The
odds of fully recovering from a single concussion, while not 100 percent, are
fairly decent. If you get a second concussion while still recovering from the
first though, those odds drop and you are even more likely to experience long
term, perhaps even permanent residual damage. There are times, however, when
the brain is routinely exposed to one of the worst possible scenarios:
frequent, repetitive subconcussive hits (resulting in mild traumatic brain
injury, or mTBI) over a protracted period of time. This is common in many
sports, most notably football. In the course of a single season, football
players may experience thousands of such hits. Chronically repeated mTBI causes
a progressive degeneration of neurological function over time, eventually
leading to Alzheimer and Parkinsonian-like diseases, dementia, social
difficulties, emotional and motor control problems. This is referred to as chronic traumatic
encephalopathy, or CTE. It has come to national attention because of its very
public exposure through professional football.
What
does CTE look like in real life? Imagine a hypothetical pro-football player. He
is six foot three inches in height, 260 pounds, and a virtual human hurricane. Inured
to pain, he trains brutally hard, pushing himself past the limits of what most
men can endure. He is focused, determined, driven and single-minded. Imagine
that this player has retired, but gradually begins to change. He becomes
forgetful and moody. He starts yelling at his kids, can't concentrate or focus,
and is probably plagued by chronic headaches. These are early symptoms of CTE. But
this is just the beginning, because eventually even basic judgment starts to
become impaired. He becomes socially unstable and starts to experience severe
memory loss. By the end, long before his body would have failed, brain damage
has reduced this hero of professional sports into someone who may be so severely
compromised mentally and physically that he is unable even to care for himself.
Concussion
and CTE are endemic to the sport of football. It is ironic that the National
Football League (NFL), the top of America’s football food chain, has downplayed
the effects of concussion and then refused to provide the players benefits
through the very retirement plan which it set up to help those players. According
to the book League
of Denial, this program was
"...the place where [the players] pleas for help went to die...". Only
317 of 10,000 claims have ever paid to players injured in the NFL, according to
that book. The way this retirement plan is described reminds me a lot of my
experiences with state workers’ compensation insurance companies. Each
organization was set up to help their injured constituents. Both types of organizations
(the NFL and workers’ comp insurance companies) have millions of dollars in the
bank. Both employ a complex bureaucracy seemingly designed more as a roadblock
rather than anything remotely helpful. Both groups routinely deny care and
dispute a huge percentage of claims. Both use hired-gun doctors who perform ‘independent’
examinations that almost always find nothing wrong with the patients. Both
groups therefore put their respective injured workers’ physical and financial
health at risk, oftentimes with disastrous results. It is no wonder that
football players and injured workers alike often view these programs with
contempt, and why they are forced to turn to legal counsel in order to pursue their
legitimate claims.
It
is the nature of large organizations swimming with money to look to their own
interests first rather than those of the people they were originally designed
to serve. Fortunately, the torrent of medical research on concussion has
brought the reality of the problem home, even to a group as rich and powerful
as the NFL. It should no longer be taken lightly. Over time, hopefully a
balance will be found between the necessary toughness required to play
professional football and the very real frailties of the human brain. The real
issue then is prevention and aftercare, because there is no cure for CTE. It is
in preventing CTE from happening in the first place where real progress can be
made.
While
every brain responds in a unique way depending on the mechanism of injury, all brains
also need time to recover from mTBI or clear cases of concussion no matter the
activity that causes them. Some people are more susceptible to CTE than others,
so it is important that medical care be tailored to the specific needs of the
individual. I believe the NFL and state level workers’ compensation can fairly
and competently treat their injured charges, but not with an attitude of denial
and the tacit assumption that injured people are just in it for the money. The
truth is more likely the opposite: they are making claims they well deserve.
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