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Description: Ok, so what do you think we “know” about the long-term impact of concussions on athletes who play hockey or football? Let’s see, concussions and inappropriate responses to how such injuries are managed or followed up have lead to a serious issue that the sports of hockey and football are now only staring to address with the NHL entering mediation to try and settle a lawsuit regarding the long term impact of concussion brought by former players and football introducing a raft of new rules and enforcement  practices regarding “head shots” and late hits on quarterbacks. We know there is data supporting the need for steps to be taken with all but one of the 111 brains of deceased former NFL players showing clear signs of Chronic Traumatic Encephalopathy (CTE). Cases like that of Zarley Zalapski who played for the Calgary Flames in the 1990’s and who died in his sleep at 49 years of age are surfacing regularly. Zalapski’s brain was analyzed and showed clear indications of CTE along with a huge amount of tau (abnormal brain protein) even though Zalapski was NOT a fighter, saying that if you fight you sit in the penalty box and you cannot score goals from there. So, we are seeing and increasingly clear picture of the effects of concussions on the brains of hockey and football players over time, right? Well yes BUT do we really have a clear understanding of how this works? Are there some players who sustain concussions but do NOT have issues with CTE later in life? And what about sub-concussive hits? Are these issues confined to the “hit sports” of hockey and football? And are enough steps being taken to deal with them? There is more we need to know to have a clear understanding of what we essential DO NOT know yet about hits in sports, concussion and CTE. Read the article linked below in which Zarley Zalapsky’s sister talks about her brother and a number of neuro scientists point out some of what we do not know (and must find out) about concussions and CTE.

Source: Zarley Zalapski’s story shows CTE isn’t black and white, Allan Maki, The Globe and Mail.

Date: September 14, 2018

Photo Credit: Glenn Cratty/Getty Images

Article Links:

There IS some puzzling data out there.  A man who never played sports and never suffered a concussion whose brain showed clear signs of CTE and the brain of John Forzani who played for the Calgary Stampeders for 7 seasons as an offensive lineman and who suffered several concussions but whose brain shod no signs of CTE on post mortem analysis. To quote Peter Cummings, a neuropathologist “…to think we have CTE solved in a nice, wrapped little box in the space of four, five years doesn’t make any sense.” His biggest point is that instead of stopping with news media summaries we must read the original research articles if we want to properly understand what we DO know about concussion and CTE in sports AND, more importantly, to understand what we DO NOT know, which is a LOT. Indeed, more research and more reflection are both needed in this important area.

Questions for Discussion:

  1. What is CTE and how might it be related to concussions?
  2. What data do we have that speaks to ways in which concussions among hockey and football players might be related (is related) to later issues with CTE?
  3. What sorts of research do we need to be doing to expand our understanding of concussion, CTE and sports?

References (Read Further):

Small, G. W., Kepe, V., Siddarth, P., Ercoli, L. M., Merrill, D. A., Donoghue, N., … & Barrio, J. R. (2013). PET scanning of brain tau in retired national football league players: preliminary findings. The American Journal of Geriatric Psychiatry, 21(2), 138-144.

Shahim, P., Tegner, Y., Wilson, D. H., Randall, J., Skillbäck, T., Pazooki, D., … & Zetterberg, H. (2014). Blood biomarkers for brain injury in concussed professional ice hockey players. JAMA neurology, 71(6), 684-692.

Shahim, P., Linemann, T., Inekci, D., Karsdal, M. A., Blennow, K., Tegner, Y., … & Henriksen, K. (2016). Serum tau fragments predict return to play in concussed professional ice hockey players. Journal of neurotrauma, 33(22), 1995-1999.

McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, B., Dvořák, J., Echemendia, R. J., … & Sills, A. (2013). Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med, 47(5), 250-258.

Kamins, J., Bigler, E., Covassin, T., Henry, L., Kemp, S., Leddy, J. J., … & McLeod, T. C. V. (2017). What is the physiological time to recovery after concussion? A systematic review. Br J Sports Med, 51(12), 935-940.

Stein, T. D., Alvarez, V. E., & McKee, A. C. (2015). Concussion in chronic traumatic encephalopathy. Current pain and headache reports, 19(10), 47.