Monday, August 1, 2011

Update: Head Injuries Revisited

Head injuries in athletes resulting in concussions occur more frequently than previously thought.  We are learning more about the problem and the important consequences. Each year more than 300,000 athletes in the U.S. suffer some form of traumatic brain injury (TBI).  High school athletes comprise 60,000 of these injuries. The consequences vary a great deal but can be physical, emotional and intellectual.

TBI can result in short term symptoms as well as problems that are more serious which may not surface until several years later. What kind of problems develop depend on what portion of the brain is affected, the severity of the blow, the number of repeated blows to the head, preexisting conditions of the individual and personality traits of the injured person. The more blows to the head that occur, even small ones, increase the risk of for mental deficits. Significant head trauma to a football player occurs hundreds of times a week during practice and game experience. Exploring options for protective equipment in contact sports and teaching fundamental techniques in sports that can reduce head trauma are paramount to reducing the number of injuries and the serious consequences.

A 2000 study surveyed 1,090 former N.F.L. players and found more than 60 percent had suffered at least one concussion in their careers and 26 percent had three or more. Those who had concussions reported more problems with memory, concentration, speech impediments, headaches and other neurological problems than those who had not, the survey found. Considering these professional players spent many years coming up through the ranks as amateurs, the frequency of head trauma is likely under-reported. Other common problems are being discovered as we examine this challenge more closely. Depression, insomnia, attention deficit, personality changes occur more frequently among those who had even a single episode of head trauma. Long-term problems may take eight years or more to develop and become evident.

Immediate symptoms that require removal from sports activities include amnesia, poor balance, headaches, dizziness, or other neurologic deficits on exam regardless of how quickly they subside on the sidelines. It is widely accepted that symptoms of a concussion can reappear hours or days after the injury, indicating that the player had not healed from the initial blow. This requires strict guidelines that conservatively allow adequate time for healing to occur. This is challenging and unclear how much time is enough. A health care provider should be involved in examining and investigating these head injuries to insure the best outcome. Even one episode of head trauma makes the athlete at risk for serious consequences and more vulnerable for the next episode, which in many contact sports is inevitable.

Both professional and college sports authorities are changing their recommendations regarding contact sports. Reducing the numerous head blows by enforcing more practices where there is no contact. Research has shown the number of head blows during a college football season totals in the thousands to an individual player.  Many of these have forces comparable to driving a car into a concrete wall at 40 miles per hour. Teaching better techniques to reduce the head leading contact and providing better equipment can reduce the negative effects. Football helmet manufacturing and testing are not closely regulated. New helmet technology and better monitoring of equipment after repeated impact can reduce the consequences of head impact.

Repeated head trauma resulting in serious consequences of traumatic brain injury should be no surprise. We can do more to preserve and protect athletes of all ages. A concussion is a complicated problem that needs thorough initial evaluation. Seek medical attention for head injures even if they seem mild and no loss of consciousness. Severity of symptoms and initial imaging studies can detect serious problems early and be the reassuring basis for ongoing treatment.