Traumatic brain injury, or TBI, has been a hot-button issue in contact sports such as football and hockey over the last several years. Concerns that repeated concussions can lead to cumulative or long-term brain injury deficits and related chronic traumatic encephalopathy (CTE) have led governing bodies to tighten regulations on allowing play following a head injury.

News stories about the dangers to young athletes abound. Though there is enough media frenzy to cause concern, evidence-based study has shown that catastrophic neurodegenerative disease among ex-football players is rare and whether the incidence is higher than the general population requires continued population research.

Advances in CTE Detection

Recent cases in the news included former NHL players Bob Probert, Derek Boogaard, Rick Martin and Reggie Fleming, all of whom suffered long-term health problems and all of whom were found to have CTE after death. According to TSN, U.S. government data showed 76 of 79 former NFL players tested were found to have CTE after death. The trouble with CTE is that it can only be detected during autopsy, after a patient is deceased, and scientists do not know the complete clinical significance of the CTE findings.

Yet chronic traumatic encephalopathy detection may now be possible in living humans. A specialized Positron Emission Tomography scan, or PET scan, may now be used to detect tau protein, a marker found in cases of CTE. If the technique works and becomes more affordable as more people opt to take the test, this breakthrough might be the first step in better understanding and developing treatments for those living with the mental and physical aspects of CTE.

Be Careful with Early Findings

A word of warning is warranted. The PET scan study mentioned in the TSN article has not been published yet. The validity of that study is yet to be vetted through peer review and commentary. Since there is little experience and research validating the clinical importance of the PET scan findings, making clinical assessments and treatment decisions based on PET scan data is premature and potentially dangerous. Medical treatment and career decisions based on misinterpreted findings can have devastating results.

Common imaging findings are not always clinically significant. As we have learned with MRI, there are certain findings on scans of almost every body part, that are common in people without complaints, are not pathological, do not signify disease, but are not “normal.” But most of us do not have the clinical sophistication to ignore “abnormalities” even when told it is normal to have them. The review article “Traumatic Brain Injury and Chronic Traumatic Encephalopathy: A Forensic Neuropsychiatric Perspective” provides “a cautionary note against prematurely generalizing current findings on CTE to entire populations of persons with, or at risk for, concussion exposures.” Only by pain-staking and unbiased research will the significance of PET scan findings and clinical correlation be clarified.

For now some high-profile cases and logic tell us that it cannot be healthy to have repeated head trauma. Yet not every concussion has lasting effects, and CTE is likely not very prevalent. The clinically wise approach is to minimize exposure to head trauma, protect athletes and workers from brain injuries with protective gear, objectively assess and treat early all mild traumatic brain injuries and implement secondary prevention measures after a brain injury has occurred. There are a number of exciting brain injury imaging technologies being researched, but only clinical correlation and well controlled research can advise us on what tests will be medically helpful and when.

Paradigm Outcomes and TBI

At Paradigm Outcomes, we are regularly faced with the consequences of TBI. If understanding CTE can help the medical profession better treat TBI, our care management teams stand ready to advocate for those treatments. Improving or reversing the effects of TBI can quite literally change the lives of these injured workers and their families.

Our comprehensive teams of specialists place the injured worker at the center of all they do to ensure the highest level of care and attention available. This approach improves quality of life and long-term outcomes. It’s our hope that a viable test for CTE in the living human brain will lead to medical advances that help injured people recover and the workers’ compensation industry reduce lifetime costs.

To learn more about TBI best practices, visit Paradigm’s website or contact us. You can also follow us on Twitter, Facebook and LinkedIn.