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Taking Brain Injuries Out of Sports
A helicopter airlift to Harborview Medical Center is never a good thing, and on the evening of October 12, 2006, the news was particularly grim. Zackery Lystedt, only 13, was on board. A star football player for Tahoma Junior High School, Zack hit the ground headfirst after a tackle in the second quarter. “He grabbed his head and rocked from side to side,” says his father, Victor Lystedt. An injury time-out was called, and Zack was walked off the field. He returned to the game in the third quarter, playing every play, and hit one boy so hard, that player fumbled the ball. It’s possible this impact caused a second concussion.
At the end of the game, Zack walked off the field, shaking his head and wobbling. He told his father, “Daddy, I can’t see,” and then collapsed and started convulsing. “I was distraught; I couldn’t hold him down,” Lystedt says. “He was having seizures; he had at least 10 to 15 strokes on the field; his brain was shutting down.”
At Harborview, surgeons removed parts of his skull to relieve the pressure caused by hemorrhaging. Zack was in a coma and placed on life support. It was impossible to tell the extent of the brain damage. His father and his mother, Mercedes, were in shock; they didn’t know if he’d make it. And if he did, they were concerned he might not be able to recognize anyone or be able to communicate.
While most who suffer brain injuries are not so badly injured, the Centers for Disease Control and Prevention (CDC) has identified traumatic brain injury (TBI) as a major public health issue and estimates that nearly 4 million sports-and recreation-related concussions occur each year. Head injuries are being incurred by kids in youth sports and by baby boomers and weekend athletes while engaged in activities such as biking and skiing, in motorcycle and auto accidents, and in falls. More than 70 percent of emergency room visits for sports- and recreation-related TBI are for young people ages 10 to 19 years old, and during the last decade, children and adolescents visiting ERs for sports-and-rec-related brain injuries increased by 60 percent. Young athletes, such as Zack, are especially susceptible to something called second impact syndrome—a second hit after initial impact that can cause severe permanent disability and even death.
In recent years, the dangers of TBI have been widely reported—from actress Natasha Richardson’s fatal fall on a ski slope in 2009 to lawsuits against the National Football League (NFL) by more than 3,000 former football players alleging the organization concealed the long-term dangers of head trauma for years. Football legend Terry Bradshaw said that if he had a son today, he would not let him play football. There is definitely a sea change in public awareness about the dangers of brain injury and concussion, says Richard H. Adler, an attorney for the Lystedt family and founding principal of Adler Giersch PS, a Puget Sound–area law firm specializing in cases related to TBI, as well as spinal trauma, joint injuries and musculoskeletal trauma.
"In five years, tracking brain impact and taking preventative action to eliminate sports brain injuries will be as common as wearing a seatbelt or bicycle helmet."
As attorney for the Lystedts and president of the Brain Injury Association of Washington, Adler organized and led a coalition of community partners (including the Seattle Seahawks, Washington Interscholastic Activities Association and others) and local and national medical experts to do groundbreaking work as an advocate for stopping preventable brain injuries in youth sports. He is given much of the credit by his colleagues for drafting legislation leading to the passage of the Zackery Lystedt law in Washington state in 2009.
Designed to prevent what happened to Zack (being returned to play immediately following suspicion of a concussion, thereby causing a much more severe, even life-threatening injury), the law requires young athletes with signs or symptoms of a concussion to be removed immediately from practice or play and to receive written clearance from a licensed health care professional trained in the evaluation and management of concussions before returning to play. It was the first player protection law of its kind in the nation, and the model, pushed along by Adler and the University of Washington’s Dr. Stanley A. Herring, for other states.
But that is only the beginning. Washington state—and the Seattle area in particular—is not only a leader in player protection legislation, it’s also a leader in brain injury prevention, research and treatment. Some of the world’s leading TBI experts and advocates are here—many working with Zackery Lystedt to transform our understanding of brain injury.
From Youth Sports to the NFL
Dr. Herring, a world-renowned expert in concussion evaluation and management, provided testimony focusing on the medical justification to get the Zackery Lystedt law passed in Washington. He works closely with the Lystedt family and does as much advocacy around the country on player protection laws as Adler, often joining him on road trips to make presentations. Herring is in a good position to make a big difference for many athletes: He’s the director of Sports, Spine and Orthopaedic Health for UW Medicine and co–medical director of the Seattle Sports Concussion Program; one of the team physicians for the Seattle Seahawks and Seattle Mariners; consultant to the UW Sports Medicine Program and the Seattle Storm; and a member of the NFL’s Head, Neck and Spine Committee.
Herring has been a member of groups that wrote sports concussion guidelines widely used by health care providers. He has worked with the CDC, USA Football and Pop Warner to develop sports concussion information for athletes, parents and coaches, as well as serving as a panelist at the prestigious International Conference on Concussion in Sport, held every few years.
Dr. Richard G. Ellenbogen, another strong advocate for the Lystedt law, is co–medical director, along with Herring, of the Seattle Sports Concussion Program. He is the UW professor and chairman of the Department of Neurological Surgery, chief and attending of neurological surgery at Harborview Medical Center and attending neurosurgeon at Seattle Children’s. It was his surgical team at Harborview that performed Zackery Lystedt’s surgeries. Ellenbogen is considered one of the foremost neurological surgical experts in the country, especially in brain injury cases.
With Herring, Ellenbogen contributed to the CDC’s online educational course for health care providers titled “Heads Up to Clinicians: Addressing Concussions in Sports Among Kids and Teens.” As co-chair of the NFL’s Head, Neck and Spine Committee, Ellenbogen, with Herring and others, persuaded NFL commissioner Roger Goodell to put the weight of the NFL behind the drive for youth player protection laws in every state.
Creating Wireless Tools
Passing laws, providing concussion management guidelines and changing culture can only do so much without tools to measure the force of brain impacts in real time. Rich Able and Christoph Mack, cofounders of the Pike Place Market–based startup X2Impact, aim to fill that gap.
Veterans of the medical device industry, they came up with the idea to start the company after Able’s son Kyle was injured in a football game in 2007. Playing for Tacoma’s Bellarmine Prep, Kyle was racing up the middle. He was tackled and slammed headfirst onto the field. “I kept thinking, ‘Please move your legs….Please move,’” Able says. “It was the longest 45 seconds of my life.”
Able started doing research and realized that families all over America had experienced the same agonizing moments; concussions in football, baseball, basketball, soccer, snowboarding and other sports were occurring at alarming rates.
He realized something else: Nothing existed that could measure what was happening to the athletes.
X2Impact is developing sensors that players wear as mouth guards, headbands and skin patches (which adhere behind a player’s ear) to measure impacts, which are transmitted wirelessly to a trainer’s or coach’s tablet or smartphone.
“The system measures each impact and displays it in the context of the individual athlete’s head impact history,” Mack says, “thereby helping athletic trainers, team physicians and coaches to determine if a player is at risk for brain injury.”
The technology is designed for helmeted and unhelmeted sports, and male and female athletes of all ages. The Stanford women’s soccer, lacrosse and field hockey teams will be wearing skin patches this fall, according to Able. “The technology we developed would have given Kyle’s trainers information about the number of hits he was taking and their severity,” Able says. “Although Kyle eventually recovered, his concussion might have been prevented.”
“In five years,” Mack predicts, “tracking brain impact and taking preventive action to eliminate sports brain injuries will be as common as wearing a seatbelt
or a bicycle helmet.”
Shortly before press time, X2Impact told Seattle Health that the NFL has signed a contract to utilize the X2 Concussion Management System (X2 CMS) this season. The software system will be used by the NFL’s athletic trainers and clinicians to record a player’s baseline assessment and to assist in the evaluation of a player after head injury is suspected.
Brainiacs Studying the Brain
Despite these positive developments, still more needs to be known about the brain, and the Puget Sound region supports some of the most innovative research to be found anywhere in the world. In March 2012, Paul Allen committed $300 million to expand the Allen Institute for Brain Science, based in Fremont, bringing his total commitment to $500 million since the organization was established in 2003. It is one of the largest philanthropic commitments ever made to neuroscience research.
The institute is an internationally respected powerhouse, tackling some of the most complex questions about how the brain works. Each month, approximately 50,000 visitors, including researchers from universities, pharmaceutical and biotechnology companies, and government laboratories in 70 countries, access the institute’s data. Scientists predict such access could shave years of effort off research programs, leading to groundbreaking discoveries about brain disease and disorders, including traumatic brain injury.
From left: Richard Adler, Dr. Richard Ellenbogen and Dr. Stanley Herring
Plus, the Seattle-area is home to leading edge clinical trials that are challenging even insiders’ ideas about what is possible. Xavier Figueroa, Ph.D., admits he was skeptical when a colleague at the UW suggested he join Restorix Research Institute to manage clinical trials examining the potential of hyperbaric oxygen therapy to accelerate recovery and reverse brain damage for mild to moderate traumatic brain injury.
Hyperbaric oxygen therapy—which Restorix Health uses for the treatment of diabetic wounds, pressure sores and limb injuries—has been around for more than 50 years. It is probably best known as a therapy for the bends (the decompression sickness suffered by scuba divers who rise to the surface too quickly).
Until recently, there hadn’t been much study done regarding the impact of hyperbaric oxygen therapy on brain injury. After more than 18 months of clinical trials, Figueroa (now director of scientific research at Redmond-based Restorix) is a believer.
“I am seriously shocked by the results I am seeing; the outcomes have been astounding,” he says. “Patients feel normal again; light doesn’t bother them; they can sleep; they aren’t irritable. Memory improves; the ability to handle stress does, too. It’s an amazing transformation for patients—and a relief to their families.”
Those who have suffered traumatic brain injury from military service, sports injuries or accidents may be eligible to participate in the study. (Information is available online at restorixresearch.com/ActiveStudy.)
Seeds for a Better Future
With so much going on in the Puget Sound area in terms of TBI, no one can predict what the future might hold. Ultimately, the Lystedts and Adler want a unified federal player protection law covering all 50 states. Herring hopes there will one day be a robust, multidisciplinary medical organization for TBI—one devoted to research, education, advocacy and clinical care, something like the American Heart Association—perhaps here in Seattle, given everything else that’s already in place.
Zack says his life mission is nothing less than working to eliminate preventable brain injury. “Many people will never get to recover—even as much as I have. I need to walk for them and to talk for them. Because they can’t. I remember who I’m doing this for—it’s for the ones who don’t get the chance.” ✚