DR. Stephen Honor

Welcome to the inaugural edition of HeadCase! On this first episode, I speak with Dr. Stephen Honor, a clinical neuropsychologist based in Smithtown, Long Island. Dr. Honor and I go over the topic of CTE and concussions and how exactly it affects one’s brain. This is the first post on my new blog. I’m just getting this new blog going, so stay tuned for more. Subscribe below to get notified when I post new updates.

Hello everyone! Welcome to Headcase! My name is Cameron Bongaura and I will be your host throughout this story. In recent years, a lot has been mentioned about the debate of concussions and CTE. The NFL in particular, has been in the driver’s seat in these discussions. Over the last couple of years, there have been numerous lawsuits against the NFL and for a while, the NFL denied the link between head injuries and CTE. The debate has now found its way into national youth football. The number of participants in youth football nationally has been steadily declining over the last few years. One of the biggest declines in numbers is taking place right here on Long Island. Throughout HeadCase, we will talk with an expert in the medical field, the head of high school sports in Nassau County, a high school football coach, members of a Long Island youth flag football league and a parent who has lost their son due to a hit to the head.   Their thoughts will give us an understanding of why the numbers are declining on Long Island and how it can be fixed. 

In this first installment, I sit down to neuropsychologist Dr. Stephen Honor to talk about concussions and the topic of CTE. Dr. Honor is based within Smithtown, a town located on the North Shore of Long Island. Dr. Honor primarily deals with the evaluation of people who are suspected of having brain injuries and work with them and their families in order to get better. 

I first asked Dr. Honor on how his work relates to CTE and concussions 

HONOR: I would say half my patient population are individuals who have sustained  concussions. I have never actually seen a patient who was referred here because of CTE. We have to separate the idea of a concussion form CTE. CTE is a disease, it is progressive and it occurs to the largest extent in individuals who are involved in sports where there is a lot and there is perhaps head related things that happen. Most people are aware footfall is an example.  Football players are constantly banging heads so to speak and many, many, if not the majority of football players in the course of their career in football, even if it starts in high school or younger, have had either a concussive injury or what’s called a sub-concussive injury, which is they bang heads but they really don’t have any symptoms. When that happens over and over, and over, again over the course of the years, it may develop into an illness.  The majority of concussive injuries that I work with are people who will probably have resolutions to those problems over time. There are a proportion of the people who I work with whose injuries don’t get better, but they don’t get CTE. CTE is a among the generally population probably not very common. It would certainly be more common in any kind of sport where people have a lot of concussive injuries. It involves not only cognitive problems but it involves the development of severe behavioral and personality changes that unfortunately get worse over time and ultimately lead to the death of the individual. 

I was curious about these behavioral changes and Dr. Honor explains it in great detail. 

HONOR: Well we’re talking about CTE, although to a lesser degree they may been seen in people who never developed that but have concussions, it includes things like aggressiveness in particular.  They are very impulsive, they don’t think very well so they take action before they thought about what it means or the consequences. There is a certain amount of violence among the CTE population but they just don’t get along with people. They are reclusive, they don’t necessarily want to be around people. They more easily argue with individuals and that also  embraces the cognitive problems they have so that if they don’t remember well, and can’t think well, then will also get the corresponding change in behavior most of the time. 

Those describe the behaviors of CTE but are there changes in behavior in general concussions too? 

HONOR: Typically, they’re are in a general concussions, even when they resolve. Initially, people with concussive injuries will have things like difficulty in dealing with social situations, people become very sensitive to noise or lights so, they try to remove themselves from those circumstances. Quite frequently, they are very easily upset, they become argumentative, they may down a lot of of the time. So, it branches not only actual behavior changes, but behavioral changes psychological as well, particularly in relation  to feeling angry easily, a lot of anxiety and feelings of depression.     

In mainstream media, we hear CTE is usually diagnosed after death. I asked Dr. Honor on why this is the case.     

HONOR: Well, that’s because they don’t necessarily come to attention that way. Although today it’s probably different because so much attention has been paid to it. Those individuals will end up in the office of some sort of doctor.  If it is a doctor who is knowledgeable with the illness or works with people with people who have brain related problems, they will undergo things like brain MRIs or other brain related tests that may demonstrate, at an early stage, that they have something like CTE. Most of what has occurred over the past few years, I would say after the fact, after these changes  have taken place, where nobody really recognizes what is is. Sometimes in CTE, if the person doesn’t come to the attention of a doctor for some reason or sees a doctor who isn’t particularly knowledgeable about that because they don’t work with it, they may be seen as having a psychiatric problem or a neuropsychiatric problem, may be sent to a psychiatrist for medication, which is ok  but it can kind hide the underlying problem which really would have to determine by some of the brain related tests. ‘Once they determine it, then there is a different course of treatment. Although, right now there is no way to cure something like CTE. 

Many people would assume that you might feel the symptoms of a concussion right away. While most of the time this happens, Dr. Honor states that this might not always be the case.  

Well, were talking about different kinds of concussions. I saw a lady today who had a concussive brain  injury in a car accident. She did not have any immediate symptoms whatsoever. She hit her head, she was bleeding but she wasn’t in pain, she wasn’t confused, she was able to answer questions that were posed to her by the police and EMS Emergency Service and it was only within the next couple of days that she actually started to develop the symptoms of the concussion. More often than not, the symptoms are seen really almost immediately after.  One of the first things on may note, is that the loss of consciousness means something has interrupted the flow of oxygen to the brain even if it is for a short period of time. Persay, that’s not a symptom one would observe has the person regains consciousness. They will appear confused, they will verbalize things like it didn’t seem real, or time seems to be moving very slowly, or they weren’t able to think straight. So, that can immediately happen right after the accident. So, it goes anywheres from immediately after the accident and sometimes there is a delay symptoms   for a couple of days. 

      This got me thinking a bit. Could there be other people like this lady Dr. Honor mentioned? So I asked him if he had any other interesting patients he could talk about. 

HONOR: Well, I have to say yes. I’m doing this for a very long time.  So I’ve seen every manner of concussion and probably neurological disorder that affects the brain. Just prior to the time you sat down with me, I was on the phone with a patient who is still working. She should not be working. She’s incompantent at her job since she’s had this head injury, but she happens to work in a very benign environment where she has not told them what is wrong with her but they see from her functioning, she screws everything up on a very regular basis. They have to know something is not right but they don’t know what it is. This is a lady who is trying to hide her symptoms. She does the best she can as she tells me frequently, but her best doesn’t enable her to function to the way she did before. Whether or not she’s going to stop working, I’ve said we really need to put you out on medical disability. So far she is trying to hold on to the job, but she’s a wreck.  And then there are those people who can’t work at all after the accident because their physical injuries, certainly for people who have concussions in a car accident, usually the head or head related injuries is not the only injury they have. They injured their necks, their backs, their shoulders, so they may not be able to go to work for physical reasons. For some people, they recognize that if their jobs is cognitively demanding, many of those recognize they can’t do it after. 

Helmets are important pieces of equipment that help protect a player’s head in football. There’s been a lot of debate on how much protection helmets give and if they protect the player at all, especially to those just starting out . Dr. Honor chimes his thoughts into the matter.   

HONOR: There is no doubt that there have been changes in the structure of a football helmet. The problem is that it doesn’t necessarily stop a concussion, it may limit the effects of it because keep in mind, when someone has a concussion, the concussion comes from what happens to the brain when the head gets hit. Your brain is never outside your head so, if a football helmet could absorb part of the impact, then it may lessen the effects of a concussion, but it doesn’t necessarily stop the brain moving around inside your skull and causing an injury. So, certainly I think that the helmets that they are always striving to improve are making a difference.  I can’t speak to the issue of whether if there is less concussions as a result because I really don’t know, but it certainly has been something that has impacted a younger community, which also affects the number of people going into football. I have some awareness of parents who don’t want their children to play football because they’re considered bout the effects. I remember seeing films, training films about, I guess it’s kinda a peewee league in football. We’re talking about 5 or 6 year old children and we’ve observed they are helmeted and all wearing their football gear. I remember 2 kids running into each other at full speed knocking heads, both of them got knocked down and it showed the strength of the impact in spite of the fact that they had helmets. So it does have an effect on the willingness of parents  in some situations to allow their kids to get involved in football. 

 This leaves us one with the last question. How can we limit hed contact and therefore concussions?

 I think that the way they have practices, coaches at different at different levels try to limit the amount that the football players are actually have head to head contact, they way they go about tackling, the kind of practices they have really do try to limit to the amount of head  contact they’re going to have and that makes a difference. Still going to be a certain amount but the way one practices, and the way the coaches sets up the practices, and talk to their team, that can help to limit the head impact that exists.

That does it for the first installment of HeadCase. I hope you all enjoyed Dr Stephen Honor’s input as much as I did! For the next installment, we will be talking with Pat Pizzarelli, the executive director of Section VIII. Pat will be able to tell us how the declining participation numbers are affecting Nassau County.  See you then!