HJAR Nov/Dec 2023

CTE 18 NOV / DEC 2023 I  HEALTHCARE JOURNAL OF ARKANSAS or maybe even a computerized cognitive test comparing to a baseline. Most con- cussion diagnoses in football are [players] getting hit and communicating symptoms, saying, “I feel this; I feel that.”Without that, you can’t be diagnosed with a concussion, so that subjectivity can play in all of this. I don’t know how they did their assess- ment, the number of concussions with and without — obviously it cannot be that con- trolled or methodologically sound like a placebo-controlled study because every- one knows who’s wearing a Guardian Cap, including the person who’s going to diag- nose the concussion. Even if they use spot- ters to say, “Hey, this person had a big hit. We need to examine them,” they also know who’s wearing the Guardian Cap. So, the decision-making about who is being exam- ined and the subjectivity of who is having a symptomatic concussion would [make it] very hard for me to believe that there was an actual research study done that showed that compared to the same type of players who were randomized to not wear Guard- ian Caps, the ones who were randomized to wear Guardian Caps had 52% less con- cussion. And, unless there’s some kind of randomization, unless there’s some kind of objectivity to it, we can’t really know. Now, if using the Guardian Caps actu- ally does decrease what’s happening in the brain because of the caps absorbing some of the force, that would be great. If they can do that, then they might actually be able to absorb some of the force that would result in a non-concussive injury or a subconcus- sive injury, which would also be really good. I’m not knocking, so to speak, anything that might reduce the impact to the head and the violent movement of the brain inside the skull. What I am knocking is a statement by the NFL about reduction in concussions because it’s missing the science behind how that’s determined. It’s just a PR stunt. And the more the NFL talks about concussions — either saying that the number’s gone up or the number’s gone down — the more they’re focusing the entire issue on symptomatic concussions, the relatively rare events, they’re focusing on that and taking the focus away from the routine — every play of every game and every practice — hits that the players receive to their heads or bodies that make their brains move violently inside their skulls that may not result in symptoms or signs of a concussion, but still may do something to the brain. There’s now adequate research, time after time, in college studies, high school studies, even youth studies, that show that just one season of play can have significant changes to the structure of the brain, including the white matter of the brain, to the functioning of the brain using a variety of techniques, to various blood-based biomarkers dem- onstrating various types of injury to the brain, to cognitive functioning, intellectual functioning. So, just one season of play, study after study has been showing that the amount of hits without concussions is sig- nificantly related to changes in the structure and functioning of the brain. There are no NFL studies of that because the NFL won’t do those studies or have stopped those studies prematurely or have not published them because it might be really detrimental. But there are the stud- ies of the long-term consequences of those repetitive hits to the head. Whether they’re looking at neuropathological changes, including chronic traumatic encephalopa- thy or other changes in the brain separate from CTE, or, in living people, changes to neuroimaging findings or cognitive func- tioning or neuropsychiatric symptoms, what has been found in almost every one of these studies is that it’s the amount of blows to the head and not the number of concus- sions. In other words, the more someone is exposed to repetitive head impacts, not the concussions, the more likely someone’s going to have problems with their function- ing during life, evidence of changes to their brain during life, and a much greater risk for developing the neurodegenerative disease, chronic traumatic encephalopathy [CTE]. There’s now overwhelming evidence that the more someone is exposed to these repetitive hits in football, the greater the likelihood for the development of CTE with there being, in some cases, a dose response relationship — the more exposure to hits, the greater the risk for the disease. There’s a whole series of papers that indi- cate that the earlier someone starts getting hit in football, the greater the risk for later life problems. And again, we’re not talking about getting symptomatic concussions in any of this. We’re not talking about the person who has one or two big symptom- atic concussions, they lost consciousness, and they are out for a while. We’re talk- ing about the routine play, the line of every play at every game of every practice. They’re going across that line of scrimmage and hit- ting their heads against each other; or, lately, they’re not hitting their hands against each other as much, but they’re still bashing into each other, which results in quick move- ment of the brain inside the skull. Think about every time someone lands on the ground, every time someone is tackled violently. What’s going on inside that brain? It’s being stretched and sheared every time our heads move rapidly, and some of that stretching and shearing disturbs or destroys the integrity of the brain cells. And what seems to be happening is that with the repetitive nature of these blows, there is an overwhelming inflammatory response because each time there’s an injury, there’s going to be an immune response to clear away the toxins and the bad products of an injury. But if you get hit again an hour later, half an hour later, a week later, resulting in another injury to those brain cells, then the immune response is occurring again and then again and then again, so there isn’t the chance for recovery that we’re supposed to have. Editor As you know, I saw the back end of those hits, their results, decades later as I