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Repetitive Brain Trauma: Protecting Athletes & Veterans with Dr. Annabelle Shaffer · Broken Brains with Bruce Parkman

• 0:11
  Speaker 1: Hey folks, welcome to another episode of Broken Brains with your host, bruce Parkman, sponsored by the Mack Parkman Foundation, the largest national voice on the issue of repetitive brain trauma.
• 0:23
  Speaker 1: We're on the show.
• 0:24
  Speaker 1: We look at the issues of repetitive brain trauma.
• 0:25
  Speaker 1: On the show, we look at the issues of repetitive brain trauma, from repetitive head impacts in contact sports to repetitive blast exposure for our military veterans and what these conditions are doing to their brains.
• 0:37
  Speaker 1: That's resulting in the largest preventable cause of mental illness in this country, and why this is of such concern.
• 0:43
  Speaker 1: Because this is not taught in medical, nursing or psychological courses right now.
• 0:47
  Speaker 1: So our children, our athletes and veterans are undiagnosed, and this is why you need to be informed, so that you can protect those that you love and you can protect yourself.
• 0:57
  Speaker 1: On the show, we reach out to the leading researchers, scientists, patients, advocates, technologies on the issues of brain health, so we can understand not only more about how this is impacting Americans, but what we can do about it and how we can actually treat it and provide hope to the millions of Americans that are suffering from mental illness as a result of this exposure.
• 1:19
  Speaker 1: On our show today, another amazing guest, ms Annabelle Schaefer, who's a medical doctor, ms, and she's a neurosurgery resident at the Henry Ford Health, having earned her medical degree from Carl Illinois College of Medicine in 2025.
• 1:33
  Speaker 1: With a strong foundation in nutrition and dietetics, holding both bachelor's and master's degree from the University of Illinois, urbana-champaign, she integrates her diverse academic background into her medical practice.
• 1:45
  Speaker 1: Dr Schaefer's research focuses on head trauma very important here innovative spied trauma, another outcome of head trauma, and focal epilepsy.
• 1:53
  Speaker 1: She has contributed to over 20 publications, with notable work on youth sports concussions, feeding in journals like neurosurgery and neurosurgical focus, and her research has also been highlighted by media outlets such as WGN Chicago and WFLD Chicago, which is great man we always love.
• 2:09
  Speaker 1: People like to go on TV.
• 2:10
  Speaker 1: And beyond her clinical and research work, dr Schaefer is active in organized neurosurgery through the AANS and CNS joint section on neurotrauma and critical care and the Drugs and Devices Committee, where she leads social media outreach.
• 2:23
  Speaker 1: Her interdisciplinary approach and commitment to advancing neurosurgical care reflect a strong dedication to improving patient outcomes.
• 2:32
  Speaker 1: Dr Schaefer, welcome to the show and thank you for coming on, thank you, thank you for having me.
• 2:38
  Speaker 1: Oh, it's our pleasure.
• 2:39
  Speaker 1: We love talking to doctors and research because we're always wondering what the heck's going out there.
• 2:44
  Speaker 1: Now, you are a recent, recent graduate, I guess 2025 yes, graduated this weekend ah, congratulations.
• 2:52
  Speaker 1: All right, now you're already getting into public.
• 2:55
  Speaker 1: Uh, you know public podcasts and stuff.
• 2:57
  Speaker 1: Good on you.
• 2:58
  Speaker 1: What, what got you into brains?
• 3:00
  Speaker 1: Why is, uh, why is spine trauma?
• 3:05
  Speaker 1: Why?
• 3:05
  Speaker 1: Why is this important to you?
• 3:09
  Speaker 2: At some point in childhood, I think I just decided that I wanted to be a neurosurgeon for really no other reason than it sounded super cool.
• 3:16
  Speaker 2: And then, as I got older, I took some neuroscience courses, shadowed some neurosurgeons in high school and college and really loved it.
• 3:24
  Speaker 2: And then starting medical school, I went into it thinking something neuro but was still relatively open and just started working with some of our neurosurgeons at Carl Foundation Hospital and working with them on research and getting into the ORs and found the experience to be so rewarding to see patients with devastating brain injuries or brain tumors or spinal injuries and see the neurosurgeons help them get back to a new normal or something fairly close to what their previous normal was and decided that was what I wanted to do.
• 3:59
  Speaker 1: And that's important for our audience to understand, is that there is a way back, whether your brain injury comes from a traumatic event like a car crash or a violent incident or the result of repetitive brain trauma, that there is hope Now, having not met too many neurosurgeons, I mean, what do you do?
• 4:21
  Speaker 1: Do you like operate on the brain?
• 4:24
  Speaker 1: Or I mean, do you open it up?
• 4:25
  Speaker 1: Or you know what's neurosurgery entail?
• 4:30
  Speaker 2: So I would still say I have a pretty limited knowledge, being that I start residency in June.
• 4:35
  Speaker 2: But yes, you do open up the skull, you can take out tumors from the brain, you can take out blood if there's been a trauma, you may resect some brain if the trauma led to some death of the brain tissue or in the spine.
• 4:51
  Speaker 2: You know, often you're removing bone to decompress the nerve roots or the spinal cord and perhaps adding some metal in there and bone graft to fuse and stabilize the spine if there's been trauma as well.
• 5:05
  Speaker 1: And how long is your residency going to take?
• 5:08
  Speaker 2: It will be seven years.
• 5:10
  Speaker 1: Seven years, so you just got started.
• 5:12
  Speaker 2: Yes, yes, I am just getting started.
• 5:15
  Speaker 1: Good on you, but it doesn't take seven years of knowledge to understand how, you know, the brain is impacted by what we call repetitive brain trauma and what we need to do from there.
• 5:27
  Speaker 1: So you know, to our audience that's parents from a contact sports perspective, you know what's your understanding of how these sports are impacting these children, or even an adult brain with you know these children, or even an adult brain with you.
• 5:46
  Speaker 1: Know the amount of the long-term exposure that these people are being, you know, are subject to when they play contact sports for a large part of their lives.
• 5:53
  Speaker 2: My work's primarily in high school athletes and what we see is that after a concussion, people often have neuropsychiatric symptoms that can be transient and typically resolve in one to two weeks Symptoms like headache, dizziness, difficulty concentrating, insomnia, feeling more emotional, things like that.
• 6:13
  Speaker 2: Those typically resolve in two weeks for the normal healthy person.
• 6:18
  Speaker 2: But research shows that as head injuries add up and you get more and more, there's potential for long-term consequences which are still, I think, very much being investigated as to what those look like, particularly when those head hits are accumulated in youth sports, you know, prior to professional league, which is definitely an open area of research right now.
• 6:43
  Speaker 1: Absolutely is definitely an open area of research right now.
• 6:46
  Speaker 1: Absolutely.
• 6:46
  Speaker 1: And when you talk about, you know, symptomatic, you know the two weeks that's, you know, that's usually, you know, a concussion, or the.
• 6:51
  Speaker 1: You know, like my son had, you know, three concussions, two that we know about, we think one might've been a concussion or whatever, and that was the standard of care two weeks, you know, and then go back, you know, you know, come on back and you're pretty much cleared.
• 7:05
  Speaker 1: Is that still the protocol today?
• 7:07
  Speaker 1: Or what's being added to adjust that?
• 7:10
  Speaker 1: Because we're hearing now that they, you know it's recommended that these children can, that they exercise or they, they do something.
• 7:19
  Speaker 1: It's not just sitting in a dark room for two weeks.
• 7:23
  Speaker 2: Yeah, the dark room has definitely changed.
• 7:25
  Speaker 2: I would say.
• 7:26
  Speaker 2: You know my cousins who are my age in high school.
• 7:29
  Speaker 2: They had concussions and they were told to lie in a dark room for a week.
• 7:32
  Speaker 2: So it's been a fairly recent change.
• 7:35
  Speaker 2: But the current guidelines have a relative rest period for like 24 to 48 hours.
• 7:40
  Speaker 2: So relative rest being, you know, the child's at home they're doing some light reading, maybe some light walking around the house, but no running, no heavy schoolwork, things like that.
• 7:53
  Speaker 2: And then as they progress through, they're working with, hopefully, an athletic trainer, another clinician, and they go from.
• 8:00
  Speaker 2: If we look at return to sport, they'll do some aerobic exercise and make sure their symptoms aren't increasing during that and then they'll work their way up to some individual sport drills that are specific to their sport and then eventually work their way up to going to practice and then after that practice they'll go back to full play.
• 8:20
  Speaker 2: And what's really important is, throughout that whole process, that they're being monitored for symptoms.
• 8:25
  Speaker 2: If their symptoms increase above what they consider a mild exacerbation, then they should stay at that level or drop a level in that progression.
• 8:34
  Speaker 2: We really don't want them going back into sports, you know, still being quite symptomatic.
• 8:38
  Speaker 2: That would indicate they're not fully healed at that point.
• 8:43
  Speaker 1: And what kind of symptoms are we talking about for us?
• 8:45
  Speaker 1: Or you know our parents that are on the podcast Like what should they be looking out for Because they're part of the assessment as well.
• 8:52
  Speaker 1: They see the kids 24-7 for the most part, or, you know, with the exception of school time.
• 8:56
  Speaker 1: So what kind of symptoms are we talking about?
• 8:59
  Speaker 1: Are we still talking about headaches and pain, or are there other symptoms that they should be looking out for?
• 9:04
  Speaker 2: Headaches, dizziness, trouble sleeping, trouble concentrating, feeling more emotional or feeling additional anxiety things like that as well are all great symptoms for parents to be checking in with, as well as their athletic trainers.
• 9:22
  Speaker 1: And on the emotional side, you know a lot of parents.
• 9:26
  Speaker 1: You know, especially when you talk to teenagers, right, emotional emotions are just that's a teenager, right, their hormones are going, they're maturing and having had two daughters, right, emotions is, you know, that's the name of the game.
• 9:39
  Speaker 1: So what can they do to look at emotions?
• 9:42
  Speaker 1: And to you know, look at which emotions are my daughter being a daughter or my son being a son, and which motions are could be indicative of a deeper problem.
• 9:57
  Speaker 2: I don't know that it's so much a specific emotion but more how does the child compare to their baseline.
• 10:03
  Speaker 2: So obviously a parent's going to know best what their child's baseline anxiety level is or baseline emotional level is, and if something feels off from that, then that may be indicative that they're still experiencing symptoms.
• 10:16
  Speaker 2: We found in our research that females were more likely, both at baseline and after a concussion, to have more severe emotional symptoms.
• 10:26
  Speaker 2: So it's important to compare to that child's baseline, either if they have a baseline assessment like a sport concussion assessment tool or SCAT, or just knowing your child and what their baseline is.
• 10:40
  Speaker 1: And you know, on these, you know SCATs and the baseline test, there's a plethora.
• 10:44
  Speaker 1: You know, on these, you know scats and the baseline test, there's a plethora.
• 10:48
  Speaker 1: But it's big word Wednesday, so the old sard major man, I can't talk too well.
• 10:51
  Speaker 1: So we got a plethora of different baseline tests and we also know that most of our schools don't baseline, you know.
• 11:06
  Speaker 2: What's your feeling on that, on that particular issue and on having a baseline, no-transcript, unique in that a lot of schools don't have the feasible.
• 11:28
  Speaker 2: It's not feasible to do baselines for several hundred kids every year, and so there is debate whether it's best to have the personalized baseline, like in our case we do, or having a comparative normative value.
• 11:44
  Speaker 2: So if we take, you know, 2,000 students who all have a baseline and they're, all you know, 14-year-old girls, can we just use that average value to compare to another 14-year-old girl and kind of use that as a surrogate baseline?
• 11:58
  Speaker 2: So that's one of our projects right now is that we, since we do have these numbers of baselines, that we're working to publish those values to hopefully help schools that don't have personalized baselines at least have a suspected norm value for each child based on several characteristics.
• 12:17
  Speaker 1: Okay, and you know, and then, as a as part, talk to us about the research.
• 12:23
  Speaker 1: So what research are?
• 12:24
  Speaker 1: What research have you conducted?
• 12:26
  Speaker 1: I mean, there's 20 papers, man, you participate in quite a number of studies, and then you know what research is ongoing, especially prevalent to concussions, because I do want to dial into this for our audience, so that they become more aware of what's going on in 2025 instead of what we knew when it was 1985 or you know back then, where you know, I just shake it off and get back in the game.
• 12:49
  Speaker 1: You know.
• 12:49
  Speaker 1: I mean, obviously, concussions are a more significant concern today, but tell us about the research that you're working on.
• 12:57
  Speaker 2: Sure.
• 12:57
  Speaker 2: So, as the bulk of my research is focused on high school athletes using our data set, and so a little bit more about the data set.
• 13:05
  Speaker 2: We have athletic trainers who are partnered with our hospital, who go out to these schools and they conduct baseline SCATs.
• 13:12
  Speaker 2: Right now we're using SCAT 5.
• 13:13
  Speaker 2: We'll eventually move to SCAT 6.
• 13:15
  Speaker 2: And they conduct that each year in children and then, as students have an injury, they'll be reassessed and then that return to play protocol, return to learn, is all monitored by our trainers, and so we get that backlog of data.
• 13:29
  Speaker 2: We've had data going since 2009.
• 13:32
  Speaker 2: So we have several thousand students enrolled in the study, and so our first paper we published looked at just the baseline values and seeing how they differ from year to year.
• 13:43
  Speaker 2: So is doing a test freshman year and junior year?
• 13:47
  Speaker 2: Is that baseline still reliable?
• 13:49
  Speaker 2: Sophomore year and senior year, or do we potentially need baselines at shorter intervals to make sure we still have an accurate baseline?
• 13:57
  Speaker 2: And in that study, at least for our population, we found generally core to moderate reliability, and the reliability went down as the interim time between testing went up, and so that indicated to us that we may need to do additional work to see where that reliability is getting decreased.
• 14:17
  Speaker 2: And so we have an upcoming study that's looking at how does a scat differ from just start of the season to the end of the season and then also throughout the season each week.
• 14:30
  Speaker 2: How do students rate their symptoms?
• 14:32
  Speaker 2: So part of SCAT is a 22-item symptom checklist.
• 14:36
  Speaker 2: So dizziness, headache, et cetera, scored zero to six, 16, severe zero being none, and so doing that every week to see how are these symptoms changing, since a lot of them are, as you mentioned you know, general symptoms of just kind of being a person or being a teenager.
• 14:53
  Speaker 2: So we want to see how those change and if they're stable over time.
• 14:58
  Speaker 2: And then the second part of that research project that we've already conducted and published was looking at of the concussions we have recorded in our database.
• 15:07
  Speaker 2: How are they actually occurring, you know, are they occurring in games?
• 15:10
  Speaker 2: Are they occurring in practice?
• 15:12
  Speaker 2: Do they involve a blow or hit to the head?
• 15:15
  Speaker 2: Do they involve a fall, Things like that?
• 15:17
  Speaker 2: And then also looking at the risk factors and potential protective factors involved in sport-related concussions.
• 15:24
  Speaker 2: Of course that's in reference to our central Illinois population.
• 15:29
  Speaker 2: And then our most recent study was a review paper looking at just comprehensive look to provide an update on high school sport-related concussions to clinicians, and so we reviewed several papers looking at the epidemiology of concussions, potential preventative methods, as well as the return to play, the return to school protocols.
• 15:56
  Speaker 2: And then our next paper is, as I said before, looking at those normative reference values, so seeing if we can take our population and boil down the data to be kind of a guideline set of values for schools that don't have a personalized baseline, so that we can give them something to reference when their student does have a SCAT after an injury.
• 16:19
  Speaker 1: Wow, there's a lot going on.
• 16:20
  Speaker 1: Now.
• 16:20
  Speaker 1: This SCAT now, given that you know a lot of schools don't baseline, I know our school didn't and then I can't remember that that baseline at the test that a lot, of, a lot of people had back in the day.
• 16:32
  Speaker 1: But you know, can a can a parent, you know, do a scat?
• 16:36
  Speaker 1: I mean, the scats are downloadable document online Is there?
• 16:39
  Speaker 1: Is that something that any parent could do just to kind of get an idea of where their kid is?
• 16:46
  Speaker 2: It is freely available.
• 16:47
  Speaker 2: However, the standard recommendation is that a clinician trauma at all Do they assess.
• 16:52
  Speaker 1: You know, total aggregate or you know, repetitive head impact exposure.
• 17:13
  Speaker 1: Like do they ask questions on how long have you been playing contact sports?
• 17:19
  Speaker 2: The background information of the SCAT asks about prior concussions and prior hospitalization for head injuries.
• 17:25
  Speaker 2: The other components of the SCAT are there's a cognitive component, so things like giving a word list and asking the student to repeat back as many of the words as they can remember and then coming back a few minutes later and seeing if their delayed recall is intact.
• 17:41
  Speaker 2: So I told you this list of 10 words.
• 17:44
  Speaker 2: Tell me as many as you remember.
• 17:45
  Speaker 2: And then there's also a balance component.
• 17:47
  Speaker 1: I hate those tests.
• 17:48
  Speaker 1: Those are old man tests.
• 17:49
  Speaker 1: I hate those tests, by the way.
• 17:50
  Speaker 1: So okay, go ahead, you fix.
• 18:00
  Speaker 1: Go ahead, man.
• 18:01
  Speaker 2: There's also a balance component.
• 18:02
  Speaker 2: So having the student hold a couple stance positions and seeing how many errors they make to indicate a higher score would be higher level of errors, so more poor balance, all right.
• 18:16
  Speaker 1: So I mean, they don't really assess for that, and that's, you know.
• 18:20
  Speaker 1: That's something that we're, you know, trying to get people to understand and maybe you can help us with this.
• 18:27
  Speaker 1: All right, it is known that repetitive head impacts do impact the brain.
• 18:32
  Speaker 1: Right, it creates a cascade of effects.
• 18:35
  Speaker 1: From you know, from your perspective, you know what can be done.
• 18:42
  Speaker 1: I mean, well, first of all, do you are you, you know, we are you do you agree with the concept that you know RHI damages the brain and that that damage can result in mental illness due to the long-term exposure of these children?
• 18:59
  Speaker 2: Yeah, from what I've read of the literature, I think there's definitely effects that are long-term and we probably don't know all of them at this time that repetitive head injuries can add up to cause long-term neuropsychiatric symptoms and potentially brain damage.
• 19:17
  Speaker 1: And you know we're the foundation that worked with Boston University to actually publish the first study on under 30 brains that showed that you know that was funded by our organization.
• 19:28
  Speaker 1: We're actually re-releasing that because, while 42% of them had CTE and that was a CTE community we think the fact that 100% of the brains were damaged, 100% of them had severe, you know, psychiatric behavioral disorders and 80% of them died by suicide, is I think that's a little bit more alarming here and I think that's something that we need to work on because, you know, rhi is really not taught.
• 19:54
  Speaker 1: You just graduated in 2025.
• 19:56
  Speaker 1: Did you have any courses on subconcussive trauma, repetitive impacts on the brain, at all?
• 20:03
  Speaker 2: I don't believe, so Most of what I've learned has been through external research.
• 20:10
  Speaker 1: And this is, I think you know that's not good.
• 20:14
  Speaker 1: I mean, we got millions of children playing contact sports and if you put on a helmet or you hit a soccer ball, you're being exposed to this and we have an entirely untrained population out there on this issue.
• 20:28
  Speaker 1: How do you think we should address that?
• 20:30
  Speaker 1: What could we do?
• 20:31
  Speaker 1: I mean, is it I don't know seminars?
• 20:34
  Speaker 1: I mean, should it be part of the career?
• 20:35
  Speaker 1: I mean, I lost my son to this.
• 20:38
  Speaker 1: That was validated by, you know, a complete assessment along with all these other kids.
• 20:44
  Speaker 1: You know, how do you?
• 20:45
  Speaker 1: You know, how do we?
• 20:46
  Speaker 1: You know in your mind, could we address this from an educational perspective with our neurological, psychiatric medical community so we can start assessing and then, you know, providing a diagnosis or at least getting the kids and the parents to understand.
• 21:05
  Speaker 1: You might want Tommy to stop right now, or Sally to stop hitting these soccer balls.
• 21:09
  Speaker 1: I don't know what's your thoughts on that.
• 21:13
  Speaker 2: Sorry to hear about your son.
• 21:14
  Speaker 2: Of course, I think one of the educational initiatives that has shown some success is educating coaches on concussions and the symptoms of concussions and also when to pull students out of the game, and that's been shown to reduce concussions.
• 21:30
  Speaker 2: And then from the medical side, I think we get a lot of education on neurology in general, but not a lot on how the concussive hits add up.
• 21:44
  Speaker 2: Cte is taught about, but not to the extent as maybe other disorders, which probably is related back to that.
• 21:51
  Speaker 2: We don't have a full understanding of it.
• 21:53
  Speaker 2: So I think as the research continues to show effects of concussive head injuries, it'll start making its way into medical curriculum as well.
• 22:06
  Speaker 1: I think you're right and I don't want to put you on the spot, you're not speaking for the whole neurological community over here.
• 22:11
  Speaker 1: I just wanted to point out that you know that this is really not understood.
• 22:16
  Speaker 1: Yet it is universally accepted by all these sports.
• 22:19
  Speaker 1: Yet these neurologists and all these specialists are like, are you crazy?
• 22:22
  Speaker 1: I'm like, why aren't you allowed?
• 22:23
  Speaker 1: It's not good for their brain, why don't I know this as a parent, right, and this is the kind of things that we're slowly working on.
• 22:44
  Speaker 1: But you brought up a good point with the data that you're collecting.
• 22:48
  Speaker 1: So, and what's the data show, like the amount, the concussions?
• 22:51
  Speaker 1: You said that you, you can understand which concussions took place in during the game or in practice.
• 22:57
  Speaker 1: What was the ratio?
• 22:59
  Speaker 1: Or what did you, what was your, what did you find in?
• 23:01
  Speaker 2: that.
• 23:03
  Speaker 2: So majority across all sports take place in competitions and that's seen at collegiate levels of sports as well, probably related to, you know, higher they're in full contact at the time of a game and then also just higher stakes as well.
• 23:17
  Speaker 2: We do see a high proportion of them occurring in cheer practice in our data, so that indicates a potential area for improvement in safety measures and cheerleading and dance sports.
• 23:33
  Speaker 1: Sure, yeah, and a lot of people don't understand how concussive that activity is.
• 23:38
  Speaker 1: I don't know if it's a sport or what, right, I mean it's.
• 23:40
  Speaker 1: It's like people call golf a sport.
• 23:42
  Speaker 1: I'm like that's more of a hobby.
• 23:44
  Speaker 1: All right, I'm sorry.
• 23:45
  Speaker 1: You know you know, and so you know but.
• 23:46
  Speaker 1: Or an activity, you know I just, but you know that's.
• 23:47
  Speaker 1: You know that.
• 23:48
  Speaker 1: Um, you know but.
• 23:49
  Speaker 1: Or an activity, uh, you know I just, but uh, you know that's.
• 23:52
  Speaker 1: You know that.
• 23:53
  Speaker 1: That's interesting.
• 23:54
  Speaker 1: What, what other uh areas of improvement can we have when it comes to, at least on the concussion side, that parents could, that could indicate that you know the, the, the coaches and the, the athletic trainers are are more aware than the usual.
• 24:09
  Speaker 1: You know, let the coaches and the athletic trainers are more aware than the usual.
• 24:12
  Speaker 1: You know, let's just wait.
• 24:14
  Speaker 1: Let's wait till Tommy gets hurt and then we'll do something about it right.
• 24:19
  Speaker 2: I think one thing parents can look for, ask their coaches about, is if they've had any kind of concussion education, training.
• 24:25
  Speaker 2: So one of the initiatives with football is called Heads Up Football.
• 24:27
  Speaker 2: The CDC also has a number of resources available for parents on concussions so they can be watchful of the symptoms and learn more about the statistics of concussions in each sport.
• 24:40
  Speaker 2: And then I think also for all parents is just creating an environment within their team that tells kids it's okay to report concussions, it's okay to report symptoms.
• 24:52
  Speaker 2: This isn't something to hide.
• 24:53
  Speaker 2: We know a lot of concussions go unreported either to students don't have the knowledge of how to report them or what a concussion looks like.
• 25:02
  Speaker 2: They feel fearful that reporting it will, you know, let down their team or they'll lose playing time.
• 25:08
  Speaker 2: So I think parents and students can really contribute to a safety culture on any team sport they're a part of.
• 25:17
  Speaker 1: And were you aware that the Heads Up program just got terminated by this administration?
• 25:23
  Speaker 2: I feared for that when I saw that they were reducing funding.
• 25:27
  Speaker 1: Yeah, almost all the TBI research, the CDC heads-up program, which we still have problems with because the heads-up program is only concussion-focused, which you know.
• 25:38
  Speaker 1: Concussions are not good, but they're not as common as repetitive head impacts and I think we can agree, that's yeah, and that's where we were pushing to get them to understand that this is the larger risk.
• 25:50
  Speaker 1: The concussions can be treated, they can be healed, but there's RHI, these lifestyles that we need to modify.
• 25:58
  Speaker 1: You know our behavior on that and for our parents, you know it is.
• 26:02
  Speaker 1: I think you know I think it's presupposed that if your child has had one concussion, they're probably more likely to have another, or that the follow-on concussion might be more severe.
• 26:15
  Speaker 1: What are your thoughts on that?
• 26:16
  Speaker 1: What's the knowledge on that?
• 26:19
  Speaker 2: Our research showed that having one concussion, a prior concussion or prior hospitalization for head injury was associated with an increased risk of another concussion.
• 26:29
  Speaker 2: And also we know that sending children back into play too soon after a concussion so you know they're going through that return to play protocol but they're still having high levels of symptoms when they're sent back into play Sent back into play too soon is also associated with higher risk of concussion.
• 26:46
  Speaker 2: So we want to make sure all children are fully healed before we send them back into play.
• 26:53
  Speaker 1: And what can parents do to assure themselves that that child is fully healed?
• 26:58
  Speaker 1: I mean, we have, you know, I'm sure you're aware that we have the sports crazy parents that want their kids back in more than the kid wants to play, and you have coaches who really don't want their star players to lead the team.
• 27:09
  Speaker 1: You know, and you know, and stuff like that.
• 27:12
  Speaker 1: So what can a parent do that can say, you know, that wants not to challenge the system but to make sure should they take an extra week?
• 27:22
  Speaker 1: Or what are your thoughts on you know the parent wanting to protect their child from you know you know another injury.
• 27:29
  Speaker 2: Protect their child from you know, another injury.
• 27:31
  Speaker 2: It's challenging right now because a lot of our concussion tools deal with symptoms that are, you know, self-reported by the student.
• 27:42
  Speaker 2: There's limited objective data at this time to support that they're either fully healed or not fully healed.
• 27:44
  Speaker 2: It's not like a yes no that we can tell from a blood test right now, and so I think parents have to just have that open dialogue with their student athlete and make sure they feel that they're back to their normal before heading back into play.
• 27:58
  Speaker 1: Okay, and what are your recommendations on now?
• 28:04
  Speaker 1: We funded a study that showed that, by day 35, the potential for suicidality or suicidal ideation greatly increased after a concussion, which is pretty alarming because, you know, nobody thinks of concussions after two weeks.
• 28:24
  Speaker 1: Right, kids, back on the field, they're acting normal, you know whatever, or, you know, abnormal, depending on how crazy the kid might, you know, be in their, their, their, in their path.
• 28:34
  Speaker 1: Right, you know that's the way it is.
• 28:35
  Speaker 1: But, um, how do we, um, you know, go back and take a look at you know?
• 28:42
  Speaker 1: Uh, you know, post concussion surveys?
• 28:44
  Speaker 1: Okay, these are not a tool that's regularly used to monitor the child for at least 30 days for the same things that we talked about in the baseline.
• 28:56
  Speaker 1: Do you use post-concussion surveys, do you recommend them, or what's your perspective on those for parents to monitor their children?
• 29:06
  Speaker 2: We don't currently use them.
• 29:08
  Speaker 2: I think if your child is being deemed by a medical professional, that's the first step and certainly if the child ever expresses any kind of suicidality, then parents should be alarmed and take their child to their pediatrician or the emergency department something to get immediate help.
• 29:25
  Speaker 2: But I can't speak too much to post-concussion surveys.
• 29:29
  Speaker 2: That's a bit outside my scope.
• 29:31
  Speaker 1: Okay, Well, I mean so they're available on our website.
• 29:35
  Speaker 1: And just so the parents know out, there is that it is recommended, 30 days after a concussion, to monitor your child for at least that long, and even longer, because these surveys are very subjective series of questions.
• 29:47
  Speaker 1: But the bottom line is your child just went back to playing sports and to your.
• 29:55
  Speaker 1: You know, Ms Schaefer, Dr Schaefer, excuse me, you know when.
• 30:00
  Speaker 1: What is the?
• 30:01
  Speaker 1: You know, if the child's brain is not fully healed and they go back to sports, what are the risks to the child?
• 30:15
  Speaker 2: They can certainly have a more potential for a more severe concussion.
• 30:17
  Speaker 2: They're more likely to get another concussion if not fully healed, and then repetitive injuries certainly do add up, and they may be at risk for long-term symptoms that we don't fully understand at this time that we don't fully understand at this time.
• 30:35
  Speaker 1: Wow, and that's a lot for parents to understand.
• 30:37
  Speaker 1: And that brings us back to the issue of more brain-safe sports.
• 30:41
  Speaker 1: Are there sports?
• 30:42
  Speaker 1: As a neurologist, you would recommend the parents for their children to play above others when it comes to brain health.
• 30:57
  Speaker 2: I know we're such a sport-crazy country that it's hard to say, you know, don't play football or don't play soccer.
• 31:00
  Speaker 2: But I think prioritizing lower-risk sports you know, cross-country things like that is certainly something parents could consider, but I don't want to make any kind of outright recommendation.
• 31:15
  Speaker 1: I'll make an outright statement, since I'm not a trained physician at this time.
• 31:19
  Speaker 1: Well, don't worry about it, but all right.
• 31:21
  Speaker 1: Well, let me ask you this Do you think that?
• 31:25
  Speaker 1: Do you think it's surprising that there's no basketball or baseball brains that have been diagnosed with CTE at the Boston University?
• 31:35
  Speaker 1: Cte brain.
• 31:38
  Speaker 2: I am a little surprised, as those sports still have reasonably high concussion rates, particularly basketball elbows to the heads, knees to the head.
• 31:47
  Speaker 1: Right, but certainly football is your dominating sport, right, but certainly football is you're dominating, right, but those sports do not have repetitive head impacts.
• 31:55
  Speaker 1: They have concussions.
• 31:57
  Speaker 1: You cannot avoid the concussion, but they don't have RHI.
• 32:03
  Speaker 1: And so you know, yeah, and I think that's something that you know.
• 32:06
  Speaker 1: I was just doing some research the other day.
• 32:07
  Speaker 1: I'm like, wow, because we always have to, you know, put you know some kind of you know.
• 32:13
  Speaker 1: We got to put it in layman's terms Like well, actually, you know, if you really want to know, you know there's soccer people in there, there's rugby, there's football, there's hockey, you know.
• 32:23
  Speaker 1: But when you come down to brain, safe sports, and there's there's, you know, it's kind of logical or correlation, at least you know to us.
• 32:31
  Speaker 1: But I didn't want you to put on sports to.
• 32:33
  Speaker 1: Are you going to let your kids play football?
• 32:37
  Speaker 1: probably not okay, as a mom, I'm just saying all right, you know, that's it.
• 32:43
  Speaker 1: It's just, you know it's.
• 32:44
  Speaker 1: It's good to know.
• 32:45
  Speaker 1: If I would have been as educated as you or as I am right now, I absolutely would have said no and uh, and let's talk about that.
• 32:55
  Speaker 1: You know, one of the problems with our son that I allowed to happen is that I allowed him to play back to back concussive sports.
• 33:03
  Speaker 1: He was a blindside, uh, uh, offensive, I think it's a tackle or a guard, and um, and nobody touched that quarterback when my son was playing bad, uh God, he was awesome.
• 33:16
  Speaker 1: And then he was a wrestling guy, getting ready to be the wrestling captain wrestling captain on football and so that was.
• 33:22
  Speaker 1: You know, we started in July, went all the way through March and then, of course, you know, we were snowboarders and skiers and my son refused to take lessons.
• 33:31
  Speaker 1: So he's out there banging his head.
• 33:34
  Speaker 1: What is your, you know, from an RHI perspective perspective?
• 33:45
  Speaker 1: What is in your, in your mind, as a, you know, future mom or mom, I don't know your child status at this time.
• 33:48
  Speaker 1: Um, as an educated neurologist, you know what is your advice to parents?
• 33:52
  Speaker 1: Because you can now play football year round.
• 33:55
  Speaker 1: Now, right, you can play hockey around or, you'd like my son, you can play a combination of sports that have we call them high-risk sports.
• 34:03
  Speaker 1: You know when is too much too much.
• 34:09
  Speaker 2: I think parents should go into these collision sports with eyes wide open about that.
• 34:16
  Speaker 2: They do carry a risk of repetitive head injury and concussions and make sure that they're evaluating those risks for themselves.
• 34:25
  Speaker 2: You know when we're starting these sports younger and younger you know tackle football in grade school.
• 34:32
  Speaker 2: I think it's of utmost importance that parents really sit down and consider what the risks are to their child and think about you know also the benefits of being involved in sports there are certainly benefits to team sports and weigh those risks for themselves.
• 34:49
  Speaker 2: But definitely go in eyes wide open and think about those.
• 34:54
  Speaker 1: And so you know to a parent right, you know you're a neurologist when is their child at six years old?
• 34:59
  Speaker 1: Right, where is their child's brain in terms of development and what are the risks to that brain?
• 35:08
  Speaker 1: I mean, you know that brain has been ordained by our Lord to have a natural growth trajectory over 25 years or pick your number to get to a maturation stage that's really not supposed to be shook or, you know, banged around or whatever.
• 35:25
  Speaker 1: And you can't avoid the occasional kick on a horse or falling down in basketball.
• 35:29
  Speaker 1: Or you know they're kids, right, they're going to have, you know they're going to hurt their head here and there.
• 35:36
  Speaker 1: But you know one of the reasons that we're and I'm not a, I'm not a neurologist, I'm an educated man on this issue, but you're a brain specialist, right, where are their child?
• 35:47
  Speaker 1: Like when you start even thinking about contact sports, or now they got slap leagues and boxing it's like what are we doing with these kids brains?
• 35:56
  Speaker 1: I mean, where is their brain at this juncture?
• 35:59
  Speaker 1: It's just a grade school and what are the risks to the brain in terms of development, of participation in these sports?
• 36:07
  Speaker 1: Your opinion I'm not asking for you know your opinion.
• 36:12
  Speaker 2: The brain is still very much actively developing.
• 36:16
  Speaker 2: It develops well into adulthood, and so I don't think we know quite yet what the impacts are of you know having a concussive hit at six versus you know 26.
• 36:27
  Speaker 2: How does that affect their long-term trajectory of brain health?
• 36:31
  Speaker 2: I'm not sure we know that right now, and so I think that just goes back to the risks and benefits that parents need to consider whenever they're enrolling their child in any kind of collision.
• 36:41
  Speaker 2: Sport is that you have to consider that as a potential risk?
• 36:46
  Speaker 1: Well, the concussions are one thing, but what about repetitive head injuries when you have sports, like, you know, football, or a league, like the hockey rugby right now, where they don't really have too many limits on, you know, kids, but you know football is the largest one because you really it's hard to, you know, unless you do flag football, which is an awesome option at the age of six, right, but you know, we're speaking to the parents out there that are, you know, hell bent on.
• 37:13
  Speaker 1: This is the way I've done it, this is the way I'm doing it, but from a repetitive head injury perspective, that continuous, you know, you know impact to their, to their brain, what's, what's your perspective on that?
• 37:30
  Speaker 2: I think one thing parents can do is just explore the options out there with different leagues so different leagues will have different kinds of rules and seeing what the policies are in their state.
• 37:40
  Speaker 2: So some states have different allowances on how many contact days a sport can have, how many practices a sport can have.
• 37:51
  Speaker 2: Things like that can be effective.
• 37:55
  Speaker 2: Lower contact days and lower practice times in football have been shown to reduce head injuries.
• 38:01
  Speaker 2: We also see in hockey leagues leagues that disallow body checking have lower concussive rates.
• 38:08
  Speaker 2: So looking for policies like that and understand how those influence concussion rates and of course that influences repetitive head injuries as well is important for parents to understand those repetitive head injuries as well is important for parents to understand.
• 38:21
  Speaker 1: You just brought up an amazing fact, okay, that by taking contact, lowering contact on practice days, you know, can reduce the amount of head injuries.
• 38:35
  Speaker 1: It also reduces the amount of total aggregate exposure to repetitive head impacts.
• 38:38
  Speaker 1: So are you seeing that in new sports now?
• 38:41
  Speaker 1: Because not from a concussion perspective, because it's kind of inverse you have more concussions on game day than practice days, right, but you have far more RHI exposure on you know.
• 38:53
  Speaker 1: You figure, somebody's football like my son's football team practiced five days a week but then they had a game day, or at least four days a week.
• 38:59
  Speaker 1: You know that's.
• 39:00
  Speaker 1: That means game days.
• 39:07
  Speaker 1: You know, 20% of your total aggregate exposure.
• 39:09
  Speaker 1: What are you seeing out there in the high school world right now that might indicate that we're taking this seriously?
• 39:12
  Speaker 1: Or, you know, is there any change coming when it when it comes to reducing, reducing exposure in practice, which would be an amazing change if we could make that happen.
• 39:26
  Speaker 2: There are certainly studies out there that have shown when schools did reduce the number of contact days that there were reductions in head injuries.
• 39:35
  Speaker 2: And for instance, Illinois just passed to reduce the contact days in the summer.
• 39:40
  Speaker 2: I don't know if that was related to head injuries in their decision making, but I think programs are starting to reduce those contact days as a safety measure for children.
• 39:52
  Speaker 1: Well, I wish yeah, I mean it sounds good, I mean, but we're seeing it, you know, league by league or sport by sport, no-transcript school with mitigating circumstances that it might be okay for parents to take a look at this.
• 40:35
  Speaker 2: I'm not sure that there's an exact age available yet.
• 40:38
  Speaker 2: I think the name of the game is just prevention at this point, and so looking for ways to make a sport safer and reduce potential for impact is probably where we're we should focus right now.
• 40:53
  Speaker 1: I don't see you are you are age to start concussion or to start impact.
• 41:00
  Speaker 1: Yeah, we're, we're, we are advocating at least to the age of 14, when the prefrontal cortex starts developing, and then if we could just take the practice out of contact or the contact out of practice, then these kids will be a lot better.
• 41:15
  Speaker 1: You know from an RHI perspective.
• 41:19
  Speaker 1: You know from an RHI perspective and you've done an amazing job dodging the manholes in this very, very complicated discussion, because you know but it is very important that our parents hear from you, know trained professionals, that you know there is risk.
• 41:32
  Speaker 1: It should be judged and to judge, you know they should be knowledgeable.
• 41:36
  Speaker 1: Where can parents go?
• 41:38
  Speaker 1: Of course, you know the best book ever written on the issue I wrote.
• 41:41
  Speaker 1: It's available for free on our website.
• 41:43
  Speaker 1: But where else can parents go to understand the issue of repetitive head impacts and concussive trauma to their children, in order to be more informed, because you just can't make decisions without information more informed, because you just can't make decisions without information.
• 42:06
  Speaker 2: I think right now it's obviously all our government websites are a little bit up in the air, but certainly looking at what the CDC offers, what NIH and other institutes offer, is a great start.
• 42:14
  Speaker 2: And then also asking the child's pediatrician or if they already see a sports med professional or if their school has an athletic trainer.
• 42:22
  Speaker 2: Those people are all great resources on concussion education and care.
• 42:28
  Speaker 1: And can you explain the difference to our audience between you know a primary care physician, right, and a concussion specialist?
• 42:36
  Speaker 1: Because you know, we definitely.
• 42:38
  Speaker 1: You know we want to make sure, like I didn't even know there was such thing.
• 42:41
  Speaker 1: So my son had a concussion.
• 42:41
  Speaker 1: You know we definitely.
• 42:42
  Speaker 1: You know we want to make sure, like I didn't even know there was a such thing.
• 42:43
  Speaker 1: So my son had a concussion.
• 42:45
  Speaker 1: You know I've had so many of them from playing rugby.
• 42:48
  Speaker 1: I was like, all right, let's go see the doctor, and you know we're going to do what the doctor says.
• 42:53
  Speaker 1: You know we're not going to be messing with this and we did, but it wasn't enough because of you know his lifestyle.
• 42:59
  Speaker 1: So you know, explain to the you know the audience, like from a concussion perspective, what should they be looking for?
• 43:08
  Speaker 1: Because you definitely do not want to be playing around with this if your child is has been injured, especially in the brain.
• 43:16
  Speaker 2: I would start with that child's pediatrician and request to potentially see if the pediatrician thinks maybe a pediatric neurologist who would be an expert on brain health, particularly in children and how their brain's developing, or a sports medicine physician would also be a great person to be referred to if they think their child's having more severe symptoms or not recovering as well as they would expect.
• 43:45
  Speaker 1: Okay, great answer.
• 43:47
  Speaker 1: Final question All right, you're off the hook because you've been doing an amazing job here.
• 43:51
  Speaker 1: What is the most surprising revelation that you've seen regarding head trauma in the research that you've done?
• 44:04
  Speaker 1: Is there anything out there that just stands out that was, you know, that was not shocking, but it was like surprising that, hey, I didn't know this right.
• 44:13
  Speaker 1: And what can you think of something that surprised you in the findings, or is there more than one?
• 44:27
  Speaker 2: I think one thing I'm really excited about is looking at where the biomarker research is going to go.
• 44:29
  Speaker 2: As I said, we don't have a great.
• 44:30
  Speaker 2: There's no test to say, yes, you're fully healed from your concussion or no, you're not.
• 44:35
  Speaker 2: A lot of it's very subjective testing, and so I think biomarkers have the potential to be more informative and provide objective data that can influence someone's trajectory to recovery, and so that's an area of research I'm very excited about right now.
• 44:53
  Speaker 1: All right, and as we get ready to close, tell us a little bit more about Dr Annabelle Schaefer.
• 44:58
  Speaker 1: What are you doing right now?
• 44:59
  Speaker 1: What do you plan on doing?
• 45:02
  Speaker 1: And then, how does our audience find you to if they need more information or want to follow you in the research that you're performing right now?
• 45:12
  Speaker 2: I just graduated medical school at Carl Illinois College of Medicine and then this June I'll start my residency in neurological surgery at Henry Ford Hospital in Detroit, Michigan, and if you'd like to follow my research updates, I can be found on LinkedIn as well as Twitter, where I post upcoming papers and recently published work.
• 45:34
  Speaker 1: Well, Dr Schaefer, you have been an amazing source of information for our audience, and it's not all the time that we get I think.
• 45:41
  Speaker 1: I think you're the first neurologist to come on the show, so congratulations.
• 45:45
  Speaker 2: Not a neurologist yet.
• 45:46
  Speaker 2: All right, I'll be a neurosurgeon eventually, in seven years.
• 45:53
  Speaker 1: All right.
• 45:54
  Speaker 1: Well, you're the first future neurosurgeon we've had on the show, for sure, and.
• 45:58
  Speaker 1: But you've been a source of knowledge and our, our audience depends on qualified professionals to give them the advice right, to give them, you know, some, just some thoughts on these issues, so that they do take these contact sports a little bit, or a lot more seriously than you know, of course, I did back in the day, cause they're just not harmless.
• 46:17
  Speaker 1: I want to thank you so much for the time that you gave us today and I wish you all the best on your journey as you become a neurosurgeon.
• 46:26
  Speaker 1: I would like to follow your research.
• 46:28
  Speaker 1: We invite you to attend our summit on repetitive brain trauma in September 3rd and 4th of this year, held in Tampa, and I want to wish you all the best as you go forth on your journey in life, and may God bless you.
• 46:39
  Speaker 2: Thank you so much.
• 46:41
  Speaker 1: Thank you so much, denny.
• 46:42
  Speaker 1: Oh, and as we close out, denny, always a shout out to my producer who just graduated Magna Cum Laude crazy Denny man, best producer in podcasts in this country.
• 46:53
  Speaker 1: As we close, I want to say thank you for another wonderful episode of Broken Brains, sponsored by Mack Parkman Foundation.
• 47:01
  Speaker 1: Please look them up.
• 47:02
  Speaker 1: They are the national voice in repetitive brain trauma and the only voice out there.
• 47:07
  Speaker 1: Go to their website.
• 47:08
  Speaker 1: Their free book, broken Brains, is a very informative tool.
• 47:12
  Speaker 1: They have an app on the Google and Apple store called Head Smart.
• 47:16
  Speaker 1: It's got the book on it.
• 47:17
  Speaker 1: You can inform your parents.
• 47:19
  Speaker 1: You can do local searches for concussion specialists.
• 47:22
  Speaker 1: Please be informed on this topic.
• 47:25
  Speaker 1: Coming up September 3rd and 4th is our second International Summit on Repetitive Brain Trauma.
• 47:30
  Speaker 1: You are all quarterly invited.
• 47:33
  Speaker 1: We have some very awesome politicians invited, military commanders as well as some of the top-notch researchers in CTE, neurology, contact sports and other aspects of repetitive brain trauma to include diagnosis and treatment.
• 47:47
  Speaker 1: It's going to be a fascinating conference and we can't wait to hold it and we'll keep you updated.
• 47:52
  Speaker 1: Please go to our website, wwwmpfactorg, to get more information.
• 47:59
  Speaker 1: And to all of you, as we close out please take care of yourselves, please take care of those brains you only got one and stay informed.
• 48:07
  Speaker 1: God bless you all.
• 48:08
  Speaker 1: Take care.
• 48:09
  Speaker 1: Oh, and please like us, please subscribe or please follow us on Twitter, facebook, instagram, whatever there is out there.
• 48:17
  Speaker 1: Let us know we're reaching more and more people every week because of amazing guests like Dr Schaefer and really putting out the information that you need to know.
• 48:24
  Speaker 1: Take care y'all.
• 48:25
  Speaker 1: We'll see you next time on Broken Brains.
• 48:27
  Speaker 1: You.