Youth football playing may contribute to long-term cognitive, behavioral issues: BU study

An extension of Boston University’s pioneering CTE brain research [TTA 26 July] is this newly published study in Translational Psychiatry on cognitive and behavioral changes in former football players. This sampled 214 living former American football players who played high school, college or professional football and did not participate in any other organized contact sports. These players were recruited through BU’s LEGEND longitudinal research registry of living active and former contact and non-contact sports athletes to examine the short/long-term outcomes of repetitive head impacts (RHI). Participants in the program performed over time a battery of cognitive and functional tests. It also screened out those who self-reported concussion within one year of the study inception.

The findings point a very long finger at early tackle football playing in youth football programs, typically from age 5 to 14 when the brain is undergoing massive development. Below quotes are direct from the study:

  • Those who began playing football before age 12 had >2 × increased odds for clinically meaningful impairments in reported behavioral regulation, apathy and executive function, and >3 × increased odds for clinically elevated depression scores, compared with those who began playing at 12 or older.
  • Effects were independent of age, education and duration of football play.
  • Younger AFE (age of first exposure-Ed.) to football, in general, corresponded with worse behavioral regulation, depression, apathy and executive function, as well as increased odds for clinical depression and apathy.

To our knowledge, this study is the first to show a relationship between younger AFE to football and reported clinical dysfunction in a cohort that included both former amateur and professional football players. There was no difference in the effect of AFE by highest level of play. These findings validate and expand upon our previous work in a small, entirely distinct sample of former NFL players, and extend the influence of AFE to football on clinical function to former football players who only played through high school or college. Overall, this study provides further evidence that playing youth American football may have long-term clinical implications, including behavioral and mood impairments.

The study has an extensive discussion of brain development in the young and how ages 9-12 are critical. Two studies using helmet accelerometry on current youth American football players estimate 240 to 252 median head impacts per season.

There are a considerable number of caveats throughout the study, including the kind of protection available in past youth football for the average age respondent (51) and the self-reporting methodology. It is not a risk study for CTE, nor is it intended to advocate the reduction or elimination of youth football. It does advocate for more longitudinal studies. This Editor has attended at least two talks by the CTE Center’s Robert Stern, MD, and he has been never been content with limiting his study to either football or to purely concussive damage. 

Why is this research important to healthcare and to technology? (I’ll expand upon a previous closing.)

  • First, because repetitive brain trauma–concussive and sub-concussive–now has an even better-documented relationship to significant medical and behavioral conditions. This study is now another part of fundamental research to deepen our knowledge about the effects and long term brain outcomes of head trauma, whether from football, other contact sports, combat service (e.g. IED explosions), car accidents, and even repetitive actions by a person who is developmentally disabled.
  • Second, avoiding or minimizing head trauma in sports and warfare, plus correctly diagnosing and treating concussion and sub-concussion, are huge areas for technology about which this Editor has advocated for several years.
  • The message here is not that football is bad, but in the present state and starting age is played dangerously for long term brain development and the subsequent mental health of players. This does not exclude other high contact sports such as flag football, hockey and rugby–the orthopedist’s gift–and heading the ball in soccer. We need to know more, minimize it now, and both playing the game, with the aid of health tech, should be part of this.

Translational Psychiatry (Nature.com), STATNews has further analysis

Related reading: Our extensive backfile of CTE research coverage is here, including this Editor’s reports on Dr. Stern’s presentations at NYC MedTech and GCRI. 

VerbalCare debuts a new symbol-driven app for patient health communication

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/01/verbalcare.png” thumb_width=”200″ /]Many patients in both home and hospital/post-acute settings have difficulty communicating their needs for a variety of reasons: post-stroke, cognitive impairment, facial surgery, aphasia, age (very young, very old) and of course there are language and cultural obstacles. VerbalCare‘s relaunched patient and caregiver apps may find a way around it. The patient clicks on icons in the VerbalCare Patient tablet app, which if touched in succession can form a sentence, then sends the message either to family members or the care team via the paired Messenger app for smartphone or tablet. The app can also send custom texts, phrases, or reuse a favorite selection; it will record patient appointments with patient consent. It has been tested over the past four years at Massachusetts General and Franciscan Hospital for Children. The Boston-based early stage company was acquired in August 2015 by an area durable medical equipment company company, Medical Specialties Distributors (MSD) and operates as a subsidiary (Mobihealthnews). The current pricing is for the VerbalCare Patient app $9.99 per patient per month, BYOD, but founder/CEO Nick Dougherty expects that healthcare organizations will pick this up. MedCityNews  What would be interesting is if a telehealth company licenses this for integration, in part or wholly, with its remote patient monitoring–Ed. Donna

How technology can help fight elder abuse–ethically

The increasing awareness of abuse of older people by their caregivers, whether at home or in care homes/assisted living/nursing homes, invites discussion of the role that technology can play. This presentation by Malcolm J. Fisk, PhD, co-director of the Age Research Centre of Coventry University, in the BSG Ageing Bites series on YouTube looks at technologies viewed by level of control and intrusiveness:

  • Social alarms, which include pull cords (nurse call) and PERS–what we think of as ‘1st generation’ telecare: high level of control, low intrusiveness–but often useless if not reachable in emergency
  • Activity monitoring, which can be room sensor-based or wearable (the 2nd generation): less control, slightly more intrusive–also dependent on monitoring and subject to false positives/negatives
  • Audio and video monitoring, while achieving greater security, are largely uncontrolled by the older person and highly intrusive to the point of unacceptability. (In fact, some feedback on tablet-based telehealth devices indicates that a built-in camera, even if not activated, can be regarded with suspicion and trigger unwanted reactions.)

The issues of consent, and balancing the value of autonomy and privacy versus factors such as cognitive impairment, personal safety and, this Editor would add, detecting attacks by strangers and not caregivers, are explored here. How do we ethically observe yet respect individual privacy? This leads to a set of seven principles Dr Fisk has published on guiding the use of surveillance technologies within care homes in the latest issue of Emerald|Insight (unfortunately abstract access only) Video 11:03Hat tip to Malcolm Fisk via Twitter.

The long-term care revolution: two papers

Written for the Technology Strategy Board and published by the Housing Learning & Improvement Network, the purpose of the main study is to “outline the case for a revolution in long term care all to be set in a time scale of 2012, 2020 and 2050. This includes evidence about the views of older people and their carers in the UK, lessons from abroad and the implications for industry/providers.” It is written as a ‘study of studies’ on a broadly-scoped problem; it focuses considerably on issues such as care provision, housing (including co-housing and communities) and putting the older person in more control of decisions, housing and tech design. Telehealth and telecare, while not the focus, have a hefty section (pages 32-41) but their conclusions will not be a huge surprise to our readers such as expanding inexpensive, simple assistive technologies, the need for more research and better design. The fact it is comparative is extremely helpful for those who want to see beyond borders, and there is a large section on ethical issues which is certainly unusual in studies of this type.  We thank the lead author, Professor Anthea Tinker, Institute of Gerontology, Department of Social Science, Health and Medicine, King’s College London, for providing information on and the PDFs of the studies. Assisted Living Platform – The Long Term Care Revolution and A study of innovatory models to support older people with disabilities in the Netherlands