Given the potential for life threatening brain injuries or career ending head shots, concussions have become a growing problem in sports around the world. A phrase all too common in sports today is, “he got his bell rung.” This is, of course, referring to a big hit or gruesome body check sustained in a football or hockey game. Currently, there is a lack of suitable evidence to support the recommendations for the management of traumatic cerebralor brain injuries.
Recognizing and managing the effects of concussions is especially important to those involved in the health care of athletes (Sports Related Concussions). Head injuries are inherent risks that can occur in any sport, not just football and hockey. The question is, how can we prevent these grim and life threatening injuries from happening? I believe neurocognitive research and on the field testing are among the most vital ways to manage concussions as well as benefit the health care of athletes.
Background: In the United States, you have a 19% chance of suffering a concussion while playing a contact sport; moreover, over 300,000 sports related concussions occur annually. Among college football players, 34% have reported at least one serious head injury during their career; additionally, 20% of these injured athletes have sustained multiple head traumas. Concussions often cause significant and sustained neuropsychological impairments in information-processing speed, problem solving, planning, and memory, and these impairments are worse with multiple concussions (Sports Related Concussions).
Definition: The brain is made of soft tissue cushioned by spinal fluid, and is encased in the hard, protective skull. When a person gets a head injury, the brain moves around inside the skull and bangs against it. This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves (Quinn). A concussion of the brain results in transient loss of consciousness or memory in many cases (Dictionary.com).
NeurocognitiveTesting: Concussions and brain injuries are among the most difficult to identify. Very few athletes actually lose consciousness, which is one of the most common symptoms. Many athletes are simply fervent to return to the field, which could cause even more harm. Returning to play too soon after a brain injury or concussion, may lead to serious life-threatening complications. A computerized neurocognitive test, combined with a thorough medical exam, may better assist a trained physician with the return-to-play decision (Computerized). One particular evaluation tool, the ImPACT test, has become renowned among all professional sports teams.
Developed by Dr. Joseph Maroon, a Pittsburgh Steeler neurosurgeon, the ImPACT test utilizes a twenty minute quiz involving words, pictures, and colors. Medical doctors analyze the results and compare them to a baseline test taken in the beginning of the athlete’s season (Yahoo Sports). With the increase of attention to sports related head injuries, doctors are seeing more and more tests and products that claim to identify or prevent head injuries. According to Dr. Lovell, “mouthpieces, ear pieces, and helmets are great for research purposes, but they can’t tell if someone has been injured or if they should be playing (Yahoo Sports).”
On-Field or Sideline Evaluation: When an athlete is suspected of having a concussion, one of the best ways to detect a serious head injuryis through the evaluation of symptoms, neurocognitive functioning, and balance immediately after the injury occurs. The National Athletic Trainers’ Association suggests a checklist such as, the Graded Symptom Checklist, should be used when evaluatinga head injury. By checking off symptoms and watching the athlete over a period of 72 hours, you can greatly reduce any chance of reoccurrence.
Another suggested method of evaluation is the Standardized Assessment of Concussion Exam; this test utilizes four graded sections, which include: orientation, immediate memory, concentration, and delayed recall. This 30 point test can be completed in about five minutes and is easily given right on the side line during a game. Another test, the Balance Error Scoring System, can easily be performed by a trainer of coach. The athlete stands in three different positions and is timed for 20 seconds each; ultimately, the less coordination the player shows, the higher the risk of a concussion is evident (kch.illinois.edu).
How do Concussions occur? Concussions can happen in any sport, at any time. They can occur during drills in practice, as well as in games. In fact, injuries during practice can be just as serious as those that happen during a game. Although more prevalent in contact sports, they may result from a fall, or when a moving object strikes a person’s head. A blow that twists the head is more likely to result in loss of consciousness (Familydoctor.org).
Mechanism of Injury: Studies show the most common mechanism of a concussion is when an athlete is moving at a high rate of speed and collides with another object (Quinn). Immediately, the brain shifts inside the skull and strikes the bony surfaces. A direct impact to an athlete’s head causes shock waves to pass through the skull to the brain. This violent impact creates acceleration which may lead to shear, tensile and compression forces. On average, three to five percent of all sport and recreational injuries are head injuries (Quinn),
Signs and Symptoms: The signs of a concussion do not always immediately appear. Headache, amnesia, and confusion, dizziness, slurred speech, and fatigue are the most common symptoms of concussions. In addition, the duration of time that symptoms are present is often indefinable, and depends on the extent of the injury (Mayoclinic.com). Even a minor blow to the head can result in a concussion; if left untreated, it can result in a life-threatening complication (Internationalbrain.org). Sidney Crosby, a National Hockey League super star for the Pittsburgh Penguins, is currently not playing this post season after a concussion he sustained on New Year’s Day. Unfortunately, he was cleared to play the very next game, and suffered another blow to the head. Sidney was symptom free after the first hit, and apparently, he did not show signs of concussions until the second hit. Had Crosby been given a better on-ice evaluation, he would not have been cleared to play, and could have evaded the second concussion all together.
Additionally, the problem is just as prevalent in the National Football League. At the University of North Carolina’s Center for the Study of Retired Athletes, studies of brain injuries were performed on more than 2,500 former N.F.L. players. These studies found that cognitive impairment, Alzheimer’s-like symptoms and depression rose proportionately with the number of concussions the former athletes had sustained (Quinn).
N.F.L. player, Andre Waters committed suicide in November 2004, and an explanation for his death has remainedunknown for years. He left a suicide note stating he would like to leave his brain for science to further study the effects of concussions. A Pittsburgh neuropathologist, Dr. Bennet Omaluh, was given permission to perform such tests. The doctor concluded that Mr. Waters had sustained brain damage from playing football, and said this led to his depression and death. The doctor determined that Mr. Waters’s brain tissue had degenerated into that of an 85 year-old man with similar characteristics as those of early stage Alzheimer’s victims. Dr. Omalu said he believed that the damage was caused by successive concussions (neurosurgery.pitt.edu).
I believe there needs to be congressional help in combating this difficult issue of athletic concussions. Wearing a good quality helmet, a mouthpiece, and strengthening the neck muscles can help prevent concussions; however, much responsibility lies on the doctors, coaches, and surrounding medical staff. Also, although athletes may be eager to return to play, they need to be honest with the examiner, telling him or her exactly how they feel (EHow.com). On the field baseline neurocognitive test may be our best hope for the time being, that is, until more research on concussions and the equipment player’s use can be conducted.