LA-area Jeff Victoroff, M.D. is a Harvard trained neurologist who directed USC's Traumatic Brain Injury/Neuropsychiatry Clinic at Rancho Los Amigos National Rehabilitation Center for more than a decade, is also an award-winning teacher of neurology and one of the five neurologists recruited by former U.S. Surgeon General David Satcher to provide care for concussed, demented, former NFL players.
This is the final part of the interview.
What do you think of the current push for better safety equipment?
The not very good news: Plastic helmets are better than nothing. But they mostly protect against skull fractures and still allow concussions to occur. One study showed that leather helmets from 1920 are better for preventing concussions! Rowson and Duma (2011) at Virginia Tech developed an adult helmet rating system. This year, Virginia Tech also published a rating of child football helmets. Helmet makers are scrambling to be at the top of the Virginia Tech rating hill. But other scholars, including Don Comrie and Blaine Hashaszki, have warned that the rating system is fatally flawed (Comrie, 2014; Moore, 2015).
For-profit companies soldier on. Here's an irony: almost all the recent helmet "improvements" consist of a bigger shell with more padding. The reduces linear accelerations but increases rotational accelerations--which may be more brain damaging!
In 2017, Vicis.com introduced the ZERO1, a soft-shell helmet that mimics the biomechanical benefits of leather. The Vicis is now available for youth. Is this an "advance" or marketing gimmick? After 40 - 60 years, we will see if this new technology has any effect on long-term brain damage.
The bad news:
First: the scientists consulting on helmets--such as the team at Virginia Tech-- hugely oversimplify the problem. They think that concussive damage is proportional to linear and/or a rotational acceleration. That makes their math easier, but it's untrue. Want to measure brain damage? Maybe measure axon stretch? It's way more meaningful--but a little impractical. How many parents would say, "Sure!" when the emergency room doctor suggests an immediate autopsy?
Say high-school football players Timothy and Muhammed suffer hits that are measured (using helmet accelerometers) at exactly the same force: 56 Gs of linear acceleration. One boy may be out of the game for a minute. The other may be out for a month. That is because it's not the force that determines the harm. It's the brain changes such as axon stretch. Tim 's 56 G hit may cause a 12% axon stretch. Poor guy's out for a month. Muhammed's identical hit caused a 5% stretch. He's good to go.
Second: There is absolutely no way to protect the brain from concussive damage when a person stops suddenly. It doesn't matter whether she hits her head. It doesn't matter what helmet she wears. Her brain still slams against the interior of her skull.
Want to help? Easy! All we have to do is open up every child athlete's head and wrap a woodpecker's tongue around and around his or her brain! That's why woodpeckers don't knock themselves out. Unfortunately, unlike goats and woodpeckers, our children simply did not evolve to tolerate head impacts, and no hat will change that.
How can parents encourage their kids to think about the safety aspect of sports, not just what's popular?
As the kids say, OMG! This is a massive frustration for any parent with a child over nine years old. That's the age--across societies--when children begin to trust what their peers tell them more than what their parents tell them.
Smoking? Driving? Drugs? Sex? We should give it a shot. We should make our kids familiar with the risks. But it's mostly in one ear and out the other, because of (a) the amazingly long delay in human brain maturation (it happens around age 25 to 26), and (b) the amazingly strong mandates of peer pressure.
That's why it all comes down to us. We are the adults. Until our child is 18, we are morally and legally responsible to make health decisions for her or him. They may kick, and sob, and scream, and tell us we have ruined their lives forever (second time this week!) We must tell our 11-year-old daughter firmly, "Sorry sweetheart. No. You will not borrow the car because it's unsafe and illegal. Let's hit the go-kart track!!" The most recent advances in brain science strongly suggest that we must also tell our seven-year-old, "Sorry, sweetheart. No. You will not play Pop Warner football because it would definitely increase your chances of permanent brain damage. Let's shoot some hoops!"
Jeff Victoroff, M.D. is a Harvard trained, board certified neurologist and psychiatrist, also certified in Behavioral Neurology and Neuropsychiatry. He serves as Associate Professor of Clinical Neurology and Psychiatry at the Keck School of Medicine of the University of Southern California (USC). He directed USC's Traumatic Brain Injury/Neuropsychiatry Clinic at Rancho Los Amigos National Rehabilitation Center for more than a decade. He is an award-winning teacher of neurology and the recipient of an award from the Brain Injury Association of America. He was one of the five neurologists recruited by former U.S. Surgeon General David Satcher to provide care for concussed, demented, former NFL players. His new book, Concussion and Traumatic Encephalopathy: Causes, Diagnosis and Management, is available on Amazon and other fine booksellers.
What do you think of the current push for better safety equipment?
The not very good news: Plastic helmets are better than nothing. But they mostly protect against skull fractures and still allow concussions to occur. One study showed that leather helmets from 1920 are better for preventing concussions! Rowson and Duma (2011) at Virginia Tech developed an adult helmet rating system. This year, Virginia Tech also published a rating of child football helmets. Helmet makers are scrambling to be at the top of the Virginia Tech rating hill. But other scholars, including Don Comrie and Blaine Hashaszki, have warned that the rating system is fatally flawed (Comrie, 2014; Moore, 2015).
For-profit companies soldier on. Here's an irony: almost all the recent helmet "improvements" consist of a bigger shell with more padding. The reduces linear accelerations but increases rotational accelerations--which may be more brain damaging!
In 2017, Vicis.com introduced the ZERO1, a soft-shell helmet that mimics the biomechanical benefits of leather. The Vicis is now available for youth. Is this an "advance" or marketing gimmick? After 40 - 60 years, we will see if this new technology has any effect on long-term brain damage.
The bad news:
First: the scientists consulting on helmets--such as the team at Virginia Tech-- hugely oversimplify the problem. They think that concussive damage is proportional to linear and/or a rotational acceleration. That makes their math easier, but it's untrue. Want to measure brain damage? Maybe measure axon stretch? It's way more meaningful--but a little impractical. How many parents would say, "Sure!" when the emergency room doctor suggests an immediate autopsy?
Say high-school football players Timothy and Muhammed suffer hits that are measured (using helmet accelerometers) at exactly the same force: 56 Gs of linear acceleration. One boy may be out of the game for a minute. The other may be out for a month. That is because it's not the force that determines the harm. It's the brain changes such as axon stretch. Tim 's 56 G hit may cause a 12% axon stretch. Poor guy's out for a month. Muhammed's identical hit caused a 5% stretch. He's good to go.
Second: There is absolutely no way to protect the brain from concussive damage when a person stops suddenly. It doesn't matter whether she hits her head. It doesn't matter what helmet she wears. Her brain still slams against the interior of her skull.
Want to help? Easy! All we have to do is open up every child athlete's head and wrap a woodpecker's tongue around and around his or her brain! That's why woodpeckers don't knock themselves out. Unfortunately, unlike goats and woodpeckers, our children simply did not evolve to tolerate head impacts, and no hat will change that.
How can parents encourage their kids to think about the safety aspect of sports, not just what's popular?
As the kids say, OMG! This is a massive frustration for any parent with a child over nine years old. That's the age--across societies--when children begin to trust what their peers tell them more than what their parents tell them.
Smoking? Driving? Drugs? Sex? We should give it a shot. We should make our kids familiar with the risks. But it's mostly in one ear and out the other, because of (a) the amazingly long delay in human brain maturation (it happens around age 25 to 26), and (b) the amazingly strong mandates of peer pressure.
That's why it all comes down to us. We are the adults. Until our child is 18, we are morally and legally responsible to make health decisions for her or him. They may kick, and sob, and scream, and tell us we have ruined their lives forever (second time this week!) We must tell our 11-year-old daughter firmly, "Sorry sweetheart. No. You will not borrow the car because it's unsafe and illegal. Let's hit the go-kart track!!" The most recent advances in brain science strongly suggest that we must also tell our seven-year-old, "Sorry, sweetheart. No. You will not play Pop Warner football because it would definitely increase your chances of permanent brain damage. Let's shoot some hoops!"
- References
- Bailes JE, Petraglia AL, Omalu BI., et al. Role of subconcussion in repetitive mild traumatic brain injury: A review. J. Neurosurg 2103, 119: 1235–1245.
- Baugh CM, Kiernan PT, ,4 Emily Kroshus E., et al. Frequency of head-impact–related outcomes by position in NCAA Division I collegiate football players. J Neurotrauma, 2015;32:314–326.
- Broglio SO, Eckner JT, ,2 Douglas Martini D., et al. Cumulative Head Impact Burden in High School Football. JOURNAL OF NEUROTRAUMA 28:2069–2078 (October 2011)
- Comrie D. In Reply to Rowson et al. Response. Letters to the Editor: Football helmet design and concussion. Posted online on 27 Jun 2014. Available at http://thejns.org/doi/pdf/10.3171/2014.2.JNS14294
- Hirst RB, Haas AL, Teague AM, et al. Bell ringers: Factors related to concussive events in children playing tackle football. J Pediatr Health Care, 2018;33:1.
- Kay MC, Welch CE, , Tamara C. Valovich McLeod TC. Positive and negative factors that influence concussion reporting among secondary-school athletes. J Sport Rehabil, 2015, 24:210 -213.
- McCrea M, Hammeke T, Olsen G, et al. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med, 2004;14:13-17.
- Moore J. How a football helmet industry titan sells the false promise of safety. Feb 13, 2015. Available at https://www.vice.com/en_us/article/pg55ev/how-a-football-helmet-industry-titan-sells-the-false-promise-of-safety
- O’Connor KL, Peeters T, 2 Stefan Szymanski S. et al. Individual impact magnitude vs. cumulative magnitude for estimating concussion odds. Ann Biomed Engineer 2017; 45: 1985–1992.
- Register-Mihalik JK, Guskiewicz KM, Valovich McLeod TC, et al. Knowledge, attitude, and concussion-reporting behaviors among high school athletes: A preliminary study. J Athletic Training, 2013;48:645–653.
- Rowson S, Duma SM. Development of the STAR evaluation system for football helmets: integrating player head impact exposure and risk of concussion. Ann Biomed Eng 2100;39: 2130-2140.
- Wunderle K, Hoeger KM, Erin Wasserman, E. et al. Menstrual phase as predictor of outcome after mild traumatic brain injury in women. J Head Trauma Rehabil, 2014; 29: E1–E8.
Jeff Victoroff, M.D. is a Harvard trained, board certified neurologist and psychiatrist, also certified in Behavioral Neurology and Neuropsychiatry. He serves as Associate Professor of Clinical Neurology and Psychiatry at the Keck School of Medicine of the University of Southern California (USC). He directed USC's Traumatic Brain Injury/Neuropsychiatry Clinic at Rancho Los Amigos National Rehabilitation Center for more than a decade. He is an award-winning teacher of neurology and the recipient of an award from the Brain Injury Association of America. He was one of the five neurologists recruited by former U.S. Surgeon General David Satcher to provide care for concussed, demented, former NFL players. His new book, Concussion and Traumatic Encephalopathy: Causes, Diagnosis and Management, is available on Amazon and other fine booksellers.
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