What do the NFL and the VA Have in Common?

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Like the Department of Veterans Affairs (“the VA”), the NFL has eloquently side-stepped the effects of brain trauma caused my massive or repeated concussive events.

In a most disturbing study, the Journal of the American Medical Association has concluded that “110 of 111 NFL players were found to have chronic traumatic encephalopathy, or C.T.E., the degenerative disease believed to be caused by repeated blows to the head.”

Chronic Traumatic Encephalopathy or CTE

This should come as no surprise to most anyone who has followed repeated denials by NFL officials and team owners that repeated concussive events on the field of play lead to permanent brain damage.

Why?  The liability is simply too great and public outcry might hurt the lucrative revenue stream of the NFL, which is currently exempt from antitrust laws thanks to the largesse of Congress.

Personally, I don’t believe that the risk of brain injury will deter rabid fans from attending college or NFL games anymore than residents of Rome passed up an opportunity to attend a bloody spectacle at the colosseum.

Nevertheless, there is a strong grassroots effort to cut back on football programs for young children.  A recent news report from Tampa, Florida highlights the dilemma faced by parents whose 9 and 10 year-old children want to play contact football.

NFL Players and our Military Heroes

While NFL players have the opportunity to walk away from the sport they dearly love, the brave men and women who serve in our armed forces don’t have quite the same options.

More to the point, Veterans suffering from from PTSD and TBI have few possibilities given the VA’s limited menu of therapy options: Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT).   As the VA acknowledges, neither of these therapies has produced significant improvements in the well-being of Veterans.

To mask the their failure in treating PTSD and TBI, the VA has resorted to potent prescription drugs with unsettling side-effects.   In effect, treating PTSD and TBI has largely been a “loss loss” for Veterans with equally devastating results on their families.

What the VA and the NFL have in common is a culture of arrogance and denial based on a concerted and prolonged effort to hide the truth from those it purports to serve and protect.   In effect, the VA has told Veterans that “it is the VA way or the highway.”

Sadly, far too many Veterans have opted for the highway.

Dr. David Cifu and the Culture of Doom

Nowhere is this arrogance of the VA more manifest than in the pompous and self-serving performance by Dr. David Cifu, a consultant for the VA on PTSD and TBI, at a 2016 Congressional subcommittee:

Scholars in attendance were revolted by Dr. Cifu’s anecdotal and silly justification for why the VA’s policies and procedures for treating PTSD and TBI are so far out of touch with the latest scientific research.

Sadly, Dr. Cifu’s opinions reflect entrenched attitudes at the VA and deprive tens of thousands of brave Veterans the treatment they deserve to combat this debilitating injury.

While Dr. David Shulkin is cleaning house at the VA, he would do well to look at those like Dr. Cifu to determine if they are up to the task in reestablishing the credibility of the VA.

Veterans that talk to SFTT believe that the VA is useless in helping to address their problems with PTSD and TBI.

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What do NFL and Military Helmets Have In Common?: Not Much!

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Like many, I am moved by the tributes paid to military Veterans and active service members at NFL games.  Nevertheless, both the NFL and the military have come under sharp criticism regarding the number brain injuries suffered on both the playing field and battlefield.

chronic_traumatic_encephalopathy

Both the NFL and military have stonewalled the problem for many years, but it now appears that the NFL is taking action to introduce a “safer” helmet in the hope that they can reduce concussions and permanent brain injuries for professional athletes. Hopefully, better protective gear will work its way through college and high school football programs.

The Vicis Zero1 helmet has now been purchased by 25 NFL teams and will be introduced during the 2017 season. According to initial press releases:

In testing against 33 other helmets to measure which best reduces the severity of impact to the head, the Vicis ZERO1 finished first. Included in the study were helmets from Schutt and Riddell, which currently account for approximately 90 percent of helmet sales.

Vicis was founded by neurosurgeon Sam Browd and Dave Marver, former CEO of the Cardiac Science Corporation, with the goal of reducing the high rate of concussions in football. While it would take years of play and further studies to conclusively prove that they’ve been successful, the studies show that they’re on their way to making an impact.

Found below is a video explaining how this helmet helps provide additional protection to football professionals:

While the safety requirements for battlefield and football helmets differ significantly, it does appear that the NFL has acted a lot quicker than the military to protect its professionals.

Reducing brain injuries at their point of origin is far preferable to treating neurological damage to sensitive brain cells in the aftermath.

The US Army – and other DoD components – have long been aware that current helmets offer battlefield personnel little protection against IED devices typically found in Afghanistan and in the Middle East.  Indeed, SFTT has been reporting on various studies by the military embedding sensors into military helmets.

According to my calculation, the US Army has over 10 years of sensor data to draw on.  Surely, this is sufficient to draw some conclusions and develop a better-designed helmet capable of providing additional protection against concussive brain injury.

While the military continues to “study” the issue, it is encouraging to see the NFL to take action.  Frankly, I don’t buy the NFL sales pitch that the league rushed in to protect the health and safety of its players.  If true, they would have done so long ago when the NFL first started studying brain injuries.

As the New York Times reported earlier, the NFL leadership buried extensive “concussion” evidence collected between 1996 and 2001 to deflect potential claims by former NFL players who had suffered brain damage.

As we have seen in the case of body armor,  DoD leadership and the NFL have much in common:  a strong propensity to hide the facts from their employees and the public at large.

While one can find many faults in the way the NFL leadership has acted “to protect the safety of its players” and the integrity of their franchise, NFL teams are now treating brain injuries far more seriously than the DoD.

In addition to helmets, several NFL teams are now treating players with suspected brain injury with hyperbaric oxygen therapy (HBOT).    Sadly, the Department of Veterans Affairs continues to block the use of HBOT in treating Veterans with PTSD and TBI.

Could it be that DoD personnel charged with evaluating HBOT therapy failed to employ the proper protocols in 2010 clinical testing procedures?  If so, why?

SFTT remains hopeful that both the VA and the DoD will act quickly to introduce helmets that afford more protection to battlefield personnel and approve HBOT as an acceptable treatment procedure for PTSD and TBI.

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NFL Reluctantly Opts to Research Concussions

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In yet another token concession to those concerned with repeated trauma of concussions on NFL players, Commissioner Roger Goodell announced a new initiative “intended to increase the safety of the game, specifically by preventing, diagnosing and treating head injuries.”

As reported by CNN, Goodell said:

. . . the league and its 32 club owners will provide $100 million in support of engineering advancements and medical research — in addition to the $100 million previously pledged by the league to medical and neuroscience research.

The Play Smart Play Safe initiative also requires hiring a physician to serve as the league’s chief medical officer.  The physician will work with each team’s medical staff and establish an independent scientific advisory board to consider head injury research proposals.

Concussions and, more importantly, chronic traumatic encephalopathy ( or”CTE’) continues to be a subject that is only whispered about behind closed doors at the NFL.  Nevertheless, it is a problem that will not soon disappear and SFTT remains hopeful that researchers will be able to improve the safety of the game and provide insights into how this horrific “sport” injury can be prevented and,  hopefully, treated more effectively.

chronic_traumatic_encephalopathy

While the NFL has been slow to address this problem, the Department of Defense and the Department of Veterans Affairs (the “VA”) have been even slower.  Consider what SFTT stated in March, 2016 in its article entitled “NFL Preempts Veterans with Brain Injuries“:

With hundreds of thousand of Veterans suffering from brain trauma, isn’t it about time our political and military leadership quit burying their heads in the sands and deflect public scrutiny by investigating the NFL, which has Congressional immunity from antitrust regulation?  What a strange but convenient retreat for our feckless political leadership.

If the NFL owners had any sense, they would embrace the battle against brain trauma and work with the military to help both its gladiators and the brave men and women suffering from PTSD. Indeed, this public relations initiative could help deflect “public” outrage and provide the medical profession and others with the resources and impetus to deal with the silent wounds of war.

While the causes of brain trauma are different, shared research could go a long way in helping both Veterans and NFL players deal with the problems of repeated concussions.  No one expects easy answers, but the military has collected a wealth of data on concussions over the last six years from sensors implanted in helmets of soldiers serving in combat.

The first step in solving a problem is to admit you have a problem.  Sadly, both the NFL, the VA and the DoD have been slow to address this most serious problem and one wonders how committed either organization is to do so.

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Latest Developments on Treating PTSD

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Much has been written about the terrible long-term consequences of Post Traumatic Stress or “PTSD,” but there appears to be no clear way of treating PTSD.  Some argue that PTSD is best treated using “psychological” methods to treat the trauma while others argue that certain war-related events (i.e. IEDs) cause physiological changes in the brain.

treating ptsd

This dilemma makes diagnosing and treating PTSD so difficult.  Based on SFTT’s experiences, we have found that Veterans with symptoms of PTSD respond differently to various forms of therapy.   In short, there seems to be no definitive solution to a very serious problem which is now reaching epidemic proportions.

In a recent article published in the New York Times, medical scientists now believe that traumatic war-related events may actually cause physiological changes in the brain.

Quoting Dr. Daniel P. Perl, a neuropathologist who led a study for Lancent Neurology, evidence now exists that changes brain patterns:

Less understood is how the blast wave — the pulse of compressed air that shoots in all directions faster than the speed of sound and arrives before the wind — affects brain tissue after crashing through the helmet and skull. Blasts are also believed to compress the sternum and send shock waves through the body’s blood vessels and up into the brain. . .

The researchers examined the brains of the five veterans who had been exposed to blasts, and compared samples with those of 16 other veterans and civilians with and without brain injuries from military service or other activities. Scar tissue in specific locations of the cerebral cortex, which regulates emotional and cognitive functioning, was found only in the blast-injury cases.

Dr Perl and fellow researchers discovered the following changes in the brain following concussion like events:

Perl and his lab colleagues recognized that the injury that they were looking at was nothing like concussion. The hallmark of C.T.E. is an abnormal protein called tau, which builds up, usually over years, throughout the cerebral cortex but especially in the temporal lobes, visible across the stained tissue like brown mold. What they found in these traumatic-brain-injury cases was totally different: a dust-like scarring, often at the border between gray matter (where synapses reside) and the white matter that interconnects it. Over the following months, Perl and his team examined several more brains of service members who died well after their blast exposure, including a highly decorated Special Operations Forces soldier who committed suicide. All of them had the same pattern of scarring in the same places, which appeared to correspond to the brain’s centers for sleep, cognition and other classic brain-injury trouble spots.

Then came an even more surprising discovery. They examined the brains of two veterans who died just days after their blast exposure and found embryonic versions of the same injury, in the same areas, and the development of the injuries seemed to match the time elapsed since the blast event. Perl and his team then compared the damaged brains with those of people who suffered ordinary concussions and others who had drug addictions (which can also cause visible brain changes) and a final group with no injuries at all. No one in these post-mortem control groups had the brown-dust pattern.

Dr. Perl on Treating PTSD

While it will takes years of analysis and research to determine whether these neurological changes can be reversed, many Veterans will continue to suffer the “invisible wounds of war.”  Dr. Perl is justifiably worried:

 After five years of working with the military, he (Dr. Perl) feels sure, he told me (author Robert Worth), that many blast injuries have not been identified. “We could be talking many thousands,” he (Perl) said. “And what scares me is that what we’re seeing now might just be the first round. If they survive the initial injuries, many of them may develop C.T.E. years or decades later.”

This is not hopeful news, but at least we as a society are beginning to take PTSD seriously.  Hopefully, we will not try and bury the research in the way the NFL has sought to hide the effects of CTE on NFL players and downplay its significance to football fans who seem addicted to the violence of the spectacle.

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NFL Preempts Veterans with Brain Injuries

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One cannot be surprised to learn that the NFL leadership and some club owners played “foot-free” with the fact that brain-injuries suffered by NFL players may be far worse than suspected.

NFL and Concussions

A New York Times story entitled “N.F.L.’s Flawed Concussion Research and Ties to Tobacco Industry,” has concluded that:

For the last 13 years, the N.F.L. has stood by the research, which, the papers stated, was based on a full accounting of all concussions diagnosed by team physicians from 1996 through 2001. But confidential data obtained by The Times shows that more than 100 diagnosed concussions were omitted from the studies — including some severe injuries to stars like quarterbacks Steve Young and Troy Aikman. The committee then calculated the rates of concussions using the incomplete data, making them appear less frequent than they actually were.

Not surprisingly, Congress has now gotten involved to determine if the NFL manipulated the data to hide the unpleasant fact that repeated concussions causes permanent brain damage.    Nobody who has ever given this issues a serious thought could have concluded otherwise, but politicians of every ilk cannot resist seeing their names at the forefront of a Congressional investigation into the NFL.

Needless to say, the NFL has demanded that the New York Times retract its story on concussions.    Clearly, the gladiator money machine is more important to NFL owners, advertisers and broadcast TV than the lives of the mercenaries recruited to entertain us.

Thousands of Veterans with PTSD must be scratching their heads and wondering where are Congressional leaders have been while the DoD and VA report on the ravages of PTSD and TBI among Veterans serving in Iraq and Afghanistan.

Why does the NFL have priority over Veterans suffering from terrible brain injuries?  Is the stage for pubic exposure greater for politicians with the NFL than our brave Veterans?  Sadly, we must conclude that it is so.

us-army-helmet-sensors

As long as our politicians are investigating the NFL, why not take the opportunity to make public the lengthy sensor studies conducted by the U.S. Army on brain injuries?   This sensor-data information collected for well over 5 years would certainly be useful to the medical profession in understanding what happens to the brain during concussive events.  It may also help developing a better helmet to protect our brave warriors.

Who knows, the leadership of the NFL may actually learn something about brain trauma.

With hundreds of thousand of Veterans suffering from brain trauma, isn’t it about time our political and military leadership quit burying their heads in the sands and deflect public scrutiny by investigating the NFL, which has Congressional immunity from anti-trust regulation?  What a strange but convenient retreat for our feckless political leadership.

If the NFL owners had any sense, they would embrace the battle against brain trauma and work with the military to help both its gladiators and the brave men and women suffering from PTSD. Indeed, this public relations initiative could help deflect “public” outrage and provide the medical profession and others with the resources and impetus to deal with the silent wounds of war.

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PTSD and the Super Bowl

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As we all settle in to watch the Super Bowl tomorrow, let us reflect on the large number of brave Veterans who have suffered from PTSD and traumatic brain injury (TBI). Indeed, there are enough wounded Veterans from our wars in Iraq and Afghanistan to fill several Super Bowl stadiums.

PTSD and CTE

Nevertheless, I suspect that sports’ pundits will be more focused on CTE – chronic traumatic encephalopathy – found on the brain of former pro quarterback, Kenny Stabler caused by “repeated blows to the head.” Indeed, there is now a list on Wikipedia that lists the number of deceased pro football players that were diagnosed with CTE.

Veterans with post traumatic stress disorder and/or TBI now exceed some 200,000 and they are simply not receiving the treatment they require to reclaim their lives.  The Veterans Administration’s preferred solution is to mask the symptoms of brain trauma with an often lethal cocktail of pharmaceuticals. At the same time the VA blocks other far more inexpensive technologies, like Hyperbaric Oxygen Therapy,  used around the world.  Why?

PTSD by the Numbers

Less we forget, please find below a video from the late Navy S.E.A.L, Chris Kyle who explains how difficult it is for some Veterans to adjust after they come home from war.  We now believe that some 20% of Veterans are affected by some form of brain trauma, although many experts believe that the number is far higher.  Listen to Chris Kyle:


via: PTSD by the Numbers: Battling Post Traumatic Stress Video

As we watch the Super Bowl, let us reflect on the conditions of our brave Veterans and the personal demons they face each day.

UK Troops Suffering from PTSD and Depression

Traumatic brain injury is not only prevalent in the US, but the British Armed Forces are also coping with serious problem.  Based on the statistics below, they are probably underestimating the scope of the problem, but it is clear that they see clear evidence of “alcohol-related” behavioral disorders and Veterans try to “self-medicate.”  Substance abuse is rampant among Veterans in the US, particularly with those who suffer from PTSD.   One health specialist suggested it could be as high as 90%.

See what the British say about traumatic stress among their own troops:

Of those, 1,235 have been awarded compensation and discharged with post-traumatic stress disorder. The figures, obtained under a Freedom of Information request, show 718 were discharged for depression, while 130 were suffering from alcohol-related behavioral disorders.

Speaking yesterday Patrick Rea, of the charity PTSD Resolution, said: “Assuming that most of these cases involve the Army, it brings us to a ratio nearing one in 10. Previous figures suggest that around two per cent of troops across all branches are suffering from PTSD. Of course, the problem is that there is a latency about PTSD that may not show up in official figures.Then, five years after they leave, it results in breakdown of their marriage, loss of employment and even criminality.”
via: Rising toll of stressed out troops suffering from PTSD and depression

Mental Health Week: PTSD and Suicide

Jenny Hale, a Public Relations graduate student at the Newhouse School of Public Communications, discusses below the relationship between PTSD and suicide.   While Jenny is right to suggest contacting the CRISIS LINE at 1-800-273-8255 for help, the Veterans Administration has not done a good job in helping Veterans with PTSD.  I would take the advice provided below with a grain of salt.

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Post-Traumatic Stress Disorder (PTSD) is a mental health problem that can occur after someone goes through a traumatic event like war, assault, an accident or disaster. Symptoms can start immediately after an event or can develop years later. These symptoms usually include flashbacks or memories, sleep problems or nervousness. Indicators lasting longer than a month may be related to PTSD.

Since 2002, 128,496 service members have been diagnosed with PTSD after being deployed in post-9/11 wars. The highest numbers reported were in the year 2012, with over 20,000 total cases between deployed and non-deployed soldiers.

If you or someone you know is suffering from PTSD, there are several outlets for both civilians and military to find help.

  • VA Center—All VA hospitals have care for PTSD. Contact your nearest VA Medical Center for an appointment.
  • Consult a therapist—The International Society for Traumatic Stress Studies can help locate a clinic near you. Find a list here.
  • Call the Veterans Crisis Line—Family and friends, as well as veterans, can speak to VA workers 24/7 online or by phone for confidential support. 1-800-273-8255 or chat with a professional here.

Suicide is another serious mental health issue among veterans. A veteran commits suicide every hour, while a service member commits suicide every day. 8,000 veterans commit suicide every year.

24 percent of suicides include veterans with PTSD symptoms and 66 percent of those have been deployed. Over 50 percent of veterans had no sign of behavioral health disorders prior to their death.

Suicide is preventable. If you or someone you know is showing feelings of guilt, saying that life isn’t worth living or expressing failure, seek help through the Suicide Prevention Line at 1-800-273-8255.
via: Mental Health Week: PTSD and Suicide

While I too will be sitting around the television watching this great American tradition of the Super Bowl, I will think of our many Veterans suffering from PTSD who don’t have access to the latest therapies available to help them reclaim their lives.  CTE has surfaced as a “big issue” within the NFL.  I only wish Veterans with PTSD and/or TBI would receive the same level of national attention.

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Military News Highlights: December 2, 2010

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‘Progress Made’ In Afghanistan’s Helmand Province

When interviewed by . Generic drugs that do so should have the same therapeutic effect and therefore the same benefits as their brand-name counterparts, but at less cost.

“But let’s talk a little bit about Marja, because I know that’s one you’ve been following. If you could come over and visit today I would take you down to the district center, where across the street is a very nice restaurant that’s opened up – two dining rooms. You can get a really nice chicken dinner there. There’s three major bazaars in town, all three flourishing. All of the activity now – all the enemy activity in Marja’s been pushed to the perimeter, where a few lone insurgents creep back, usually at night, and try to intimidate some of the locals. And have not done a very good job of it.”

When asked to comment on Sanjin, heartland of the current bloodbath that has claimed the lives of at least 14 Marines assigned to 3rd Battalion, 5th Regiment since mid-September, General Mills made no mention of this sacrifice but commented that, “It’s been tough fighting. It continues to be tough fighting. I think that Sangin is Marja, perhaps five months ago. And we are going to remain focused on that mission up there, and we will win.”

When they start serving chicken dinners in Sangin, I guess the General can claim victory.

The following two news reports from the New York Times add to SFTT’s recent discussion on combat related and sports related head injuries and trauma and the stark difference between the actions taken by the sports industry and lack of action and non-prioritization of these type injuries taken by the Congress, DoD, and the Services.

Scans Could Aid Diagnosis of Brain Trauma in Living

If athletes are subject to chronic traumatic encephalopathy (CET) as a result of sustained head trauma, then it’s obvious that US troops are prone to CET in the future as well due to combat related head trauma.   In fact, Boston-based researchers have developed new imaging techniques that confirmed CET in athletes brains with a history of head trauma.  Currently, CET can only be confirmed through a specialized brain tissue examination after death.  So imagine if you can monitor CET and its symptoms and treat these injuries effectively.  Why wait until you are on the morticians slab to confirm the obvious?  While there is more work to be done with the initial positive results of this new type of imagining and study, the question that remains is whether or not this type of sports/medical science will ever transfer over to DoD and its medical services as it identifies, monitors, and treats troops suffering from TBI. Probably not given their track record.

Ward Calls League Hypocritical on Safety

Maybe Pittsburgh Steelers wide receiver Hines Ward is onto something in his criticism of the National Football League’s recent call and emphasis on safety.  Ward’s take is that the league only toughened its stance because of a pending desire to extend the season to 18 games.   If DoD, the services, and Congress ever wake up and start addressing combat related head injuries and trauma properly maybe it’s because they want to extend the time spent on the battlefield as well.  Nah, just because 2011 turned into 2014 and beyond in Afghanistan doesn’t mean that there is going to be new emphasis placed on improving helmets and reducing head injuries and traumas.  In Afghanistan, its all systems forward without these types of safety and quality of life considerations.  Why should we kid ourselves and believe there was a purpose for “extending the season”.

Department of Defense Headquarters Staff Comparisons (2000-2010)

Senator James Webb requested a pre-and post-9/11 staff comparison of Department of Defense, Services, and Combat Command Headquarter as he studies the Department’s recent decision to axe Joint Forces Command.   After nearly a decade, of the 17 reporting headquarters there has been approximately 11,000 civilian/military staff personnel billets added.  If you only take uniform personnel back into the fold you could man at least two Brigade Combat Teams – imagine that!  Read more from Tom Ricks.

Dragon EOD Squad Leader Sergeant First Class “William”

Just in time for the holidays.  Your very own toy-set of body armor, Advanced Combat Helmet, and an M-4 carbine!  Enjoy!

  • The set is outfitted in the newer ACH, with older style Interceptor body armor in woodland camouflage, and helmet with woodland camouflage cloth cover.
  • Weapon: M4 Assault Rifle or M4 Carbine with Infrared Pointer / Illuminator, Aimpoint optic sight, Forward Hand Grip, tactical light attached under the barrel, retractable / extendable butt stock and removable magazine.
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Brain Trauma Injuries and A.L.S.

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In a paper released this week, there are new indications that brain trauma injuries may mimic many of the symptoms of Lou Gehrig’s disease.  In an news article published August 18th by the New York Times entitled Brain Trauma Injury can mimic A.L.S.,  NYT’s reporter Alan Schwartz indicates that A.L.S. or amyotrophic lateral sclerosis, commonly referred to as Lew Gehrig’s Disease may have been triggered by concussions and other traumatic head injuries. 

According to the New York Times report, “Doctors at the Veterans Affairs Medical Center in Bedford, Mass., and the Boston University School of Medicine, the primary researchers of brain damage among deceased National Football League players, said that markings in the spinal cords of two players and one boxer who also received a diagnosis of A.L.S. indicated that those men did not have A.L.S. They had a different fatal disease, doctors said, caused by concussion-like trauma, that erodes the central nervous system in similar ways.”

As previously reported by SFTT and other reliable sources, the military is paying far greater attention to brain trauma injuries and its long-term effects on military personnel if left un-diagnosed.    Officially, military sources place the number of troops suffering from brain trauma injuries at 115,000, but informed sources place the number much higher.    Clearly, the  rapid deployment of new helmet sensors by BAE based on preliminary field studies suggests that is a serious problem that is attracting the attention of our military leadership.

While pleased brain injuries caused by frequent I.E.D incidents is receiving more careful diagnosis and serious medical study, the question remains:  Do our troops have the best protective gear and military helmets to cushion the immediate effects of an I.E.D. explosion?  Simply deploying our troops with sensors to “study” the effects of brain trauma injury is akin to a laboratory experiment with rats.  More succicntly, is there currently a better alternative to the current standard-issue military helmet that would help reduce brain trauma injury.

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