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The Longevity Project: Road to independence after permanent brain injury paved in support systems

Editor’s note: This is the fourth and last of a weekly series The Longevity Project, a collaboration between The Aspen Times and the Glenwood Springs Post Independent.

Kara Brouhard’s dog, Tucker, instantly greets her guests with a wagging tail when they enter her home, festive Halloween decorations covering the walls of her cozy space in south Glenwood Springs. 

“I just took down a lot of the decorations,” said Kara’s mom, Alice Brouhard, who helps her daughter out when she needs it. 

The naturally lit home with vaulted ceilings is open but snug and filled with things that make Kara happy, like her guitar and her kitchen where she loves to bake. 

Her quiet space to herself is all she ever wanted in life. 

After sustaining a traumatic brain injury in a ski accident on Sunlight Mountain when she was a child, Kara Brouhard and her family have been innovative in finding ways to let her live by her own means. 

“I don’t want people telling me what to do,” Kara said.

In her home are two of her biggest helpers, her Alexa and her tablet. The tablet is filled with constant alarms that have different songs and pictures, or sound clips of her and her mom’s voices to remind Kara of what to do next. 

Kara gets lost in her thoughts and has little comprehension of time, according to her mother. Without having something to remind her where to go and what to do, Kara might just end up sitting on her bed all day thinking to herself. 

She’s a busy person and the reminders keep her on track.

After she finished high school, Kara and her mom toured different options for how Kara might choose to live her own life, including a potential group home in Grand Junction. Kara made her mind up then. 

“I was not going to live in a group home,” Kara said. 

She wanted to make those choices on her own and her parents supported her in that. 

At the time, there weren’t any resources to help give her the independence she sought, or at least there weren’t any that Kara’s family were able to find. 

So they got creative.

“Technology has been one of the biggest helpers,” Alice said.

Glenwood Springs resident Kara Brouhard and professional support person Katie Londo work together to make banana bread for the local fire department at her home.

She and Kara have become spokespeople for independence for people with disabilities, and Alice has become a strong advocate for tablet technology to help people with cognitive challenges like traumatic brain Injuries.

Alice lives close by, while Kara has a nanny cam, a fall monitor and a caregiver in case of emergencies or anything unpredictable like a seizure. 

No one holds her hand, but this technology along with help from her mom support her and keep her safe. She has now been able to live a full and exciting life in her home for the past 15 years thanks to this support.

Supporting instead of enforcing

“There’s persons with all disabilities that need that support or just need the answer to that simple one question to push them in the direction they want to go,” said Drene Stevens, a counselor for the Center for Independence based in Grand Junction.

Stevens also suffers from a traumatic brain injury. 

“I myself have epilepsy and its results from viral encephalitis back in 1983,” Stevens said. “The brain swelled up against the skull and there is so much scar tissue leftover that it causes seizures.”

The Center for Independence was created to help connect people with disabilities to resources they need to live independently. 

Glenwood Springs resident Kara Brouhard delivers homemade baked goods to the local police and fire departments weekly.

Originally created in 1982 by five women who found themselves newly blind, they started a nonprofit to offer other blind people resources for survival and independence. They expanded their cause to all types of disabilities in 1986 and now cover 12 counties throughout the Western Slope, including Mesa, Garfield, Eagle and Pitkin counties. 

The satellite office in Glenwood Springs covers the three counties that make up the Roaring Fork Valley, while the location in Grand Junction provides a support group. 

In Glenwood Springs, Coleen Graves is a disability benefits case manager for the Center for Independence and works specifically with all people with disabilities to provide resources to gain independence.

Resources include everything from working with social workers to helping people get through the grueling process of signing up for Social Security. They are also able to help with job hunting and applications, disability applications, food assistance and housing vouchers. 

Kara Brouhard has been able to live independently with the assistance of her parents, support professionals and through the use of technology.

County Human Services also have people who can help those with disabilities sign up for Medicaid and Temporary Assistance for Needy Families, along with helping people to access the Assistance for the Needy and Disabled program while they wait on Social Security or disability services.  

Resources don’t end there.

They also connect people to other community organizations like Catholic Charities USA or The Salvation Army for additional help with rental assistance, utilities and even gas cards for people who can still drive. 

When people do have housing but need help in their home, they can assist with in-home services like referrals for medical services, caregivers or homemaker services like grocery shopping, laundry or any other errands.

“We connect them with Northwest (Colorado) Options for long-term care, which is part of the human services group of services, but it’s separate from where you apply for SNAP or Medicaid,” Graves said.

An assessment is done to determine if that person qualifies for at-home services and then there are a couple of different Medicaid waivers that pay for those services so the person doesn’t have to pay out of pocket, she said.  

Glenwood Springs resident Kara Brouhard and professional support person Katie Londo work together to make banana bread for the local fire department at her home.

“This will give them the support and services they need in their home rather than having to go to an assisted living or even a nursing facility,” Graves said.

The satellite office in Glenwood Springs communicates well with all of the human service organizations in the valley, getting referrals from many local doctors’ offices, County Human Services and even Catholic Charities.

Alice and Stevens said one big challenge is when families hold out too much hope that their loved one will go “back to normal” without accepting that there will be differences in that person.

Stevens lost her fiance, who wasn’t able to accept she wouldn’t go back to the way she was before her accident. She needed to accept those changes herself to know how to move forward, and that sometimes those loved ones can be more of a hindrance in that recovery when they can’t accept the changes. 

Today, both Kara Brouhard and Drene Stevens are able to live their life by their own means because of the acceptance and support they received. 

Stevens said that many of the people in her group who have the least success are the ones without a support system of some sort.

Post Independent reporter Cassandra Ballard can be reached at cballard@postindependent.com or 970-384-9131. 

The Longevity Project:

Brain Health & Injury 

The Longevity Project is an annual campaign to help educate readers about what it takes to live a long, fulfilling life. This year’s project will focus on the critical and relevant topic of brain health after injury.

Our panelists are experts in treating concussions and TBI. They will share the latest research, treatments, physical therapies and how concussions impact aging. Whether for themselves or someone they know, attendees will learn useful takeaways for optimizing brain health after injury.

WHEN: Nov. 10

WHERE: TACAW, The Arts Campus at Willits Willits

TIME: 5 p.m. Meet and Greet; 5:30-7 Panel Discussion

TICKETS: Can be purchased online at https://events.cmnm.org/e/longevity2022

How to mitigate the impacts of traumatic brain injuries an aging population

Every year, an estimated 1.5 million people in the United States are diagnosed with a traumatic brain injury (TBI). For some, they may experience a mild concussion. For others, the impacts of brain injuries can be long-term or even deadly.

For those in the age group 65 years or older, the impacts of brain injuries can be the most severe when compared to other age groups. According to the National Library of Medicine, an estimated 80,000 people in this age group visit an emergency department each year with concerns of brain injury. 

One doesn’t need to be in the NFL or participate in extreme sports to endure the harmful affects a brain injury can have on the body. A simple fall, for some, can change the rest of their lives in the a blink of an eye.

Falls are the leading cause of TBI-associated death in the United States for women over 75 years old and men over 85 years old.

“Falls are one of the most common reasons why older adults get brain injuries,” said Krista Fox, occupational therapist at Aspen Valley Hospital. “And, it’s usually falls from just a standing height.”

The National Institute of the Aging estimates that one in four people ages 65 or older will experience a fall every year.

While no one can predict a fall, there are plenty of preventative measures one can take to better protect themselves.

According to Fox, there are three main areas to focus on when preventing accidents that could lead to TBI:

1.) Biologic

This population may experience muscle weakness, changes in their vision, changes in sensation of their feet, or alterations in equilibrium. With this, it’s recommended to see a physician if you notice any changes in your balance. In addition, physical exercise is highly recommended in order to build muscle and improve joint, tendon, and ligament flexibility, according to the National Institute of the Aging.

2.) Behavioral

Inactivity in this age group is a cause for concern when thinking about how to prevent falls. When someone is inactive, they may have slower reaction times, making falls more likely when active. By cultivating an active lifestyle, one can improve their overall health and balance.

3.) Environmental

Decluttering one’s home can significantly prevent falls. In addition to maintaining an organized space, it’s highly recommended that this age group make alterations to fall-proof their home. This can include having hand rails on both sides of a stair case, getting rid of rugs, and keeping electrical chords out of walkways. These small alterations may seem like insignificant improvements, but they can help save one’s life.

For more tips on how to fall-proof your home, read The National Institute of Age’s tip guide.

What to do if you’re a caregiver of an elder

While experiencing a traumatic brain injury is a significant injury, those who may have a TBI may not even know an injury has happened. One can experience brain fogginess as a symptom of their brain injury or not remember that a fall had occurred, making it challenging to recognize the severity their accident.

According to Fox, if you’re a caregiver of someone who may be significantly impacted by TBI’s, it’s important to ask questions like: “Have you fallen in the last year?” and “Do you have concerns with your balance?”

If you’re concerned that someone you know in this age group may have fallen, she recommends to bring them to a doctor.

“We always recommend that if you have concerns about falling as an older adult, or have concerns for a family member, to see your physician get physical therapy because it is clinically shown to help people,” she said.

Activities for seniors in Aspen

In addition to keeping in mind the three areas to prevent falls, seeing a doctor if you have concerns with your balance and coordination, there’s also groups for those 65 years or older can participate in here in Aspen to improve their overall health.

Pitkin County Senior Services Center offers balance, yoga, tai chi classes and more to seniors. Aspen Recreation Center offers a fitness program designed for seniors called Silver Sneakers.

Traumatic brain injuries in the High Country: Nadine Adamson’s hopeful recovery

Editor’s note: This is the third of a weekly series The Longevity Project, a collaboration between The Aspen Times and the Glenwood Springs Post Independent.

In 2016, Aspen resident Nadine Adamson, 66, spent the Fourth of July in Aspen enjoying the parade in front of Jerome Hotel. The following day, however, changed her life.

On July 5, 2016, she was riding her bicycle on her way to pick up groceries from City Market. She was going to attend a potluck later that evening. She can recall her grocery list: organic spinach, berries, and nuts. What followed was a blur.

She learned years later that she biked her way across the river. She imagines she was taking in the beautiful mountainous terrain and perhaps lost sight of what was in front of her. On her way back from the store, she catapulted over the handle bars of her bicycle.

Her head hit the street first; the front of her skull fractured.

“My whole body flew over the handlebars,” said Nadine, who was 59 at the time.

“I was riding a bike without a helmet, which is something I can’t emphasize enough: Always wear a helmet when you’re riding a bike,” she said. “No matter how old you are, wear a helmet.”

Her friend, David, was bicycling home from work and found her lying on the ground. There was blood coming from her head and mouth. Her eyes were rolling back in her head.

She was rushed to Aspen Valley Hospital. Then, she flew in the Flight For Life helicopter to St. Anthony’s Hospital in Lakewood.

She was later told the doctors didn’t think she would live.

“I’m sure maybe with all the different vital signs that the doctors took, that’s why they really didn’t know if I’d survive the flight or not,” said Nadine. “Thank goodness I did. God had better plans for me.”

She has three daughters, one of whom took a photo of her while she was in the hospital.

Nadine Adamson at St. Anthony’s Hospital following her bicycle accident.
Courtesy photo

“All I could think of was right away is how I must have scared my three daughters horribly,” said Nadine, after seeing the photo.

However, after the feeling of horror set in, she let out a chuckle. The metal rod coming out of her head reminded her of a television show she used to watch as a child called “My Favorite Martian.”

She spent two weeks at St. Anthony’s Hospital. Then, she was transferred to Craig Hospital in Denver.

In recovery, she had to go back to relearning the basics. She spent over a month relearning to walk. She relearned how to use the left side of her body, as she couldn’t quite open her left hand.

Learning to drive was one of the most lengthy recovery-processes, taking over a year. Her driving therapist, Lizzy Ransbottom, later told her that her treatment process inspired a new program at Aspen Valley Hospital.

“She said, and because of that, we’ve helped hundreds of people that have had TBI, accidents, or strokes,” said Nadine. “They’ve been able to incorporate that program to help several people. So, I think that’s a huge blessing.

“I’m so thankful and grateful for that.”

Despite the long recovery process, the devastating injuries, she knows her recovery is a miracle.

Bicycling and Traumatic Brain Injuries

While many may think of brain injuries in connection to football, bicycling is actually the type of recreation in which traumatic brain injuries most commonly occur, according to The American Association of Neurological Surgeons.

Nadine is one of an estimated 596,972 U.S. residents who went to the emergency department during the time 2009 through 2018 for bicycle-related TBIs.

While we cannot predict when an accident may occur, wearing a helmet while riding your bicycle has been proven time and time again as a way to mitigate the impacts of bicycle-related injuries.

According to a meta-analysis of 55 studies, “The use of bicycle helmets was found to reduce head injury by 48%, serious head injury by 60%, traumatic brain injury by 53%, face injury by 23%, and the total number of killed or seriously injured cyclists by 34%.”

Despite the benefits of wearing helmets, many still do not wear helmets while riding their bicycles. The Centers for Disease Control and Prevention surveyed 4,170 U.S. residents in the summer of 2012 and found that only “29% of adults and 42% of children always wore a helmet.” 

Colorado ranked No. 6 in the country in The League of American Bicyclists’ 2022 “report card” of the most bicycle-friendly states. Despite the popularity of bicycling here, Colorado state law does not require the use of helmets while riding a bicycle.

Exercise as Medicine

While Nadine was in recovery, her doctor told her that she would likely not be able to return to her long career as a real-estate agent in the Denver area. 

“I have to agree with him on it when I think about it now,” said Nadine. “I think there was a lot more healing needed to happen over the next couple of years.”

While Nadine was in recovery, her doctor told her that she would likely not be able to return to her long career as a real-estate agent in the Denver area.

Fortunately, she had another part-time career that she was told she encouraged to continue, teaching Zumba.

During her last week as an inpatient at Craig Hospital, her therapist scheduled her to instruct a Zumba class. Some of her friends from the Denver area, patients, and therapists came to the class, which was scheduled to be only 30 minutes long.

After instructing the class, Nadine learned she had led the class for 45 minutes, 15 minutes more than she anticipated.

“I handled it, and I think that they were pleasantly surprised that I did that so good,” she said. “I said, you know, that’s amazing.”

Now, six years following the accident, she instructs Zumba once a week in Aspen.

“It’s a happy thing,” said Nadine. “It just makes you feel really good.”

In addition to the emotional health benefits of Zumba, her doctor told her by teaching and participating in Zumba classes, she was creating new pathways in her brain.

“A neurologist at Craig Hospital showed me a scan they had of my brain, and there were two different dark areas there, and he said, ‘That will never come back,'” said Nadine. “So, to regain everything, to learn to adapt, learning to walk, and all that, plus the dancing and Zumba, it’s all really good because it’s building new pathways in my brain.”

The Longevity Project:

Brain Health & Injury 

The Longevity Project is an annual campaign to help educate readers about what it takes to live a long, fulfilling life. This year’s project will focus on the critical and relevant topic of brain health after injury.

Our panelists are experts in treating concussions and TBI. They will share the latest research, treatments, physical therapies and how concussions impact aging. Whether for themselves or someone they know, attendees will learn useful takeaways for optimizing brain health after injury.

WHEN: Nov. 10

WHERE: TACAW, The Arts Campus at Willits Willits

TIME: 5 p.m. Meet and Greet; 5:30-7 Panel Discussion

For ticket information: click here!

Nadine’s hopeful recovery

Nadine said her name translates to “hope” in French, in line with the kind of person she is and her preservation through her accident.

During the challenges of her recovery, she was frequently asked about her emotional state and whether she experienced depression or feelings of hopelessness. But, she always tried to look on the positive side of things.

“I’m a happy person,” she said. “I’m mainly just so grateful and thankful.”

She credits God, the neurologists, and doctors, as well as the treatments available to her recovery.

Tuchfarber: Traumatic brain injury research enters a new frontier

Earlier this year I was sitting in the office of Dr. Briony Catlow, executive director of the Knoebel Institute for Healthy Aging at Denver University, surrounded by some of Colorado’s top brain researchers and Alzhemier’s advocates. 

Dr. Daniel Paredes, neurochemist at the Knoebel Institute, was excitedly scribbling diagrams and math onto the office window like John Forbes Nash in the movie, “A Brilliant Mind.” He was showing us how in the future we will detect dementia years before symptoms develop from a tiny blood sample using artificial intelligence and a special sensor he has developed.

I was in awe that I had a front row seat to the development of such a potentially powerful technology. I was also filled with hope.

My personal journey to overcome troubling health problems lead me to a deep interest in health-care sciences and creating relationships with experts from around the world who study everything from sleep and exercise to nutrition and dementia. I am honored to be moderating the Brain Injury and Health Panel next month as part of The Longevity Project.

Punch-drunk is a term we’ve heard used to describe the stupor and foggy-headedness associated with a series of heavy blows to the head. Though it is often used in a light-hearted and humorous way, its roots date back to the 1920s, when dementia pugilistica was discovered in boxers. Dementia pugilistica is the serious brain damage caused by repeated traumatic brain injuries (TBI), such as concussions or blows to the head.

In 2002, nearly 75 years after the first diagnosis of dementia pugilistica, National Football League center Michael “Iron Mike” Webster was the first NFL player to be diagnosed with CTE. The movie “Concussion,” released in 2016, tells the story of Nigerian-born pathologist Dr. Bennet Omalu who performed the autopsy on Mike Webster. He subsequently discovered the presence of tau proteins forming toxic “tangles” in nerve cells in the brain, which can significantly impair moods and alter cognitive functions, according to Dr. Lotta Granholm- Bentley, professor at the University of Colorado Neurosurgery Department.

For years, the NFL denied the connection between repeated brain injuries and long-term brain damage, but in a 2016 congressional hearing, Rep. Jan Schakowsky of Illinois asked whether “there is a link between football and degenerative brain disorders like CTE” Jeff Miller, the NFL’s senior vice president for healthy and safety policy, said on the record, “The answer to that is certainly yes.”

The game has changed. While traumatic brain injuries are centuries old, the study of how trauma impacts the brain in the long term is gaining traction across many organizations, including the Federal Interagency Traumatic Brain Injury Research (FITBIR) Informatics System.

“In many ways, traumatic brain injury is both an old science and a very new science,” said Granholm-Bentley, which begs the question of what is on the frontier of TBI research, prevention and treatment.

The work of Granholm-Bentley and her colleagues, including biomarker expert Dr. Aurélie Ledreuxat the University of Colorado, is beginning to shed light on how different molecules in the blood, known as biomarkers, have the potential to help scientists predict if someone is likely to develop a long term cognitive disability or a neurodegenerative disorder like dementia.

The FITBIR database will be able to help scientists define which data should be collected so that useful benchmarks can be established. Granholm-Bentley and Ledreux envision a world not far away when simple biomarker tests can be done in every emergency room giving doctors definitive direction for patients navigating brain recovery.

“After six years, we have some interesting preliminary data that shows that the brain does react even in a very young person,” Granholm-Bentley said. The pathological proteins found in the brain are indicative of what’s going on and whether the brain is trying to heal, she said. “The healing of the brain and the ability of the brain to form new nerve cells and new glia cells reduce as we age, so we already know that brain injuries are worse for older persons. Aging itself leads to low-state inflammation in the brain, so understanding brain injuries when they happen can help us to predict future cognitive impairment.”

We can also thank cancer researchers for pioneering and developing technologies that can translate to degenerative brain application, especially related to the study of exosomes, which are like molecular sacks that hold an array of contents. These sacks are produced by every cell in the body and their contents are rich with materials that can be used for repairing and enhancing the brain. According to Granholm-Bentley, the cutting edge of TBI research may lie in exosome injections to improve the recovery of TBI patients and promote neuroplasticity in the brain.

The good news, according to Granholm-Bentley? She’s a firm believer we can reduce the progression of dementia and long-term effects of brain injury with appropriate lifestyle adjustments.

“The message is simple,” she said. Reduce stress, engage with music, eat lots of antioxidants and anti inflammatory foods and exercise moderately.

There is a chemical answer to why lifestyle change works, she said. “There are good and bad proteins in the brain. For example, tau is essential for normal cells to function properly, but with TBIs and dementia, it increases exponentially and becomes pathological.”

When we increase physical exercise and engage our minds in memory games or listening to music, the levels of a beneficial protein named BDNF increase in the brain, which helps to balance tau. When we don’t have an active lifestyle, tau can get a foothold that exacerbates mental deterioration.

Lee Tuchfarber is the CEO of Renew Senior Communities, LLC. He is a developer, owner and operator of innovative senior living communities. He sits on the boards of the Knoebel Institute for Healthy Aging at Denver University and the Neuroscience Innovation Initiative at the University of Colorado. Over the course of his career, he became unimpressed with the traditional approach to senior living and decided to change it.

The Longevity Project: Traumatic brain injury and concussion protocols in youth sports

Editor’s note: This is the second in a weekly series called The Longevity Project, a collaboration between The Aspen Times and the Glenwood Springs Post Independent. Read part 1, “Traumatic Brain Injuries in the High Country” in the Oct. 17 Post Independent.

Every high school sports sideline, courtside or team box in Colorado has an extra-special set of eyes and ears on the action.

While the coaches and players focus on trying to call or make the best play, athletic trainers are close by intently focused on the heads themselves.

If a player stays on the turf, floor or ice for an extended time after a play, or gets up a little wobbly, certain concussion protocols must be followed, per state law which is now written into the rules of the Colorado High School Activities Association.

“Sometimes you see a hit or a fall, or something that might cause a concussion, and it’s our job to assess the kid from there,” said Ryan Erickson, Certified Athletic Trainer (CAT) for Roaring Fork High School in Carbondale.

“Other times you don’t see what happened, but a kid will self-report or come over and say they’re not feeling right,” he said.

Then there are times when it’s not immediately obvious to the player or the sideline staff that an injury may have occurred, or, in the heat of game battle, the player won’t speak up right away.

That’s when those eyes and ears have to be especially astute in order to keep health and safety at the forefront of youth sports.

Erickson is part of a team of CAT’s sponsored by Valley View Hospital/Valley Ortho in partnership with the Roaring Fork School District to provide preventative services, emergency care, therapeutic intervention and rehabilitation for student-athletes at Glenwood Springs, Roaring Fork and Basalt high schools.

Erickson’s work, along with Marni Barton at Glenwood Springs and Mike McCann at Basalt, covers the gamut of sports-related injuries and medical conditions. But concussions and protection against traumatic brain injuries (TBIs) through very careful “return-to-play” policies and procedures are a major focus.

At National Athletic Trainers’ Association conferences he’s attended over his 18 years as a trainer, Erickson said that about a third of the overall attention is given to concussive head injuries. That includes prevention, treatment and rehabilitation.

“It’s a major topic, and there is lots of new research coming out constantly,” he said.

The texts he used in college in 2005 on the topic might as well be tossed out, but not because the people who were researching and studying it at the time didn’t know what they were doing, he said.

“They were the leaders in research and the care of concussions,” Erickson said. “It’s just that so many new things have come to light, and we need to stay up with that.”

Concussion law

The Colorado Legislature in 2012 passed Senate Bill 40, or the “Jake Snakenberg Youth Concussion Act,” named after an athlete from Grandview High School in Aurora who died after suffering a concussion during a football practice.

The law laid out a series of measures and protocols to protect young athletes from head injury during sports, including:

  • Requirements for coaches to take annual training around proper concussion protocol.
  • Immediately removing athletes from play who sustain a suspected concussion, and not allowing them to return to a game or practice the same day.
  • Notifying parents if their child has been removed from play due to a suspected concussion, and providing them with information about signs and symptoms so that they can monitor their child at home.
  • Ensuring that a health care provider evaluates the player and gives written clearance for them to return to play, including practices and games.

Kim Gorgens is a neuropsychologist, board-certified in rehabilitation psychology, and also a professor for 22 years at the University of Denver. She helped write Jake’s Law, and continues to be a brain injury policy advocate.

Roaring Fork High School Certified Athletic Trainer Ryan Erickson keeps watch on the action during a game.
John Stroud/Glenwood Springs Post Independent

“At the time, Colorado was really out in front in responding to the risks due to concussions in sports,” she said. “There’s been a real push since then to quantify the risk for players, so that those in charge can make the right decisions.”

Gorgens gives TED Talks on the subject, focusing on preventative measures in youth sports, from pee-wee leagues through middle school and into high school, return-to-play policies and sharing information about DU’s biomarker studies around the long-term impacts from head injuries, including dementia and other conditions that appear with age.

“There is a lot of research on some of the poorer outcomes, so that we can better understand what confers the risk for these really terrible outcomes,” Gorgens said. “We are coming to understand youth sports brain injury from every angle, and we’re working really hard to do better by coaches, trainers and parents who are out there coaching on the sand lots.”

Sideline protocols are critical when it comes to avoiding successive concussions, which can lead to more severe TBIs.

When a suspected concussion occurs, coaches and trainers get involved by checking for any immediate symptoms and questioning the players directly involved or who might have witnessed what transpired in order to know what to look for.

A Glenwood Springs Demon football player waits his turn to run drills during a recent after school practice.
Chelsea Self/Glenwood Springs Post Independent

“We gather the history of what happened, look for any symptoms they may have at the moment, test their balance and just generally observe them and their behavior,” Roaring Fork’s Erickson said. 

Symptoms typically include headache, dizziness, nausea, vision problems such as double vision, and sudden sensitivity to light or sounds.

“From that, it’s usually not very hard to determine if they have a concussion,” Erickson said.

But that’s not his call. A medical doctor is often on site at the game or event, or on call so that they can come and give the diagnosis.

Concussions aren’t limited to contact sports, either, he said.

“Football gets all the attention, because of the violent nature of the sport,” Erickson said. “But soccer can have as many or more concussions, and in basketball you have kids taking charges and hitting their head on the hardwood.”

Oftentimes, it’s not the initial blow from contact with another player that causes the concussion, “it’s you falling hard and hitting your head on the ground or the court,” he said.

Prevention key, but no fail-safes

DU’s Gorgens is also involved on the technology side of protective sports equipment — another science that’s ever-evolving, but an area where youth sports programs have a hard time keeping up.

And it’s an area where Colorado has fallen behind other states on the prevention side, due to high equipment replacement costs and a lack of routine equipment replacement plans, Gorgens said.

Following the implementation of Jake’s Law, school districts across Colorado were able to ride a funding push to buy new, more-advanced football helmets and other equipment, such as extra-protective Guardian caps that can be used on helmets during practice. Some soccer teams also began using protective headgear.

But much of that equipment is now at or beyond its lifespan, leaving school and club sports programs to hold fundraisers to buy new equipment, Gorgens said.

“We’re having bake sales for brain health, which is sad but true,” she said.

“It is an expense, and it’s an ongoing expense. And it’s an investment that school districts, especially the smaller ones, really wrestle with,” she said.

Glenwood Springs Demon football players practice high knee drills during a recent after school practice.
Chelsea Self/Glenwood Springs Post Independent

Gorgens said there may be opportunities for high school sports programs to obtain equipment through corporate research sponsorships, similar to college and professional programs, to test some of the newer advancements. Helmets can be equipped with what are called accelerometers, which measure the G-force and provide important research data, she said. 

“Manufacturers need that field research,” she said.

Glenwood Springs High School head football coach Tory Jensen said much of the protective equipment in his program is at the end of its life cycle. But even that seven-year-old equipment is far superior to what he used in his playing days, and even in his earlier coaching days at Roaring Fork High School in the early 2000s.

“We had terrible equipment when I played, and we hit 10 times harder than we do now,” Jensen said of the evolution of his sport.

“It’s a conversation that has been going on at the high school level for, what, 20 years now,” he said. “It’s a question of how we help our athletes work through playing a collision sport, and it’s difficult. As a coach, it’s unnerving when a head injury happens. You don’t want to see any athlete, or any parent, go through it.”

It’s the down side of any sport, whether it’s a collision sport like football, or even skateboarding, skiing and snowboarding, or mountain biking.

“We are a very active community, and we put ourselves at risk all the time,” Jensen said. “It’s definitely a part of our culture in this valley, no matter what you do.”

More to prevention than padding

There’s a lot more to prevention than just wearing the proper, up-to-date protective equipment.

As Erickson said, “There’s no perfect helmet.”

For Jensen’s football squad, it starts in the weight room.

“The number one thing we do to prevent those kinds of injuries is getting into the weight room and doing the strength and conditioning training you need to help your body absorb the contact that comes with football,” he said.

That can apply to any sport, really. 

“We work on the preventative piece year-round, just trying to get in the weight room as much as possible and working on our strength and conditioning, so when a collision happens you’re less likely to get injured.”

Gorgens concurs.

“Neck strength in particular is a really important predictor in avoiding head injuries,” she said. “That’s one of the reasons we’re really focusing now on the junior high kids, because they don’t have the neck muscular build yet to be able to take those hits.”

Strength and conditioning is a big part of recovery from a head injury, too. 

“The physical therapy field has really emerged as a leader in successful treatment, which runs upstream to doing more on the prevention side,” Gorgens said.

Proper conditioning is a practice Jensen said he carries into his athletic pursuits as an adult. 

“I play hockey all winter long,” he said. “It’s not really a contact sport but, yeah, there’s contact, whether that’s a collision with another player or contact with the ice.

A Glenwood Springs High School football player listens in during a huddle with the coach during practice.
Chelsea Self/Glenwood Springs Post Independent

“Think about it; a bunch of old dudes on skates, sometimes things don’t go the way you want it to.”

Staying properly hydrated during physical activity is also key to avoiding injury, including head injuries, Jensen said.

One of the things he emphasizes with his athletes is avoiding energy drinks and certain supplements, which can have the negative side effect of causing dehydration.

“Part of the concussion prevention piece is dehydration, because your brain works within a liquid base that helps protect itself from bumping into the skull,” he said. “If you’re on a two-hour mountain bike ride and crash in the last hour when you’re dehydrated, it’s going to have more of an impact on your body.”

Recovery to return

“The only healer in a brain injury is time. It just takes time,” Jensen said.

A bad concussion can sideline a player for the rest of the season, if not longer. That’s just one of the risks, he said.

The statistics coming back from the National Football League around prevention and proper recovery when concussions occur is encouraging, and something youth programs can learn from, Jensen said.

During the just-concluded NFL preseason, the league reported 70% fewer concussions than in previous years, after new safety measures were put into place.

“I think it would be silly not to follow down that path and get all of our kids doing the same things,” Jensen said.

Erickson said the brain should be treated like any other muscle that gets injured.

“You have to work that injury out, same as any other muscle,” he said.

It can take some athletes longer to recover than others, which is why the return-to-play procedures are so critical. Initially, there’s a five-day progressive return protocol, but the doctor’s advice is the last word.

“We refer to the doctor to say do or don’t return to play,” Erickson said. Initially, that may even include a doctor’s order to stay home from school for a period of time and to not engage in other activities.

“We start with light activity, then gradually increase that activity, and if the symptoms come back, then they’re not ready to return to play yet,” Erickson said. “If they clear all the steps, they’re usually ready to go.”

It’s also important to understand that no two concussions are the same, and no two people are the same when it comes to sustaining a concussion and recovering from one.

“I played a lot of rugby, and I know there are people who have coconut heads, and who can just take more than another person,” Jensen said.

Still, “Every time you get hit in the head, it’s got to add up,” he said.

The Longevity Project:

Brain Health & Injury 

The Longevity Project is an annual campaign to help educate readers about what it takes to live a long, fulfilling life. This year’s project will focus on the critical and relevant topic of brain health after injury.

Our panelists are experts in treating concussions and TBI. They will share the latest research, treatments, physical therapies and how concussions impact aging. Whether for themselves or someone they know, attendees will learn useful takeaways for optimizing brain health after injury.

WHEN: Nov. 10

WHERE: TACAW, The Arts Campus at Willits Willits

TIME: 5 p.m. Meet and Greet; 5:30-7 Panel Discussion

TICKETS: Can be purchased online at https://events.cmnm.org/e/longevity2022

jstroud@postindependent.com

The Longevity Project: Preventing concussions in sports and the road to recovery if it happens

You can help prevent traumatic brain injury

Be sure to wear a helmet or appropriate headgear whenever you or your children:

  • Ride a bike, motorcycle, snowmobile, scooter or use an all-terrain vehicle;
  • Play a contact sport, such as football, ice hockey, or boxing;
  • Use in-line skates or ride a skateboard;
  • Bat and run bases in baseball or softball;
  • Ride a horse; or
  • Ski or snowboard.

Helmets should be age-appropriate, fit properly, be well-maintained, be worn consistently and correctly and be appropriately certified for protective use.

While there is no concussion-proof helmet, a helmet can help protect your child or teen, and adults, from serious brain or head injury. Even with a helmet, it is important to avoid hits to the head.

Source: Centers for Disease Control and Prevention

Returning to play after a concussion

A concussion is a type of mild traumatic brain injury caused by a forceful blow or jolt to the head or body that disrupts how the brain normally works. A person does not need to be knocked out or lose consciousness to have a concussion.

Many parents wonder if it is safe for their young athlete to return to playing football, soccer, lacrosse or other sports after a concussion. An appropriately trained health care provider can answer these questions and provide guidance on when it is safe and sensible for an athlete to return to sports.

Athletes should not be allowed to continue playing sports, including practices and conditioning, while recovering from a concussion for a variety of reasons:

Recovery time: In one study among high school athletes, athletes who were immediately removed from play after a concussion recovered twice as fast as athletes who continued to participate.

Worsening symptoms: Strenuous activity soon after a concussion has been associated with worsening symptoms.

Increased risk: Parents and young athletes should be aware that a second head injury while an athlete is recovering from a concussion can increase the risk of complications, including the potential for worsening symptoms and longer recovery.

Catastrophic brain injuries, such as those that result in death or permanent neurologic injury, are extremely rare in youth sports. Nevertheless, it’s important to understand that they can happen so that they can be identified immediately and appropriately managed.

Source: Children’s Hospital Colorado

jstroud@postindependent.com

The Longevity Project: Traumatic Brain Injuries in the High Country

Editor’s note: This is the first of a weekly series The Longevity Project, a collaboration between The Aspen Times and Post Independent.

Many individuals who experience traumatic brain injuries (TBI) undergo what is called perseveration, where they often repeat words or phrases. For Carbondale resident Darryl Fuller, 52, the word he clings to is “nature.”

“Sometimes he calls me nature,” Darryl’s wife, Susan Jordan, said. “Sometimes he calls other people nature. Sometimes he just uses it to fill in.”  

In the early stages following Fuller’s TBI, the word clung to was “determination.” These words choices seem to be in line with the kind of person Darryl Fuller is.

He and Susan have been living in Carbondale for over 20 years. They moved here in 2000, when Darryl took a job at Colorado Rocky Mountain School as the outdoor programming director, a title he’s held since he moved here. 

Susan Jordan (left) and Darryl Fuller (right) riding bikes.
Courtesy photo

Before the accident that led to Darryl’s TBI, on a typical weekend, Darryl and Susan would spend it biking or skiing, enjoying all the things living in the mountains has to offer.

A love of nature seems to have carved out a career and lifestyle for Darryl. 

Darryl Fuller’s traumatic brain injury

On May 21, 2022, Darryl was in a backcountry skiing accident on Cathedral Peak. He was with a friend, trying to enjoy one of the last snow storms of the season.

While walking up the peak, Darryl slid on a patch of rocks and lost a ski. He was not injured at this point. After he fell the first time, he and his friend decided to descend the peak, making their way back down the way they had come up. 

They were both being cautious and wearing protective gear, including helmets. Darryl is an experienced skier and outdoorsman, given his long career as an outdoor program director. Still, accidents can happen to the most experienced outdoor adventurers, even those who make safety a priority.

It was on their way back down the peak that Darryl fell again, sliding an estimated 1,000 feet. His friend found him lying unconscious.

Before Darryl’s friend was able to make it to him safely, others who witnessed his fall were able to reach him.

“The miracle was that there were two people, a father and a son hiking at the Cathedral Lakes Trail on May 21. Like, who does that?” said Susan. “Even locals don’t really do that.”

Darryl was airlifted to Aspen Valley Hospital, then transferred to St. Mary’s Medical Center in Grand Junction. According to Susan, he almost didn’t make it.

“He was covered with blood, his eyes were slow and he was intubated. He couldn’t talk. He was not conscious,” Susan said about her first time seeing her husband.

Darryl had broken his leg, tore the upper side of his left eye, and endured a traumatic brain injury.

He moved from St. Mary’s Medical Center in Grand Junction to Craig Hospital in Denver, where he and Susan have been since July 6.

Traumatic Brain Injuries in the High Country

Darryl is one of 1.5 million people diagnosed with a TBI this year, according to estimates from the Centers for Disease Control and Prevention.

The number of people living with TBIs in the United States nearly equals the entire population of Colorado. According to Aspen Valley Hospital, an estimated 5.3 million adults and children living in the United States are suffering from permanent brain injuries. The U.S. Census from 2021 estimates the population of Colorado at 5.8 million.

Each year, Aspen Valley Hospital sees an estimated 2,000 people who come in with concerns of brain injuries. Concussion is the most frequent diagnosis for those patients, but even a mild concussion can lead to lasting impacts.

Austin Colbert, the sports editor and lead photographer for The Aspen Times, endured a mild concussion a handful of years ago and still has lingering symptoms. 

“I had a very light, insignificant knock on the head, and I’m still dealing with symptoms five years later.” Colbert said. “It impacts your life.”

Dr. John Hughes, who owns Aspen Integrative Medicine, described a TBI as “a bomb that explodes in the brain.” This “bomb” often goes undetected on CT or MRI scans, which makes the treatment for TBI all the more challenging.

The most common events that lead to TBIs are falls, car collisions, combative injuries or sports-related injuries. People living in rural or mountainous regions are more likely to experience a TBI than those who live in urban or eastern regions.

With this, Colorado ranks ninth in the country for TBI-related fatalities and 13th for TBI-related hospitalizations, according to Brain Injury Alliance of Colorado.

A study from Craig Hospital estimates that Region 12 of Colorado, which consists of Pitkin, Eagle, Summit, Jackson and Grand counties, ranks No. 1 for TBIs when adjusted for the population.

According to a study from Craig Hospital, traumatic brain injury is more prevalent for those who live in mountainous regions, compared to urban areas or eastern regions.
Kristen Mohammadi/The Aspen Times

Like the severity of TBIs, treatment and recovery for TBI patients varies.

“I tell my patients, it’s still going to be a six- to nine-month process, even a year before they might get back to some resemblance of normal and can say, ‘Hey, I have my identity back,'” said Dr. Hughes.

“I think everybody has to have those kinds of kind of long-term expectations.”

Golden nuggets of hope

For Darryl Fuller and Susan Jordan, every day seems to get a little better.

“Every little thing is just like this little golden nugget of hope,” said Susan.

He can read, write, do math problems and more — signs that Darryl is recovering. Conversing and walking are still challenging. 

He and Susan pass the time between his treatments playing games or rolling around the hospital. 

Both of them are currently not able to work. This, along with the cost of medical treatment, is why Darryl’s sister started a GoFundMe page that is still taking donations.

Susan also started a blog on Caringbridge in which she writes journal updates on his progress. She considers the blog a good way to keep people informed and hopes that it is something they can look back on in the future, when Darryl gets better.

For now, they are still in Craig Hospital. The release date always seems to change, depending on the fluctuating recovery process.

Susan hopes Darryl will be treated in more of a residential-style treatment facility soon. 

 “As much as we’d like to get home, he’s not ready to go home,” said Susan. “So, I am super hopeful that we’re going to get Darryl back to a very high level.

“Whatever’s left, we’ll just continue to work on whatever that is.”

The Longevity Project:

Brain Health & Injury 

The Longevity Project is an annual campaign to help educate readers about what it takes to live a long, fulfilling life. This year’s project will focus on the critical and relevant topic of brain health after injury.

Our panelists are experts in treating concussions and TBI. They will share the latest research, treatments, physical therapies and how concussions impact aging. Whether for themselves or someone they know, attendees will learn useful takeaways for optimizing brain health after injury.

WHEN: Nov. 10

WHERE: TACAW, The Arts Campus at Willits Willits

TIME: 5 p.m. Meet and Greet; 5:30-7 Panel Discussion

For ticket information: click here!