Wednesday, November 5, 2014

Concussion Crisis

Despite the recent surge in concussion awareness, researchers and doctors still know very little about the exact mechanics of a concussion. They understand the initial trauma, when the brain bumps up against the skull and begins to bleed or bruise. Less clear is what Shane Caswell, executive director of George Mason University’s sports medicine lab, calls the “effects downstream” - such things as impaired cognition, memory loss, imbalance, mood disorder and changes to brain physiology.

According to High School RIO (reporting information online), an injury surveillance system built by Dr. Dawn Comstock of the Colorado School of Public Health, the number of girls suffering concussions in soccer accounts for the third largest amount of all concussions. Only football and boys’ hockey players report concussions at a higher rate. Since 2008, high school girls’ soccer players have reported an average of 14 concussions per 10,000 games played (a game is equal to one game played by one player). The figure is nearly twice the average for boys’ soccer (7.30), and only football (27) and boys’ hockey (18) have reported more concussions than girls’ soccer. 

Researchers also don’t entirely understand why women seem to suffer more concussions than men. The most common theory: Women have smaller and weaker necks, which makes their heads more prone to the violent snapping that results in serious concussions. Estrogen levels and cerebral bloodflow, which differ by sex, may also play a role.

Concussions also tend to amplify certain preexisting conditions, and women experience far higher migraine, anxiety and depression rates than men. But there’s also a serious risk of reporting bias: Perhaps women only appear to get more headaches because women are more comfortable speaking up when they’re hurt. An extensive study released by the Institute of Medicine and the National Research Council warns that young athletes in particular face a “culture of resistance” when it comes to reporting and treating concussions.

According to the CDC, a concussion is a “traumatic brain injury that alters the way your brain functions that may or may not involve loss of consciousness,” and results from “the rapid acceleration or deceleration” of the brain within the skull. The force behind the brain’s change in velocity is often from direct contact to the head, but can also come from indirect forces like whiplash — as could result from a car accident or being blindsided by a hit on a soccer field.

Statistics indicate that it’s not head-to-ball contact that poses the greatest concussion danger for younger players, but rather player-to-player or player-to-ground contact that can result from a heading attempt.



The signs and symptoms of a concussion can be subtle and may not be immediately apparent. Symptoms can last for days, weeks or even longer.

Common symptoms after a concussive traumatic brain injury are headache, loss of memory (amnesia) and confusion. The amnesia, which may or may not follow a loss of consciousness, usually involves the loss of memory of the event that caused the concussion.

Signs and symptoms of a concussion may include:

  • Headache or a feeling of pressure in the head
  • Temporary loss of consciousness
  • Confusion or feeling as if in a fog
  • Amnesia surrounding the traumatic event
  • Dizziness or "seeing stars"
  • Ringing in the ears
  • Nausea
  • Vomiting
  • Slurred speech
  • Delayed response to questions
  • Appearing dazed
  • Fatigue

Some symptoms of concussions may be immediate or delayed in onset by hours or days after injury, such as:

  • Concentration and memory complaints
  • Irritability and other personality changes
  • Sensitivity to light and noise
  • Sleep disturbances
  • Psychological adjustment problems and depression
  • Disorders of taste and smell

The American Academy of Pediatrics recommends that you call your child's doctor for advice if your child receives anything more than a light bump on the head. If your child doesn't have signs of a serious head injury, and if your child remains alert, moves normally and responds to you, the injury is probably mild and usually doesn't need further testing. In this case, if your child wants to nap, it's OK to let him or her sleep. If worrisome signs develop later, seek emergency care.

No one should return to play or vigorous activity while signs or symptoms of a concussion are present.

Experts recommend that an athlete with a suspected concussion not return to play until he or she has been medically evaluated by a health care professional certified as a Sports Concussion Expert and trained in conducting an ImPACT test. 

What is ImPACT?

ImPACT is a 20-minute neurocognitive test battery that has been scientifically validated to help assess and measure the effects of sports-related concussion. Conducting baseline and post-injury neurocognitive testing using ImPACT help objectively evaluate an athlete’s cognitive status to prevent the cumulative effects of concussion. ImPACT can help answer difficult questions about an athlete’s readiness to return to play, protecting them from potentially serious consequences of returning too soon and avoiding long-term complications.

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