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M I N N E S O TA

August 2007 Volume 5 Number 8

Webster defines concussion as a stunning, damaging, or shattering effect By Dean Wennerberg, M.S., ATR, CSCS from a hard blow, which actually Media coverage of sports-related describes the cause concussions and post-concussion Who is affected? rather than the effect. syndrome has increased significantly Each year, more than 1.4 million It is the most commonly cases of traumatic brain injury in the last two years. High-profile (TBI), of which concussion is a mild used term for a mild cases involving former National form, are reported in the U.S. Of traumatic brain injury those, more than 300,000 Football League player Andre Waters (about 20 percent) are sports(mTBI). According to prominent sports agent, and Major League Baseball player and recreation-related, most the Brain Injury Assoof them concussions. recently made news by Corey Koskie have made this topic ciation of America, People over 75 have the highest declaring concussions to front-page news in sports sections. overall rate of TBI. The most comTraumatic brain injury mon cause is falls. People 15 to be a health epidemic, the Waters committed suicide in November (TBI) is caused by a 24 years old have the next highest consequences of which are 2006. A neuropathologist who examrate; transportation is the most blow or jolt to the head common cause. a ticking time bomb that ined his brain tissue concluded that or a penetrating head Among all age groups, the top may not be seen in their brain damage from numerous concusthree causes of TBI are motor vehiinjury that disrupts the totality for 10, 15, or 20 cle crashes, falls, and violence. sions during Waters career led to his normal function of the Source: Centers for Disease Control years. depression and suicide. Koskie was brain. A rapid acceleraIt may be difficult to unable to start the season for the tion or deceleration of the head, which determine if the number of concussions Milwaukee Brewers because of can force the brain to move back and has actually increased, because of athpost-concussion syndrome (PCS) forth inside the skull, can also cause letes tendency to under-report sympsymptoms related to a fall during a TBI. The stress from these rapid movetoms during competition. It is appargame in July 2006. ments pulls apart nerve fibers and causent, though, that the heightened awareWhile acknowledging that there is es damage to the brain tissue. ness of long-term symptoms is causing no universally accepted definition for TBI encompasses all severities of the public and the medical community PCS, Dr. Eric Legome of New York brain injuries from mild to severe. to recognize this as an important issue. University Hospital says most of the According to the Centers for Disease At the same time, it is also important literature defines the syndrome as the Control, more than 1.4 million people continuation (beyond three weeks) of at to realize that athletics does not suffer from this type of injury annually account for the majority of concusleast three of the following symptoms: in the United States. Most sports consions or brain injuries. Only about 20 headache, dizziness, fatigue, irritability, cussions and some others are not percent of all brain injuries are from impaired memory and concentration, included in these numbers because they sports and recreation, according to insomnia, and lowered tolerance for go unreported. According to research Snell and Surgenor in the New noise and light. Leigh Steinberg, a presented at the First International
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Prevention, early recognition of symptoms best counter to this type of brain injury

Concussions

Zealand Medical Journal in 2006. Nonetheless, the world of athletics is a good place to gather information because it is a visible and easily observable venue for collection of data. Concussion: a form of traumatic brain injury

Signs and Symptoms of TBI

Conference on Concussion in Sport in 2001, there are more than 300,000 sports-related brain injuries per year, including 250,000 in football alone. This is considered a conservative estimate. Recognizing brain injuries

Parents and coaches are in a position to be on the front line of recognition and initial treatment for these mild brain injuries. Concussions can occur from trauma directly to any part of the skull or from incidents that cause the head to move in one direction violently, causing the brain to strike the opposite side of the skull. It is easy to be fooled into missing a brain injury because it is not visible on the outside and injuries at the location of the trauma (jaw, nose, ear) appear to be the primary problem. In such situations, a coach or parent would be wise to suspect brain injury. Look for confusion, memory loss, and uncoordinated movement. The individual may report a headache, nausea, feeling of sluggishness, and sensitivity to light. (See sidebar.) Any of these symptoms should exclude the individual from further activity until medically cleared for participation. Exertion after a brain trauma can increase the severity of the injury and delay recovery time dramatically. Increased blood flow to an area rich with blood vessels and already bleeding will increase intracranial pressure and make clotting more difficult. An ounce of prevention The more that is learned about these types of mild brain injuries, the more we see the importance of prevention. Helmets have become more common in

Indicators of a traumatic brain injury (TBI) can be subtle. Symptoms may not appear until days or weeks following the injury or may even be missed, as people may look fine. The following are some common signs and symptoms of a TBI: Headaches or neck pain that do not go away; Difficulty remembering, concentrating, or making decisions; Slowness in thinking, speaking, acting, or reading; Getting lost or easily confused; Feeling tired all of the time, having no energy or motivation; Mood changes (feeling sad or angry for no reason); Changes in sleep patterns (sleeping a lot more or having a hard time sleeping); Light-headedness, dizziness, or loss of balance; Urge to vomit (nausea); Increased sensitivity to lights, sounds, or distractions; Blurred vision or eyes that tire easily;

shown that some of the newer helmets do have an effect in limiting the number Children with a brain injury can of concussions. Interestingly, have the same symptoms as adults, the severity of concussions but it is often harder for them to let others know how they feel. Call was not seen to decrease your childs doctor if she or he has (Journal of Neurosur-gery, had a blow to the head and you notice any of these symptoms: February 2006, Michael Tiredness or listlessness; Collins et al.). Irritability or crankiness (will An effective prevention not stop crying or cannot be consoled); and treatment tool that is Changes in eating (will not eat gaining acceptance is baseline or nurse); pre-season testing, which is a Changes in sleep patterns; simplified test of an athletes Changes in the way the child plays; ability to perform memory Changes in performance at and reaction-time skills in an school; uninjured condition. Data Lack of interest in favorite toys or activities; saved from the computerized Loss of new skills, such as toilet test can be used to compare training; the athletes post-concussion Loss of balance or unsteady walking; or performance on the same Vomiting. test. The doctor also takes Centers for Disease Control into consideration whether concussion symptoms are sports such as snowboarding, skiing, present before returning an athlete biking, and skateboarding, but because to play. of an increase in the number of particiMore work to be done pants, the number of injuries is not
Loss of sense of smell or taste; and Ringing in the ears.

decreasing. A U.S. Consumer Products Safety Commission study, quoted in the Aspen Times, showed that snowboarding injuries nearly tripled and the number of snowboarding head injuries increased fivefold from 1993 to 1997. An increase in the use of helmets may help bring the number of injuries down. As the younger participants use helmets from the beginning stages of learning, overall compliance should increase. Use of head protection in sports such as basketball and soccer may be difficult to introduce. Athletes in these sports tend to think of any type of head protection (soft or hard) as too bulky or restrictive during competition. Head protection is mandated in collision sports such as hockey and football, with specific rules for helmet design. While football helmet manufacturers will never create a concussionproof design, recent research has

The incidence of mild traumatic brain injuryof which concussion is the least severe typedoes not appear to be improving in our athletic and general culture. Awareness of the conditions that can lead to these types of injuries, the use of preventive strategies, and the ability to recognize mild brain injury on the field or in other settings are very important. Look for much more research (and publicity) about post-concussion syndrome and traumatic brain injury over the next several years. There is reason to hope for advances in treatment. In the meantime, protective equipment and education in recognition of concussion symptoms are the best methods to minimize risk and worsening of brain injuries that do occur.
Dean Wennerberg, M.S., ATR, CSCS, is an athletic trainer and marketing associate at Bethesda Concussion Clinic in St. Paul.