Concussions have always been an issue in contact sports, but in the recent years we’ve not only seen an increase in the number of reported concussions, but we’ve also seen an increase in media coverage of professional players suffering from these dangerous and difficult injuries. It seems as if everyday, whether it’s the newspaper, TV, or internet, one can find some article or segment discussing concussions and the associated risks and implications that they may have on a range of topics from youth sports to long-term neurological functioning and memory. Unfortunately these articles leave many wondering what a concussion actually is.
A concussion used to be defined as a traumatic brain injury that causes a loss of consciousness in the individual suffering from the trauma, but as we’ve learned more and more about neurology and brain physiology, the definition has evolved to: a form of traumatic brain injury that is caused by a blow to the head or body, a fall, or another injury that jars or moves the brain within the protective skull. This means that a concussion does not necessarily involve symptoms such as passing out or forgetting what happened leading up to the injury. It also means that we need to be more careful with athletes obtaining head injuries and develop better on-field diagnostic testing to help us determine when such traumatic brain injuries have occurred.
Concussions occur because the brain is a soft organ that is, essentially, floating in a fluid called cerebrospinal fluid (CSF). This allows us to reduce the effective weight of the brain and cushion it, while simultaneously bathing it in a solution of “brain goodies.” As with any object that is suspended in fluid, when the body changes motion, the brain will, literally, lag for a moment before it follows in the direction that the body moved. In the case of a sudden hard hit or fall, the fluid will not be enough to slow the brain down and prevent it from hitting up against the inside of the skull. When the soft tissue of the brain hits the skull this can cause damage to the tissue, which is what we consider a concussion.
So what can we do to help better diagnose and assess concussions on the field? Diagnostic tests have been around for years to try to figure out if a patient/athlete has suffered from a concussion, but it hasn’t been until recently that we’ve really looked into improving these tests to catch more injuries before they become more severe. One of these standardized assessment tests is called the Sports Concussion Assessment Test 2 (SCAT-2).
This kind of tool assess and athlete by asking the athlete if they’re experiencing symptoms such as: headache, “pressure in head,” blurred vision, difficulty remembering, sadness, increased emotionality, irritability, trouble falling asleep, etc. and asks the athlete to rate the symptom as none, mild, moderate, or severe. Then there is a calculation that is done using the self-reported score and after this the physician, athletic trainer, or other sports medicine specialist will indicate if the individual lost consciousness, perform a Glascow Coma Scale assessment, balance exam, coordination exam, Maddock’s assessment, and cognitive assessment to get the athlete’s overall score.
The SCAT-2 is a great tool to begin with, but more recently people have been wondering if a standardized test is appropriate to account for the variability that may exist between individuals, ages, and sexes. A recent study out of Still University in Arizona showed that there was, indeed, significant variability between males and females in the way that they scored on the SCAT-2, as well as with individuals whom suffered previous concussions compared to individuals whom hadn’t.
This suggests that we need to improve our method of assessing concussions on the sidelines to account for the idiosyncrasies and variability between athletes. One promising suggestion has been to incorporate a baseline SCAT-2 assessment of athletes before the season begins in order to have a comparative marker for later SCAT-2 scores when trying to assess a head injury during the season. Implementing this baseline assessment would certainly help sports medicine professionals to better assess the severity of an injury and help the athlete to not only remain safer and healthier, but to return to playing in the most appropriate and timely manner.
Concussions are, undeniably, a rising and concerning matter in all of athletics. With approximately 1,400 Massachusetts high schoolers per year are being sent to and emergency department for a traumatic head injury, we really need to look into ways of more accurately diagnosing and assessing the severity of these traumas in order to protect our athletes from irreparable damage or long-term neurological deficits. As a state, we are doing a pretty good job. We’ve implemented the “Heads Up” program to educate players and coaches, and there has been a great deal of public awareness as well as legal changes made in attempt to prevent these injuries in youth sports. As a nation, though, we still have a long way to go 9% of all high school injuries are documented as concussions. Hopefully as our knowledge and understanding of these types of injuries progress, we will better diagnose and educate our youth in more efficient ways to lower these statistics and create a healthier, safer, and more protected athletic scene.
For more information about Massachusetts’ “Heads Up” program in the Boston area check out: Massachusetts Keeps Athletes Safe from Concussions
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