Films on Demand

The Hidden Epidemic: Post-Concussion Syndrome

Hello, I’m Dr. Casey Cooper, sports psychology professional.

You know, in my practice I see athletes, their families, and teams and I've become aware of something we should all be very concerned about.

It's post-concussion syndrome.

For some of you the material in this film is going to be very familiar.

For the rest of you, you're going to become quite aware of this hidden epidemic.

Hey guys, I'm Matt Hasselbeck, quarterback of the Seattle Seahawks.

When I was a freshman in high school I had a concussion just like many of you.

It's important to take care of your brain.

Listen to your doctors, listen to your coaches, your parents, and remember you only have one brain - take care of it.

Most brain injuries are not treated.

Head injuries are a terrible epidemic in our country and nobody knows about it.

Nobody knows about it because nobody's basically looking at the brain in people that have learning, emotional, or behavior problems.

The center for disease control estimates that over 800 sports related concussions occur in the united states every day.

Then there's nonsports related concussions that are five times that number.

When someone experiences one head trauma, their risk of experiencing a second goes up three times.

After a second or third head trauma that risk increases by eight times as likely.

I think what's important for parents and educators to know—we don't normally think about how someone had an injury to their brain…

Like in a fall, slipped, thrown off a horse, fallen off a bike.

Normal activities in many cases for many people but we don't think that that hit to the head did that kind of damage when in fact it can.

So that the problem goes unnoticed, it goes unseen, it goes undetected.

I did a survey in my classrooms and in every single class—six classes, over180 students total—at least one quarter of the students had had a concussion that had been diagnosed and up to a third had had one that they thought they'd probably experienced.

Sarah, you okay?

Hi, I'm Johnny Damon of the New York Yankees and I've had a concussion just like you.

My first one happened when I was in high school.

My major concussion actually came when Damien Jackson ran into me in the playoff game and I was knocked out for a couple minutes before I could even move.

But I actually had no idea where I was until five or six hours later.

A concussion is a serious deal and it's something that needs to be treated and no one really knows what you're going through unless you've had it.

You're going to see right here- brooks gets the ball and he gets hit out of bounds.

When Darren Woodson delivers a blow you don't get up until you're about five yards outside.

I got injured at Dallas.

I was on the sidelines and I got hit by a player and then I hit my head on the cement when I fell back.

And I wanted to stay there.

I said "I'm staying in the game. This is a championship game, I'm not leaving".

The doctor said "You're hurt,you're going to the hospital" I said, "No, I'm not".

They put me on a board and they took me to a hospital and I woke up two days later and I had a fractured skull, I had a concussion, I was scrambled.

So what happens if you have a head injury and nobody treats it?

Well, maybe nothing. Maybe it's just decreasing the reserve that your brain has.

Maybe it's turning you into someone who can't be married or can't do school or goes from job to job.

So depending on your brain, it might, in fact, ruin your whole life.

After I had a great career at Harvard playing football I went on to wrestle for world wrestling entertainment where I got a very bad concussion.

I found out it wasn't my first.

I had some here and probably before.

But I had post concussion syndrome that lasted- still lasts this day, which is over three years since it happened.

But for about 18 months I was in really bad shape.

I had bad memory problems and I had horrible headaches which I still get… constant migraines.

You're about to meet Michelle Navarro.

She's 15 years old, and eight months ago she experienced a severe fall down the stairs which left her with a concussion.

Immediately she experienced some short term memory loss and as a result her grades fell to d's and f's.

I lost my balance apparently and I went head first down a flight of concrete stairs and I landed on my back and my head hit the concrete first.

I don't remember the ambulance ride.

I don't remember arriving at the hospital.

I was involved in a triple fatality car accident in Mexico.

Ended up with a skull fracture and damaged some of my brain stem and I was knocked unconscious for a couple of minutes.

Brain injury causes psychiatric problems in a large number of people.

Does anybody remember the name of the treaty?

Sarah.

The treaty of Versailles?

Excellent, the treaty of Versailles.

Somebody's had a brain injury…

Their behavior can change.

Maybe not initially.

It may be three months later, four months later, even a year later because as the brain tries to recover from the injury sometimes scar tissue is formed in the brain and then the symptoms actually show up later.

But you look for changes- changes in mood, changes in temper, changes in learning.

You see it in the classroom.

You don't see it on the field very much because it's a money job, they're trying to make money and they're trying to stay here for a long time.

But in the classroom there's times when they have a tendency to fall asleep or they're looking out the window and not paying attention to you.

This time of the year at training camp they're tired, but during the season when they're healthy and strong and we're going fast, if something like that comes up, that's a red flag and we gotta check it out.

As a coach and a teacher, you have to be able to see that.

Head injuries tend to be cumulative, so it may not be the first head injury you have that causes your symptoms.

It may be the second or the third.

The brain has a tremendous amount of reserve.

Maybe that fall down the stairs took away 50% of your reserve.

And then that diving accident took away 25%, and then that concussion you had playing football took away the rest, and now all of a sudden you have severe symptoms with what a lot of people go "it doesn't fit the accident" and it's because it's cumulative and it's the other accidents that really set this one up to be the bad one for you.

Concussions can come from almost anywhere.

It can come from blunt trauma to the head or it can come from some sort of toxic exposure.

I had a patient once brought to me, seven years old, Christopher, and he was diagnosed with mental retardation.

He had an IQ of 63. And when I scanned him he had low overall activity in his brain and he had been exposed to pesticides.

He lived in the San Joaquin Valley.

And so we made sure we got him out of the environment and I put him on some supplements and medication and the next year his brain was much better and he tested at an IQ of 103.

So head injuries can come from blunt trauma, but they can also come from being injured by certain exposure to toxins in the environment.

Participation in athletics is inherently risky which is why we require athletes to wear protective gear.

That's what helmets are for.

They prevent you from sustaining a fracture to your skull.

But "concussion" translated actually means "shaken brain" so we need to be very aware on the field and off the field.

Please protect yourself.

Bicycling is the number one reason that kids get concussions.

Make sure they wear a helmet.

And make sure they wear a helmet that fits because the injuries from helmets that fit versus those that don't are significantly less.

So make sure the helmet fits.

One reason I use a Riddell helmet- probably five years or so they've had it- and before that- the old shell, there was concussions.

The shell has gotten bigger, I think there's more distance between the padding and the shell, instead of the shell banging onto the guy's head like that.

The most comfortable helmet right there.

Yeah, it does a good job.

It's comfortable.

The second year it's been like this.

When I first came here it was like this.

Almost by definition, a brain injury is invisible.

There doesn't need to be a broken bone or bleeding.

The damage is to the brain, not to the scalp or the skull.

When you have a head injury you can't see it so you think you're okay.

When you break your arm you've got a cast on it, or a knee you've got a cast on it.

Here you can't tell, but there is something wrong if they tell you.

Skateboarding, actually behind me is an image of a child that lost about25% of their frontal lobe so it'll affect him for the rest of his life.

He had a skateboarding accident.

Coming down head first on the coping or something like that.

Just the whiplash, you know, I've done a couple where I've woken up in the hospital in a cat scan machine.

Cheerleading, where girls are up on the top of the pyramid and they fall, they fall on their head.

We see those kinds of accidents.

Soccer- I think soccer is a bad brain sport.

Hitting soccer balls with your head is just plain stupid for a developing brain.

Soccer studies show15% of high school kids are getting multiple concussions a season.

And so this is a very prevalent problem.

She was an elite level soccer player who had suffered many blows to her head because she was a goalkeeper and there were many times when she quite possibly could have suffered from a concussion.

Players have to fight that urge to be the tough guy and play through anything.

We're all kind of conditioned.

There's no point in being tough and dead.

I think everyone who plays this game has a toughness and you're not being a wimp to go to the doctor if you're not feeling right and let him know.

When I was a brand new coach "I'm fine, coach, put me back in the game".

"Okay, sure.

I believe you.

You can do it.

You're a lot better than who's in there right now.

We need to win this game.

Get in there".

You hear all these stories about kids with second impact syndrome that went back onto the field and they didn't know they had a concussion or they didn't tell anyone about their first concussion.

My sophomore year high school football coach lost his son from second impact syndrome.

All of his teammates, all the kids knew he had a concussion the week before except for the coaches, his parents, and the trainer.

He went back on the field the next Friday night and he got a second concussion and died on the field.

The help they're giving the kids and the way they're taking care of them is way better than it was years ago when they said: "get back into the third quarter".

No, you're definitely not a wimp if you want to take yourself out of a game, so definitely pay attention.

Don't put them back in the game.

No game is worth a child's life.

A lot of people don't know that the brain is the consistency of soft butter…

Tofu.

Somewhere between egg whites and jello.

The brain is very, very soft and it's housed in a really hard skull.

And if you look at the inside of the skull what you see is there are many ridges in this skull.

So during a concussion what you see are these parts of the brain slam up against these bony surfaces in the brain and they cause direct trauma.

Also, the brain is made up of 100 billion nerve cells and it can break or shear those nerve cells so they don't connect well to the network they were working in.

And so you end up with these massive numbers of short circuits in the brain.

I don't remember who my friends are.

Some of my friends, I don't know who they are.

I made my friend cry this morning who is apparently my best friend and I don't know who she is.

Physically, common people have headaches.

They get dizzy, they have memory problems.

Their balance is off, they become more sensitive to light.

I can always feel a headache coming on, bright lights.

It's tough on me at times but that's why I always try to wear sunglasses.

Reading is a problem for them where it might not have been a problem before.

I have one patient…

After a car accident, she forgot how to read and she had to be retrained over again.

I opened up the book and the pages were just kind of an off whitish gray.

I thought, okay, that's kind of bizarre.

Maybe there was a misprint, so I flipped the page- same thing.

Flipped the page- same thing.

I said "my book is blank" and the teacher came over and said, "you don't see anything on the page?" I said, "no, there's blank pages there".

She said, "you better go straight to the office".

They whisked me over to the hospital, the doctor said: "you've got a concussion".

The main doctor told me to slow down and not go fast.

I did not pay attention to him, I tried to it my own speed.

My hands went numb, my legs went numb, and I went back to him and he said: "what are you doing?" I said, "I'm running on the treadmill".

He said, "I told you to walk, not run".

So the point I can tell all of you folks, whatever the doctors tell you, they're right.

They have way more experience than you.

The doctor said you basically have to take it easy.

No running, no jumping, just take it real easy for the next six months to a year.

I thought "six months to a year?" at 17 years old, you know… anyway, I waited it out and things got back to normal pretty quick.

Changes in mood often follow post concussion syndrome.

As you're going to see, depression can be one of those symptoms.

My brain actually gets physically, physiologically depressed.

But also, for me, being an athlete it took away my support network, the WWE, it took away my job, my livelihood.

So not only is your brain changed, and that creates actual physical depression, but then your world changes.

And it's kind of like a double whammy.

You become a different person and your friends and family and your coworkers, they don't really understand that and so they start treating you differently.

My 14 and a half year old daughter committed suicide.

It wasn't until after Amber's death, looking backwards, that we realized in putting the pieces back together that amber did suffer from depression.

We just didn't know that teens could suffer from depression and what that looked like.

I had quit all sports and my grades had gone down and at that point, I started hitchhiking to bowling alleys so I could smoke.

I started to drink and just making terrible life choices.

And I had no idea why I was doing it.

No idea why.

She was kind of weird.

Yesterday she was fine, she remembered everybody, she was doing okay.

But then today she was totally lost.

She didn't know my name but she kind of remembered my face.

I walked into her class, I talked to one of the speech and debate girls and told her about it and a lot of people were going up to her and she never remembered any of them.

I don't remember yesterday at all.

I don't remember what I did yesterday.

One of the things that sometimes makes athletes more depressed is being removed from their athletic involvement and what makes it really complicated during a concussion experience and recovery is it's almost like a double whammy.

During the brain's recovery depression sometimes occurs.

But then they're also not able to be involved in the coping things they would normally do to help themselves feel better.

And a lot of times that is their athletic involvement.

So we need to be aware to encourage them to be involved in some nonsports related things that are safe for them as they recover from their concussion and post concussion syndrome.

You just get really down. You feel like there's nobody that understands you, nobody you can talk to.

Even if you do have somebody to talk to, you just feel like you don't.

You just kind of feel lost.

When that head injury occurs, often there's an experience of depression that follows and with that depression comes an experience of someone being suicidal.

And it's really the loss of life that we're trying to prevent.

During the filming of the hidden epidemic, makeup artist Leah Sakamoto shared that she had experienced post concussion syndrome.

Since recovered, Leah describes her experience.

Don't talk to them like they're crazy, they're insane, out of their mind, or that what they're thinking is wrong, because most likely they are thinking irrationally but to them, it's the right answer.

Because I've been in those shoes where I was at the point that I thought it was the right answer.

Sarah, what's the matter?

I don't know.

This isn't like you.

Normally you'd have at least half a page done.

I know.

Parents, teachers, anybody who comes in contact with teens, they need to understand one thing.

The misconception is that depression in teens looks like depression in adults and that's not necessarily true.

Not always is depression in teens sad like you would see it in adults.

Sometimes it can even be anger.

With Amber, the things that we missed and the signs that you need to look for are differences in sleep patterns, differences in eating.

Are they feeling hopeless and helpless?

Is there a decline in grades?

Have they limited contact with friends?

Have they kind of become isolated?

Those types of things.

Lack of interest in things that they once had great passion for.

Those are the things that parents need to look for.

Do you think you can do a little bit better?

Can you focus?

I'm sorry.

Okay?

When there's been a brain injury it makes it difficult for people to think clearly.

Psychologically, it depends on what area of their brain was hurt.

If the front part of the brain was hurt, they start to have problems with emotional control.

The front part of your brain actually helps modulate your emotions, and when it doesn't work right you're sort of too cold or too hot depending on the situation.

Psychologically they have a lot of problems with judgment and that's one of the hardest things that people have secondary toa head injury and they don't think before they say things.

They don't think before they do things and that gets them into a lot of trouble.

The brain is such an interesting organ.

The left side of the brain is the happy side of the brain, and when you hurt it, people get depressed.

They have these really dark, evil, awful, terrible thoughts and they often, in my experience, act out on those thoughts.

When the right side of the brain gets hurt- well, the right side of the brain is the anxious side of the brain.

When the right side of the brain gets hurt people often appear like they don't care.

Especially when the front part of the brain is hurt, people have problems with substance abuse because they don't have the impulse control.

Most of us know that if we have a drink or if we have two, that should be enough.

But they don't have that control so they end up having much more problems with drugs or alcohol.

The drugs they choose to abuse are methamphetamines and cocaine because it stimulates the brain, it sort of brings back some of the function they had in really tiny doses but people don't use tiny doses and they end up getting into a lot of trouble with either drugs or alcohol.

Many people with head injuries use those substances to try and feel better, but in the process, they are making their brain worse.

And when you make your brain worse you're actually limiting the access you have to yourself.

The brain is really the hardware of the soul…

Who you really are inside, that person that's only known to you.

When your brain is damaged you don't have full access to that person.

When kids are using drugs and alcohol, too often people don't look underneath it and go"what's going on?" are they medicating an emotional, psychological condition like depression?

Are they medicating a head injury?

And if you never look at the brain you never know.

You are left to guess and that's why I think looking at the brain is so crucial.

Because if somebody is suffering with depression or someone is suffering with violence or someone is not learning, the organ of loving, learning and behaving is the brain.

The biggest thing for parents is to support your kids and support them as much as you can and if for some reason things are going well and it stops going well, then something's up.

That's a red flag right there.

My parents would bring things up about my childhood and I don't remember.

Things from school I don't remember.

Athletic involvement can increase their self esteem, their sense of being a competent individual.

These are all necessary things when recovering from depression.

Moms and dads, just support your kids and when something goes wrong, talk to them.

If they don't get a hit in a game or if they don't get to play in a game, talk to them and don't let them quit.

When left untreated, depression can sometimes go to a very dark and hopeless place.

Let's not let this happen for our athletes.

Let's get them involved in some nonathletic things that are going to help them to feel very good about themselves, who they are, and what they have to offer.

People don't talk about suicide and depression because in our culture unfortunately depression is still considered a weakness.

We know it to be a brain disorder.

We know it to be an illness, but unfortunately, still society looks at depression as a weakness.

What happens is they don't want to talk about that, they don't want to acknowledge it.

There's not enough education about it and depression left untreated can lead to suicide.

95% of suicides are committed by people who suffer from depression.

One in five high school students will think about committing suicide during their high school career.

It's the number three killer of teens ages 15-24.

It moves to the number two killer of teens once a teen enters college.

One in eight high school students suffers from depression undiagnosed.

These are all statistics that parents need to be aware of even if it doesn't apply to their child.

If your child's not the one in five, if your child'snot the one, four of their closest friends that are sitting in your living room watching your tv, eating your food, it could be one of them.

Our friends mean more to us- almost more than family.

Because our friends are us.

It's just like looking in the mirror, saying "I had a bad day today".

"Oh, really?

Just tell me about it" and we'll spill everything.

We spill everything to each other because we trust each other.

And I feel really bad for the kids that can't trust anybody.

There are always outward signs of somebody who is thinking about taking their life.

Unfortunately, those signs are seldom picked up until after.

The number one thing that kids do is they always, always tell somebody in some way, shape or form. 8 It could be a comment " I feel like life isn't worth living".

It can be as simple as that.

It can be cleaning their room for the last time, getting their affairs in order, giving away valued possessions.

Those are all signs of somebody who is thinking about killing themselves.

For a teen, that's the way they get their affairs in order.

But always there is some sign that this is going to happen.

Not always is that information brought forward before the attempt is made.

There are two million new head injuries every year in the united states.

And people just don't look.

I haven't been able to sleep very well.

I'm going to sleep at around3:00 or 4:00 in the morning.

And I wake up really tired.

I have really bad headaches during the day.

I don't eat as well as I used to.

I took a look at your grades and I noticed that they've dropped in the past three months.

You went from a's and b's to d's and f's.

I'm sorry.

Well, there's no reason to be sorry but I was concerned about you and wondering if anything's going on, you know because this is so unlike you.

I'm fine.

It's at that point that I would have said: "what happened?" things don't appear out of nowhere typically.

And particularly if there's been an acute change, a dramatic change in mood or behavior from one point to the next.

Then identifying the starting point of that is really important.

I talked with some of your teachers too and they're concerned.

They've noticed a big change in your behavior.

Just seeing you on campus I can tell that you're not the same person you were three months ago.

Is there anything going on that you would feel comfortable talking to me about?

Always checking for substance abuse, always checking to see if there's some kind of medical problem that's beginning to emanate at that point.

And a third possibility would be to say "has there been any kind of loss of consciousness?" well if you do feel like talking, I'm here.

You come see me anytime and I can help you.

Whenever there's a change in behavior you want to ask yourself, what are the potential causes?

And head injuries should always be in that list.

It's important to protect their heads once they've had a head injury, it's even more important to protect them from that next head injury.

The key element that we have to keep in mind is that any time there's been an injury to the brain we have to watch for changes.

Most school personnel do not understand the ramifications of this problem and the connection with depression and the connection with suicide.

The schools are going to need to have expert trainers come in and help them learn.

If we don't do that, we're going to lose up to a third of our population at some point.

Whether they go into prisons, whether they commit suicide, or whether they become the people that are not going to be able to support themselves in society.

There's a certain genet hat predisposes people to have really bad outcomes from a head injury.

Not everybody has it.

That's why ten people can have the same injury and only two have really bad fallout from the injury.

It's a gene called the apolipoprotein e-4 gene, the same gene that predisposes people to Alzheimer's disease.

We can do a blood test to find out who has the gene and who doesn't.

My belief is if you're going to let your child play a contact sport he should be tested for the gene.

If a child has a head injury, the first thing to do is be aware that things might change.

Not every head injury causes a bad outcome, but every head injury may be taking away somebody's reserve.

So what I tell people is early on make sure they're taking a good multivitamin that has antioxidants in it because the head injury increases free radical formation and subsequent damage.

This can be treated.

That's the good news.

So that if people are mindful and if people are assertive about getting treatment, then that can make a big difference.

Sometimes you need medication, and the medication needs to be targeted to the problem in the brain.

So if it's low activity in the front part of the brain you might use a stimulant to increase activity.

If it's problems in one of the temporal lobes we'll use anticonvulsants to stabilize that.

Often if a person presents with impulse control problems and temper we'll give them an anticonvulsant which will help stabilize their temporal lobes and decrease their temper.

And then we'll give them a stimulant so they can think better and concentrate.

So supplements including ginkgo and fish oil- fish oil is one of the things we recommend a lot because the nerve cell membranes are made up of the fatty acids found in fish oil.

If you notice changes in their behavior, get 'em scanned, have somebody look at their brain.

And the functional scans which are just becoming more widely available, like the study we do called s.p.e.c.t. Are actually better for head injuries because they show problems in function which happen before problems in anatomy occur.

And over the last 15 years, we've done over 31,000 scans.

And the single most important thing I've learned from looking at these scans is that brain injuries affect more people than we had any clue.

Especially people who have learning problems or people who have behavior problems, temper problems, or people who have emotional problems like depression.

This idea of suicidality as being intolerable pain, that people, get very, very confused- what they want is they want this pain to end in some way.

But the difficulty is they get confused between ending the pain and ending their life.

If they tell you they're hurt inside they're probably hurting more than you can imagine.

Suicide is the ultimate and final decision that anybody can ever make, and whatever pain is really causing that- that extreme pain to make you feel like life's not worth living and you really don't want to see the next day - you really should listen to what they have to say because, honestly, if somebody didn't listen to me, if somebody wasn't there to listen to what I had to say…

I probably wouldn't be sitting here, I'd probably just be like, you know what?

I'm done.

I don't want to put up with this anymore and it's not worth it.

But since somebody was there listening, and somebody was there to hold my hand and tell me "you'll see tomorrow because this isn't worth it".

After amber's suicide, we were desperately looking for signs.

What did we miss? How did this happen?

What didn't we know?

And a couple of students came forward to our home to share the information that they knew that Amber had been thinking about taking her life.

The devastation, the paint hat those students felt was overwhelming.

And really it was because of those students that "with hope" started and realized that if we're going to do anything about the prevention of this we really need to talk to the kids because those students' lives have forever been changed and they will have to live with the "what if's" because they didn't know what to do.

I feel completely lost and I don't want to feel like that.

So it's scaring me right now, the fact that I can't remember.

I want to be able to, I guess, go back to how I was.

Or how people say I am.

They don't want to lose you because that's the worst feeling is knowing something horrible is going to happen and you didn't do anything about it.

Their lives have been changed by a decision that amber made.

If you feel depressed if you're not doing as well in school as you're used to doing, if you don't feel like getting up in the morning, if you feel like being alone…

Get help now.

Don't hold yourself back.

Get help.

We're out here to help you.

Find us…find us now.

The good news here, the hopeful news, is that it can be treated.

We just have to have people be able to have a proper assessment and then get them the treatment that they need or the help that they need.

Trust in the way the brain works and that it does recover after this concussion and post concussion syndrome only lessens after time.

It might take months, it might take years, but it does happen.

And believing it's going to happen does help you push through.

One day I wrote a column about head injuries and I got a call from a very distraught mother who just had to see me…

So I worked her into my schedule the next day.

And she told me about her 16 year old son who had a bicycle accident.

The front tire of his bike hit the curb and he flew over onto his head.

And she said that boy was the sweetest boy- I mean, he was really the pride of her life.

He did well in school, he had lots of friends, he played sports. He was a great kid.

And then she said he started to change.

He got mean, he didn't do well in school, he wasn't responsible, he started drinking, and three years later he shot and killed himself.

And she was just weeping in my office and she said "I had no idea that the head injury was at all related to his failure.

I took him to the hospital and he was unconscious but only for a short period of time and the doctor examined him and said 'he'll probably be fine' and they sent us home.

And no one said to me, if his behavior changes, if his learning changes, if his temper changes, you need to get him an evaluation.' and it broke my heart because…

He's somebody that we could have helped.

Somebody out there cares about you whether you think so or not.

And just having that person there kind of helps you and gives you that strength to know that life is worth living and that death is not the answer until it's your time.

Sarah, are you here to see me?

Yeah.

You okay?

I need help.

Do you want to go into my office?

You know, honestly, I think I was meant to be a part of this because Dr. Amen did my brain scans and he was there when, you know, telling me "you're not stupid" and that made me feel so much better about myself knowing that it's not me, knowing that it's my brain, not just me being stupid.

And because I just couldn't do what I needed to do and that really hurt me and just made me feel like, wow, I'm stupid, I can't do this, I can't handle this anymore.

But then finally Dr. Amen helped me and he was like, you know, it's not you, it's your brain.

Your brain's not functioning the way it was meant to function and we can help you".

And then through that, I finally got the help that I needed and I'm here talking today and I'm living a life that I'm perfectly happy with.