head injuries in sports

Head Injuries In SportsJOHN GONOUDE

“Pain is weakness leaving the body.”

the brain• Most complex organ

of the human body• Foundation of the

mind• All thoughts,

perceptions, and behaviors are a direct result of combinations of signals among neurons

Society for Neuroscience

Neurons

• Basic working unit of the brain

• Responsible for the transmission of information–Nerve impulses– Action potential

Society for Neuroscience

NEUROTRANSMITTERSThe brain’s chemical messengers.

• Responsibilities– Generation of action

potential– Tightening of muscles– Beginning of enzyme

activity– Releasing more

neurotransmitters

Nowinski, Head Games: Football’s Concussion CrisisSociety for Neuroscience

neurotransmitters• Acetylcholine (ACh)– Normal attention,

memory, and sleep• Glutamate and

aspartate– Signal the release

of N-methyl-D-aspartate (NMDA)• Learning, memory, and the development of nerve contactsSociety for Neuroscience

WHATIS A

CONCUSSION?

A concussion is a mild traumatic brain injury.

National Athletic Trainers’ Association

Features of a Concussion

• Vacant stare• Delayed verbal and motor

responses• Disorientation• Confusion and inability to

focus attention• Incoordination• Slurred and incoherent

speech• Emotions out of proportion• Memory deficits• Any period of

unconsciousness

American Academy of Neurology

SYMPTOMSEarly Symptoms

• Headache• Dizziness• Lack of awareness of

surroundings• Nausea or vomiting

Late Symptoms

• Low-grade headaches• Lightheadedness• Poor attention and

concentration• Memory dysfunction• Easy fatigability• Irritability and low frustration

tolerance• Intolerance of bright lights or

difficulty focusing vision• Intolerance of loud noises• Anxiety or depressed mood• Sleep disturbance

American Academy of Neurology

During a concussion, the brain develops inabilities in regulating

blood supply and making energy.

Nowinski, Head Games: Football’s Concussion Crisis

(PLASTICITY)

• Neurotransmitters bind on to receptors and change the receptors– Susceptible to

glutamate• Excitotoxic

death

Nowinski, Head Games: Football’s Concussion Crisis

“IF PEOPLE SAY THERE IS NO CORRELATION BETWEEN WHAT HAPPENED TO THEM AND PLAYING; BULLS***, BULLS***. AND PEOPLE CAN CALL ME ANYTHING THEY WANT. THEY CAN CALL ME A MALCONTENT, A BABY; WHATEVER THE F*** YOU WANT TO CALL ME. BUT NOBODY IS GOING TO SHUT ME UP FROM TALKING ABOUT WHAT I KNOW.”

HARRY CARSONESPN, Outside the Lines

POST-CONCUSSION

SYNDROME• Condition may take

days, weeks, months, or even years to recover from

• Symptoms include prolonged cases of physical, cognitive, emotional, and behavioral issues

University of Buffalo, Current Treatment Options in Neurology

DEPRESSION

Persistently sad or empty mood, low energy level, unusual fatigue, headaches, unresponsive chronic pain

MedicineNetNowinski, Head Games; Football’s Concussion Crisis

Neurology Now, “Head Games”

The injured athlete is initially dazed by the impact and remains alert for another 15 seconds to a minute before collapsing to the ground in a semi-conscious state. They display rapidly dilating pupils and may even stop breathing.

Nowinski, Head Games: Football’s Concussion Crisis

Zachery LystedtMaple Valley, WA

Max ConradtWaldport, ORCovington Reporter

Goliath

CHRONICTRAUMATIC

ENCEPHALOPATHY

American Association of Neuropathologists

Chronic Traumatic Encephalopathy is the progressive degeneration of brain tissue involving the build-up of tau protein.

American Association of Neuropathologists

ANDRE WATERS MIKE WEBSTER 1962-2006 1952-2002

Nowinski, Head Games: Football’s Concussion Crisis

“I don’t know how much sense that makes, because we’re dealing with the same organ. No cardiologist ignores a ‘mild’ heart attack. He doesn’t say to his patient, ‘don’t worry about exercise or your diet unless the heart attack is severe.’ He still treats him as if he has had a heart attack. Yet we don’t treat a concussion in the same way as we do a brain injury. For some reason we tell people, ‘you’re fine,’ when we know they aren’t.”

Dr. Heechin Chae

Nowinski, Head Games: Football’s Concussion Crisis

Return to Play Decisions

• Multiple Grade 1 concussions– 1 week

• Grade 2 concussion– 1 week

• Multiple Grade 2 concussions– 2 weeks

• Grade 3 with brief loss of consciousness– 2 weeks

• Multiple Grade 3 concussions– 1 month or longer (based on

clinical decision of evaluating physician)

National Athletic Trainers’ Association

SCAT2

Zurich Consensus

ImPACT

• Immediate Postconcussion Assessment and Cognitive Testing

ImPACT

ImPACT

• Attention span• Working memory• Sustained and

selective attention time

• Response variability

• Non-verbal problem solving

• Reaction time

ImPACT

Disqualification Guidelines

GAME, SEASON, or CAREER

National Athletic Trainers’ Association

NEUROIMAGING• Computed Tomography (CT)

Scan– Uses x-rays to create cross-

sectional pictures of the brain to produce a three-dimensional image

• Magnetic Resonance Imaging (MRI)– Radiology technique using

magnetism, radio waves, and a computer to produce images of body structures

MedicineNetNational Athletic Trainers’ Association

Injury Treatment

• No evidence-based pharmacologic treatment options

• Wake-ups• Rest– Avoid activities that

create cognitive or physical stress

National Athletic Trainers’ AssociationNowinski, Head Games: Football’s Concussion Crisis

It is estimated that between 1.6 to 3.8 million concussions occur every year in the United States. In 2008, only 126,926 sports-related concussions were treated in United States hospital emergency rooms. 47,807 (37.6%) of those concussions occurred in children under the age of 14.

American Association of Neurological SurgeonsCenters for Disease Control and Prevention

What is being done?

i nnovat ion in p ro tec t ion

• Maher B-Protect Splint (Level III) Mouth Guard– Carefully designed

to help prevent concussions

– Designed for optimum fit, comfort, communication, and stability

Mahercor Laboratories

Xenith X1

Xenith

THE EVOLUTION OF THE HELMET.

Popular Mechanics

Popular Mechanics

HELMET FITTING

HEAD IMPACT TELEME

TRY SYSTEM(HITS)

Journal of Athletic Training

Head Impact Telemetry System (HITS)• Evaluates regions of the head that are most

susceptible to damage• Accounts for linear & rotational acceleration, jerk,

force, impulse, and direction• Has only been used as a tool for research, but may

have a future in diagnostics

Journal of Athletic Training

“We need to take a step back and start taking care of ourselves.”

Chris Nowinski

From 1945-1999, 491 head-related football fatalities occurred in high school, collegiate, professional, and recreational levels.

Journal of Athletic Training

TEN POINT PLAN TO SAVE FOOTBALL

1. Reevaluate how the game is practiced

2. Encourage mandatory brain trauma education

3. Reevaluate protective equipment

4. Develop better methods of diagnosis

5. Develop better methods of management

6. Consider minimum medical resources

7. Reevaluate techniques of tackling and blocking

8. Reevaluate the rules9. Reevaluate rule

enforcement and role of referees

10.Reconsider the culture of the game

Sports Legacy Institute

Acting Upon A Crisis.

Pennsylvania House Democratic CaucusThe Covington ReporterThe Register-Guard

Starting From The TopThe Role of the National Football League

88 PLANNational Football League

New York Times

Luck of the Draw Foundation

Upper Merion Concussion Survey63 out of 100 student athletes responded; 38 seniors, 15

juniors, 4 sophomores, and 6 freshmen.

78 total concussions were reported by 39 out of 63 (61.9%) student athletes.

Only 37 out of the 78 (44.8%) concussions were reported to have been diagnosed by an athletic trainer.

25 out of 63 (39.7%) student athletes said they would not tell a coach or athletic trainer if they had a concussion.

9 out of 39 (23.1%) student athletes reported that they have had three or more concussions during their athletic careers.

Luck of the Draw Foundation

CONCLUSION

• Concussions should be treated as a brain injury

• Guidelines at all levels of play must be set in order to best protect our athletes

• Athletes, parents, and coaches must be educated on the signs, symptoms, and risks of mild traumatic brain injuries

• No child’s life should be put at risk to perform on the playing field