Anyone who has played sports or is a sports fan has either experienced or heard of athletes experiencing concussion as a result of play. A concussion is a brain injury caused by a force transmitted to the head from a direct or indirect contact with the head, face, or neck, resulting in collision between the brain and skull, or a strain on the neural tissue or vasculature. Symptoms of concussion include loss of consciousness, amnesia, behavioral changes (irritability), cognitive impairment (slowed reaction times), sleep disturbances, headaches, and emotional lability. It is believed these symptoms are causd through a cascade characterized by abrupt neuronal depolarization, release of excitatory neurotransmitters, altered glucose metabolism, and impaired axonal function.
Athletes are at a higher risk for concussion, particularly those in contact sports such as football and hockey. It is estimated that 1.6-3.8 million sports and recreation-related traumatic brain injuries (75% are mild TBI or concussion) occur in the United States each year, with no evidence that the newest equipment reduces the incidence of concussion or severity of concussion symptoms. It has also been shown that as many as 15% of people with a history of concussion still suffer from deficits 1 year after injury.
As I am subjected to multiple football games Sunday after Sunday (and occasionally Monday and Thursday), the topic of helmet-to-helmet contact seems to be a constant source of discussion. It is similarly mentioned in hockey as they recap the hardest hits of the week, and continue to bring up the topic of Sydney Crosby and when he will be able to return to the ice, following his severe concussion last season. So I was suprised to find the league policies in the NFL and NHL were so lenient.
In August 2009 the NFL implemented a new set of guidelines against concussions, saying a player cannot return to practice or game if he shows any symptoms of a concussion, and must be analyzed by an independent neurologist, as well as by the team physician after the game. In 2010, the NFL began to crack down on helmet-to-helmet hits in an attempt to reduce the concussions incurred by players (no results were found to see if these changes have made difference).
The NHL and NHL Players' Association have taken more steps in protecting against concussion in creating a Concussion Working Group that continually examines the issues regarding concussion. Blindside hits to the head have been banned, and there is talk of banning head shots altogether, as well as looking into ways to slow the game down to decrease the number of accidental concussions. NHL players are required to be examined by a doctor in the locker room after showing concussion symptoms, whereas in the past the player had only to be examined by a trainer on the bench (they didn't even have to see a physician!!).
To me, these policies seem lenient. Examination by a physician and sitting out of a game or practice until a player doesn't show symptoms doesn't seem sufficient. There are no guidelines in place for athletes of any caliber, or the average person, to be rechecked to ensure no neurological deficits remain. Brain trauma has been thought to play a role in initiating or accelerating several degenerative disease including Alzheimer disease, Parkinson disease, and ALS. Additionally, repetitive concussion and brain trauma has been implicated as the primary risk factor for developing the progressive neurodegenerative disease chronic traumatic encephalopathy (CTE). But perhaps it's not only the policies that need to be revisited, but protective equipment and game-day policies to protect the players from immediate harm and associated long-term consequences.
"Long-Term Consequences: Effects on Normal Development Profile After Concussion." Daniel Daneshvar. Phys Med Rehabil Clin N Am 22 (2011) 683-700.
ReplyDelete"Concussion in Sports." September 7, 2011. http://espn.go.com/nfl/topics//page/concussions
"A prospective study of concussions among National Hockey League players during regular season games: the NHL-NHLPA Concussion Program." Brian Benson. CMAJ, May 17, 2011, 183 (8).
Improving the structure and protection of football helmets have been in development for many years. Football helmets worn at all levels (high school, college, and professional) are held to an industry standard that addresses only the extreme forces that would potentially fracture skulls, not the less severe impacts that are believed to cause concussions (Schwarz).
ReplyDeleteRecently, researchers studying a degenerative brain disease, Chronic Traumatic Encephalopathy (CTE), plan to test 100 retired NFL players (“New study to test former NFL”). CTE is linked to repeated brain trauma that includes symptoms like memory loss, impaired judgment, depression, and progressive dementia. Robert Stern, the co-director of the study and professor of neurology and neurosurgery at Boston University’s medical school, also studies Alzheimer’s which inspired the progression of seeking evidence to diagnose CTE during life. CTE has only been confirmed in examining brains after death, so the Center for the Study of Traumatic Encephalopathy at BU of Medicine will conduct this three-year study on living patients (“New study to test former NFL”). The goal of the study is to find differences between the NFL players and athletes who have not experienced repeated blows to the head—the comparison group will consist of retired swimmers and tennis players. The NFL subjects being tested are not required to have a history of multiple concussions because the evidence suggests that CTE can occur simply through play after play of head-to-head contact. CTE has been found in more than 50 former athletes including Dave Duerson of NFL and Rick Martin of NHL (“New study to test former NFL”).
Limiting the helmet-helmet contact is crucial for the prevention of long-term effects that may initiate or accelerate degenerative diseases. As Corey discussed, the programs are making advances to address these long-term effects by “cracking down on helmet-to-helmet hits” and potentially changing rules. I agree that follow up examinations on concussed athletes should be required to ensure no neurological damage remains. This may assist in the studies of treating and preventing these long term conditions.
“New study to test former NFL players.” The Associated Press. November 17, 2011. http://espn.go.com/nfl/story/_/id/7248268/new-study-brain-injuries-test-100-former-nfl-players.
Schwarz, Alan. NFL invites helmet safety ideas. The New York Times, December 8, 2010. http://www.nytimes.com/2010/12/09/sports/football/09helmets.html.
Throughout the last couple of years concussion awareness has increased greatly throughout high-school, collegiate, and professional sports. As a college athlete, I have witnessed the changes made in procedure and rehabilitation of concussions.
ReplyDeletePreviously, those who have had concussions have only had to sit out a couple of days. Now, they have mandated preliminary concussion testing that every college athlete must complete in order to compete. So later if an athlete recieves some head trauma they can re-take the test and the athletic trainers can compare it to the baseline test to see if there is indeed a concussion.
In addition, athletes going through rehab after a concussion are monitored much more closely. After their symptoms fade, the athletic trainers put them through exercises that increase their heart rate. If their symptoms return once their heart rate has increased then they are not released to play.
Although improvements have been made, a lot of people still don't know how dangerous and life-changing a concussion can be. Still an increase in awareness and stricter rules need to be established throughout all levels of athletics.