head injuries in sports
TRANSCRIPT
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