Concussions: What's all the fuss?

It seems there has been a lot of information on concussions in the news in the past year. Some wonder what all the fuss is about. First, we are taking concussions more seriously. We are even eliminating the euphemisms we used to use such as "getting your bell rung" or "getting dinged" because they diminish the fact that someone actually received a mild traumatic brain injury.

So why all the attention and news? Are concussions on the rise or are they just the most recent hot topic. The answer is both. They are a hot topic because recent research and the NFL have put them on our radar and, consequently, we're identifying them with better accuracy and more frequency.

But they are also on the rise. We are a sports-oriented society and our athletes, amateur and professional alike, continue to get bigger, stronger and more powerful. To put it another way, athletes in today's sports pack more of a punch than in the past.

The numbers

In this country, 44 million children and adolescents participate in organized sports each year and the Centers for Disease Control reports up to 3.8 million sports concussion occur annually. But, these numbers are likely under-representative, as they do not include injuries where no medical intervention was sought or the concussion wasn't reported.

In Nebraska, in 2009, 79,000 youths participated in Nebraska high school athletics--14,000 of those were in football and 63 percent of all mild TBIs are related to football.

Why is a

Concussion Serious?

Most of us are familiar with concussion: a head-on collision that causes headache and feeling of being dazed, fatigued and uncoordinated. These are, in fact, neurological symptoms. They typically resolve given time, but in some cases may have lasting and serious effects.

Concussions are typically caused by a blow to the head but they can also result when the head or upper body is violently shaken with no head contact at all. Loss of consciousness does not always occur. Initially, the abrupt insult causes chemical changes in the brain resulting in cell damage or death. Regardless if it is mild, a concussion is a brain injury and it can lead to long-term cognitive problems including impaired memory, attention and concentration.

Junior High and High School Athletes At-Risk

Research indicates that junior high and high school athletes are more at risk for concussion than college or professional athletes and thus require a longer recovery time. Young athletes' brains are not fully developed and they may have lower thresholds for injury.

Teenage bone structure, including the skull, is slighter and may provide less protection to the brain. Also, neck muscles are not totally developed and cannot sustain the physical force a body blow may cause. Younger athletes do not have the body control and technique of older, stronger athletes, making them more vulnerable to injury.

Another factor is the number of medical professionals available during games and practices in professional sports versus high school sports, especially in smaller schools putting teen athletes at risk

There are also gender differences. Females tend to report more cognitive deficits following concussion possibly because they have different perceptions about playing while injured. Females may be more willing to sit out of a game than males; males act on a perceived pressure to return to play.

And finally, some sports are riskier than others. Concussion can occur in any sport, however, the rougher sports carry more risk, such as football, boxing, wrestling, rugby, hockey, lacrosse and soccer.

Caution: Concussions and Repeated Concussions

Concussions can cause permanent physical and cognitive impairments but in most cases, deficits are temporary. One study, completed in Nebraska, found significant impairment in reaction time, speed of processing, and memory three days after injury. Though the athlete may have appeared to have fully recovered from their concussions, he or she continued to demonstrate memory deficits up to seven days post-injury. However, within 10 days, all athletes returned to baseline cognitive status. This study, and others like it, illustrates that effects can last several days after symptoms appear to have completely resolved, so caution is key.

After one concussion the risk for future concussions increases by three times and the risk continues to increase with each new event. A rare, but serious phenomena known as second impact syndrome, occurs when a second concussion is sustained before an athlete fully recovers from a previous head injury. Second impact syndrome typically results in death, but when it doesn't, the effect is catastrophic physical and cognitive impairment. Adolescents are at much higher risk for second impact syndrome than older athletes, highlighting the need for awareness and education about closely monitoring the blows our kids are taking.

Prevention

We know that exercise and participation far outweigh the ever-present risks of injury when it comes to kids and sports activities. The Nebraska Brain Injury Association seeks to provide helpful information to athletes, their families, coaches, trainers and officials about the signs, symptoms and effects of concussion. Concussions haven't changed over the course of history; what we know about them has. However, knowledge is power, and we now have the power to make some changes to protect our young athletes.

For more information on brain injury contact the Nebraska Brain Injury Association at 800-444-6443 or www.biane.org.

-- Judy Harvey is a speech language pathologist with eighteen years experience in diagnosis and treatment of communication and swallowing disorders in adults and children with brain injury at Madonna Rehabilitation Hospital in Lincoln, Neb. She is currently pursuing her Ph.D. in communication disorders at the University of Nebraska- Lincoln with an emphasis in acquired brain injuries.