LEARNING ABOUT CONSUSSION DANGERS

Concussion Signs and Symptoms

When an athlete gets a direct or indirect hit to the head that causes physical signs, loss of consciousness (LOC) and post-traumatic amnesia, or physical symptoms i.e. headache, the most frequently reported symptom), mental, feeling like in a fog, and/or emotional i.e. uncontrolled laughter, sadness or crying.

The Post-Concussion Symptom Scale (PCSS) comprised of:

• Signs - noticed by coaches, parents and teammates
• Symptoms - feelings or problems expressed by the athlete

Sgns and Symptoms of concussion categories:

1. Physical - headache, nausea, vomiting, dizziness, visual problems, sensitivity to light/noise, balance problems);
2. Conciousnes, Cognitive - feeling mentally “foggy,” feeling slowed down, difficulty concentrating and remembering (e.g. amnesia)
3. Emotional (irritability, sadness, nervousness, more emotional); and
4. Sleep (drowsiness, difficulty falling asleep, sleeping less than usual, sleeping more than usual). 1.
5. A detailed concussion history is also an important part of the evaluation, both in the injured athlete and when taking a pre-participation physical evaluation or examination.

NO SAME DAY RETURN TO PLAY

“The 3rd International Consensus Statement on Concussion in Sport (May 2009) “strongly endorsed the view that children should not be returned to practice or play until clinically completely symptom-free, which may require a longer time frame than for adults.”

“ It is not appropriate for a child or adolescent athlete with concussion to return to play on the same day as the injury regardless of the level of athletic performance.”

Studies show that child and youth athletes might manifest neuropsychological signs and symptoms that may not be evident during an initial sideline evaluation and they are more likely to have delayed onset of symptoms than adult athletes.

“As a result, the Zurich Consensus Statement emphasizes the importance of treating athletes under 18-years-old more conservatively (such as by extending the amount of time of asymptomatic rest and/or the length of time for completing the symptom-limited, exercise program recommended before return to play), even if the resources (e.g. the presence of team physicians experienced in concussion management, access to neuropsychologists, consultants, neuroimaging etc.) are the same as for an older, professional athlete.”

The Zurich Consensus Statement recommendations are if a concussion is suspected the athlete should not return to play the same day and should only return to play after a written, signed clearance from a “concussion specialist”.

Concussion Signs and Symptoms, MOMS TEAM Concussion Safety Center,
Concussion Signs and Symptoms

Read more: http://www.momsteam.com/health-safety/concussion-safety/concussion-signs-and-symptoms-PCSS#ixzz1UR93IIXC
Self-reporting of the number and severity of symptoms under the Post-Concussion Symptom Scale is critical in treating concussion By Lindsay Barton Reviewed by MeehanWPMD

References:
Meehan W, d’Hemecourt P, Comstock D. High School Concussions in the 2008-2009 Academic Year: Mechanism, Symptoms, and Management. Am. J. Sports. Med. 2010; 38(12): 2405-2409 (accessed December 2, 2010 at http://ajs.sagepub.com/content/38/12/2405.abstract?etoc).
Blinman TA, Houseknecht E, Snyder C, Wiebe DJ, Nance ML. Postconcussive symptoms in hospitalized pediatric patients after
mild traumatic brain injury. J Pediatr Surg. 2009;44(6):1223-1228.
Halstead, M, Walter, K. Clinical Report - Sport-Related Concussion in Children and Adolescents. Pediatrics 2010;126(3): 597-615 at notes 40-42.
Sport Concussion Assessment Tool 2 (SCAT2), Br. J. Sports Med. 2009; 43: i85-i88; Guskiewicz, KM, Bruce SL, Cantu RC et al. National Athletic Trainers’ Association position statement: management of sport-related concussion. J. Athl. Train. 2004; 29(3): 280-287.
Gioia, GA. Schneider JC. Vaughan CG. Isquith PK. Which symptom assessments and approaches are uniquely appropriate for pediatric concussion? Br. J. Sports Med. 2009; 43 (suppl1): i13-i22.
Concussion Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008, P. McCrory et. al, Br. J. Sports Med. 2009; 43; i76-i84.
Frommer L, Gurka K, Cross K, Ingersoll C, Comstock R.D., Saliba S. Sex Differences in Concussion Symptoms of High School Athletes. Journal Ath. Train. 2011; 46(1):000-000.
Lau BC, Collins MW, Lovell MR. Sensitivity and Specificity of Subacute Computerized Neurocognitive Testing and Symptom Evaluation in Predicting Outcomes After Sports-Related Concussion. Am. J. Sports Med. 2011; 20(10), published on February 7, 2011 as dol:10.1177/0363546510392016 (accessed February 16, 2011).
Meehan WP, Kids, Sports, and Concussion (Praeger 2011).
Notes
1. Pardini D, Stump JE, Lovell MR, Collins MW, Moritz K, Fu FH. The post-concussion symptom scale (PCSS): a factor analysis. Br. J Sports Med. 2004;38:661-662.
2. Frommer L, Gurka K, Cross K, Ingersoll C, Comstock R.D., Saliba S. Sex Differences in Concussion Symptoms of High School Athletes. Journal Ath. Train. 2011; 46(1):000-000.
3. Meehan W, d’Hemecourt P, Comstock D, High School Concussions in the 2008-2009 Academic Year: Mechanism, Symptoms, and Management. Am. J. Sports. Med. 2010; 38(12): 2405-2409 (accessed December 2, 2010 at http://ajs.sagepub.com/content/38/12/2405.abstract?etoc).
4. Symptom descriptions courtesy of Robin Karpf,M.D., Medical Director, Al Rashid Health and Wellness Center, The Lawrenceville School, Lawrenceville, New Jersey.
5. Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed following sports-related concussion. J Clin Exp Neuropsychol. 2005; 27(6):683-689.
Revised and updated July 25, 2011

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CONCUSSION: BASELINE AND POST-INJURY TESTING

Dr. Robert Cantu says Baseline and Post-Injury Neuropsychological Testing IS A Valuable Tool in Concussion Management [MOMS TEAM The Trusted Source for Sports Parents]

Recent studies demonstrated the value of neuropsychological testing in evaluating the cognitive effects of and recovery from sport-related concussions. It has become increasingly popular. According to the 2004 Prague consensus statement, testing is a “cornerstone” of concussion evaluation.

Baseline pre-injury and post-injury testing is now frequently utilized in professional, college and increasingly in high school. The cost is sometimes a limiting factor.

“Standard Pen-and-paper neuropsychological tests have proven useful for identifying cognitive deficits resulting from concussions, and have been available to sports medicine clinicians for several years. These tests are designed to assess various domains of cognitive functioning such as short-term memory, working memory, attention, concentration, visual spatial capacity, information processing speed, and reaction time. The tests assist clinicians in quantifying the severity of the injury and eliminating some of the guesswork. The key to a successful testing program is having results from pre-season baseline testing for comparison to post-injury results.”

“Because most states require advance training and licensing to purchase and use neuropsychological tests, and they are copyright protected, the NATA’s 2004 Position Statement recommends that a licensed psychologist, preferably board-certified in clinical neuropsychology or with clinical experience in evaluating sport-related concussions, oversee and supervise the testing. These requirements are, unfortunately, likely to restrict how widely testing can be implemented at the high school level and in rural areas where access to neuropsychologists for consultation is likely to be limited.”

Computerized Neuropsychological Tests programs have been developed and are currently being sports tested and have advantages over traditional pen and paper neuropsychological tests. Widespread use of such tests faces many of the same challenges as with use of pen-and-paper tests, including:

There is a debate about test timing. There are two main approaches. After symptoms clear: This is the view taken in the Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport held in Prague in 2004. Testing at fixed time intervals: Some clinicians incorporate neuropsychological testing at fixed time points (e.g. postinjury day 1, day 7, etc.) until the test results return to normal, pre-injury (e.g. baseline) levels and the players is asymptomatic..

“Regardless of which approach is taken, return to play decisions should be based on all clinical information, including the player’s medical history i.e. history of prior concussions, severity, whether subsequent concussions occur with less impact force; recovery time”.

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CONCUSSION
The Kentucky Traumatic Brain Injury Prevalence Study January, 2004 showed that sports and recreational activities were the second leading cause of Traumatic Brain Injuries in Kentucky. Sports and recreational represents 17.1% of TBI. Automobile accidents were first at 34%. These two were by a considerable margin the leader categories. 1.

American football athletes and coaches often suffer with mental illness and depression from concussions. Multiple head injuries have been shown to result in severe mental illness to football players later in their life. A traumatic brain injury is characterized by loss of consciousness, confusion, amnesia for the events, and other neurological signs. Concussion often results later with loss of mental functioning, memory, migraine, seizures, dizziness, and depression.

Charlie Pell, a Bear Bryant disciple, and an assistant to Charlie Bradshaw at UK from 1965-1969 suffered with severe depression. Pell made a public service documentary about his depression for the state of Alabama. His documentary was a very noble achievement and an excellent source of public information.

Bear Bryant said he cried often when head coach at Kentucky. He would often stop and vomit on the way to football practice and games. “I’ll tell you I’ve cried, literally cried like a baby” over some minimal matters.

Bryant was a textbook of depression. He felt hopelessness and insecurity. Bryant manifest the depressive symptoms of inappropriate crying, empty feelings, loss of confidence and loss of temper. He was irritable, felt miserable, had difficulty sleeping and awakened too early. 5.

An investigation has been conducted concerning the association between prior head injury and the likelihood of being diagnosed with clinical depression among retired professional football players. Depression is the most cited psychological disturbance after traumatic brain injury, with prevalence rates from 6% in cases of mild traumatic brain injury to 77% in more severe TBI within the first year after injury. Retired players reporting three or more previous concussions (24.4%) were three times more likely to be diagnosed with depression; those with a history of one or two previous concussions (36.3%) were 1.5 times more likely to be diagnosed with depression. 2.

“In 2001 Kevin Guskiewicz, research director of the Center for the Study of Retired Athletes at the University of North Carolina at Chapel Hill was surprised by the depression statistics. Athletes with no concussions had a lifetime diagnosis rate of 6.6 percent. That is about the same as the general male population. Once they suffered three or more traumas, however, the rate skyrocketed to 20.2 percent. The depressions, can interact with other health problems to destroy the former athletes’ lives. The depressions have a snowball effect. The football player is retired from football, overweight, has musculoskeletal problems like sore knees, ankles, hips, not exercising. and life begins to go downhill.” 4.

Concussions can trigger a chemical chain reaction in brain neurons that that can cause athlete disorientation, unconsciousness, or death. TBI can also impair learning over a period of years. Barret Robbins, Oakland Raiders Pro Bowl center, suffered from severe depression. “The demons running loose inside Barret Robbins’ head put the football player in a San Diego hospital on Super Bowl Sunday”.

The physical power of his 6-foot-3, 320-pound body was no match for the illness. Athletes can be devastated by emotional and physical changes that come with depression. Worse is the athletes’ unwillingness to deal with their condition. The tough-man football environment makes them ashamed of their supposed “weakness,” Physical side effects from medication and the depression are the most difficult opponents they will ever confront.

”As athletes, we are taught to be tough,” said former NHL all-star Pat LaFontaine, who has battled depression. “You get up and shake it off. But you can’t do that with depression. For me, the harder I tried, the worse it got.” Spiraling into shadows so dark she thought she’d never get out, former U.S. Olympic diver Wendy Williams once collapsed in front of her refrigerator, overwhelmed by something as simple as deciding what to eat. She quit getting into her car for fear she would drive off a cliff to escape her misery. 3.

Harry Carson, middle linebacker with the New York Giants was a renowned defensive football player, intelligent, athletic and forceful, selected for the Pro Bowl. He was known for aggression. After a collision a dazed, Carson got up and walked back into the Giants’ huddle. As he stood holding his teammates’ hands, everything went black. He didn’t faint or stop playing. He was unable to figure out his coach’s signals from the sidelines. He couldn’t call the next play, as the middle linebacker is expected.
Blackouts like these were becoming familiar sensations for Carson. Over 13 seasons, he estimates he received between 15 and 18 concussions. Toward the end of his career Carson began to exhibit the cumulative effects of all these hits. He developed post concussion syndrome.

Carson developed headaches and muscle twitches. He grew sensitive to bright lights and loud noises, making it difficult for him to sit in a busy restaurant or do a television interview. He’d lose track of time. Athletes like Carson were not studied by scientists until recently. Because of the numerous football fatalities each year in the 1960s, particularly at the high school level, researchers were much more concerned with on-field catastrophes.

“When someone dies, that catches everyone’s attention,” says neurosurgeon Robert Cantu, medical director of the National Center for Catastrophic Sports Injury Research. “It’s not surprising that fatalities in football have been tracked since 1931.”

“Thanks to better protective equipment and safer coaching techniques, football deaths have now dropped to single digits each year. The decline has allowed scientists to focus on more subtle traumas, and concussions are chief among them. Neurosurgeons have shown that even a minor ding can trigger a neurological cascade that can eventually cause cognitive dysfunction and mental illness. Among retired football players who have sustained three or more concussions, 20 percent have been diagnosed with clinical depression—more than three times the rate of players who never got a concussion.”

Half of those players are taking antidepressant medications. Most report that the condition impedes their normal daily activities, such as shopping for groceries and going to work. At the UCLA Brain Injury Research Center, neuropsychologist David Hovda has studied the cascade of these injuries. An injured athlete may be oblivious to the neurochemical cascade inside his brain. “You can see a broken arm,” says Carson. “You can see a torn ligament in the knee. But with a concussion, you don’t see it.” The effects show up in statistical research.

Many other sports other than American football have frequent concussions. Soccer, hockey and baseball are examples. Matser and Lezak compared the results of swimmers and runners and found the soccer players were three to four times more likely to show deficits in memory and planning skills. The more concussions players suffered, the lower their scores on three of the 16 tests. Lezak is unsurprised. “I know what happens when you bat on the brain,” she says. “Given what we know about boxing, it would have been surprising if we hadn’t found anything. In soccer, people are punishing themselves in much the same way boxers do.”

The athletic community has developed a heightened awareness concerning traumatic brain injury and concussion. Scientists are researching concussion pathology.

Manufacturers are developing better protective helmets. Taking the head out of football during blocking and tackling is an extremely important technique that should be instructed and enforced.

References:

1. University of Kentucky Center on Drug and Alcohol Research
KENTUCKY TRAUMATIC BRAIN INJURY PREVALENCE STUDY
January 2004 Prepared For The Kentucky Traumatic Brain Injury Trust Fund Board and The Kentucky Department of Mental Health and Mental Retardation, Brain Injury Services Unit, Colleen A. Ryall, Ed.D., Director Report Prepared by: Robert Walker, M.S.W., L.C.S.W., Assistant Professor TK Logan, Ph.D., Associate Professor Carl Leukefeld, D.S.W., Professor and Director Erin Stevenson, M.S.W., Research CoordinatorCDAR TECHNICAL REPORT NO. 2004-01
2. Recurrent Concussion and Risk of Depression in Retired Professional Football Players MedScape Posted 06/19/2007 Kevin M. Guskiewicz; Stephen W. Marshall; Julian Bailes; Michael McCrea; Herndon P. Harding Jr; Amy Matthews; Johna Register Mihalik; Robert C. Cantu
3. Fearsome opponent By Patrick Saunders Denver Post Sports Writer Monday, March 10, 2003 - Bipolar disorder.
4. Discover Science, technology, the future Lights Out Can contact sports lower your intelligence? by Barry Yeoman December 3, 2004
5. SIVAULT August 15, 1966, “I’ll Tell You About Football” by Paul Bryant and John Underwood