I had the privilege of attending grand rounds at VGH where the guest lecturer was neurosurgeon Dr. Christine Ann Duhaime discussing new research on concussion. I first became aware of her work while working on a Shaken Baby Case, because she was the neurosurgeon whose work resulted in the description of the most common symptoms of shaken baby syndrome known as Duhaimes triad. Dr. Duhaime was presenting on her work in the area of concussion and concussion in sport. I found the talk fascinating. Dr. Duhaime described the studies she is involved in at some American universities. They are installing sensors in the helmets of football players that measure the forces on the players heads as they play throughout the year. Essentially, the data gathered shows rotational, angular and direct impact forces in G-Forces which is then compared to the reports of concussion. The science is fantastic, but I expect that the researchers in the audience were disappointed with small sample sizes and the need for longitudinal studies and consistent measures. She candidly stated that the science does not show any specific cut off for angular, direct or other force that can be related to result. In other words, host specific or individual differences between individuals are important, but difficult to study. Some people sustain huge forces with no impacts, but others develop concussions and symptoms with less force.
Dr. Duhaime described the fMRI studies that were conducted on some of the players following there concussions. Apparently they were given basic neuro-psychological testing while the fMRI studies were performed. Comparing these test results to those who were not concussed revealed much greater areas of brain utilization amongst the concussed individuals, although the two groups scored the same on the testing. This result is not surprising to those who have worked in this field, as our clients constantly describe how they put in much more cognitive efforts to accomplish necessary tasks, resulting in cognitive fatigue and other sequalae. While we have come far in our ability to image and see brain anatomy and physiology, we still dont know who will sustain injury and who will have a difficult course of recovery.
Dr. Duhaime was also candid in describing her own history and that of neurosurgery. She spoke about how medicine has changed from her perspective – where in the 1980s a neurosurgeon might have told a patient that “its just a concussion”, today, she would tell patients that it is a “brain injury”. She believes that instead of denying injury to the brain, the focus should be on the recovery and on the potential for the individual to recover function.
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