Traumatic Brain Injury: Not Just Football Anymore

It's not just football anymore. Concussions and traumatic brain injury are being investigated and treated as such in victims of domestic violence. Read about this sad breakthrough in our new Healing the Brain book.

According to an article in Science Daily, physicians and researchers at Barrow Neurological Institute have identified a link between domestic violence and traumatic brain injury. The findings could have important implications in the treatment of domestic violence survivors, both in medical and social service communities. The research, led by Dr. Glynnis Zieman, was published in the July 2016 issue of the Journal of Neurotrauma.

"Head injuries are among the most common type suffered in domestic violence, which can lead to repetitive brain injuries that often have chronic, life-changing effects, much like what we see in athletes. We found that 88 percent of these victims suffered more than one head injury as a result of their abuse and 81 percent reported too many injuries to count," said Dr. Zieman.

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Researchers are uncovering the link between domestic violence and TBI.

The research was conducted at Barrow Concussion and Brain Injury Center in Arizona, where a specialty program has been established to address traumatic brain injury (TBI) in the domestic violence survivor. The program is believed to be the first of its kind in the nation. Dr. Zieman and her team performed a retrospective chart review of more than one hundred patients seen through the program to obtain data for this research.

While concussions have been a significant topic in sports, Barrow has taken special interest in concussions and domestic violence. Barrow experts say that women who previously suffered silently are becoming more aware of the real issue of concussions from their abuse.

The Barrow program provides both medical care and social service assistance for homeless victims who have sustained a TBI as a result of domestic violence. It was created after Barrow social worker Ashley Bridwell and physicians identified a three-way link between homelessness, domestic violence and TBI. The medical team has found many victims are suffering from a full spectrum of side effects that can lead to the loss of a job, income, and eventually homelessness.

"This is the third chapter in the concussion story," says Dr. Zieman. "First it was veterans, then it evolved into professional athletes, and now we're identifying brain injuries in victims of domestic violence. And, unlike well-paid football players, these patients rarely have the support, money and other resources needed to get help."

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Should kids play football? No.

In this excerpt from the Dana Foundation's blog post by Dr. Guy McKhann, he looks at the choice faced by parents regarding letting their kids play football. We cover this topic in our new book, Healing the Brain.


“Don’t Let Kids Play Football” is the title of a New York Times OpEd column by Bennet Omalu. Dr. Omalu gets credit for being the first to recognize the distinctive neuropathology associated with repeated head injuries in an NFL player. Omalu was on call when an autopsy was needed for former Pittsburgh Steeler Mike Webster.

Not being a football fan, Omalu was one of the few adult males in Pittsburgh unfamiliar with Webster, a star center for 17 seasons. Some time after Webster’s retirement in 1990, he gradually began to deteriorate mentally, first with depression and paranoia, then gradual loss of cognition, so that at the time of his death, he was essentially demented. Because of his football notoriety, his troubles were documented in the local newspapers.

Omalu realized that he was seeing a very unique pathology. The gross brain appeared normal, but when he cut into it and made stained sections, he noted the marked accumulation of the protein tau. Tau, in the form of tangles, is one of the hallmarks of Alzheimer’s disease, as is the accumulation of another protein, beta amyloid, in the form of plaques. In Webster’s brain there were very few amyloid-containing plaques and the tau accumulation was in a different distribution than what one would see with Alzheimer’s. Omalu and his colleagues published two papers in the journal Neurosurgery: one on Webster and another on fellow Steeler Terry Long. They described their findings, suggesting that repeated head injuries might be associated with this pathology. All hell broke loose. The NFL powers that be were not happy that their sport might be associated with brain damage. Several physicians involved with NFL teams wrote the journal asking that the papers be withdrawn. (Withdrawing a paper rarely happens, and is done when there is clear misconduct such as fraud). The papers were not withdrawn.

Deciding that challenging the powerful NFL was an impossible task, Omalu left Pittsburgh and became a medical examiner in California, out of the limelight. However, Dr. Ann McKee, a well-regarded neuropathologist in Boston, picked up the slack and let the world know she and her colleagues were available to do the neuropathology on athletes, and military personnel, with head injuries. She was joined by a neurosurgeon, Robert Cantu, and Chris Nowinski, a former Harvard football player and professional wrestler, who became concerned about his own history of head injuries. Chris has become the liaison between the Boston investigators and the athletic world, active in obtaining permission and access for the Boston group to do autopsies.

As of September 2015, they’ve analyzed the brains of 91 former NFL players and found the distinctive pathology in 87 (96 percent).

The clinical course in the others is much like that of Mike Webster: exposure to a series of head injuries over years, a period of normal functioning after retirement, and gradual decline in cognitive functions. What’s going on in these brains? We really don’t know. However, one possibility is that the accumulation of tau is initiated by head trauma. Even after the trauma stops, the accumulation continues until tau reaches a level that is toxic to nerve cells. This process may take years and might be exacerbated by the person’s use of alcohol or drugs.

So should kids play football? I have nine grandchildren. My youngest, twin seven-year-old boys, are into gymnastics and swimming, so they’re not at risk of head injuries (though they enjoy pummeling each other). The others are into soccer, lacrosse, mountain climbing, and cross country skiing. What would I tell them? I think that there is a lot of hand-waving about the susceptibility of the developing brain. In some instances the younger brain is more resistant to injury. An eight-year-old can survive and make a remarkable recovery from a stroke, while a similar stroke in an 80-year-old would be devastating. However a diffuse injury (one that is spread more widely), associated with a head injury, may have effects on brain development.
I don’t know where to draw the line regarding age. I suggest that prior to age 18 kids play less violent forms of football, like touch or flag football, to significantly reduce the chance of head injury.

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