head injuries in sports

Head Injuries In SportsJOHN GONOUDE

Mild traumatic brain injuries are an inherent risk of contact sports, and yet they have continually been misunderstood or regarded as a sign of weakness in the integrity of an athlete. All who are involved in such activities must be educated on the signs, symptoms, and risks of repetitive head injuries in order to ensure the safety of our athletes through proper management and diagnostic skills.

John Gonoude6’0” 210 lbs.#58 OL/DL

“Pain is weakness leaving the body.”

the brainSociety for Neuroscience

Neurons• Responsible

for the transmission of information–Nerve

impulses– Action

potentialSociety for Neuroscience

NEUROTRANSMITTERSThe brain’s chemical messengers.

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

OVER/UNDER?

WHAT IS ACONCUSSI

ON?

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


“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”

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


Let’s put a concussion into perspective.

Popular Mechanics

“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


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)


Disqualification Guidelines

GAME, SEASON, or CAREER


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

NEUROIMAGING

MedicineNetNational Athletic Trainers’ Association

ComputedTomography

Scan

MagneticResonance

Imaging

Injury Treatment

• No evidence-based pharmacologic treatment options

• Wake-ups• Rest

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, 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

Mahercor Laboratories

THE EVOLUTION OF THE HELMET.

Popular Mechanics

Popular Mechanics

Xenith X1

Xenith

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


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


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

Chris Nowinski

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

Works CitedBaker, Mark. "The Brain behind the Bill." The Register-Guard [Springfield, OR] 5 Apr. 2009. Print.

"Brain Facts." Society for Neuroscience. 2009. Web. 23 Apr. 2010. <http://www.sfn.org>.

Broglio, Steve P., Jacob J. Sosnoff, SungHoon Shin, Xuming He, Christopher Alcaraz, and Jerrad Zimmerman. "Head Impacts During High School Football: A Biomechanical Assessment." Journal of Athletic Training 44.4 (2009): 342-49. Web. 23 Apr. 2010.

"Center for the Study of Traumatic Encephalopathy." Boston University Alzheimer's Disease Center. Sports Legacy Institute, 2008. Web. 23 Apr. 2010. <http://www.bu.edu/alzresearch/cste/#3>.

Guskiewicz, Kevin M., Michael McCrea, Stephen W. Marshall, Robert C. Cantu, Christopher Randolph, William Barr, James A. Onate, and James P. Kelly. "Cumulative Effects Associated With Recurrent Concussion in Collegiate Football Players: The NCAA Concussion Study." American Medical Association 290.19 (2003): 2549-555. Web. 23 Apr. 2010.

Guskiewicz, Kevin M., Scott L. Bruce, Robert C. Cantu, Michael S. Ferrara, James P. Kelly, Michael McCrea, Margot Putukian, and Tamara C. Valovich McLeod. "National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion." Journal of Athletic Training 39.3 (2004): 280-97. Web. 23 Apr. 2010.

Hart, Alexander C. "NFL Head Injuries a Hot Topic in Congress." Los Angeles Times [Los Angeles, CA] 29 Oct. 2009. Print.

Higgins, Matt. "Football Physics: The Anatomy of a Hit." Popular Mechanics. Hearst Communication. Web. 23 Apr. 2010. <http://www.popularmechanics.com>.

Kelly, James P., and Jay H. Rosenberg. "Practice Parameter: The Management of Concussion In Sports." American Academy of Neurology (1997): 1-7. Web. 23 Apr. 2010.

McCrory, Paul, Willem Meeuwisse, Karen Johnston, Jiri Dvorak, Mark Aubry, Mick Molloy, and Robert Cantu. "Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport Held in Zurich, November 2008." Journal of Athletic Training 44.4 (2009): 434-48. Web. 23 Apr. 2010.

McKee, Ann C., Robert C. Cantu, Christopher J. Nowinski, Brandon E. Gavett, Andrew E. Budson, Veronica E. Santini, Hyo-Soon Lee, Caroline A. Kubilus, and Robert A. Stern. "Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy After Repetitive Head Injury." American Association of Neuropathologists 68.7 (2009): 709-35. Web. 23 Apr. 2010.

Mueller, Frederick O. "Catastrophic Head Injuries in High School and Collegiate Sports." Journal of Athletic Training 36.3 (2001): 312-15. Web. 23 Apr. 2010.

"Neuropsychological Tests (Baseline and Post-Concussion)." ImPACT: The Best Approach to Concussion Management. ImPACT, 2010. Web. 23 Apr. 2010. <http://www.impacttest.com>.

Nowinski, Christopher. 10 Point Plan to Save Football. Rep. Sports Legacy Institute. Print.

Nowinski, Christopher. Head Games: Football's Concussion Crisis. East Bridgewater, MA: Drummond Group, 2007. Print.

Parker-Pope, Tara. "The Risk of High School Football Tackles." New York Times [New York City, NY] 16 July 2009. Print.

Phillips, Lisa. "Head Games." Neurology Now (2007). Web. 23 Apr. 2010.

"Sports-Related Head Injury." Neurosurgery Today. American Association of Neurological Surgeons, June 2009. Web. 23 Apr. 2010. <http://www.neurosurgerytoday.org>.

"The Maher B-Protect Splint (Level III)." Mahercor Laboratories, LLC. Web. 23 Apr. 2010. <http://www.mahercorlabs.com>.

Willer, Barry, and John J. Leddy. "Management of Concussion and Post-Concussion Syndrome." Current Treatment Options in Neurology 8 (2006): 415-26. Current Science Inc. Web. 23 Apr. 2010.

Xenith Helmet Catalog. Rep. 2009. Print.

"Zackery Lystedt Law Should Go Nationwide." The Covington Reporter [Maple Valley, WA] 6 Nov. 2009. Print.

Talk with Upper Merion Varsity

Football

Upper Merion Middle School Football

Program

CHRISTOPHER NOWINSKISPORTS LEGACY INSTITUTE

TIM BRIGGSPENNSYLVANIA STATE REPRESENTATIVE

149TH LEGISLATIVE DISTRICTMONTGOMERY COUNTY

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

head injuries in sports

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