Guest Perspective: Concussion - Spotlight on mTBIs

Guest Perspective: Concussion - Spotlight on mTBIs

Editor's Note: As part of the Center for Deployment Psychology’s ongoing mission to provide high-quality education on military- and deployment-related psychology, we are proud to announce a new feature on our blog site. Starting today, and continuing every other Tuesday, we will be presenting blogs from esteemed guests and subject matter experts from outside the CDP. Our weekly Staff Perspective column on Wednesday will still feature entries from CDP staff members, but this new feature on Tuesday will allow us to offer more insight and opinions on a variety of topics of interest to behavioral health providers.

As these blog entries are written by outside authors, one important disclaimer: all of the opinions and ideas expressed in them are strictly those of the author alone and should not be taken as those of the CDP, Uniformed University of the Health Sciences (USUHS), or the Department of Defense (DoD).

That being said, we’re very happy to offer a platform where we can feature these individuals and the information they have to share. We’d like to make this an ongoing dialog. If you have questions, remarks, or would like more information on a topic, please feel free to leave comments below or on our Facebook page, and we’ll pass them along to the author.

By Dr. Anthony Doran
Guest Columnist

The much-anticipated movie “Concussion” was released on Christmas Day, and already there is Oscar Award talk for Will Smith, who plays the role of Dr. Bennet Omalu. It was Dr. Omalu who discovered the tragic progressive degenerative effects of years of multiple concussions in NFL players, which he named CTE (chronic traumatic encephalopathy).

The film highlights the NFL’s initial response of anger and denial. Indeed, since Dr. Omalu’s discovery in 2002, the NFL has experienced lawsuitsexposés, and finger-pointing in general. Now, 13 years later, bystanders have watched the NFL’s reaction to this scientific research unfold in a manner not unlike many stages of grief – first denial, then anger, on to bargaining and, finally, acceptance. (Although, the League is still working on fully coming to terms with this last step).  For their part, the NFL hasn’t had much reaction to the movie, preferring to keep the controversy at arm’s length. While Dr. Omalu has vocalized his opposition to children playing football until they are legally and emotionally old enough to understand the danger of putting their brains at risk, the NFL can’t afford to lose any of their reported $7+ billion in annual revenue.

After the dust has settled I think there will be several key issues still on the table - hitting your head during your developmental years repeatedly is not a good thing and if you continue to do it into college and for a professional career there can be some significant health consequences; how serious are families in America and around the world going to hear that message and will they keep their children from playing football?   

This isn't just the end of a conversation about head injuries and traumatic brain injuries, but just the beginning.  HeadFirst is a community-based concussion clinic that over the past three years has seen over 30,000 traumatic brain injury visits.  Not only is football a violent game, but soccer, lacrosse and hockey also put the brains of our youth at risk to head trauma.  Could rule changes and modifications, such as keeping your feet on the ground in soccer, no slide tackling, no checking in hockey, and limited contact in lacrosse, increase the athleticism and reduce head injuries?  How are we gearing our sports program to focus on the benefits of sportsmanship, discipline, hard work, leadership, and exercise for everyone - not just the top 1% of the physically talented? Do we enjoy violence so much that we want to have our youth jump into the gladiator pit?  In the HeadFirst sample of 30,000 visits from ages 2 to 99, sports only account for 35% of traumatic brain injuries.  

Motor vehicle accidents, bike accidents, and slips and falls make up the majority of the mechanism of injury for our head traumas and traumatic brain injuries.  Hopefully, parents and schools and employers continue the conversation that traumatic brain injuries can happen to anyone.  Baseline neurocognitive testing can be helpful in the diagnosis of a traumatic brain injury and monitoring the recovery from a traumatic brain injury for all students and employees.  Policemen, firemen, air traffic controllers, nuclear power plant workers, and other professionals who have high-risk, zero-defect jobs suffer head injuries....what's their return to the job protocol?

My wish is that families begin to talk about head injuries and the safety of sports and that in the New Year schools and employers continue to develop traumatic brain injury protocols to keep all children safe and learning at school and get employees back to work as safely as possible. 

Dr. Anthony Doran is the Program Director of Righttime’s HeadFirst Sports Injury and Concussion Care, overseeing clinical operations and research initiatives. As a pediatric neuropsychologist, Dr. Doran also assesses patients with head injuries at HeadFirst clinics. His assessment approach utilizes concussion management software technology and a developmental neuropsychological approach to head injury evaluation and management. Current research initiatives are being developed with the University of Pittsburgh evaluating mTBI in children 5-10 years of age and University of Maryland on the process of word retrieval constitutes a sensitive indicator of cognitive recovery in children with mTBI.

Dr. Doran has over 20 years of experience in psychological assessment. He did his post-doctoral training in pediatric neuropsychology at Harvard Medical School and received a doctorate of psychology from the University of Hartford. Past research projects have been several studies evaluating severe stress in Special Forces personnel and studies monitoring DoD and Navy suicide prevention efforts. Dr. Doran has taught multiple psychology classes at the United States Naval Academy and John Hopkins University and was the psychological consultant for the Leadership, Ethics, and Law department that trains over 4,000 midshipmen each year. In addition to his private practice, over the past several years Dr. Doran has served as a subject matter expert and consultant for Military and Law Enforcement Commanders selecting Special Forces personnel at a variety of sites throughout the country.