The incidence of mild traumatic brain injury experienced today by youths in sports is climbing in the United States. In fact, the Center for Disease Control reports that between 2001-2009 there was a 60 percent increase in emergency room visits for brain injuries among adolescents and children. The National Center for Sports Injury Research has reported that the 4.4 million children who participate in tackle football in the United States suffer more than 500,000 concussions. Since 1997, at least 50 football players in more than 20 states of high school age or younger have died or sustained serious brain injuries on the football field. Due to this growing problem, the American Headache Society is holding a session on mild traumatic brain injury awareness, recognition and treatment during the 54th American Headache Society Scottsdale Symposium in Arizona this week.
A concussion or traumatic brain injury (TBI) takes places when the brain encounters significant movement to the head or a penetrating injury with or without the loss of consciousness. This "jarring" or penetrating motion can occur when the skull is struck, bumped or hit during a fall, motor vehicle accident or sports injury. During this action, the brain hits the opposite side of the skull from where the hit occurs - forcing the brain in the opposite direction - where it is accelerating. Then the brain bounces back or decelerates. This is called an acceleration-deceleration injury. If the head/neck is turning at the same time, or has additional force or pressure placed on it, the brain may also rub inside the skull. This motion can result in the shearing and tearing of neurons and the loss of connections of those neurons.
Dr. David Dodoick, President of the American Headache Society and Professor of Neurology at the Mayo Clinic College of Medicine, is a lifelong hockey player well acquainted with sports related injuries. In a recent phone interview with him, we discussed this shearing effect. He compared the damaged brain cells of a TBI to a tree trunk that has been damaged. The weakened trunk sends signals to the branches that then become sick, which make the leaves drop off and die. Thousands of dead neurons can result from a TBI.
After an individual sustains a TBI, some symptoms can occur immediately while others may not appear until days, weeks or months later. These may include a mix of conceptual and operational symptoms. Conceptual symptoms include loss of consciousness for a few seconds (though this may not always occur), blurred vision, dizziness, ringing in the ears, headache, confusion, trouble sleeping, changes in mood, inability to concentrate, memory problems, sensitivity to light and sound, anxiety, among others. After a TBI, operational symptoms - things we do on a daily basis such as homework, housework and personal care - can be negatively impacted as well.
The standard treatment after a TBI is to rest for three days. During recovery, there should be no cognitive or visual simulation, including no TV, radio, and/or video games. The athlete must be symptom free before he returns to play. Dr. Dodick said it takes a younger athlete - a 15 year old, for example - longer to recover than 25 year old due to the developing brain. Eighty percent recover in seven to ten days, but if at any time the player becomes symptomatic, he is immediately removed from sports and maybe even school.
One problem facing young athletes, coaches, trainers and parents today is that student athletes don't always let coaches know they've just had their "bell rung." Worse yet, they may hide their symptoms. They don't want to let their coaches or teammates down by being pulled out of the game. Alternatively, athletes may have been taught to "play through the pain" and assume incorrectly that a little blow to head is no big deal. However, as Dr. Dodick commented, "There is no such thing as a mild traumatic brain injury or concussion." Multiple blows to the head mean repeated injury to the brain. In fact, if a student has one concussion, his risk of getting a second concussion is four times greater. For this reason, it is crucial to have certain protocols in place for concussion education, treatment and prevention in schools and in youth sports leagues.
ImPACT(Immediate Post-Concussion Assessment and Cognitive Testing) is one tool schools can utilize to measure memory, processing speed and reaction time before the sports season begins. This computerized neurocognitive test is also used to determine how a student's brain was affected after a TBI. Some school districts make this mandatory for each athlete. In addition to the ImPACT test, other valuable tools schools have access to include the CDC's "Heads Up Initiative," which was developed to educate students, parents, the coaching staff and school staff about TBI. In addition, 38 states have started or passed concussion legislation. Recently the NFL introduced stronger rules on concussion management. In June of this year, USA Hockey approved new, stiffer regulations for body checking beginning with the Bantam level - 13/14 year olds.
Parents, players, coaches, trainers, teachers, nurses, doctors, and school staff - everyone involved in youth sports should see this as a wakeup call. Better recognition and education are two huge components of the sports concussion issue right now. Dr. Dodick was clear in saying the more we understand and educate ourselves and students about traumatic brain injury, the better able we will be to prevent and protect our young athletes.
- Evans, Randolph. "Mild Closed Head Injury and Headache." The Fred Sheftell, MD Education Center. 2011.
- "Facts About Sports Concussions from the American Headache Society." American Headache Society. November 10, 2011.
- Centers for Disease Control and Prevention. "Heads Up: Concussion in High School Sports." Injury Prevention and Control: Traumatic Brain Injury. May 25, 2010.
- National Institutes of Health. "Traumatic Brain Injury: Hope Through Research." National Institute of Neurological Disorders and Stroke. April 15, 2011.
- Phone interview with Dr. David Dodick. November 7, 2011.
- Robert, Teri. "Concussion - The Basics." MyMigraineConnection.com. April 24, 2011.
- Schwartz, Alan."Silence on Concussions Raises Risk of Injury." NY Times. September 15, 2007. Sports. <http://www.nytimes.com/2007/09/15/sports/football/15concussions.html>.
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©HealthCentral Network, 2011.
Last updated November 10, 2011.
Published On: November 14, 2011