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Tag: neurological disorders

  • Heading a ball contributed to brain injury suffered by late Scotland defender McQueen, coroner says

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    NORTHALLERTON, England — Repeatedly heading a soccer ball “likely” contributed to the brain injury that was a factor in the death of former Manchester United and Scotland defender Gordon McQueen, a coroner found Monday.

    McQueen died in June 2023 at the age of 70, with the cause of death given as pneumonia after he became frail and bed-bound for months.

    In his narrative conclusions following an inquest, coroner Jon Heath said McQueen died from pneumonia as a consequence of mixed vascular dementia and chronic traumatic encephalopathy. CTE is a neurodegenerative disease linked to repeated head trauma.

    “It is likely that repetitive head impacts sustained by heading the ball while playing football contributed to the CTE,” the coroner said.

    His daughter, Hayley McQueen, was in court to hear the findings. She gave evidence during the inquest, saying her father had said that ’heading a football for all those years probably hasn’t helped” his condition.

    She said her father was relatively injury-free during his career but did suffer some concussions, adding: “They would just head back out and play.”

    Hayley McQueen, a TV presenter, said she hopes the findings of the inquest will lead to change in soccer and “make sure that this really real, horrible problem isn’t a problem for future generations.”

    McQueen played 30 games for Scotland between 1974-81, and for Manchester United and Leeds in a 16-year career.

    After retiring as a player, McQueen went into coaching and became a TV pundit.

    After his death, his family donated his brain to professor Willie Stewart, a consultant neuropathologist at the Queen Elizabeth University Hospital in Glasgow, the inquest heard.

    Stewart has conducted extensive research into brain injuries in soccer and rugby players. He told the inquest he found evidence of CTE and vascular dementia.

    Stewart said the only evidence available was that McQueen’s “high exposure” to heading a soccer ball contributed to the death and that heading the ball contributed to the CTE.

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    AP soccer: https://apnews.com/hub/soccer

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  • The Miami Project to Cure Paralysis follows science and steady funding to a broader mission

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    Marc Buoniconti said his father, the late NFL Hall of Famer Nick Buoniconti, explained the secret to the success of their nonprofit and its fundraising efforts simply: “We’re just not good listeners.”

    In the 40 years since Marc Buoniconti, then a college football linebacker at the Citadel, was paralyzed during a routine tackle, they have been told countless times that it was a problem that couldn’t be fixed. The Buonicontis didn’t listen.

    Instead, through the fund that bears their name, they have helped raise more than $550 million for The Miami Project to Cure Paralysis, and improved the lives of millions with spinal cord and brain injuries.

    “The Buoniconti Fund has lasted because we’re relentless,” Marc Buoniconti recently told The Associated Press. “We never give up. When we see a challenge, we face it head-on and don’t stop until we find a solution. It’s that determination, that refusal to quit that’s kept us going all these years.”

    That drive has also led The Miami Project to expand its work beyond curing paralysis. Its research center at the University of Miami Miller School of Medicine now also studies neurological diseases and disorders including Alzheimer’s disease and Parkinson’s disease, and it is testing the brain-computer interface implant from Elon Musk’s technology company Neuralink.

    Dr. Barth A. Green, chairman of The Miami Project, who co-founded the organization in 1985 with Nick Buoniconti, says the most surprising developments from the center have been the broadest ones.

    “Every operating room in the world that puts people to sleep monitors their nervous system for safety,” Dr. Green said. “That was all developed at The Miami Project.”

    Therapeutic hypothermia, where the body is cooled after an injury to protect the brain and spinal cord, is another widely used treatment developed at the center.

    Dr. Green said that before Buoniconti’s accident he had been working on helping those who had been paralyzed for 20 years. Yet there wasn’t a hub for that work until The Miami Project was established.

    It provided a home for him and “thousands of scientists and researchers in Miami and around the world, who were equally engaged by the opportunity to change people’s everyday quality of life and their opportunities to have more function and a better opportunity to be mobile and do things they never dreamt they could before.”

    Miami Project Scientific Director W. Dalton Dietrich III said gathering those people from a variety of disciplines – neuroscientists, researchers, clinicians, biomedical engineers – into one building has led to unexpected advances.

    “Not one particular treatment is going to cure paralysis,” Dietrich said. “So I’ve tried to look at other disciplines to bring into the project to help us achieve that goal.”

    One new, multidisciplinary area, neuromodulation, is “something we never thought about five years ago,” Dietrich said. “It’s just an exciting area where you can stimulate these residual circuits after brain injury or spinal cord injury in patients and they start moving their limbs.”

    The Buoniconti Fund’s support for the center helps accelerate research in these areas by funding early trials. That, in turn, makes it easier to eventually receive grants from government agencies like the National Institutes of Health or the Department of Defense, Dietrich said.

    Marc Buoniconti says “it’s hard to put into words” seeing so many people rally behind him and the millions of others who have been paralyzed.

    “What started as a promise to help me walk again became a mission to help millions,” he said. “Every resource, every dollar, every hour given is a testament to the belief that we can change lives.”

    Mark Dalton, chairman and CEO of Tudor Investment Corp., said that belief resonated with him and made him want to get involved with The Buonicontis even before he met them.

    “I had tremendous admiration for him as a father who was never going to give up on finding a cure for what ailed his son,” Dalton said. “And his son was a representation of millions of other people.”

    Once he learned more about The Miami Project, Dalton said he was impressed by its science-driven approach. Its setting on a university campus was also important to the former chairman of the board of trustees at Denison and Vanderbilt universities.

    “They put the line in the water,” said Dalton, who now chairs the Buoniconti Fund’s biggest annual fundraiser, The Great Sports Legends Dinner. “They hooked me. I’m all in.”

    That’s a common feeling around The Miami Project, which counts legendary golfer Jack Nicklaus and Grammy winner Gloria Estefan among its supporters. And it’s something Marc Buoniconti says he does not take for granted.

    He hopes The Miami Project’s work will continue to expand.

    “My biggest dream is for our researchers to find a way to fully repair the nervous system,” Buoniconti said. “When we do that, we’ll change the entire landscape for paralysis and so many other neuro conditions. We’ll give so many people their lives back. That’s what keeps me going, and that’s what makes every struggle to this point worth it.”

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    Associated Press coverage of philanthropy and nonprofits receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content. For all of AP’s philanthropy coverage, visit https://apnews.com/hub/philanthropy.

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  • An autoimmune disease stole this man’s memory. Here’s how he’s learning to cope

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    “My year of unraveling” is how a despairing Christy Morrill described nightmarish months when his immune system hijacked his brain.

    What’s called autoimmune encephalitis attacks the organ that makes us “us,” and it can appear out of the blue.

    Morrill went for a bike ride with friends along the California coast, stopping for lunch, and they noticed nothing wrong. Neither did Morrill until his wife asked how it went — and he’d forgotten. Morrill would get worse before he got better. “Unhinged” and “fighting to see light,” he wrote as delusions set in and holes in his memory grew.

    Of all the ways our immune system can run amok and damage the body instead of protecting it, autoimmune encephalitis is one of the most unfathomable. Seemingly healthy people abruptly spiral with confusion, memory loss, seizures, even psychosis.

    But doctors are getting better at identifying it, thanks to discoveries of a growing list of the rogue antibodies responsible that, if found in blood and spinal fluid, aid diagnosis. Every year new culprit antibodies are being uncovered, said Dr. Sam Horng, a neurologist at Mount Sinai Health System in New York who has cared for patients with multiple forms of this mysterious disease.

    And while treatment today involves general ways to fight the inflammation, two major clinical trials are underway aiming for more targeted therapy.

    Still, it’s tricky. Symptoms can be mistaken for psychiatric or other neurologic disorders, delaying proper treatment.

    “When someone’s having new changes in their mental status, they’re worsening and if there’s sort of like a bizarre quality to it, that’s something that kind of tips our suspicion,” Horng said. “It’s important not to miss a treatable condition.”

    With early diagnosis and care, some patients fully recover. Others like Morrill recover normal daily functioning but grapple with some lasting damage — in his case, lost decades of “autobiographical” memories. This 72-year-old literature major can still spout facts and figures learned long ago, and he makes new memories every day. But even family photos can’t help him recall pivotal moments in his own life.

    “I remember ‘Ulysses’ is published in Paris in 1922 at Sylvia Beach’s bookstore. Why do I remember that, which is of no use to me anymore, and yet I can’t remember my son’s wedding?” Morrill wonders.

    Encephalitis means the brain is inflamed and symptoms can vary from mild to life-threatening. Infections are a common cause, typically requiring treatment of the underlying virus or bacteria. But when that’s ruled out, an autoimmune cause has to be considered, Horng said, especially when symptoms arise suddenly.

    The umbrella term autoimmune encephalitis covers a group of diseases with weird-sounding names based on the antibody fueling it, such as anti-NMDA receptor encephalitis.

    While they’re not new diseases, that one got a name in 2007 when Dr. Josep Dalmau, then at the University of Pennsylvania, discovered the first culprit antibody, sparking a hunt for more.

    That anti-NMDA receptor encephalitis tends to strike younger women and, one of the bizarre factors, it’s sometimes triggered by an ovarian “dermoid” cyst.

    How? That type of cyst has similarities to some brain tissue, Horng explained. The immune system can develop antibodies recognizing certain proteins from the growth. If those antibodies get into the brain, they can mistakenly target NMDA receptors on healthy brain cells, sparking personality and behavior changes that can include hallucinations.

    Different antibodies create different problems depending if they mostly hit memory and mood areas in the brain, or sensory and movement regions.

    Altogether, “facets of personhood seem to be impaired,” Horng said.

    Therapies include filtering harmful antibodies out of patients’ blood, infusing healthy ones, and high-dose steroids to calm inflammation.

    Those cyst-related antibodies stealthily attacked Kiara Alexander in Charlotte, North Carolina, who’d never heard of the brain illness. She’d brushed off some oddities — a little forgetfulness, zoning out a few minutes — until she found herself in an ambulance because of a seizure.

    Maybe dehydration, the first hospital concluded. At a second hospital after a second seizure, a doctor recognized the possible signs, ordering a spinal tap that found the culprit antibodies.

    As Alexander’s treatment began, other symptoms ramped up. She has little clear memory of the monthlong hospital stay: “They said I would just wake up screaming. What I could remember, it was like a nightmare, like the devil trying to catch me.”

    Later Alexander would ask about her 9-year-old daughter and when she could go home — only to forget the answer and ask again.

    Alexander feels lucky she was diagnosed quickly, and she got the ovarian cyst removed. But it took over a year to fully recover and return to work full time.

    In San Carlos, California, in early 2020, it was taking months to determine what caused Morrill’s sudden memory problem. He remembered facts and spoke eloquently but was losing recall of personal events, a weird combination that prompted Dr. Michael Cohen, a neurologist at Sutter Health, to send him for more specialized testing.

    “It’s very unusual, I mean extremely unusual, to just complain of a problem with autobiographical memory,” Cohen said. “One has to think about unusual disorders.”

    Meanwhile Morrill’s wife, Karen, thought she’d detected subtle seizures — and one finally happened in front of another doctor, helping spur a spinal tap and diagnosis of LGI1-antibody encephalitis.

    It’s a type most common in men over age 50. Those rogue antibodies disrupt how neurons signal each other, and MRI scans showed they’d targeted a key memory center.

    By then Morrill, who’d spent retirement guiding kayak tours, could no longer safely get on the water. He’d quit reading and as his treatments changed, he’d get agitated with scary delusions.

    “I lost total mental capacity and fell apart,” Morrill describes it.

    He used haiku to make sense of the incomprehensible, and months into treatment finally wondered if the “meds coursing through me” really were “dousing the fire. Rays of hope?”

    The nonprofit Autoimmune Encephalitis Alliance lists about two dozen antibodies — and counting — known to play a role in these brain illnesses so far.

    Clinical trials, offered at major medical centers around the country, are testing two drugs now used for other autoimmune diseases to see if tamping down antibody production can ease encephalitis.

    More awareness of these rare diseases is critical, said North Carolina’s Alexander, who sought out fellow patients. “That’s a terrible feeling, feeling like you’re alone.”

    As for Morrill, five years later he still grieves decades of lost memories: family gatherings, a year spent studying in Scotland, the travel with his wife.

    But he’s making new memories with grandkids, is back outdoors — and leads an AE Alliance support group, using his haiku to illustrate the journey from his “unraveling” to “the present is what I have, daybreaks and sunsets” to, finally, “I can sustain hope.”

    “I’m reentering some real time of fun, joy,” Morrill said. “I wasn’t shooting for that. I just wanted to be alive.”

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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  • An autoimmune disease stole this man’s memory. Here’s how he’s learning to cope

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    “My year of unraveling” is how a despairing Christy Morrill described nightmarish months when his immune system hijacked his brain.

    What’s called autoimmune encephalitis attacks the organ that makes us “us,” and it can appear out of the blue.

    Morrill went for a bike ride with friends along the California coast, stopping for lunch, and they noticed nothing wrong. Neither did Morrill until his wife asked how it went — and he’d forgotten. Morrill would get worse before he got better. “Unhinged” and “fighting to see light,” he wrote as delusions set in and holes in his memory grew.

    Of all the ways our immune system can run amok and damage the body instead of protecting it, autoimmune encephalitis is one of the most unfathomable. Seemingly healthy people abruptly spiral with confusion, memory loss, seizures, even psychosis.

    But doctors are getting better at identifying it, thanks to discoveries of a growing list of the rogue antibodies responsible that, if found in blood and spinal fluid, aid diagnosis. Every year new culprit antibodies are being uncovered, said Dr. Sam Horng, a neurologist at Mount Sinai Health System in New York who has cared for patients with multiple forms of this mysterious disease.

    And while treatment today involves general ways to fight the inflammation, two major clinical trials are underway aiming for more targeted therapy.

    Still, it’s tricky. Symptoms can be mistaken for psychiatric or other neurologic disorders, delaying proper treatment.

    “When someone’s having new changes in their mental status, they’re worsening and if there’s sort of like a bizarre quality to it, that’s something that kind of tips our suspicion,” Horng said. “It’s important not to miss a treatable condition.”

    With early diagnosis and care, some patients fully recover. Others like Morrill recover normal daily functioning but grapple with some lasting damage — in his case, lost decades of “autobiographical” memories. This 72-year-old literature major can still spout facts and figures learned long ago, and he makes new memories every day. But even family photos can’t help him recall pivotal moments in his own life.

    “I remember ‘Ulysses’ is published in Paris in 1922 at Sylvia Beach’s bookstore. Why do I remember that, which is of no use to me anymore, and yet I can’t remember my son’s wedding?” Morrill wonders.

    Encephalitis means the brain is inflamed and symptoms can vary from mild to life-threatening. Infections are a common cause, typically requiring treatment of the underlying virus or bacteria. But when that’s ruled out, an autoimmune cause has to be considered, Horng said, especially when symptoms arise suddenly.

    The umbrella term autoimmune encephalitis covers a group of diseases with weird-sounding names based on the antibody fueling it, such as anti-NMDA receptor encephalitis.

    While they’re not new diseases, that one got a name in 2007 when Dr. Josep Dalmau, then at the University of Pennsylvania, discovered the first culprit antibody, sparking a hunt for more.

    That anti-NMDA receptor encephalitis tends to strike younger women and, one of the bizarre factors, it’s sometimes triggered by an ovarian “dermoid” cyst.

    How? That type of cyst has similarities to some brain tissue, Horng explained. The immune system can develop antibodies recognizing certain proteins from the growth. If those antibodies get into the brain, they can mistakenly target NMDA receptors on healthy brain cells, sparking personality and behavior changes that can include hallucinations.

    Different antibodies create different problems depending if they mostly hit memory and mood areas in the brain, or sensory and movement regions.

    Altogether, “facets of personhood seem to be impaired,” Horng said.

    Therapies include filtering harmful antibodies out of patients’ blood, infusing healthy ones, and high-dose steroids to calm inflammation.

    Those cyst-related antibodies stealthily attacked Kiara Alexander in Charlotte, North Carolina, who’d never heard of the brain illness. She’d brushed off some oddities — a little forgetfulness, zoning out a few minutes — until she found herself in an ambulance because of a seizure.

    Maybe dehydration, the first hospital concluded. At a second hospital after a second seizure, a doctor recognized the possible signs, ordering a spinal tap that found the culprit antibodies.

    As Alexander’s treatment began, other symptoms ramped up. She has little clear memory of the monthlong hospital stay: “They said I would just wake up screaming. What I could remember, it was like a nightmare, like the devil trying to catch me.”

    Later Alexander would ask about her 9-year-old daughter and when she could go home — only to forget the answer and ask again.

    Alexander feels lucky she was diagnosed quickly, and she got the ovarian cyst removed. But it took over a year to fully recover and return to work full time.

    In San Carlos, California, in early 2020, it was taking months to determine what caused Morrill’s sudden memory problem. He remembered facts and spoke eloquently but was losing recall of personal events, a weird combination that prompted Dr. Michael Cohen, a neurologist at Sutter Health, to send him for more specialized testing.

    “It’s very unusual, I mean extremely unusual, to just complain of a problem with autobiographical memory,” Cohen said. “One has to think about unusual disorders.”

    Meanwhile Morrill’s wife, Karen, thought she’d detected subtle seizures — and one finally happened in front of another doctor, helping spur a spinal tap and diagnosis of LGI1-antibody encephalitis.

    It’s a type most common in men over age 50. Those rogue antibodies disrupt how neurons signal each other, and MRI scans showed they’d targeted a key memory center.

    By then Morrill, who’d spent retirement guiding kayak tours, could no longer safely get on the water. He’d quit reading and as his treatments changed, he’d get agitated with scary delusions.

    “I lost total mental capacity and fell apart,” Morrill describes it.

    He used haiku to make sense of the incomprehensible, and months into treatment finally wondered if the “meds coursing through me” really were “dousing the fire. Rays of hope?”

    The nonprofit Autoimmune Encephalitis Alliance lists about two dozen antibodies — and counting — known to play a role in these brain illnesses so far.

    Clinical trials, offered at major medical centers around the country, are testing two drugs now used for other autoimmune diseases to see if tamping down antibody production can ease encephalitis.

    More awareness of these rare diseases is critical, said North Carolina’s Alexander, who sought out fellow patients. “That’s a terrible feeling, feeling like you’re alone.”

    As for Morrill, five years later he still grieves decades of lost memories: family gatherings, a year spent studying in Scotland, the travel with his wife.

    But he’s making new memories with grandkids, is back outdoors — and leads an AE Alliance support group, using his haiku to illustrate the journey from his “unraveling” to “the present is what I have, daybreaks and sunsets” to, finally, “I can sustain hope.”

    “I’m reentering some real time of fun, joy,” Morrill said. “I wasn’t shooting for that. I just wanted to be alive.”

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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  • Man appears to have a seizure as ICE arrests his wife, but officials disagree

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    FITCHBURG, Mass. — A Massachusetts man seen on video having an apparent seizure during a struggle with immigration agents as he holds his wife and crying toddler says he lost consciousness after agents pushed and hit him and pressed on his neck.

    Department of Homeland Security officials accused him of faking the medical emergency to keep agents from arresting his wife, who was wanted for allegedly stabbing a co-worker with scissors.

    “I wasn’t letting go of my wife because they wanted to take her away,” Carlos Zapata, 24, told The Boston Globe in Spanish. He spoke to the newspaper on Friday, a day after his wife was detained in a chaotic traffic stop.

    Bystanders shouted and recorded the confrontation as Immigration and Customs Enforcement officers surrounded the family’s car Thursday morning in Fitchburg, a city about 40 miles (65 kilometers) northwest of Boston. Agents were seeking Juliana Milena Ojeda-Montoya, who was inside the vehicle with her husband and 1 ½-year-old daughter, according to a Homeland Security news release.

    Widely circulated video shows Zapata behind the wheel, his body shaking and the whites of his eyes visible as masked agents reach into the car.

    “He’s having a seizure!” bystanders can be heard shouting.

    Zapata told the newspaper that agents were pushing him and his wife together with the child between them, and that he blacked out after agents pressed on his neck.

    “I had convulsions or something. I don’t know what they did to me,” he said. When he regained consciousness, he said, agents were handcuffing him.

    Zapata said he and his wife are from Ecuador and entered the country unlawfully several years ago. They have since applied for asylum in a case that is pending and are authorized to work, he said. He was driving his wife to her job at Burger King when they were stopped, he said.

    Homeland Security responded to the video Friday, saying: “Imagine FAKING a seizure to help a criminal escape justice,” in a post on social media.

    “Medical personnel found there was no legitimate medical emergency,” Tricia McLaughlin, the department’s assistant secretary, said in a news release. “He was even caught on video on his feet and coherent moments later.”

    The department said officers were conducting a targeted operation to arrest Ojeda-Montoya for the alleged scissor stabbing and for throwing a trash can at her coworker in August. She was charged with assault and battery with a dangerous weapon, the Globe reported.

    Ojeda-Montoya was in custody pending removal proceedings, according to Homeland Security.

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  • A neurological disorder stole her voice. Jennifer Wexton takes it back on the House floor.

    A neurological disorder stole her voice. Jennifer Wexton takes it back on the House floor.

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    When Jennifer Wexton rose Thursday to speak on the House floor, something she has done countless times before, the congresswoman used a voice she thought was gone forever.

    After a rare neurological disorder robbed her of her ability to speak clearly, Wexton has been given her voice back with the help of a powerful artificial intelligence program, allowing the Virginia Democrat to make a clone of her speaking voice using old recordings of speeches and appearances she made as a congresswoman. She used that program to deliver what is believed to be the first speech on the House floor ever given via a voice cloned by artificial intelligence.

    “It was a special moment that I never imagined could happen. I cried happy tears when I first heard it,” Wexton told The Associated Press in the first interview she’s participated in since attaining her new voice.

    Standing at a lectern on the floor, Wexton rose to commemorate Disability Pride Month, a time each July that aims to commemorate the Americans with Disabilities Act, the landmark 1990s civil rights law aimed at protecting Americans with disabilities. But her speech was also a symbol of her strength in the face of a debilitating disease.

    “I used to be one of those people who hated the sound of my voice,” she remarked from the floor. “When my ads came on TV, I would cringe and change the channel. But you truly don’t know what you’ve got til it’s gone, because hearing the new AI of my old voice for the first time was music to my ears. It was the most beautiful thing I had ever heard.”

    Wexton’s voice now plays out of her iPad, propped up using a rainbow-colored floral case. During the interview at her dining room table in Leesburg, Virginia, the congresswoman typed out her thoughts, used a stylus to move the text around, hit play and then the AI program put that text into Wexton’s voice. It’s a lengthy process, so the AP provided Wexton with a few questions ahead of the interview to give the congresswoman time to type her answers.

    Wexton was diagnosed with progressive supranuclear palsy in 2023, an aggressive neurological disorder that impacts many aspects of life, including speech. Sitting across from a credenza filled with photos marking the high points of her personal life – weddings, family trips, her children – the congresswoman called the diagnosis “cruel” for someone whose “entire professional life has been built around using my voice,” from Virginia prosecutor to state Senator to member of Congress.

    “A politician who can’t do public speaking will be a former politician before too long. But this AI voice model has given me a new opportunity to have my voice heard and it reminds listeners that I am still me,” Wexton told the AP.

    The congresswoman, whose runaway win in 2018 signaled the success Democrats would have that year, initially announced a Parkinson’s diagnosis in April 2023, striking an upbeat tone by telling supporters they were “welcome to empathize” with her, but not to “feel sorry for me.” Her tone in September 2023 was vastly different: She described her PSP diagnosis as “Parkinson’s on steroids” and said she would not seek reelection in 2024.

    “This new diagnosis is a tough one. There is no ‘getting better’ with PSP. I’ll continue treatment options to manage my symptoms, but they don’t work as well with my condition as they do for Parkinson’s,” she said at the time.

    The diagnosis has changed Wexton’s personal and professional life. The congresswoman doesn’t look like she once did. Her posture slumped, her movements less precise, her natural voice muted – all impacts of the disease. As it became more difficult for Wexton to use her voice, she turned to a traditional text-to-speech app that many people with speech disorders often use. The voice sounded more like a robot than a human, but Wexton used it to conduct interviews and give speeches.

    “This is not a situation I would have chosen to find myself in,” she said from the House floor. “I never thought that at my age and otherwise good health, something like PSP could, in the space of just over a year, rob me of my ability to speak, run or dance, and force me to stop doing the job that I love.”

    ElevenLabs, a start-up with one of the most widely used AI-powered voice cloning models, saw Wexton speak using the older technology. They contacted her office several weeks ago and Wexton’s aides provided the company with several recordings, mostly speeches she had given as a member of Congress.

    “Our technology gives individuals who have lost their voice the ability to speak as they once did, with the emotion and passion they feel, and we hoped to help the Congresswoman do just that,” said Dustin Blank, Head of Partnerships at the company.

    Wexton told AP she first used the cloned voice to speak with President Joe Biden in the Oval Office earlier this month when he signed the National Plan to End Parkinson’s Act, a bill that Wexton called the “most consequential action we have taken in decades to combat Parkinson’s and related diseases, like my PSP.” A few days later, Wexton publicly debuted her cloned voice in a video, leading to an outpouring of support and thrusting the congresswoman into a debate over AI.

    This is “not the way I thought I would be leaving Congress,” she said. “I didn’t anticipate being at the forefront of a debate over the future of AI.”

    Using AI-powered cloning to give Wexton her voice back is one of the positive applications of this technology. However, voice cloning has also been used nefariously, like defrauding people and pushing fake political messaging. The most notable of these instances was when an AI-generated robocall impersonating President Joe Biden urged voters ahead of the New Hampshire primary not to vote. The call was quickly reported and resulted in serious consequences for those behind it, but the incident raised serious questions about the future of this technology and the companies behind it.

    Wexton, whose district is home to scores of data centers that power AI, harbors those questions, too. After she debuted her voice clone, Wexton jokingly texted a few friends the same message: “AI isn’t entirely evil, just mostly.”

    Hany Farid, a professor and digital forensics expert at the University of California, Berkeley, said Wexton’s example is the exception to the numerous nefarious uses for voice cloning technology.

    “I found it really moving… and I am all for this application,” he said. “But I just want to emphasize, just because there are these really beautiful stories… doesn’t mean we should just ignore the pretty nasty things with these technologies.”

    One way to ensure the technology is being used for good, said Farid, is “better checks and balances” to ensure “people aren’t doing nefarious things with your products.” That includes content credentials that say how the audio was developed, storage of all audio created using the technology and know-your-customer rules that require voice cloning companies to know who is using their technology.

    Wexton agrees more guardrails are needed. Her team of advisers has taken precautions to make sure her likeness is protected, from limiting access to the voice to only three people and tightening security on the program.

    “It is humanizing and it is empowering. It can also be dangerous,” she said. “I still believe that the dangerous potential of AI technology must be better understood and steps must be taken to prevent abuses of the technology like deepfakes from proliferating and part of that falls on lawmakers like us in Congress,” she later added.

    In 2019, Wexton won bipartisan approval for an amendment directing the National Science Foundation to research public awareness around deepfake videos generated by AI.

    Wexton also said the technology isn’t perfect. Because the audio used came from speeches and public events, it isn’t great for regular conversation, often making everything sound “like some big proclamation.” Her two college-aged sons, she said, don’t like it for that reason and, she quipped, she doesn’t use it to “ask my husband to please pass me the ketchup,” displaying a sense of humor that she is known for on Capitol Hill.

    “At the end of the day, it will never be me. But it is more me than I ever could have hoped I could hear again and for that, I am so grateful and excited,” she said. “I plan to make the most of it.”

    For doctors like Jori Fleisher, the Director of Rush CurePSP Center of Care, that sentiment is why this kind of technology could be life-altering for those diagnosed with the rare neurological disorder.

    Too often PSP patients lose their voices and have to rely on traditional speech-to-text programs to communicate, Fleisher said. But those programs use robotic voices that often sound nothing like the patients. Fleisher notes that people with “neurological diseases are already stigmatized,” so speaking with a voice that sounds like a computer “perpetuates the stigma” and often leads them to withdraw from relationships and “worsens the social isolation that can be such a huge part of these conditions.”

    “To know of and already deeply respect Representative Wexton and then hear her speak so beautifully in her own voice, using her own words through this technology, it is giving me goosebumps now,” she said, growing emotional. “It’s so empowering.”

    The key, Fleisher added, is making this technology available to more people by encouraging patients in the early stages of PSP and other neurological disorders to “bank enough sounds from your own voice that it could be used later” and for insurance companies to cover this kind of treatment. Wexton said she tried to do this late last year through an Apple program, but her voice was already too impacted by the disease for their AI to use.

    Wexton’s new voice particularly helps in more emotional moments when hearing sentiment in her speech is significantly more powerful than a more robotic sound. When asked how Barbara Comstock, the Republican congresswoman Wexton has grown close to since defeating her in 2018, had helped support her since Wexton revealed her diagnosis, the Democrat grew emotional and said, “She has been so gracious.”

    “I was just thrilled for her,” Comstock said, recalling when she first heard Wexton’s AI voice. “Just great to hear she is getting her literal voice out there for others to see the power of the technology. … I am getting teary thinking about it again.”

    After defeating Comstock in 2018, Wexton’s future in Virginia politics was bright, with many in the state speculating she could seek higher office. Her diagnosis has taken that future away — her political career will end next year — but it has given Wexton a new resolve.

    “I want to be a voice, even an AI voice, for Americans facing accessibility challenges and other disabilities because too often people only see us for that disability,” Wexton said. “I hope that by continuing to do my job to the best of my ability, whether that means using a walker or a wheelchair to get to the House floor to vote or delivering my speeches through an AI-recreated version of my voice, that it can help show I am just as much me on the inside that I have always been.”

    —

    The Associated Press receives financial assistance from the Omidyar Network to support coverage of artificial intelligence and its impact on society. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org

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  • Grounded charter jet freed to leave France. Lawyer says most passengers expected to return to India

    Grounded charter jet freed to leave France. Lawyer says most passengers expected to return to India

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    PARIS — A charter plane sequestered while carrying 303 Indians to Nicaragua was authorized Sunday to leave the French airport where it has been grounded for four days for a human trafficking investigation. A lawyer for the airline said the plane would take many of the stranded passengers back to India on Monday.

    Local authorities were working through Christmas Eve on formalities to allow some passengers to leave the small Vatry Airport in Champagne country, regional prosecutor Annick Browne told The Associated Press. All of the passengers, including a 21-month-old child, had been stuck in the airport terminal since Thursday.

    Two passengers were detained as part of a special French investigation into suspected human trafficking by an organized criminal group. Several others requested asylum in France, according to the local administration. Prosecutors said 11 passengers were unaccompanied minors who were put under special administrative care.

    The Legend Airlines A340 plane stopped Thursday for refueling in Vatry en route from Fujairah airport in United Arab Emirates for Managua, Nicaragua, and was grounded by police based on an anonymous tip that it could be carrying trafficking victims.

    The airport was requisitioned by police for days, and then turned into a makeshift courtroom Sunday as judges, lawyers and translators filled the terminal to carry out emergency hearings to determine whether to keep the Indians sequestered any longer.

    The hearings were halted midway because of a dispute over the procedure used to block the Indians in the airport, and a decision on next steps was expected overnight, the prosecutor said Sunday.

    The seizure order for the airliner was lifted Sunday morning, a decision that “makes it possible to contemplate the passengers in the waiting area being rerouted,″ according to a statement from the Marne administration.

    The French Civil Aviation Authority then set about trying to get the necessary permissions for the plane to take off once again, which should be in place “no later than Monday morning,” according to the prefecture.

    Legend Airlines lawyer Liliana Bakayoko told AP that the company hoped the plane could head to Mumbai, India, on Monday ‘’with as many passengers as possible.”

    She estimated around 280 passengers should be able to leave. The prosecutor and regional administration could not confirm an exact figure.

    Local officials, medics and volunteers installed cots and ensured regular meals and showers for those held in the airport. But lawyers at Sunday’s hearings protested authorities’ overall handling of the strange situation.

    ‘’I’m surprised at how things unfolded in the waiting area. People should have been informed of their rights, and clearly that was not the case,” Francois Procureur, the head of the Châlons-en-Champagne Bar Association, told BFM television. He called the mass, hasty airport hearings ‘’unprecedented.”

    Foreigners can be held up to four days in a transit zone for police investigations in France, after which a special judge must rule on whether to extend that for eight days.

    Prosecutors wouldn’t comment on what kind of trafficking was alleged, or whether the passengers’ ultimate destination was the U.S., which has seen a surge in Indians crossing the Mexico-U.S. border this year.

    The 15 crew members were questioned and released Saturday, Bakayoko said. She said the airline denied any role in possible human trafficking. A “partner” company that chartered the plane was responsible for verifying identification documents of each passenger and communicated their passport information to the airline 48 hours before the flight, Bakayoko said.

    The U.S. government has designated Nicaragua as one of several countries deemed as failing to meet minimum standards for eliminating human trafficking. Nicaragua has also been used as a migratory springboard for people fleeing poverty or conflict because of relaxed or visa-free entry requirements for some countries. Sometimes charter flights are used for the journey.

    Indian citizens were arrested 41,770 times entering the U.S. illegally from Mexico in the U.S. government’s budget year that ended Sept. 30, more than double from 18,308 the previous year. ___

    Morton reported from London. Associated Press journalist Jeffrey Schaeffer in Paris contributed to this report.

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  • Private Louisiana zoo claims federal seizure of ailing giraffe wasn’t justified

    Private Louisiana zoo claims federal seizure of ailing giraffe wasn’t justified

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    A private Louisiana zoo says that federal regulators overreached last week when they took away an ailing giraffe

    ByThe Associated Press

    September 17, 2023, 4:11 PM

    ETHEL, La. — A private Louisiana zoo says that federal regulators overreached last week when they took away an ailing giraffe.

    Local news outlets report that Barn Hill Preserve, which markets close-up encounters with exotic animals, is challenging the decision by the U.S. Department of Agriculture to seize a giraffe named Brazos on Tuesday.

    Leaders of the zoo, which also operates a location in Frankford, Delaware, told local news outlets that the department had “no warrant, no ruling, no judgment, and no oversight” when inspectors took the giraffe. Barn Hill’s Louisiana location is in Ethel, about 25 miles (40 kilometers) north of Baton Rouge.

    The USDA’s Animal and Plant Health Inspection Service says inspectors documented “continued failure” to provide adequate veterinary care, “resulting in a state of unrelieved suffering for the identified animal.”

    Barn Hill said it’s being unfairly retaliated against for notifying the USDA that the giraffe was in poor health. The company said in a statement Wednesday that a veterinarian who has cared for Brazos for the past two years committed “committed medical malpractice by not treating the giraffe properly or possessing the necessary skills to treat him in the first place.” Barn Hill said the veterinarian has since been fired.

    “If they can take our animals, they can take your cows, your horses, and we believe we have just been completely disrespected and that our civil rights are not being honored,” said Gabriel Ligon. CEO of Barn Hills Preserve. “The fact that our vet admitted via email that she misdiagnosed our animal and basically didn’t know what she was doing, I don’t know how we should be penalized. I think that the USDA should’ve given us more guidance and the resources.”

    The company said it hired a giraffe specialist when it learned the USDA planned to seize Brazos, and that the specialist recommended the giraffe not be moved.

    Barn Hill says it tried to appeal the decision but that inspectors showed up too soon.

    USDA records show problems at the nature preserve since 2018, WBRZ-TV reports, including a 2021 complaint that veterinary staff failed to properly diagnose or address the health concerns of some animals.

    The USDA said the giraffe was sent to another zoo licensed under the Animal Welfare Act.

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  • Australian rules footballer diagnosed with CTE in landmark finding for female athletes

    Australian rules footballer diagnosed with CTE in landmark finding for female athletes

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    ADELAIDE, Australia — A former Australian rules player has been diagnosed with chronic traumatic encephalopathy in a landmark finding for female professional athletes.

    The Concussion Legacy Foundation said Heather Anderson, who played for Adelaide in the Australian Football League Women’s competition, is the first female athlete diagnosed with CTE, the degenerative brain disease linked to concussions.

    Researchers at the Australian Sports Brain Bank, established in 2018 and co-founded by the Concussion Legacy Foundation, diagnosed Anderson as having had low-stage CTE and three lesions in her brain.

    CTE, which can only be diagnosed posthumously, can cause memory loss, depression and violent mood swings in athletes, combat veterans and others who sustain repeated head trauma. Anderson died last November at age 28.

    “There were multiple CTE lesions as well as abnormalities nearly everywhere I looked in her cortex. It was indistinguishable from the dozens of male cases I’ve seen,” Michael Buckland, director of the ASBB, said in a statement.

    On Tuesday, Buckland told the Australian Broadcasting Corp. that the diagnosis was a step toward understanding the impact of years of playing contact sport has on women’s brains.

    “While we’ve been finding CTE in males for quite some time, I think this is really the tip of the iceberg and it’s a real red flag that now women are participating (in contact sport) just as men are, that we are going to start seeing more and more CTE cases in women,” Buckland told the ABC’s 7.30 program.

    Buckland co-authored a report on his findings with neurologist Alan Pearce.

    “Despite the fact that we know that women have greater rates of concussion, we haven’t actually got any long-term evidence until now,” Pearce said. “So this is a highly significant case study.”

    Anderson had at least one diagnosed concussion while playing eight games during Adelaide’s premiership-winning AFLW season in 2017. Anderson had played rugby league and Aussie rules, starting in contact sports at the age of 5. She retired from the professional AFLW after the 2017 season because of a shoulder injury before returning to work as an army medic.

    “The first case of CTE in a female athlete should be a wakeup call for women’s sports,” Concussion Legacy Foundation CEO Chris Nowinski said. “We can prevent CTE by preventing repeated impacts to the head, and we must begin a dialogue with leaders in women’s sports today so we can save future generations of female athletes from suffering.”

    Buckland thanked the family for donating Anderson’s brain and said he hopes “more families follow in their footsteps so we can advance the science to help future athletes.”

    There’s been growing awareness and research into CTE in sports since 2013, when the in the United States settled lawsuits — at a cost at the time of $765 million — from thousands of former players who developed dementia or other concussion-related health problems.

    In March, a class action was launched in Victoria state’s Supreme Court on behalf of Australian rules ers who have sustained concussion-related injuries while playing or preparing for professional games in the national league since 1985.

    ___

    More AP sports: https://apnews.com/hub/sports and https://twitter.com/AP_Sports

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  • 8-year-old girl sought medical help 3 times on day she died, US immigration officials say

    8-year-old girl sought medical help 3 times on day she died, US immigration officials say

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    HARLINGEN, Texas — HARLINGEN, Texas (AP) — An 8-year-old girl who died last week in Border Patrol custody was seen at least three separate times by medical personnel on the day of her death — complaining of vomiting, a stomachache and later suffering what appeared to be a seizure — before she was taken to a hospital, U.S. immigration officials said Sunday.

    The girl’s mother had previously told The Associated Press that agents had repeatedly ignored her pleas to hospitalize her medically fragile daughter, who had a history of heart problems and sick cell anemia. Anadith Tanay Reyes Alvarez, whose parents are Honduran, was born in Panama with congenital heart disease.

    “She cried and begged for her life, and they ignored her. They didn’t do anything for her,” Mabel Alvarez Benedicks, the mother of Anadith, had previously told The Associated Press during an interview Friday.

    In a statement, U.S. Customs and Border Protection said it knew about the girl’s medical history when personnel began treating her for influenza four days before her death on May 17.

    CBP Acting Commissioner Troy Miller said in a statement that while his agency awaits the results of an internal investigation, he has ordered several steps be taken to ensure appropriate care for all medically fragile people in his agency’s custody.

    These actions include reviewing cases of all known medically fragile individuals currently in custody to ensure their time being held is limited and examining medical-care practices at CBP facilities to see if more personnel are needed.

    “We must ensure that medically fragile individuals receive the best possible care and spend the minimum amount of time possible in CBP custody,” Miller said, adding his agency is “deeply saddened” by the girl’s “tragic death.”

    Anadith’s death has raised questions about whether the Border Patrol properly handled the situation. It was the second child migrant death in two weeks in U.S. government custody after a rush of illegal border crossings amid the expiration of pandemic-related asylum limits known as Title 42 severely strained holding facilities.

    According to a CBP statement, Anadith had first voiced complaints of abdominal pain, nasal congestion, and cough on the afternoon of May 14. She had a temperature of 101.8 degrees Fahrenheit (38.7 Celsius)

    After a test showed she had influenza, Anadith was given acetaminophen, ibuprofen, medicine for nausea and Tamiflu, a flu treatment, according to CBP.

    The family was then transferred from a facility in Donna, Texas, to one in Harlingen, Texas.

    She continued to be given Tamiflu for the next two days. She was also given ibuprofen, according to CBP.

    Alvarez Benedicks had told the AP her daughter’s health got progressively worse during those days and that doctors at the station denied her repeated requests for an ambulance to take the girl to a hospital.

    “I felt like they didn’t believe me,” Alvarez Benedicks said.

    On May 17, the girl and her mother went to the Harlingen Border Patrol Station’s medical unit at least three times, CBP said. In the first visit, Anadith complained of vomiting. In the second, she child complained of a stomachache. By the third visit at 1:55 p.m., “the mother was carrying the girl who appeared to be having a seizure, after which records indicate the child became unresponsive,” according to CBP.

    Medical personnel began performing CPR before she was taken to a hospital in Harlingen, where she was pronounced dead at 2:50 p.m.

    A medical examiner is waiting for additional tests before determining a cause of death.

    Her death came a week after a 17-year-old Honduran boy, Ángel Eduardo Maradiaga Espinoza, died in U.S. Health and Human Services Department custody. He was traveling alone.

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  • Former NFL star, CBS anchor Irv Cross had brain disease CTE

    Former NFL star, CBS anchor Irv Cross had brain disease CTE

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    PHILADELPHIA — Irv Cross was a man of faith and devout fan of who could no longer in his final years attend Bible study or watch NFL games with friends. The degenerative brain disease that festered inside the former Philadelphia Eagles cornerback had triggered depression, mood swings and the type of memory loss that forced him into isolation.

    “He really didn’t want to be with people,” said his widow, Liz Cross. “The only person he wanted to be with was me. When he was with me, he really didn’t want to be with me. He just wanted me to be there.”

    Cross, the former NFL defensive back who became the first Black man to work full-time as a sports analyst on national television, is the latest player diagnosed with the brain disease CTE. Cross, who was 81 when he died Feb. 28, 2021, suffered from stage 4 chronic traumatic encephalopathy, Boston University researchers said Tuesday.

    Stage 4 is the most advanced stage of CTE, showing the kind of damage that often causes cognitive and behavioral issues in those exposed to repetitive head trauma. He struggled physically with his balance and was paranoid.

    “Toward the end,” Cross said, “he saw things that weren’t there.”

    Cross said her husband, who was diagnosed with mild cognitive dementia in 2018, often sat in a chair and grimaced from headaches that weren’t going away. He declined any kind of medicine because it didn’t help the pain. He stopped going to church. Once a student of the game, NFL games were mostly background noise because he didn’t know who was playing.

    “He was afraid someone would ask him a question,” Cross said, “and he wouldn’t know the answer.”

    Irv Cross, of course, was not alone in misery among his former NFL brethren. According to its latest report, the BU CTE Center said it has diagnosed 345 former NFL players with CTE out of 376 former players who were studied, a rate of 91.7%. The disease can be diagnosed only after death.

    “He was the nicest, kindest, most helpful, wonderful man I ever met,” Cross said. “But that wasn’t who he was at the end. And that wasn’t who he was. It was the disease that did that.”

    Dr. Ann McKee, a professor of neurology and pathology at Boston University, said she was not surprised Irv Cross’ brain reached stage 4 given the length of his overall career (the study counted 17 years) and his age. Irv Cross and his family made the decision to donate his brain to help raise awareness of the long-term consequences of repeated blows to the head.

    “I do think there’s more education about the risks of and I do think there’s more awareness of concussion management but I still think we’re way, way behind where we should be,” McKee said. “We need to educate young athletes that this is a risk that they are undertaking. We need to educate coaches to keep head trauma out of the game. We need to do more managing of athletes by monitoring them better. I still think there’s a very cavalier attitude toward CTE. There’s a lot of denial.”

    In fact, Liz Cross said she and her husband were “both in denial” about the cause of the breakdowns in his health until about five years before his death.

    “For somebody who had been so active and so able to do everything, and an athlete, not having balance, not having strength, not being able to do any of the things he had done before, it was embarrassing,” she said. “He was pretty much in a constant state of depression.”

    One of 15 children from Hammond, Indiana, Cross starred in football and track and field at Northwestern. He was drafted in the seventh round by Philadelphia in 1961, was traded to the Los Angeles Rams in 1966 and returned to the Eagles in 1969 as a player coach for his final season.

    The two-time Pro Bowl cornerback had 22 interceptions, 14 fumble recoveries, eight forced fumbles and a pair of defensive touchdowns. He also averaged 27.9 yards on kickoff returns and returned punts.

    Chris Nowinski, the founder of the Concussion Legacy Foundation, said he met with Cross in 2018 and “it was very clear” the former Eagle was suffering.

    “It’s important to highlight cases like Irv Cross’ because he was able to live a long and successful life where CTE didn’t dramatically impair him,” he said. “But at the end, it was a struggle.”

    Cross joined CBS in 1971, becoming the first Black network sports show anchor. He left the network in 1994, and later served as athletic director at Idaho State and Macalester College in Minnesota. In 2009, he received the Pro Football Hall of Fame’s Pete Rozelle Radio-Television Award. He was married to Liz for 34 years when he died.

    Cross said her husband never experienced regret over his football career.

    “He would have done it again in a heartbeat,” she said. “But he didn’t think kids should play football.”

    As for diagnosed concussions, Cross said her husband told her he did suffer from several during his playing career but did not keep count. He suffered so many head injuries in his rookie season that his Eagles teammates called him “Paper Head.”

    Irv told his wife that after a blow to his head that almost caused him to swallow his tongue, doctors said if he suffered another concussion “he would die.”

    “And so did he stop playing? No,” the 76-year-old widow said. “They made him a stronger helmet.”

    Liz Cross said she wanted to remember the joy their young grandson brought Irv over his final years and not dwell on how she had to watch the man she loved slip away.

    “He was just a wonderful man,” she said, “and this disease changed his life.” ___ AP NFL website: www.pro32.ap.org and www.twitter.com/AP_NFL

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  • Iowa jury gives $27 million verdict in misdiagnosed flu case

    Iowa jury gives $27 million verdict in misdiagnosed flu case

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    A jury has returned a $27 million verdict against a central Iowa medical clinic after a man with bacterial meningitis was misdiagnosed with the flu, suffered strokes and said he has been permanently injured

    DES MOINES, Iowa — An Iowa jury has returned a $27 million verdict against a Des Moines medical clinic after a man with bacterial meningitis was misdiagnosed with the flu, suffered strokes and said he has been permanently injured.

    The Polk County jury returned the verdict Monday in the lawsuit filed in 2017 against UnityPoint Clinic Family Medicine in Des Moines.

    Joseph Dudley and his wife Sarah Dudley filed the lawsuit after Joseph became ill in February 2017 and went to the clinic in southeast Des Moines. They reported he had dizziness, delusions, a headache, high fever and a cough.

    A physician’s assistant in charge of the clinic at the time diagnosed him with the flu although tests returned negative, said Dudley’s lawyer Nick Rowley. Dudley was given Tamiflu and a pain reliever and sent home.

    Two days later he went to the emergency room at UnityPoint Iowa Methodist Medical Center, where a doctor diagnosed the bacterial meningitis resulting from a heart valve infection. Dudley was put into a medically induced coma and was in intensive care for eight days during which he had a series of strokes causing the loss of hearing in his right ear, vertigo and dizziness, numb feet and legs, and much slower thinking and reaction time, Rowley said.

    “Mr. Dudley will suffer from a lifetime of permanent brain damage because they failed to perform a simple blood test, a complete blood count,” said Rowley, founder of Trial Lawyers for Justice.

    West Des Moines, Iowa-based UnityPoint Health has 400 clinics, 20 regional hospitals and 19 community network hospitals in Iowa, Illinois and Wisconsin.

    UnityPoint Health spokesman Mark Tauscheck said the company believes it met well-established standards of care.

    “We respect the jury process but strongly disagree with this verdict and are exploring all options including an appeal,” he said.

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  • QB’s Head Injury Spurs Scrutiny of NFL Concussion Protocol

    QB’s Head Injury Spurs Scrutiny of NFL Concussion Protocol

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    By Dan Diamond/The Washington Post

    Sept. 30, 2022 — A high-profile NFL injury has put the spotlight back on football’s persistent concussions, which are linked to head trauma and a variety of long-lasting symptoms, and can be worsened by rushing back to physical activity.

    Miami Dolphins quarterback Tua Tagovailoa, who appeared to suffer head trauma in a prior game Sunday afternoon that was later described as a back injury, was diagnosed with a concussion Thursday night following a tackle in his second game in several days. After Tagovailoa’s head hit the turf on Thursday, he remained on the ground and held his arms and fingers splayed in front of his face – which experts said evoked conditions known as “decorticate posturing” or “fencing response,” where brain damage triggers the involuntary reaction.

    “It’s a potentially life-threatening brain injury,” said Chris Nowinski, a neuroscientist and co-founder of the Concussion Legacy Foundation, a nonprofit group focused on concussion research and prevention, adding that he worried about Tagovailoa’s long-term prognosis, given that it can take months or years for an athlete to fully recover from repeated concussions. Nowinski said he was particularly concerned about situations where people suffer two concussions within a short period – a condition sometimes known as second impact syndrome – which can lead to brain swelling and other persistent problems.

    “That’s why we should at least be cautious with the easy stuff, like withholding players with a concussion from the game and letting their brain recover,” Nowinski said.

    The Dolphins said that Tagovailoa had movement in all of his extremities and had been discharged Thursday night from University of Cincinnati Medical Center.

    The NFL’s top health official said in an interview on Friday that he was worried about Tagovailoa’s health, and pointed to a joint review the league and its players association was conducting into the Dolphins’ handling of the quarterback’s initial injury on Sunday.

    “Obviously, I am upset and concerned just like any fan and just like any physician is any time one of our players suffers any type of injury,” said Allen Sills, the NFL’s chief medical officer. “We want to be thorough, and we want to be consistent and be fair to everyone involved and make sure that we have all the data on hand before we reach a final determination.”

    – How athletes – and the rest of us -get concussions

    The causes and symptoms of concussions vary widely. Some athletes compete for years in contact sports like football without suffering a concussion, while other people can be concussed from a sudden jolt, such as whiplash from a car accident, without even hitting their heads.

    But in many cases, the condition is triggered by a blow to the head, which can lead to days or weeks of headaches, memory problems, mood changes and sleep disorders. People recovering from concussions may be unable to balance themselves, see clearly or control their emotions. Neurologists also have warned that repeated concussions appear to be a contributor to a neurodegenerative disease known as chronic traumatic encephalopathy, or CTE.

    “When you’ve seen one concussion, you’ve seen one concussion . . . there’s just such wide variability,” said Jennifer Wethe, the lead neuropsychologist for the Mayo Clinic Arizona Concussion Program, adding that it’s a common problem beyond professional sports. “Most of us at some point in our life probably will have a concussion . . . and if it’s managed appropriately, and [you’re] not having one concussion on top of another, we’ll end up recovering fine.”

    Medical experts who treat concussion say it can be difficult to diagnose, particularly in athletes who may conceal their injuries because they fear losing playing time and opportunities, or because they don’t experience symptoms for hours after the initial blow.

    “This is a subjective injury until you get something like” Tagovailoa’s visible symptoms, said Dustin Fink, head athletic trainer for the Mount Zion, Ill., school district, who also runs The Concussion Blog. “As medical professionals, we are so reliant upon the athlete telling us what’s going on with them, to help us make a judgment or decision. Because they can pass tests that we give them.”

    Fink said that on Thursday night – as millions of people tuned in to watch the Dolphins face the Cincinnati Bengals – he was working as a trainer at a freshman football game in Illinois where a 14-year-old player visibly stumbled after getting hit, but was initially evasive about his symptoms.

    “He was afraid that this was concussion number X and he was done for his career,” Fink said. Under the school’s concussion protocol, Fink said the player was held out of the game and will be reevaluated Friday within 24 hours after the apparent injury.

    Experts also say that the risks tend to be cumulative; a person who has suffered repeated blows to the head, such as a football or rugby player, is more likely to suffer a concussion and also incur long-lasting symptoms. A person healing from a recent concussion is also more susceptible to suffering another concussion.

    “On rare occasions, receiving another concussion before the brain has healed can result in brain swelling, permanent brain damage, and even death, particularly among children and teens,” the Department of Health and Human Services warns.

    The consequences are particularly severe for mental health, with experts warning of a strong association between head injuries and potentially lifelong neurological problems.

    “Concussions are a cause of novel mental health disorders like anxiety, depression, self-harm and suicidal ideation,” said Nowinski.

    In rare cases, a concussion can lead to a blood clot forming on the brain, creating pressure in the skull and requiring surgery to remove the clot.

    – What is the NFL concussion protocol?

    The NFL finalized a new concussion protocol in 2011 and has repeatedly updated it amid intense scrutiny and lawsuits filed by thousands of former players, alleging the league downplayed head injury risks for decades.

    Under the current protocol, a player must be immediately removed from a game and evaluated for a concussion if he reports symptoms, or if a trainer, coach, teammate or others tasked to observe the game suspect a concussion. The player then must undergo a series of quick exams, such as repeating words back in a memory test, showing coordinated eye movement and demonstrating balance.

    Those diagnosed with concussion must undergo a five-step process before returning to play, which includes being able to complete football-related activities without any symptoms – a hurdle that some players complete within a week, but that has ended others’ careers. The player must also be cleared by a team doctor, as well as by an independent physician jointly approved by the league and its players’ union.

    But Nowinski noted potential “gaps” in the NFL’s protocol: A doctor can send a player back into a game, for instance, if he concludes that signs of an apparent concussion – like a player stumbling to stand after a blow to the head – are caused by something besides a head injury.

    NFL players also are initially evaluated for concussion in a blue tent on the sideline of the field, which is intended to provide privacy for a diagnosis, but has often led to players returning within a few minutes of a blow to the head.

    “Maybe it’s time to reconsider whether the protocol is not strong enough and that every player who’s suspected [of concussion] needs to be out and do a full 15-minute locker room evaluation,” Nowinski said, although he noted Tagovailoa did go through a locker room evaluation before returning to play.

    Sills, the NFL’s medical officer, on Friday defended the protocols, saying the league had developed them through recommendations from experts on brain and spinal trauma, most of whom do not work with NFL teams. “We’re constantly updating and looking to modify the protocol as we learn more from our own data and also as we learn more from the scientific community,” he said.

    Concussion care has rapidly evolved in recent years, as experts learn more about the brain, Wethe noted. For instance, she said the maxim “rest is best” was a cornerstone of concussion therapy for years, with patients urged to cloister in dark rooms for days until their symptoms resolved.

    “Now, we recognize that too long of that rest and kind of cocoon therapy can almost be detrimental,” Wethe added, saying that “one to three days of relative rest followed by a gradual return to normal activities is best. And we’ve even realized that past those acute stages, exercise can actually be rehabilitative.”

    Wethe said that she and her colleagues have worked to develop a program to train parents and coaches on how to check young athletes for head injuries. “When in doubt, check them out,” she said.

    Rep. Bill Pascrell Jr. (D-N.J.), who founded the Congressional Traumatic Brain Injury Task Force, said Tagovailoa’s injury underscores the need for better concussion funding, awareness and care at all levels. The congressman has spent more than a decade pushing legislation to improve concussion care, including reintroducing a bill this spring that would standardize how public schools treat athletes who have suffered concussions.

    “Concussions are devastating and as a nation we must do more to protect people with brain injury – that starts with our pro sports leagues,” Pascrell wrote on Twitter.

    – Why Tagovailoa may have been at higher risk

    Heading into Thursday night’s game, Nowinski had called for the Dolphins to bench their quarterback, arguing the team was hiding a concussion that Tagovailoa suffered just days earlier and was rushing him back to competition, elevating the risk of a more serious brain injury.

    “If Tua takes the field tonight, it’s a massive step back for #concussion care in the NFL,” Nowinski wrote on Twitter on Thursday, several hours before the game.

    Nowinski said he took no pleasure predicting Tagovailoa’s injury.

    “Frankly, it didn’t take a genius to figure out that this was possible,” he said.

    Tagovailoa on Sunday afternoon had visibly stumbled and appeared to have trouble standing following a tackle where his head snapped back into the ground. While the Dolphins initially said the quarterback had suffered a head injury, the team quickly reclassified it as a back injury and Tagovailoa returned to Sunday’s game. The move prompted an outcry from public health experts, and the league and its players association opened an investigation, although the NFL on Wednesday said the Dolphins appeared to follow the league’s concussion protocol and properly care for Tagovailoa.

    Nowinski said that Tagovailoa’s injury on Sunday “showed five separate signs of concussion,” and that it was not plausible he was suffering only from a back injury.

    “First, he grabbed his helmet after his head hit the ground. Then he stood up and had [to] . . . step backwards because he was off balance. Then he shook his head side-to-side in a classic shaking off the cobwebs motion, which I do not know another reason why you do that unless you’re having a visual disturbance after concussion. Then he fell. Then when he stood up, he was gonna fall again if . . . his teammates didn’t hold him up,” Nowinski said.

    – How common are football concussions?

    More than 100 NFL players per year report concussions, with the true number considered to be well higher.

    “I’ve definitely had concussions,” star quarterback Tom Brady acknowledged in a 2020 interview with Howard Stern in 2020, several years after his wife, Gisele Bündchen, claimed that Brady had suffered multiple concussions despite never being diagnosed with the injury.

    While many athletes rapidly return to play after concussions – potentially lured by the incentives or the fear of losing opportunities – others can struggle to make it back. Former NFL players like Austin Collie, Kyle Fitts and Jordan Reed have retired in recent years, citing multiple concussions.

    Donald Parham, Jr., a tight end for the Los Angeles Chargers, was injured in a nationally televised game in December 2021, where – like Tagovailoa – he rigidly positioned his arms after impact and was admitted to a hospital.

    While Parham, Jr., has said he has recovered from that concussion, he has not played in the NFL since that game, with the team citing a hamstring injury this season.

    – Why experts are concerned about Tagovailoa

    Nowinski, who played football at Harvard University before becoming a professional wrestler with World Wrestling Entertainment, said he was worried about Tagovailoa’s long-term prognosis following Thursday night’s injury.

    “The problem is Tua has two brain injuries in four days, which may end his career,” Nowinski said. “And I know this because I had two concussions in a month 19 years ago, and that ended my [professional wrestling] career. And I now have met dozens and dozens of people who had their career ended by too many concussions in a row.”

    Physicians, lawmakers and other experts cite progress in the NFL and other leagues in combating concussions, but say athletes and teams still have incentives to hide injuries.

    Following Tagovailoa’s removal from Thursday’s game, the announcers on Amazon Prime did not immediately address his injury on Sunday, and avoided using the term concussion. (Amazon founder Jeff Bezos owns The Washington Post.)

    “When are we finally going to put our foot down and say that enough is enough? ” Rep. Jan Schakowsky (D-Ill.), who has spent years pressing the NFL on its concussion protocols, said in a statement to The Washington Post. “So long as this game is played, more resources must be devoted to prioritizing player safety, The NFL must take full accountability for the harms inflicted on its players, and anyone in the Dolphins organization, including leadership, found to have broken concussion protocols must be held accountable.”

    (c) 2022, The Washington Post

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