pop Warner level, the weight of the message had increased exponentially. The CSTE team had known that it would.

“The NFL made it about NFL players,” Nowinski says. “We made it about kids. We said this is not about what’s happening to grown men who make a lot of money. This is about one in eight boys in this country who play the sport and where everybody models what they do on the NFL. They have a responsibility, especially since they’re funding USA Football, to take care of them and acknowledge them. It was about changing the terms.”

In May 2009, the NFL invited McKee, along with other concussion researchers, to present her findings to the MTBI Committee in New York.

“I’m from a small town in Wisconsin,” she says. “NFL headquarters is on Park Avenue. You get photographed and IDed on the way in. You’re taken to this big mahogany boardroom with Vince Lombardi posters everywhere and a bunch of men sitting around a big table. I insisted Chris come. It was intimidating. I was the only woman. There was a lot of testosterone in the room. They were very skeptical. One of them said I was making up the disease. They were polite, but you felt like it was falling on deaf ears.”

Alan Schwarz, however, a freelance baseball reporter whom Nowinski first approached in 2007 with the Andre Waters story, had been capturing every word. He has since been hired by the New York Times, which kept the narrative on its front page, earning two Pulitzer Prize nominations along the way for Schwarz’s coverage. It wasn’t long before Bob Simon of 60 Minutes showed up at McKee’s office, followed by Malcolm Gladwell of the New Yorker. The issue had reached the water coolers.

The Last Straw

In early October 2009, as BU’s School of Medicine was gearing up to host a conference on athletes and concussion at Gillette Stadium, in Foxboro, Mass., home of the New England Patriots, the results of a long-touted study commis­sioned by the NFL had leaked to the media. The research showed the prevalence of dementia, Alzheimer’s, or other memory-related diseases among retired players to be as much as 19 times higher than in the general U.S. male population. The league claimed the study was incomplete. Fur­ther findings, it said, would be needed.

BU researchers have found a link between repetitive head trauma and a new form of motor neuron disease similar to amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease. The findings were published in the September 2010 issue of the Journal of Neuropathology and Experimental Neurology.

“The significance of this finding is that not all ALS-like disease attacks out of the blue,” says MED’s Ann McKee. “Sometimes it’s because of our choices in life.”

McKee and her colleagues discovered the new disease while examining the brains and spinal cords of 12 athletes stored in the CSTE brain bank. Each showed evidence of the neurodegenerative disease chronic traumatic encephalopathy (CTE), but two former NFL players—Wally Hilgenberg of the Minnesota Vikings and Eric Scoggins of the San Francisco 49ers—as well as a boxer, developed motor neuron disease late in their lives. Scoggins died in 2009, at age 49, and Hilgenberg in 2008, at 66. Both had been clinically diagnosed with ALS, although they also showed behavioral changes and cognitive decline, which is associated with CTE.

In the three athletes diagnosed with ALS, McKee found the abnormal protein TDP-43 in the brain and spinal cord in a unique pattern, along with deposits of an abnormal form of tau protein. Abnormal tau deposits, a marker of CTE, are not found in ALS.

The findings suggest that the motor neuron disease that affected the three athletes, while similar to ALS, represents a distinct disease never before described in the medical literature. McKee and her colleagues have named it chronic traumatic encephalomyelopathy (CTEM), and believe that it is caused by repetitive head trauma sustained in contact sports such as football and boxing.

“They had a very bizarre reaction,” Nowinski says. “They paid for the study, yet they tried to distance themselves from it. But you understand their position. The guys who commissioned the study are probably not the same guys who had to react to it.”

The study, conducted by the University of Michigan, helped prompt the House Judiciary Committee, headed by Michigan Democrat John Conyers, to order the first of several hearings on the subject. At the end of October 2009, Nowinski, Cantu, and McKee testified, along with dozens of other researchers, doctors, players, players’ wives and widows, league executives, and players’ union officials.

“There were a lot of ex–football players there,” McKee recalls. “The older ones reminded you of a neurology clinic. It was very sobering. You got the sense that this was mainstream.”

Stern believes that even as some in the NFL expressed doubts, Goodell and a few other league leaders had grasped the scope of the concussion problem before the hearings. In 2007, a year after Goodell took over, the league had estab­lished a fund for retired players strug­gling with dementia.

“Unfortunately, things were moving too fast and Goodell was made to look like a villain, when, in fact, he wasn’t,” Stern says. “He was stuck with having to deal with people who were still in important positions within the NFL, people who were the old guard. He wasn’t just going to undo things until he learned more.”

In November 2009, Goodell, in Boston for an owners’ meeting, asked Cantu to swing by for a private get-together. They talked for 90 minutes about ways to move the league forward on the concussion issue. Cantu stressed the impor­tance of education at the USA Football level and of shutting down the MTBI Committee. Both have since happened.

“Goodell allowed for the appointment of some of the biggest critics to the new Head, Neck and Spine Medical (HNSM) Committee,” Cantu says. “Kevin Guskiewicz was a very vocal critic and had gotten into brouhahas with the original chairman. Now, lo and behold, he’s on the committee. To me, that shows great integrity. It’s pretty amazing the landscape today versus a few years ago.”

The HNSM Committee cochair, Richard Ellenbogen, a Seattle, Wash.–based neurosurgeon and longtime youth concussion awareness advocate, is now consulting with Cantu, who was appointed senior advisor to the committee. “Bob Cantu has been one of the biggest names in con­cussions in the country,” says Ellenbogen. “After 30 years, finally people believe him. He deserves a lot of credit for all this and for keeping the focus on this issue.”

The Rest of the Iceberg

Robert Stern calls his group's science “one piece of an incredibly complex puzzle.”

For Nowinski, McKee, Cantu, and Stern, the quarrel was never with the game of football, although they were accused often enough along the way of being “football-killers.” All of them are fans who hit the couch on Sunday afternoons. McKee is an NFL Network subscriber. Stern’s son played the game. “It was always about education and awareness,” Nowinski says.

McKee has since found CTE in 26 other brains: a hockey player, pro wrestlers, boxers, and college and semipro football players. She is also probing the brains of combat soldiers exposed to bomb blasts. “This isn’t just an NFL problem,” she says. “It’s an enormous public health problem.”

Beyond concussions, the CSTE crew has been exploring the cumulative damage caused by repeated, but less violent, head knocks on the field. The National Institutes of Health is currently reviewing a $9 million grant application the center has submitted to work on diagnosing CTE in living patients.

“The rest of the iceberg is a gazillion times bigger and scarier,” says Stern. “It includes everything from the linebackers in high school or Pop Warner who in every play in every practice and every game are hitting their heads. They might not be diagnosed with a concussion, but we’re talking 500 to 1,500 times a season whacking their heads. Even in something like soccer, we have no idea what those repetitive, very mild, nonsymptomatic headings cause. That’s the stuff we’re trying to understand.” ■

Read more coverage of the links between head trauma and dementia.

You Asked, We Answered
Readers took advantage of our invitation to ask Robert Cantu and Christopher Nowinski, codirectors of BU’s Center for the Study of Traumatic Encephalopathy, about concussions in youth and adult sports and their effects on the brain. Here are some of those questions, along with Cantu's responses.

QCan you tell me from these studies, is there a connection between football-related brain damage and occipital stroke? My husband who attended college on a football scholarship and suffered at least one concussion in his career in the late 60's, had a stroke last year at age 58, for which no cause has been determined. With the myriad of usual and unusual tests completed by physicians and neurologists, no cause for the stroke was ever determined. He has none of the usual conditions which typically lead to stroke and is confirmed otherwise extremely fit and healthy. A holistic practioner did suggest "old football head injury" as a cause. Medical doctors dismissed this theory. Now I wonder. Any information would be appreciated. Regards. — Nancy (SED’76)

AThere is no association between stroke and concussion. Your husband’s occipital stroke was not related to his high school concussions.

QThe football team my son is on is looking into buying one of the Riddell HITS systems for some of the high impact players and some of the players who are at particular risk for concussions. Given the expense of the system, I'm wondering how well the system works? It does not seem to be that widely deployed. Is that because it is mostly for data collection, rather than for diagnosis? Basically, I'm wondering whether this is the best/only option for protecting my son? Any feedback would be welcomed. — Anonymous

AThe Riddell hit system measures the force, location, and number of hits to the helmet over 20g. It is does not of itself provide safety. If used to pull a player and examine him if he takes a very high impact, say over 80g, then it may provide recognition of some concussions that would otherwise go unrecognized. The best protection for your son is a new helmet and not purposefully hitting with his head.

QI understand that a blood test may reveal mild TBI. Is it based on the presence of tau protein in the blood? — Ralph (CAS)

AThe blood and CSF marker for brain injury has been found to be useful in rodents with a severe blast injury. It has not been validated in a man with a brain injury at the concussive level. Hopefully, in the near future there will be markers, and tau protein is one of many markers and metabolites that are being studied.

Note: The questions below were answered by Christopher Nowinski, codirector of the Center for the Study of Traumatic Encephalopathy and president of the Sports Legacy Institute.

QI am always amazed that there are numerous articles and research about concussions that are surrounded by football injuries. I have 2 varsity high school soccer players who have both suffered concussions. Most recently, the younger one who plays goalie was kicked severely in the head while diving for a ball. He is still recovering 6 weeks later. When he is cleared to play, he will wear a rugby helmet, which isn't optimal but does offer some protection. What does it take to make it mandatory that all youth players should wear protective head gear? — Nancy (SON'83)

AProtective headgear is not the answer in all situations and needs to be approached on a sport-by-sport basis. It is clear that because of the addition of hard-shelled helmets in football and hockey, the game changed and the head became involved in a larger number of collisions involving greater force. It is unclear if the helmet provides enough protection to offset the additional trauma. Therefore, we should be cautious about adding helmets to sports.

QI have an eight-year-old son who played a little soccer in the summer and wants to continue with it during the winter. My son told me that the coach asked the boys now and then to hit the ball with their heads. Since I did not and do not feel comfortable with this, I was wondering whether you can provide me with some information that pertains specifically to soccer and any possibel traumatic encephalopathy caused by kopfbaelle. I personally would feel most comfortable if he would not kick the ball at all with his head. What is your opinion? Do you have any advice I may relate to the coach regarding this topic? Many thanks and best regards. — Yvonne

AThere are no firm guidelines or recommendations on heading the ball in soccer. However, with our new appreciation for damage caused by repetitive brain trauma, it is always wise to scale back brain trauma in sports where appropriate. Headers among young soccer players is a key area where we can minimize repetition and consider a minimum appropriate age. I would share with your coach SLI’s 7 Steps to Brain Safety, which includes a recommendation to reduce overall brain trauma other simple and free recommendations.

QI currently attend Middle Tennessee State University, and I am in my first year of a three-year athletic training program. I am wondering if there has been a specific number of concussions by an individual that should end an athlete’s football career or if each individual varies by the damage their brain has endured? This info has been very informative and alarming. Thanks. — Robbie (CGS'10)

AThere is no magic number of concussions to recommend retiring from football. Each concussion and each individual are different, and the severity of the injury additionally depends on the type of injury and how it is managed after. Therefore, at this stage of research, a number is not appropriate and is not well correlated to brain damage or disease.

QI have a few questions about concussions and your study. I am a former football player. I played 4 years of football in high school and I also played 2 years of semipro football. I was a linebacker and was constantly taking blows to my head, mainly because I was taught early on to lead with my head. Our coach would tell us to "put the screws on them," which is basically to say lead and hit with the two screws on the top of your face mask that's around your forehead. In my playing time, I've had 10 concussions that I know of for sure. Four of them were during high school ('99-'02) and 6 were over my two years of semipro ('08-'09). My last one put me in the hospital for 3 days with a concussion, a dissected carotid, and fluid/blood in my lungs. That one ended my "career," and it happened on my birthday no less. So, after reading this article, I am pretty concerned. I have numerous symptoms that still occur from them daily. I was wondering if there is any advice you can offer me or any type of screening or tests that could be done to see if I have any markers. Also, if you could suggest any further reading I could do to educate myself more that would be great. I've also heard of something called secondary impact syndrome. What exactly is that and how might it be related, if at all? — Matt (SAR'07)

AThere is currently no diagnostic test for CTE—that is a goal of our research at CSTE. However, I would recommend meeting with a concussion expert (often, but not limited to, a neurologist, neurosurgeon, neuropsychologist, or physiatrist) who may be able to evaluate you for post-concussion syndrome. For further reading I would recommend reading the medical and media articles on the CSTE website at Second-impact syndrome is a catastrophic injury that can occur if an athlete receives further head trauma while symptomatic from a concussion. It happens less than 10 times a year in football in America, and leads to loss of autoregulation and swelling of the brain, and about 50 percent of suffers die from it.

QAre Pop Warner-aged children (13 and under) susceptible to these brain injuries as well? Are there equipment developments on the horizon to help this concussion issue? Would special mouth pieces help reduce thie incidence of concussions? — Bob (SMG'94)

AThe brains of young children are considered to be the more sensitive to brain trauma than adults, so, yes, they are at risk. The equipment industry, specifically helmet manufacturers, continues to make advances to protect against brain trauma. Currently, there is no evidence that mouthguards reduce the incidence or severity of concussion.

QWith the apparent huge improvements in, especially, NFL head gear, what further recommendations and changes are under consideration by the NFL? — Anonymous

AWe would not know.

QAs a small, 5'7" high school hockey player, I remember that ejections were automatic for excessive boarding, cross checking, sticks to the head, and drawing blood. Seems that the ejection rule should be reinstated for hockey (not just a 5-minute major) and football (not a 15-yard penalty and fine). Baseball may be extreme in ejections for arguing with the umpire, but batters do not question calls very often.— George (SMG'59)

AUsing rule changes to protect players from dangerous play has become a major priority in hockey and football, and I believe they are already paying dividends.

Q I have a 13-year-old-son who plays lacrosse and would love to start playing football as well. When he was 6 years old, he suffered his first concussion while learning to ride a two-wheeled bike. He was luckily wearing a bike helmet. He suffered his second concussion 1 month later when he slipped on a wet floor and hit his head. The second concussion caused headaches and sleep disturbances, which took 6 months to resolve. He was thoroughly checked out by a neurologist at the time, and there were no underlying problems. My question is, if my son hasn't suffered any concussions in the past 7 years, is it as if the earlier concussions never occurred? Are the negative effects of concussions cumulative? Does risk increase with each successive concussion regardless of how much time passes between injuries? Thank you in advance for your time. And thank you for the important research that you continue to do. — Theresa (CAS'81)

AHistorically, it was assumed that people recovered completely from concussion. However, with recent work coming out of multiple research groups, including BU, it is becoming clear that people do not recover completely from every concussion, and brain injury can happen from brain trauma that does not cause concussion symptoms. It is better to have concussions spaced far apart than close together, but brain trauma can be cumulative, although we aren’t precisely sure why yet. Studies show athletes with a history of concussion are more likely to suffer future concussions, but how much more likely is a matter of debate.

QMy 11-year-old daughter plays hockey on a boys Peewee Team that starts checking this year. There has never been any discussion about concussions, but I imagine hockey is right up there with football in terms of impact. Are there any training programs for coaches to attend where they can learn techniques that will make this sport safer for our daughters and sons? As a lacrosse coach, I would like to know what advice I can give my players about how to avoid concussions. Are there any training programs out there for coaches on this topic? — Kristin (CAS'86)

AYes, hockey is a high-risk sport for brain trauma. CSTE’s partner organization, the Sports Legacy Institute, offers Concussion Clinics to educate coaches, parents, and athletes on the dangers of brain trauma and how to protect athletes. In addition, SLI’s 7 Steps to Brain Safety provides link to a large number of free online educational programs that should be mandatory for all youth coaches.

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On 25 October 2013 at 9:20 PM, Ashlee Therriault:

Sports concussions is one of the many aspects that interest me about the human body. Right now I am currently writing an editorial for my critical health issues class on concussions in football. This article helped a lot, and really opened my eyes to what has been found/diagnosed with concussion, what is being done etc.

On 14 May 2012 at 3:21 PM, Brush Lee (ENG’98) wrote:

I have had 12 documented concussions throughout the course of my football career and active sports life. These concussions included blackouts followed by nausea for some time. I am fairly certain that I have had over 15 in my lifespan (37 yrs). Has there been a correlation between the number of concussions and those football players with CTE issues?

On 4 May 2012 at 7:24 PM, Todd Mackay (CAS’97) wrote:

I am a former college and semi-pro football player who has suffered a number of concussions through my football career. I have experienced, and been diagnosed with, temporal lobe seizures since college. Currently 38, I have been concerned with the declining quality of my short-term memory and my increasing disorganization for a few years. I have even brought the memory concerns up with my neurologist. Is there any evidence to suggest that concussions and temporal lobe seizures are connected, and that either could lead to early onset dementia....even at my age?

On 3 May 2012 at 12:45 PM, Michael Gutierrez wrote:

This article needs to mention and give credit to Bennett Omalu. McKee studied the 5th case, but Omalu saw things differently from Nowinski and thus, was semi-scrubbed from the history of CTE.

On 7 December 2011 at 7:31 AM, Anonymous (COM'11) wrote:

I am very greatful for this information, thanks for sharing with us.

On 19 October 2011 at 1:24 PM, Raymond V. Renner wrote:

Knowing that I have had a minimum of 8 concussions, at least 2 in the Marine during the early 80's, I have one question: Can anyone help ME?

Is there a study that I can be involved with to help this cause as I recognize my own dilemma's in life that always are attributed as the fact that I am just "OUT THERE".

I am currently attempting to get help through the V.A. because of what I have been reading about concussions, but they seem to be looking at it from the stand point that I am looking for compensation. All I want is to know if I am developing CTE. I hope to just get GOOD advise on what I can do now that I am 50 years old. Is it too late for me?

On 7 March 2011 at 2:52 PM, Bryan J Josefowski wrote:

can anyone with a history of depression and no concussions have or develop CTE ?? can certain chemicals used in various industries also contribute to developing CTE ????

On 2 February 2011 at 12:44 PM, reg (CFA'11) wrote:

As a parent of a son suffering from post-concussion syndrome I find the cover image today offensive For such a serious subject this is a poor choice. As a graphic designer it too easy a solution and not appropriate for the message or tone of the subject matter.

On 20 January 2011 at 10:05 PM, m pem wrote:

my husband is a recreational wakeboarder who can spend 2-4 hrs on the water each weekend. he likes to jump & spin so repetitive falling on water going 20+mph while perfecting these tricks is common. is this type of repetitive impact harmful to the brain. (no helmets are involved)

On 9 November 2010 at 11:10 AM, Janet G O'Connor (SON'52) wrote:

On Sunday, a GB Packer violently head butted a Dallas player, and was funed $50'000. A 3 game suspension for such OBVIOUS violence must be required by law (assault) if the NFL can't do it on their own


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