Concussion Rehab using FITLIGHT trainer

May 18, 2020

More than $US500 million in claims have been approved under the NFL's concussion settlement, nearly a decade earlier than league officials estimated they would reach that amount.

Claims administrators in the settlement released an updated report on the concussion settlement information website saying about $US502 million ($676.63 million) had been approved in less than two years of the settlement.

The original actuarial estimates from the NFL estimated little more than $US400 million ($539.15 million) would be paid out in the first decade.

Is this a bit ludicrous?

Impaired cognition is one of the most serious consequences of a concussion. Attention, memory and learning can be gravely impacted by trauma to the head. However, evidence is emerging which suggests that cognitive training can play an important role in post-concussion rehabilitation.

In recent years, brain training, whereby an individual is challenged to engage in a series of visual and auditory tasks, has gained popularity within the professional sporting community. Cognitive training has been shown to improve cognitive skills such as reaction-time, agility, executive function, and perception among others. Several world-class athletes, including NBA point-guard Steph Curry and NFL safety Reshad Jones have incorporated cognitive-based exercises into their training.

Danish inventor, Erik Veje Rasmussen, created FITLIGHT Trainer – an interactive training tool, which uses lights to challenge cognition by way of visual tracking, motor coordination, processing speed and working memory. The system has been utilized for performance training and brain trauma rehabilitation (i.e. concussion).

What happens physiologically to the brain during a concussion?

A concussion is a mild form of traumatic brain injury that causes a temporary disturbance in brain cells that can disrupt brain function. This injury is the result of acceleration and deceleration of the brain inside the skull causing brain tissue to stretch and shear. This stretching of the brain leads to an ion imbalance, causing an excitatory response and ultimately an energy deficit in the affected cells of the brain (Pavlova, 2018).

Unfortunately, a person’s physical state post-concussion says very little about the health of their brain. An individual may feel fine physically, thinking they are ready to return to their sport, when in actuality, they have decreased cognitive ability. Therefore, brain training, through use of FITLIGHT Trainer, for instance, should be a staple of most concussion rehabilitation programs. It has the ability to both detect cognitive impairment and improve cognitive skills that may have been lost due to the trauma. A study conducted by Mercy Sports Medicine in 2017 highlights the importance of taking an athlete through a gradual return to sport progression. The use of brain training systems that mimic the visual cues an athlete receives in their sport allow for the athlete to retrain their brain in a controlled environment (Keenan).

How does FITLIGHT Trainer work?

A person is presented with a number of lights (usually ranging from 4-12 lights) that they are tasked with deactivating when they flash. The speed at which the individual responds to the lights and deactivates them is recorded. The data is then analysed to study an array of cognitive skills such as attention and information processing. It is an extremely versatile tool that not only helps to detect impaired cognition but also to improve cognitive ability.

Using FITLIGHT Trainer can lead to:

  • Improved reaction & response times

  • Improved physical speed, agility and coordination

  • Increased neuroplasticity

  • Improved visual cognitive processing

Other benefits of FITLIGHT Trainer:

The use of FITLIGHT Trainer at the beginning of a sporting season provides athletes with valuable baseline data about their cognitive abilities, which can be used for comparison post-season or even post-in season concussion. This data can be invaluable in assessing the players recovery time and in determining a more accurate prognosis for return to play.

Developing quicker reaction times through cognitive training could even decrease the rate of concussions. An important 2015 study suggests that when vision training is implemented, it decreases the incidence of concussion in those players when compared to players who do not receive vision training (Clark, 2015). The researchers noted a small improvement in peripheral vision and reaction times.

Let us look back into the history of concussions in the NFL

Reports show an increasing number of retired NFL players who have suffered concussions have developed memory and cognitive issues such as dementia, Alzheimer's, depression and chronic traumatic encephalopathy (CTE).

Facts:

Most concussions occur without losing consciousness.

CTE is a degenerative disease of the brain and is associated with repeated head traumas like concussions.

Among the plaintiffs in concussion-related lawsuits: Art Monk, Tony Dorsett, Jim McMahon, and Jamal Anderson.

Common Symptoms of Concussions: (The NFL Player Concussion Pamphlet)

Imbalance

Headache

Confusion

Memory loss

Loss of consciousness

Vision change

Hearing change

Mood change

Fatigue

Malaise

Statistics on Diagnosed Concussions: (NFL - IQVIA)

(Preseason and regular-season practices plus games)

2012 - 261

2013 - 229

2014 - 206

2015 - 275

2016 - 243

2017 - 281

2018 - 214

Timeline:

1994 - NFL Commissioner Paul Tagliabue creates the Mild Traumatic Brain Injury Committee. Dr. Elliot Pellman is named chairman despite not having experience with brain injuries.

2002 - Dr. Bennet Omalu, a forensic pathologist and co-founder of the Brain Injury Research Institute, identifies chronic traumatic encephalopathy (CTE) in the brain of former Pittsburgh Steelers' center Mike Webster, 50, who committed suicide. Omalu is the first to identify CTE in American football players.

January 2005 - The NFL's Mild Traumatic Brain Injury Committee finds that returning to play after sustaining a concussion "does not involve significant risk of a second injury either in the same game or during the season."

2005 and 2006 - Dr. Omalu identifies CTE in the brains of former Pittsburgh Steelers players Terry Long and Andre Waters. Both had committed suicide.

February 2007 - Dr. Pellman steps down as chairman of the Mild Traumatic Brain Injury Committee but remains a member.

June 2007 - The NFL holds a medical conference on concussions.

August 14, 2007 - The NFL formalizes new concussion guidelines which include a telephone hotline to report when a player is being forced to play contrary to medical advice.

October 28, 2009 - Part I of the House Judiciary Committee hearing on Legal Issues Relating to Football Head Injuries. NFL Commissioner Roger Goodell defends the League's policy regarding concussions.

January 4, 2010 - Part II of the House Judiciary Committee hearing on Legal Issues Relating to Football Head Injuries. Dr. Ira Casson, one of the co-chairs of the Mild Traumatic Brain Injury Committee, denies a link between repeat head impacts and long-term brain damage.

March 2010 - The NFL's Mild Traumatic Brain Injury Committee is renamed the Head, Neck and Spine Committee. Two new co-chairs are selected, and Dr. Pellman is no longer a member of the panel.

October 20, 2010 - NFL Commissioner Goodell issues a memo to all 32 teams that warns of possible suspensions for offenders that violate the "playing rules that unreasonably put the safety of another player in jeopardy have no place in the game, and that is especially true in the case of hits to the head and neck."

February 17, 2011 - Former Chicago Bears defensive back Dave Duerson, 50, commits suicide with a gunshot wound to the chest rather than his head so his brain can be researched for CTE. Boston University researchers find CTE in Duerson's brain, the same disease found in other deceased NFL players.

April 19, 2012 - Former Atlanta Falcons safety Ray Easterling, 62, commits suicide. An autopsy finds signs of CTE. Easterling had been a plaintiff in a class action lawsuit against the NFL over concussion-related injuries filed in August 2011.

May 2, 2012 - Former NFL linebacker Junior Seau, 43, is found dead with a gunshot wound to the chest, classified as a suicide. Friends and family members say his suicide was brought on by multiple concussions, but an initial autopsy report finds no apparent brain damage. Portions of Seau's brain have been sent to the National Institutes of Health for further study.

June 7, 2012 - A unified lawsuit combining more than 80 concussion-related lawsuits on behalf of more than 2,000 National Football League players is filed in federal court in Philadelphia. The players accuse the NFL of negligence and failing to notify players of the link between concussions and brain injuries, in Multi-District Litigation Case No. 2323.

August 30, 2012 - The NFL files a motion to dismiss the concussion related lawsuits filed by former players.

September 5, 2012 - The Foundation for the National Institutes of Health announces the NFL has committed to donating $30 million to support research on medical conditions prominent in athletes.

January 10, 2013 - The National Institutes of Health releases the results of their analysis of Junior Seau's brain tissue confirming that Seau did suffer from CTE.

January 23, 2013 - Junior Seau's family files a wrongful death lawsuit against the NFL, claiming that Seau's suicide was the result of a brain disease caused by violent hits he endured while playing the game.

December 13, 2013 - The body of former NFL linebacker Jovan Belcher is exhumed in order to perform tests on his brain, a lawyer for the player's family tells the Kansas City Star. On December 1, 2012, Belcher, 25, shot his longtime girlfriend to death and then killed himself.

January 14, 2014 - A federal judge declines to approve a proposed $760 million settlement of claims arising from concussions suffered by NFL players, saying she didn't think it was enough money.

May 28, 2014 - Former Miami Dolphins quarterback Dan Marino and 14 other former NFL players sue the NFL over concussions. Their lawsuit claims the NFL knew for years of the link between concussions and long-term health problems.

June 3, 2014 - It is reported that Marino has withdrawn his name from the concussion lawsuit.

July 7, 2014 - The US District Court in Philadelphia grants preliminary approval to a settlement between retired NFL players and the National Football League.

July 17, 2014 - Former NFL players Christian Ballard and Gregory Westbrooks file suit against the NFL Players Association, alleging the union withheld information about head injuries.

September 30, 2014 - Dr. Piotr Kozlowski releases a report on former NFL linebacker Jovan Belcher, stating that he likely had CTE when he killed his girlfriend and himself in 2012.

April 22, 2015 - A federal judge gives final approval to a class-action lawsuit settlement between the National Football League and thousands of former players. The agreement provides up to $5 million per retired player for serious medical conditions associated with repeated head trauma.

November 25, 2015 - Frank Gifford's family says he suffered from CTE. Gifford's diagnosis comes amid a growing focus on the risks athletes face from suffering repeated concussions, and just hours after the NFL admitted its concussion protocols had failed when St. Louis Rams quarterback Case Keenum kept playing Sunday even after his head injury on the field.

February 3, 2016 - Former Oakland Raiders quarterback Ken Stabler, who died in July 2015 of colon cancer, is diagnosed posthumously with CTE by researchers at Boston University.

March 14, 2016 - For the first time, a senior NFL official publicly acknowledges a connection between football and CTE. At a round-table discussion with the US House Committee on Energy and Commerce, when asked if "there is a link between football and degenerative brain disorders like CTE," Jeff Miller, the NFL's senior vice president of health and safety policy, answers "the answer to that question is certainly, yes."

July 25, 2016 - The NFL and NFL Players' Association (NFLPA) implement a new policy to enforce concussion protocol. Teams violating the policy are subject to discipline, through fines or losing upcoming draft picks.

September 14, 2016 - Commissioner Goodell announces an initiative intended to increase the safety of the game, specifically by preventing, diagnosing and treating head injuries. As part of the initiative, the league and its 32 club owners will provide $100 million in support of engineering advancements and medical research -- in addition to the $100 million previously pledged by the league to medical and neuroscience research.

September 21, 2017 - Attorney Jose Baez tells reporters that results from tests performed on the brain of Aaron Hernandez, the former New England Patriots tight end who was convicted in 2015 of murder, showed a "severe case" of CTE. (The conviction was vacated after his death in April 2017.)

November 10, 2017 - Researchers publish in the journal Neurosurgery, what they say is the first case of a living person identified with CTE. Lead author Dr. Bennet Omalu confirmed to CNN that the subject of the case, while unnamed in the study, was former NFL player, Fred McNeill -- who died in 2015. The only way to definitively diagnose CTE is with a brain exam after death.

FITLIGHT Trainer offers exciting new possibilities for athletes due to its neurocognitive training application for concussions. While there is no piece of technology or equipment that can diagnose or fully cure concussions, advancements in technologies such as FITLIGHT Trainer can be an essential tool in concussion rehabilitation. Concussions in the NFL are unfortunately inevitable, however with appropriate management, the prevention of harmful long-term effects is possible.

References

Clark, J. F., Colosimo, A., Ellis, J. K., Mangine, R., Bixenmann, B., Hasselfeld, K., Graman, P., Elgendy, H., Myer, G., & Divine, J. (2015). Vision training methods for sports concussion mitigation and management. Journal of visualized experiments : JoVE, (99), e52648. https://doi.org/10.3791/52648

Keenan, A., & Mahaffey, B. (2017). Concussion Care: Moving Beyond the Standard. Missouri medicine, 114(5), 340–343.

Pavlova, V., Filipova, E., Uzunova, K., Kalinov, K., & Vekov, T. (2018). Pioglitazone Therapy and Fractures: Systematic Review and Meta- Analysis. Endocrine, metabolic & immune disorders drug targets, 18(5), 502–507. https://doi.org/10.2174/1871530318666180423121833