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Concussions – when a flag on the play turns into a lifetime on the bench

December 27, 2019 by Kimberly Drake

In sports, from grade school to college, the ultimate “flag on the play” occurs during one second of the game, when a hit, blow or fall results in a concussion. Also referred to as a mild traumatic brain injury, or TBI, concussions send an estimated 283,000 children per year to U.S. emergency departments, with sports including football, bicycling, basketball and soccer, accounting for nearly half of those visits.

Unfortunately, for young people, concussions may have a lifelong impact, especially if they experience more than one. With the popularity of contact sports continuing to surge and the ages of players reaching down to the peewee level, researchers continue to investigate new ways to prevent, diagnose and treat concussions, and decipher whether these sports-related injuries cause issues long after the child’s school sports career is over.

What is a concussion? 

According to the CDC, a concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head or a hit to the body that causes the head to jar back and forth. This sudden movement can cause the brain to bounce around in the skull, creating adverse changes and sometimes damaging brain cells. Signs and symptoms of a concussion generally show up soon after the injury, but it is possible for symptoms to appear hours or days later.

In general, after an injury occurs, if someone can’t recall events before or after the incident, appears dazed or stunned, is confused or moves awkwardly, answers questions slowly, briefly loses consciousness, or shows mood, behavior or personality changes, they may have a concussion. Signs that a head injury is an emergency include observing one pupil larger than the other, excessive drowsiness, a persistent headache, slurred speech, weakness, numbness or decreased coordination, repeated vomiting, seizures, increased confusion, restlessness, agitation or loss of consciousness.

Most people with a concussion improve within a couple of weeks. However, symptoms can last for a month or longer, and when this occurs, it falls under the diagnosis of post-concussive syndrome. This syndrome is rare after a single concussion, but is more likely in those who suffer multiple events. The CDC warns that if an athlete continues to play with a mild TBI, it increases their chance of getting another one, and those repeat concussions that happen while the brain is still healing from an initial injury can impact the person for a lifetime.

What is the lifelong impact?

To attempt to answer that question, researchers at the Quebec Nature and Technologies Granting Agency, in conjunction with members of the Montreal Canadiens hockey team, examined the potential lingering effects of concussions as athletes get older. Investigators found that even when the symptoms of a concussion appear to be gone, the brain is still not yet 100% normal, and abnormal brain wave activity continues for years after, as well as partial deterioration of the motor pathways. Additionally, a 2016 study conducted by the Mount Sinai Hospital/School of Medicine found that TBI with a loss of consciousness may be associated with later development of Parkinson’s disease, but not Alzheimer’s disease or dementia as previously reported.

Improving diagnosis and prevention

According to Douglas Comeau, D.O., director of the Concussion Clinic at Boston Medical Center, when athletic trainers are included in school sports programs, appropriate concussion diagnoses increase, especially if the trainers are familiar with the players. Other studies show school sports-related concussions are reduced by 56% in youth hockey when body checking is no longer allowed, and 57% in football when schools eliminate full-contact.

To facilitate on the spot diagnosis, in 2018, the FDA approved a novel blood test to evaluate concussion in adults. The Banyan BTI (Brain Trauma Indicator) test measures levels of two protein biomarkers that are released from the brain into the bloodstream within 12 hours of a head injury, offering a way to confirm a diagnosis. And this year, the FDA approved the first non-invasive, baseline-free tool to aid in the diagnosis of concussion known as the EyeBox. This tool is a four-minute eye-tracking test intended to help physicians evaluate patients ages 5 to 67 with suspected concussions. Most noteworthy is it does not require preinjury baseline tests, such as those given at the start of a sports season, to accurately indicate a concussion has occurred.

Treatments on the horizon

Unfortunately, aside from rest and refraining from activities, there isn’t much else out there to treat concussions. However, a recent study in the Journal of Neurotrauma found using non-invasive low-field magnetic stimulation (LFMS) on the brain had a profound healing effect on mice suffering from TBI, with the rodent’s performance on cognitive and motor tests almost back to normal within four days of treatment. The research team also recorded a change in certain protein levels in the brain, indicating improvement at a cellular level.

School sports are an essential aspect of a young person’s wellbeing, as it helps build self-confidence, social structure and physical fitness. But at what cost? As the sports season rages on, the best we can do to prevent concussions, just short of pulling kids from contact sports, is ensuring they have proper fitting equipment and receive the appropriate training in techniques and regulations for their game of choice. Developing the skills needed to play and following the rules of the game may be the only strategy left to avoid the one “flag on the play” that, unfortunately, could lead to a lifetime on the “bench.” 

Kimberly Drake can be reached at [email protected] gmail.com.

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