Category: Concussion

Abstract

Sport-related concussion is a serious neurodegenerative condition with a complex pathophysiology, which is not well understood. Rising cases of concussion have resulted in attempts to manage the condition after the injury. Neuropsychological testing has been widely applied to assist injured athletes during cognitive disorder assessment and recovery management. While the tests are now popular, their validity and reliability have not been ascertained. Consequently, further research is necessary to develop reliable tools for neuropsychological tests for sport-related concussion.

Sport-related Concussion: A Brief Overview

Much attention has been directed to contact sports in the recent past. Specifically, the source of concern has been the immediate and long-term outcomes of sport-related concussion (SRC). Chronic traumatic encephalopathy (CTE), which is a progressive neurodegenerative disease caused by repetitive head trauma, is now studied to determine long-term effects of contact sports (Saulle & Greenwald, 2012; Yi, Padalino, Chin, Montenegro, & Cantu, 2013). Football, the prestigious National Football League (NFL), now faces lawsuits and criticism regarding player management and safety following cases of mild traumatic brain injuries.

More strikingly, most cases have originated from a majority of retired players. Understandably, the sport is based on toughness, powerful impacts, full contact and the ability to overcome attackers. To date, many researchers have presented studies on concussion and contact sports players. Concussion refers to traumatically prompted transient disruption of brain functions and constitutes an intricate pathophysiological process (Sisodia & Kumar, 2013). Sport-related concussion is not only restricted to football, but is also reported in boxing (the first known identified cases), soccer, hockey, and professional wrestling. Although neurological outcomes of sport-related concussion are well documented, neuropsychological tests and their relevance to concussion are not yet fully understood. This essay focuses on the reliability of neuropsychological tests following sport-related concussion.

Management of Sports-related Concussion

Medical management of sport-related concussion can be viewed as having two different elements. The first aspect of management encompasses acute care management of injuries suffered immediately after the contact with the goal of identifying and treating any possible neurological outcomes, such as cerebral haemorrhage. This form of intervention is usually not necessary since most sport-related concussions entail mild concussions that may not result in acute neurological crises. Medical personnel consider the second aspect of management vital. It requires observing various symptoms associated with concussion over time with the aim of noting the progress for return-to-play decisions. In instances of extremely mild concussions, absolute recovery is often noted after few minutes, allowing players to resume sports and usually eliminating the need for any additional workup.

Sports-related concussions are normally linked to more than a single symptom, reduced balance, and cognitive insufficiencies (Echemendia et al., 2013). Balance assessment, symptom scales, and neurocognitive testing are available to assess these issues. According to Echemendia et al. (2013), these assessment modalities can be used to observe any changes within the first few days after an insult. Symptoms presentation and the rate of recovery normally differ, which indicate the importance of evaluating all the three factors as components of a thorough sport concussion management.

Neuropsychological Testing

Neuropsychological evaluation of concussion is considered a vital aspect of management. Today, concussion management efforts that rely on neuropsychological assessment to help in clinical decision-making have been widely adopted across sport institutions, including professional sports and schools (Echemendia et al., 2013). Cognitive insufficiencies linked to concussion are generally elusive and could be found in multiple domains, implying that it is difficult to assess concussions. As a result, the diagnosis of concussion is based on clinical decisions depending on the evaluation of a wide range of domains with related symptoms, such as headache, loss of consciousness, cognitive deficiency and neurobehavioral changes, including irritability (Makdissi, Davis, & McCrory, 2014). Players often find it difficult to process information, and they display impaired memory and are slow to react. The application of neuropsychological tests in handling concussion is seen as an opportunity to overcome the dependence on subjective symptoms, which are also associated with other neurodegenerative conditions, such as Alzheimers disease, and are poorly recognized and reported differently (Gavett, Stern, & McKee, 2011). Moreover, such symptoms have also been associated with other outcomes, which do not necessarily reflect specific symptoms associated with concussion.

According to Sisodia and Kumar (2013), neuropsychological testing offers an objective means of evaluating sport-related concussion, as well as linking outcomes to specific individual-related factors, such as gender, age, and history past concussion. Based on neuropsychological results in sport-related concussion, patients have often displayed the above-mentioned symptoms. Notably, neuropsychological testing has undergone significant changes from the use of paper and pencil, balance field tests and now to the more commonly used computer-based test batteries (Sisodia & Kumar, 2013). Currently, multiple computerized neuropsychological test batteries are available in the mainstream markets, and they are marketed to athlete intervention programs across different institutions.

For cognitive function, formal neuropsychological testing is recognized as the clinical standard for evaluating cognitive impairment. Such a test is commended in any situations in which chances of recovery remain unclear or cases are difficult, specifically in prolonged recovery. Screening neuropsychological tests have been applied to evaluate cognitive recovery following the injury. Preferably, test results should be gauged against a persons own pre-injury baseline results. In instances where no such baseline results are available, which is usually the case, normative data should be used. These standardized or formal neuropsychological tests are used as short measurement tools, formulated for the sideline evaluation of athletes following concussion in order to quantify the severity of the injury.

They are also used alongside other clinical data to determine suitability for return to play decisions. In this respect, the Standardized Assessment of Concussion (SAC) has gained significant recognition, and its reliability, sensitivity, and change-score analyses have been sufficiently studied. It, therefore, has been observed that baseline testing can be vital for assessing cognitive limitations after injury and for evaluating recovery (Iverson & Schatz, 2015). Additionally, many screening neuropsychological tests have been authenticated for management of concussion in athletes and are easily accessible. For instance, ImPACT or Axon Sports are computerized options for concussion management. The basic paper and pencil cognitive evaluations have been used to determine or estimate cognitive impairment, but they require other conservative return-to-play strategies and cautious observation of symptoms as athletes recover to play (Makdissi et al., 2014).

Limitations of Neuropsychological Testing

Researchers have observed that athletic trainers and other sports medicine personnel generally lack adequate knowledge on psychometrics to make informed choices on the use of such tools (Randolph, McCrea, & Barr, 2005). Moreover, currently available guidelines are not peer reviewed on the use of these assessment tools (Randolph et al., 2005). While neuropsychologists can use psychometric criteria required for the implementation of a specific tool for the purpose of clinical evaluation, trainers may not get services provided by neuropsychological consultants to assist in decision-making processes. In addition, it has been observed that neuropsychological tests to assess recovery following concussion have some unique features in terms of reliability and validity, which underscore the need for further reviews and studies (Randolph et al., 2005).

Neuropsychological tests, however, face some critical drawbacks related to assessment tools, which generally focus on reliability (Sisodia & Kumar, 2013). According to results of a study conducted by Randolph et al. (2005), no available traditional or computerized neuropsychological batteries adopted for use in the evaluation and management of sport-related concussion have satisfied all the standards required to permit regular clinical use. As such, fundamental issues concerning the reliability, validity, and clinical application of these tools remain largely unresolved. In this regard, it has been shown that test-retest data from these neuropsychological tests could be difficult to interpret, and any possible interpretation is better off as a function of clinical judgment instead of statistical algorithms (Randolph et al., 2005). It also appears that the field has made abysmal achievements in improving both traditional and computerized neuropsychological tests because some recent studies have demonstrated a lack of sufficient evidence to support a widespread regular use of baseline neuropsychological tests (Echemendia et al., 2013). Nevertheless, these tests are still recognized as extremely important in the assessment and management of concussion (Echemendia et al., 2013).

Some studies have also suggested that different factors, such as psychological state, may also complicate and extend recovery from concussion in athletes (Maroon et al., 2015). In addition, age is seen as a possible major factor that may accelerate recovery in young players because of increased brain plasticity, but the same may not apply to older retired athletes. Echemendia et al. (2013) further point out that age-appropriate testing may not be available or is not well researched to be used.

Given these facts on limitations of neuropsychological testing, further research is obviously required before these assessment tools can be declared effective for regular evaluation and management of sport-related concussion. Nevertheless, the relevance of baseline testing for quantifying cognitive impairment after insults and for evaluating recovery remains important for management and decision-making purposes. Many researchers have decried the lack of sufficient evidence to ascertain the importance of baseline test results and their validity (Iverson & Schatz, 2015; Yengo-Kahn, Johnson, Zuckerman, & Solomon, 2016). Invalid test results may be detected in some instances, but validity indicators cannot expressly show specific causes of errors during testing. Thus, such outcomes explain why Yengo-Kahn et al. (2016) insist that the scientific community and the public must treat such data with caution. Interpretation of results, therefore, requires advanced psychometric systems to help with accuracy of documentation of cognitive insults and regular management of recovery.

Conclusion

The past few decades have recorded a fast increase in the application of neuropsychological tests to manage athletes after concussive insults. Neuropsychological testing is now widely recognized across various sporting institutions globally, as well as by sports medicine physicians who apply it as a component of clinical management of brain injuries. It is generally observed that neuropsychological evaluation in the management of sport-related concussion is important because of supporting empirical evidence. However, reliability and validity of these assessment tools remain unclear, as most studies have demonstrated. Therefore, further research is necessary to advance neuropsychological testing in sport-related concussion to encourage their use.

References

Echemendia, R. J., Iverson, G. L., McCrea, M., Macciocchi, S. N., Gioia, G. A., Putukian, M., & Comper, P. (2013). Advances in neuropsychological assessment of sport-related concussion. British Journal of Sports Medicine, 47(5), 294-298. Web.

Gavett, B. E., Stern, R. A., & McKee, A. C. (2011). Chronic traumatic encephalopathy: a potential late effect of sport-related concussive and subconcussive head trauma. Clinics in Sports Medicine, 30(1), 179xi. Web.

Iverson, L. G., & Schatz, P. (2015). Advanced topics in neuropsychological assessment following sport-related concussion. Brain Injury, 29(2), 263-75. Web.

Makdissi, M., Davis, G., & McCrory, P. (2014). Updated guidelines for the management of sports-related concussion in general practice. Australian Family Physician, 43(3), 94-99.

Maroon, J. C., Winkelman, R., Bost, J., Amos, A., Mathyssek, C., & Miele, V. (2015). Chronic traumatic encephalopathy in contact sports: a systematic review of all reported pathological cases. PLoS ONE, 10(2), e0117338. Web.

Randolph, C., McCrea, M., & Barr, W. B. (2005). Is neuropsychological testing useful in the management of sport-related concussion? Journal of Athletic Training, 40(3), 139154.

Saulle, M., & Greenwald, B. D. (2012). Chronic traumatic encephalopathy: a review. Rehabilitation Research and Practice, 2012, 1-9. Web.

Sisodia, V., & Kumar, S. P. (2013). Sport-related Concussion and neuropsychological testing: Shaken or stirred? Journal of Sports Medicine & Doping Studies, 3, e138. doi: 10.4172/2161-0673.1000e138.

Yengo-Kahn, A. M., Johnson, D. J., Zuckerman, S. L., & Solomon, G. S. (2016). Concussions in the National Football League: A current concepts review. American Journal of Sports Medicine, 44(3), 801-11. Web.

Yi, J., Padalino, D. J., Chin, L. S., Montenegro, P., & Cantu, R. C. (2013). Chronic traumatic encephalopathy. Current Sports Medicine Reports, 12(1), 28-32.

The issue floating around the NFL at this point is concussions, and CTE (Chronic Traumatic Encephalopathy). This certain retired NFL player was only 59 when he had his brain scanned, and in about two years people around him began to notice some change, motor deficits like very simple tasks becoming very hard. Not being able to button his shirt properly, zip up his pants, tie his shoes all because of muscle twitching he developed and the decreased muscle mass in his shoulders and arms. This man had been playing football at the age of 11, going all the way up to the pro league and retiring at 33. Being at risks for concussions his whole life and taking constant blows to the head is what put him at risk for CTE. This situation happens all too many times to football players, who have played for so long and had a large number of hits to the head. The worst part about CTE is that they have not found a way to test for the head disease until after the person has died. Then the family must send the brain into a lab, allowing scientists to test the brain. Once they find the CTE they will report back to the family letting them know there loved one has been suffering from this trauma. The saddest part about the whole thing is that there is not much that doctors can to do help. All they can do is prescribe medicine to try and decrease the symptoms with little result. There are many researchers and scientists trying to solve this uprising issue, but is there really anything that can be done?

According to Anne Mckee, CTE was first diagnosed in 1928, when Dr. Harrison Martland when he described a group of boxers with having “punch drunk syndrome”. Then later in 2005, a pathologist named Benet Omalu published the first cases of CTE in an American Football player, and former Pittsburgh Steeler Mike Webster. Shortly after the first case, the Concussion Legacy Foundation partnered with the Veterans Administration to form the VA-BU-CLF Brain Bank led by Dr. Anne Mckee herslef. Out of 202 deceased former football players brains that were submitted and scanned, they found CTE in nearly 88 percent of them (177) (Goldman). That is a huge number of retired players who have had CTE found in their deceased brains. There have been recent pushes to more investigation on CTE and how to create ways to stop it, but is it really enough? According to researchers it is one of the biggest researches done on CTE and it only covered those who played football. Just one concussion could put you at risk of having neurological symptoms even after the concussion has been gone, these symptoms include problems with hearing, problems with concentration, confusion, speech or hearing difficulties, numbness or tingling in extremities, and headaches (Rapaport). It all depends on how you treat the concussion to determine how the outcome will be for you. The players who do not realize they have a concussion and the coaches and staff who do not know the symptoms of concussions, allowing the player to continue playing is part of the reason CTE is becoming an issue. Constant blows to the head without any treatment is the cause of concussions, and multiple untreated concussions can lead to developing CTE in the brain in later years of life. Getting the players and coaches trained on concussion protocol and have them be aware of the signs and symptoms is the first step to try and tackle concussions and CTE. When a player takes a blow to the head they should immediately be pulled to the sideline for a couple of plays to be evaluated to make sure they are not experiencing any signs of a concussion. Then if the player is looking like they are somewhat experiencing the symptoms they should be evaluated by a professional to determine whether they can return to the field or how many games they should be out to ensure safety. The NFL is somewhat enforcing more rules and policies to help the safety of the players such as the head to head contact foul that punishes the opposing team and if bad enough can fine the certain player targeting the other teams heads.

According to Daniel Rapaport in his Sports Illustrated concussion timeline for football, the first survey of head injuries in the NFL only went as far back as May of 2000. If you think about it concussions have been around since the NFL has started and just in the 2000’s have people been taking it like a serious issue. In that study made back in May 2000 they came to a conclusion that players with at least one concussion is 1.5 times more likely to have depression in their life, and just one concussion can put you at risk of developing the neurological symptoms like, , problems with hearing, and concentration, confusion, speech or hearing difficulties, numbness or tingling in extremities, and headaches (Rapaport). Also people also seem to be sensitive to light and noise, nervous or anxious, could be easily upset or angered, highly emotional, irregular sleep patterns and trouble falling asleep. This is very interesting to me because as a kid I played football from elementary school all the way through High School, so does that mean there was some chance I suffered a concussion and have the odds of developing depression or those neurological symptoms? Honestly, there is no real chance of finding out, the only way really to have your brain scanned would be after you have already passed away. Researchers are trying to find new ways to scan for CTE and concussions without the person already being passed but there has not really been any break through yet. Dr. Anne Mckee recently came out and said that her and her team of researchers have been doing some great work with researching CTE and concussions but there work is nowhere near complete. She said they will need around 100 million dollars in order to fully complete research. They reached out to the NFL saying that they need donations for the research, the NFL said they fully support what they are doing and will try to fund what they can. But Dr. Anne Mckee thinks otherwise, that the NFL will not send anywhere near the amount they need because the research results will be too extreme, only killing the NFL’s ratings hurting them badly in profits (Goldman). This is a very big contradiction for the NFL and keeps the question if the NFL is doing enough. They have made some rule changes and starting somewhat fining the players who obviously target other players heads, but there is plenty more that can be done. Without the players the NFL would make little to no profit so ensuring the safety of the players should be a huge priority to the league, not only to ensure constant revenue but also for the friends, family of the players, and the players safety. Manufactures have also tried to create helmets to decrease the amount of force of impact on the head and engineered technological solutions to better detect head impacts (Spradley). Actions are being taking by multiple different industries and researchers to try and stop the increasing numbers of concussions, but is it really enough?

The numbers of players who have reported suffering at least one concussion is very alarming, and not only at the professional level but every level of football. Even kids that play football in Middle School, or even High School have more than likely suffered from at least one concussion. Personally speaking, I played football my entire life and throughout that whole time I never went to the doctor and was told had a concussion and had to sit out some games. I did however get hit in the head really bad a couple times giving me an enormous headache and a couple symptoms for a week or so. Even after telling my coach what had just happened he sent me back into the game allowing the head injury to get worse. That is what is wrong with the coaches in todays’ sports, they are so unaware of what the symptoms are they just send the player back in the game without a second thought. According to Brandon Spradley, Wirt Edwards, and Abreu Marcos in their scholar reviewed journal “The War Against Concussions” 50% of High School athletes, and 70% of College athletes did not report a concussion because they were not aware of the sign and symptoms. This goes back to the first step to eliminating concussions is to have every player and staff informed on the signs and symptoms of concussions. Once the coaches and staff realize the basics of concussions, they will be more aware of players safety when it comes to head injuries. Then taking the player out of the game allowing them to get the needed time to rest and come back well. According to Dr. Ellenbogen, the chairmen of the Department of Neurological Surgery at University of Washington Medicine, and co-chairmen of the Head, Neck, and Spine Committee of the NFL league, by tracking eye movements, they have been able to better access the brain and determine whether the player has suffered from a concussion or not (Spradley). New techniques and ways have been arising helping the league in determining whether the player has a concussion after being pulled from the game. After being looked at by the coaches they should call a medical professional to fully evaluate the player, giving the final word whether the player can return to the field, or give the player a time limit they must sit out of activities. Besides physical rest, there is no medicine out that is effective in treating the symptoms of sports concussions (Spradley). According to Brandon Spradley, a player is at even greater risk of repeating the head injury the few days that follow the concussion, and could be more likely to face greater complications later in life if suffered from the same head trauma over and over again. That means that it is very important to evaluate players who seemed to have suffered a head injury to ensure they sit out the amount of time needed, so there is no later complications with the player. The constant over and over concussions with no time to fully heal is what could lead to the player developing CTE later in life after they retire. Stopping the concussions now rather than later could be the determining factor to saving someone from developing CTE. CTE is not only found in retired football players either, according the Tom Goldman in a recent study of 202 deceased football players of all level 177 had CTE found in the brains, three of 14 who only played in High School, 48 of 53 players in college, and 9 of 14 in semiprofessional leagues. This study is pretty eye opening to the people who played football their whole life. It makes you wonder whether it Is worth it to put yourself at risk to play the sport. For people like me the love of the sport will always outweigh the consequences. As of right now there is no medicine or surgery that can help with CTE or even find out if you have it or not while you are still living. Causing ex-football players to have to live with the symptoms, struggling in everyday life. All of the research done so far has only been on people who played football in their lives, not even all the people who played any other sport or suffered a concussion doing everyday activities. Even simple tasks like tying your shoe, trying to button up or put on a shirt could be very hard for people suffering from CTE.

Concussions and CTE is a very big issue in todays’ time, and to some it is not taken nearly as serious enough. Coaches and players not fully knowing the symptoms of concussions allowing the player who just took a monstrous hit to the head back in the game, only allowing the head injury to worsen. The NFL not being serious about giving necessary funds to researchers and scientists trying to discover new ways to prevent concussions and try to develop some medicine to help those who have suffered from them, purely out of greed. The NFL wants to keep their ratings up to ensure the max number of profit coming in. Overall, above everything else the players safety should be the number one priority to the league, and not just the players but anyone who has suffered a concussion or is living life with CTE symptoms. Concussions and CTE seems to be unstoppable as of right now, having no medicine to help those with symptoms, or even being able to determine whether someone has CTE while they are still alive. But researchers and scientists are doing everything they can to help prevent them with new equipment, trying to develop new medicine, and developing new ways to determine if a player has CTE or not. The more we are blind to this somewhat invincible problem, the worse it may get.

The human brain is a complex bundle of nerves and muscles that is the nucleus for all human functions. The ability to breathe, move, think, and live are direct results of the underlying function of the brain. Therefore, based upon the overall significance of the brain, it becomes imperative to protect it from all damage. A concussion, is an injury that at its simplest form is a contusion of the brain, is the main mechanism of injury to avoid. However, there are more than just physical concerns for the brain after sustaining a concussion. Disrupted blood flow, loss of memory, and psychological and attitude changes are just a few of the many adverse effects of sustaining a concussion. The thought process around analyzing and treating a concussion has changed rapidly through the years as new technology and findings have become available to health professionals. With the always growing access to this information, it becomes necessary to understand what the best methods of treatment for a concussion are to speed up the recovery process, especially when treating high school athletes. Physical activity during the early stages of concussion rehabilitation is the most effective method of treatment for a concussion in high school athletes.

The use of physical activity in the early stages of concussion rehabilitation helps to relieve post-concussion symptoms sooner in all people. When treating a high school athlete, it is important to know the best way to treat a concussion as their brain is still developing and needs to be treated carefully. For years, it was widely considered among health professionals that the physical damage to the brain was the main concern after a concussion, and it needed to heal itself through stimulus isolation. However, now medical professionals have found that the brain not only sustains physical damage from a concussion, but psychological as well, and this damage can be more concerning when looking at the still-developing brain of a high school athlete. As the Harvard Health Medical School Publishing states in their article, “Concussion: What is it?”, the potential mental manifestations of concussions, such as depression and anxiety, can cause a prolonged healing process for a high school athlete (Harvard). High school students face new daily challenges constantly from schoolwork and tough home lives to deciding what college to attend, the additional mental strain a concussion can add makes the recovery process more difficult. Therefore, with the inability to think clearly or positively, a people can see an influx in recovery rate time, from a couple of extra days to possibly weeks. However, according to Janelle Prince, Eric Schussler, and Ryan McCann of the “Human Kinetics Journal”, exercising within a patient’s symptom and exertion threshold post-concussion can help relieve symptoms sooner due to the release of endorphins (Prince 123). Endorphins, released by the brain when exercising, help relieve mental strain and lessen the effect of stress and depression. The more the person exercises, the more endorphins are released. Therefore, the implementation of physical activity in the early stages of recovery for a high school athlete can help relieve their symptoms at a more efficient rate than any other form of treatment. This is why physical activity is a much better recovery option than rest.

Early physical activity supports the transition back into daily exercise for high school athletes at a more efficient rate when treating a concussion. The main concern of any medical professional when treating a concussion is the patient’s symptoms. If they seem to be progressing well, the athlete will begin to integrate back into exercise, daily activities, and school. However, there is a possibility that the athlete’s symptoms may not change or could worsen, which is a concern and forces the need to change their treatment. New research has found that an increase in pain or no change when recovering from a concussion could be a direct result of inefficient movement and function of the brain and body during rehabilitation. This is explained by Russell E. Banks and Anthony P. Salvatore, authors of the article “Concussions: Activity Avoidance and Rest Recommendation” at the Thieme journal, that high amounts of pain from concussions are a direct result of the body and mind becoming deconditioned due to the excess time off from physical and mental activity (Banks 33). Due to the extended time off from physical and mental activity that some concussion treatments follow, the brain and body are not able to heal and recover properly. However, the implementation of physical activity, as Bank and Salvatore further explain, can assist in speeding up recovery as it will allow the brain and body to progress back to normal (Banks 34). By allowing the high school athlete to begin physical activity early in the treatment of the concussion, they statistically will recover faster, while also nurturing their brain and body back to full health during treatment.

The integration of physical activity for high school athletes in the recovery phase of a concussion aids the improvement of both balance and blood flow. After sustaining a concussion, one can suffer from various symptoms, but most common are those of nausea, dizziness, headaches, and stimulus sensitivity. This is due to the athlete’s internal nervous system being marred after the concussion and needing the proper blood flow to reset. Even so, their blood flow is altered as well, and this can only be regulated through exercise. As Landon Lempke, Abbis Jaffri, and Nicholas Erdman describe in their article, “The Effects of Early Physical Activity Compared to Early Physical Rest on Concussion Symptoms”, concussions disrupt the proper flow of blood to the brain, slowing the brain’s ability to function and heal properly (Lempke et al. 104). Nevertheless, exercise can help increase the production of neurotrophic proteins in the brain and spinal cord, which help promote the survival of nerve cells and speed up recovery in the brain, allowing for faster healing. Additionally, cortical connectivity is the process of stimuli and neurons firing in the brain’s response to healing itself when injury and pain occur. Henceforth, this is why the use of exercise as a treatment method for a concussion will improve the balance and blood flow of the athlete as they exercise because of the brain’s ability to fire off neurons to speed up the healing process.

Physical activity as a method of treatment for concussions improves the psychological mindset and confidence in the rehabilitation process when treating high school athletes. One of the most effective ways to avoid the possible psychological side effects after sustaining a concussion is to increase activity, according to researchers. Amy M. Yorke, Sheila Littleton, Bara A. Alsalaheen, authors of the research report, “Concussion Attitudes and Beliefs, Knowledge, and Clinical Practice”, explain how modern researchers believe that certain psychological factors created after an injury can increase the perception of pain where which is not there (Yorke et al. 1025). They go on to say that this perception of pain comes from the lack of comparison in stimulus the brain and body have when you shelter it post-concussion. As discussed before, the psychological effects that a concussion can have on a teenager can be profound, but it should not be the defining factor when trying to recover from one. By allowing the athlete to recover through the use of exercise, which they are comfortable in, they will be better motivated to progress and not focus on possible or perceived pain. As a result of allowing high school athletes to get back to what feels familiar to them, which is movement and exercise, their mindset will be more optimistic. They will be in their natural setting of physical activity and will be less likely to perceive pain, therefore leading to an increase in their recovery time from the concussion.

There are, however, other methods of treatment for concussions in high school athletes, and a commonly used one is sole rest for both the brain and the body. Many health professionals who treat high school athletes would attest to the fact that rest overall will allow the body to heal itself on its own, lending itself to be the best treatment for a concussion. The article, “Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial”, from the official journal of the American Academy of Pediatrics, explains that by resting, the brain and body have time to try and subdue the symptoms and troubles one may have after sustaining a concussion (Thomas et al. 216). Therefore, the extended rest can ensure that the athlete does not endure more pressure or setbacks because of the excess of stimulus or concentration one may encounter with trying to still exercise or work post-concussion. Nevertheless, extensive rest, for both the body and the mind, have been found to prolong concussive symptoms due to the lack of stimulus and proper blood flow. This caused by the concussion and excessive rest, which is why it is a less optimal treatment for concussions when compared to early physical activity. The article, “Concussions: Activity Avoidance and Rest Recommendation”, references a study where 41 student-athletes and different rehabilitation methods for concussions were used to compare their effectiveness (Banks et al. 34). They found that when patients were given longer rest instead of earlier physical activity in the rehabilitation process, they were more likely to suffer prolonged symptoms of dizziness, headaches, lack of concentration, and depression. The body can normally heal itself with most injuries that it endures, but the mechanism of a concussion on the brain calls for further assistance as the irregularity in the blood flow can only be normalized through exercise. This, therefore, is why early physical activity is the most effective treatment for high school athletes recovering from a concussion.

When treating high school athletes for concussions, there is a sensitivity to the matter as medical professionals have the responsibility of caring for the still developing and fragile brain of the athlete. Considering how important it is for the whole body to function properly, it becomes vital to know how to treat a concussion most effectively. Though there may be some differing opinions regarding what the most appropriate treatment may be, early physical activity as a concussion treatment is considered to be the best option by most professionals. It is because of the wide-spread professional endorsement for physical activity that has led to its rise as the most effective treatment, not to mention the extensive research done to prove its effectiveness compared to other recovery methods. Hence, when treating a concussion in a high school athlete, the decision to implement early physical activity in the recovery phase would be the most appropriate choice in assisting the athlete back to normal at a more efficient rate.

A concussion is known in the scientific world as an alteration of neurological function or a brain injury. People have known about concussions since the early 1900’s but have not understood the severity of these brain injuries until recently. Studies have shown that a concussion is most likely not caused from just one single hit but from a culmination of the hits throughout a season. The first headgear produced to protect a persons head from a blow likely to cause a concussion was created by a man named Joseph Reeves. Joseph was in the U.S. Navy in 1893 when he wore the first ever helmet in an American football game(AntiqueFootball). He wore the helmet he made in one of the most prolific games in all of football, Army vs. Navy.

After Joseph Reeves wore his version of the football helmet, more athletes began to wear headgear for their football games. In 1939, John T. Riddell, the founder of what is now the most successful football helmet companies in the world, had an idea of replacing the flimsy and not very protective headgear with a new material(Michelle). He would use plastic on the outside of the shell and a cushiony material on the inside of the helmet to soften the blow on the athletes head. Before the helmet was even worn on the field, it was used in battle. World War II was being fought at the time of Riddell’s invention, this allowed Riddell to sell his product to the government to protect the soldier’s heads. In 1963 the first helmet that used air inflation to better fit the athletes head was made. It was called the TAK-29(Michelle). The first helmet created by Riddell to actually reduce concussion prevalence was the Riddell Revolution(Michelle). John T. Riddell started a movement in football by creating the first plastic helmet which then lead to fitted helmets which then lead to more and more advances in the protective headgear industry. These advancements would allow for researchers to collect data on the amount of force put on a players head and neck during a given hit and allow them to diagnose what exactly causes a concussion.

In a report given to congress in 1999, it says that deaths from a Traumatic Brain Injury or TBI decreased by 20% since 1980(Thurman). This was a result of the improved knowledge and technology of how to treat and respond to someone with a concussion or TBI. But the report also states that out of the 1.5 million people that sustained a TBI or concussion 50,000 people died(Thurman). In an updated report to Congress on TBI and concussions in 2018 it states, “From 2001 to 2012 the rate of sports related hospital visits increased significantly among males, particularly among those 10-14 years of age (139.9% increase) and those 15-19 years of age (119.3% increase). Among males, the largest number of hospital visits for sports- and recreation-related TBI occurred as a result of injuries while bicycling, or playing football or basketball”(Schuchat 20). This statistic shows that even though technology and methods of prevention are being used everyday and advanced, their is still no real answer to the very common TBI or concussion. In 2013, the NCAA revamped its penalty for targeting which is the use of the crown of the helmet as a weapon against another plays head(Cortez). The penalty’s new guideline includes that any player who gets penalized while receive automatic disqualification. This penalty was created to lower the amount of head to head hits during a game. A recent study showed that before the rule was in place in 2009-2010, a concussion occurred 1.64 times for every 1000 athletes(Geier). But the season the new rule was put in place in 2013-14, the study concluded that a concussion happened 2.87 times per 1000 athletes (Geier).This study shows contradicting evidence to what the NCAA thought was going to happen when they implemented the rule. This also shows that even with new rules and improving technology, there really is no solution or answer to how or why concussions happen so frequently to athletes especially in football.

Current technology that will help reduce the amount of concussions in sports and football specifically includes Baseline Testing, improved mouth guards, and the newest and safest helmet called the Vicis Zero 1. The Vicis helmet is made of layers which redistribute the forces put of the helmet rather than sending it all around a players head which is most likely the cause for a concussion(Skiver). The helmets are also sized to fit the players which allows for ultimate comfort while they are playing. The current Baseline testing tests the brains learning and memory skills and its ability to concentrate. It also test the athletes balance and concussion like symptoms. With this new technology, athletes are being put in safer environments to help them continue playing football and other sports without worrying about getting a concussion or TBI.

Works Cited

1. AntiqueFootball.com. “Who Invented the Football Helmet?” Who Invented the Football Helmet?, 2017, www.antiquefootball.com/who_invented_football_helmet.htm.
2. Cortez. “Concussion Timeline.” NCAA.org – The Official Site of the NCAA, 22 Feb. 2018, www.ncaa.org/sport-science-institute/concussion-timeline.
3. “FAQs about Baseline Testing | HEADS UP | CDC Injury Center.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 2015, www.cdc.gov/
4. Geier, Dr. David. “Knee and Ankle Injuries Increase with Targeting Rules for Concussions in College Football.” Dr. David Geier – Sports Medicine Simplified, 14 Apr. 2016, www.drdavidgeier.com/targeting-rule-concussions-injuries-college-football/.
5. Michelle. “Learning from InvENtors: John T. Riddell.” Edison Nation Blog, 14 June 2017, blog.edisonnation.com/2017/06/learning-from-inventors-john-t-riddell/.
6. Schuchat, Anne, et al. “The Management of Traumatic Brain Injury In Children.” Center for Disease Control and Prevention, 2018, www.cdc.gov/traumaticbraininjury/pdf/reportstocongress/managementoftbiinchildren/ TBI-ReporttoCongress-508.pdf.
7. Skiver, Kevin. “The Safest Helmet in Football: What’s inside the NFL’s Newest Headgear.” CBSSports.com, 22 Aug. 2017, www.cbssports.com/nfl/news/the-safest-helmet-in- football-whats-inside-the-nfls-newest-headgear/. headsup/basics/baseline_testing.html.
8. Thurman, David, et al. “Report to Congress: Traumatic Brain Injury in the United States | Concussion | Traumatic Brain Injury | CDC Injury Center.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 1999, www.cdc.gov/ traumaticbraininjury/pubs/tbi_report_to_congress.html.

Rationale

Boxing is a very physical intense sport, the risks of serious injury is very high due to the aggressive physical damage that can happen to your brain if not wearing headgear, the most common injury that occurs to the brain is concussion. Concussion is when a wave through brain tissue causes discharge of damaging chemicals, the nerve cells can shear, and Microscopic damage can affect the anatomy and function of brain cells. The effects happens at the mild end of the spectrum of traumatic brain injury. During boxing you don’t just need headgear, there is a series of safety gear (boxing gloves, mouth guard) this will allow you to concentrating on the opposite component and defeating them.

When wearing the right protective gear, you most likely reduce your risk of injury. All head gear in boxing is designed to cushion the most important areas of you head. The best boxing headgear will have thick padding surrounding the head and cheeks, leaving only open areas for the eyes, mouth and ears.

Concussion can affect you in many ways and give shows heaps of symptoms. As r these symptoms/ effects may include: Length of confusion can vary in time depending on the severity of the injury which can last a few seconds, minutes, or even hours. Nausea and headaches also play a big role in concussion because of the swelling of the brain and the release of neuro-chemicals. Mood changes occur a lot which can/may result in depression due to the dysfunction of the brain.

Background

Referenced in (providence health team , 2017) will need to sign a permission form to say you know the information about concussion because this sport is at high risk of concussion and gives them a 75% chance of getting concussion. The parents partake an important role in signing this form when the child is under the age of 18 because they also need to understand the importance of them having a high risk of concussion.

Signs of having concussion

• Headaches
• Nausea
• Confusion
• Slow thinking
• Sleep changes
• Mood changes
• Dizziness
• Repeated vomiting
• A loss of consciousness lasting longer than 30 seconds
• A headache that gets worse over time
• Changes in his or her behaviour, such as irritability
• Changes in physical coordination, such as stumbling or clumsiness
• Slurred speech or other changes in speech

Causes

Your brain has the consistency of gelatine. It’s cushioned from everyday jolts and bumps by cerebrospinal fluid inside your skull. A violent blow to your head and neck or upper body can cause your brain to slide back and forth forcefully against the inner walls of your skull. Sudden acceleration or deceleration of the head, caused by events such as a car crash or being violently shaken, also can cause brain injury. These injuries affect brain function, usually for a brief period, resulting in signs and symptoms of concussion. This type of brain injury may lead to bleeding in or around your brain, causing symptoms such as prolonged drowsiness and confusion. These symptoms may develop immediately or later. Such bleeding in your brain can be fatal. That’s why anyone who experiences a brain injury needs monitoring in the hours afterward and emergency care if symptoms worsen. (Mayo Clinic.2019). Scat five is mostly used for evaluating concussions designed for use by the physicians and licensed healthcare professionals and are analysed on athletes aged 13 years old and above. Fir the children under the age of 12 years old it is preferred that they use child scat 5 (Bjsm.bmj.com. (2017).

Evidence

In this investigation it was discovered that boxing is a highly risked sport that courses a lot of injuries and that head gear is very effective to prevent concussion.

As shown the physical relationships to investigate the claim is:

Jeff horn is a professional boxer, he doesn’t wear head gear, he weighs 63 kg and is 1.75 metres tall along with him being in the light-welterweight bracket category.

Conclusion

The evidence above does support the claim, this is because wearing head gear does help with getting concussion, but the problem is that the aim of this sport is to get knocked out, but the evidence above still supports the fact that headgear helps prevent that situation.

Evaluation

The reflection on the reliability of the evidence collected states that that thicker of the headgear will help prevent getting concussion throughout a round of boxing. Wearing headgear will largely impact how much longer you will stay in the round for because the aim of the sport is to get knocked out and will boosted your strength.

References

1. Price, c. (2018). Does boxing headgear prevent concussions? [Online] Quroa. Available at: https://www.quora.com/Does-boxing-headgear-prevent-concussions [Accessed 19 Aug. 2019].
2. En.wikipedia.org. (2019). Headgear (martial arts). [Online] Available at: https://en.wikipedia.org/wiki/Headgear _(martial_arts) [Accessed 20 Aug. 2019].
3. Sports.yahoo.com. (2019). Yahoo is now part of Oath. [Online] Available at: https://sports.yahoo.com/news/boxing-debate-does-wearing-headgear-000000037.html [Accessed 20 Aug. 2019].
4. Ring side. (2018). Boxing Essentials: Why Proper Headgear Matters. [Online] Available at: https://www.ringside.com/blog/boxing-essentials-why-proper-headgear-matters/ [Accessed 20 Aug. 2019].
5. Blog.providence.org. (2017). Worried about your young athlete and concussions? Advice from a boxer and a doctor. [Online] Available at: https://blog.providence.org/blog-2/worried-about-your-young-athlete-and-concussions-advice-from-a-boxer-and-a-doctor-2 [Accessed 20 Aug. 2019].
6. Mayo Clinic. (2019). Concussion – Symptoms and causes. [Online] Available at: https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594 [Accessed 22 Aug. 2019].
7. Bjsm.bmj.com. (2017). WHAT IS THE SCAT5?. [Online] Available at: https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf [Accessed 29 Aug. 2019].

Even though football players know the damage the game could bring them the still play and love the game. (Gibeaut, 2011) Especially in today’s game with how rough it can be it is very easy to injury yourself. (Gibeaut, 2011) Players are jumping, tackling, and throwing their bodies at one another with no doubts of hurting themselves and the most important part about being a football player is being and staying healthy. (Navia, 2012). One of the most frequently occurring injury in sports is the concussion. (Gibeaut, 2011) In just 2017 alone, there were 291 reported concussions the number of concussions in football in general has been rising and has been a huge talk around the world in recent years. (Gibeaut, 2011) New research is attempting to solve this problem but since it is such a common injury it is going to be very hard. (Gibeaut, 2011).

The risk of death in the NFL became big in 2009 when a study that the NFL did found that retired players were 19 times more likely to develop memory problems than any other men of similar age. (Unschooled in Hard Knocks, 2012) Over the past few years in sports concussions have been a big concern. Since some current and former athletes have suffered from this and some having career ending injuries concussions have been a focal point into today’s new research for the medical and sports communities. (Navia, 2012). In recent Studies the Sports Legacy Institute has found some athletes that have a background of head injuries and concussions have symptoms of memory loss, motor function loss, and some disorders like depression. (Navia, 2012). Because of CTE and NFL players committing suicide the NFL donated 30 million dollars the U.S. National Institutes of Health for research about sports related head injuries. (Underwood, 2013). The NFL also is doing its own study of examining 120 retired players brains and will test for brain damage. (Miller, 2009). As things went on and people kept getting injured the NFL developed and made stricter laws that when players have a concussion it is harder for them to get back to playing. (Navia, 2012).

Not only is concussion a issue in the NFL it is a big problem with all ages playing any contact sports. (Navia, 2012). An Estimated 4.5 million children play organized football in the U.S. and in the last 3 years over 400,000 concussions were reported just in high school football. (Navia, 2012). Even though so many children and athletes have suffered from concussion type injuries they still have yet to find a good solution or any solution at all. (Navia, 2012). About 144,000 people at the age of 18 or younger are treated every year in the U.S. hospitals for concussions. (Unschooled in Hard Knocks. 2012). The statistics show that by the time a student’s high school playing career is over more than 60 percent of athletes will have has a concussive injury. (Unschooled in Hard Knocks. 2012). But so many younger children that have suffered a concussion go unreported because of youth sports coach, parents and even themselves do not understand when a concussion can occur and what it is. (Faure, 2010). In recent reporting’s of concussions during high school athletics has increased a lot. (Underwood, 2016). Many schools, leagues, and even states enforced laws and protocols on concussion in youth and high school sports. (Underwood, 2016). Parents, coaches, and officials need to know and learn more about the actual hazards of concussions and how to best prevent them.(Unschooled in Hard Knocks. 2012). It is scary for players at the age of 17 or 18 whose brains are still forming because they have to potential to hurt and ruin the brain. (Faure, 2010). Doctors and health experts are worried about the effect of getting more than one concussion before the brain has a fully chance to heal. (Unschooled in Hard Knocks. 2012). The first ever law concerning concussion was passed in 2009. (Underwood, 2016). The law was named after a kid named Zackery Lystedt who was disabled at the age of 13 for the rest of his life after suffering a head injury while playing football. (Underwood, 2016).

Sports caused head injuries have gained a lot of public attention these past couple years. Will smith made movie called “Concussion” in 2015, and a settlement between the NFL and former players regarding chronic traumatic encephalopathy has been made. (Underwood, 2016)

A couple players had to give up their contracts with the team and retire because of damage to their brain due to head injuries. (Underwood, 2016). People are just starting to realize more of what the consequences of the long-term effects of a concussion can do to you. (Navia, 2012).

A concussion is an injury to the brain that results in temporary loss of brain functions. (Charleswell, Ross, Tran, & Walsh, 2015). Usually concussions are caused by a hit to the head or hard hit to the body that can slightly move and stop your brain. It can cause memory loss, depression and even personality change. (Charleswell, Ross, Tran, & Walsh, 2015). If it is not taken seriously and treated the proper way you could risk death by having a second concussion. (Charleswell, Ross, Tran, & Walsh, 2015). Concussions can happen by blows to the head or neck area, fall, car accident, or just anything active. (Charleswell, Ross, Tran, & Walsh, 2015). It does not take a big hit to cause a concussion. (Hubbard, Hodge, & Kotrotsios, 2015). There are many side effects of having a concussion and you have to treat it right. Headaches, weakness, vomiting, nausea, memory loss and much more. (Charleswell, Ross, Tran, & Walsh,2015).

Treating a concussion might be the most important of it. You have to make sure you do the right thing to treat it and everything will be ok but if you don’t then it can cause bad things for your brain health in the future. (Charleswell, Ross, Tran, & Walsh, 2015). The main treatment for a concussion is rest. You need to sleep!!! But go to a doctor and he will tell you what to do. (Hubbard, Hodge, & Kotrotsios, 2015). For athletes, many schools use special testing such SCAT2 to help detect what type of concussion it is. (Charleswell, Ross, Tran, & Walsh, 2015). A person who has had a concession in the past is at a greater risk of being diagnosed with another concussion. (Charleswell, Ross, Tran, & Walsh, 2015). In the NFL there is a rule called the Madden rule, once you diagnose a player with a concussion they have to go to the locker room and stay there for the remainder of the game. (Davies, 2014). You will need to avoid any activity that increasing symptoms like working out, sports, or any type of heavy movements. It can take roughly a week to 10 days to fully recover from a concussion. (Bartholet, 2012). Younger kid needs a longer recovery after a concussion. (Charleswell, Ross, Tran, & Walsh, 2015). Diagnosing someone is very important, you have to understand the person well. See if they look different, seem different, or see if anything looks different. (Davies, 2014).

The statistics show that there needs to be new rules put in place, even with the new ones in place. The effects showed that there isn’t enough safety and gear for the players. (Asplund, & Best, 2015). Though the stats are showing the prevention for head injuries are still getting better. (Asplund, & Best, 2015). Both the professional sports world and the amateur sports world are still lacking help in creating a solution for this problem. (Navia, 2012). Strategies to help cut down the number on concussions in the football should be a top priority for the NFL. (Asplund, & Best, 2015). It is going to take more time and a lot more research but for now we have a lot to learn. (Asplund, & Best, 2015). Remember winning might be the thing everyone wants, but your life and career comes first. (Asplund, & Best, 2015).

When considering a topic for a literature review my attention was instantly drawn to something concerning sports. Along the lines of sport, I was most interested in injury, injury prevention and rehabilitation from those injuries. Throughout my time playing sports both recreationally and in an organized setting I saw my fair share of injuries ranging from dislocations of shoulders, broken bones, and quite frequently concussions. The sports that I played were quite high impact like hockey. The concussions caught my attention and that’s what I rolled with. The idea of concussions and its relationship to sport is a topic that has a large pool of research that is only growing and will continue to grow. In sports, the conversations pertain to not only how to prevent them but also how they are received. When researching I developed the concept for this review which is the question of how concussions in high impact sports are received and the implications applied for prevention. The review is analyzing 9 articles that are concerning the topic of concussion in sport. These articles contain specific details that pertain to different aspects of the concussion discussion. The articles have been organized into three categories that are separated by the information available in each. These consist of firstly, the acquiring of the concussion in the varies high impact sports consisting of hockey, football, soccer and more. The second pool of importation is on the impacts of repeat victims and the long-term effects. The final section is the prevention of concussions through protective equipment and regulations implicated to protect the athletes.

Concussions in high impact sports

Concussions are among some of the most common injuries in athletes that play high impact sports of the likes of hockey, football, lacrosse and many more. The concussions are a result of multiple factors varying from the location of the hit, power of impact, and other physical objects in play (Delaney, Al-Kashmiri & Correa, 2014). When considering a sport like ice hockey, there are so many factors of the game that can play into a participant getting a concussion. The playing surface itself is surrounded by a rigid object in the form of the boards. Those boards act as another surface that can help to initiate a concussion. The rapid pace at which ice hockey is played doesn’t help the case of a player when it comes to concussions. As a matter of fact, the rapid pace aids the concussions being received. When the player is brought to a halt by either a rigid object such as the boards or by another player and there is contact made with the helmet of the player, there is a risk of concussion due to the rapid change in velocity that can accelerate the chances of a concussion. Along with the velocity the boards have little to no elasticity unlike when the contact is made with another human. In football, it is much of the same case. The potential for hits that or direct head contact is very high, along with the potential for hits that are unexpected or hits in which a player is blindsided. These hits are especially dangerous as the receiving player has no time to prepare for impact and brace themselves to the incoming hit.

Through analysis of multiple sources, it was evident that concussions are among one of the most common injuries but as such, they still receive very little care when compared to injuries of other magnitudes (Goodman, Gaetz & Meichenbaum, 2001). In hockey, the most common ways that concussions were acquired were through contact with the helmet of a player with either the boards or a body part or piece of equipment of another player at high velocities (Delaney, Al-Kashmiri & Correa, 2014). When looking at the other sports such as football and soccer they also have a high risk of contact about the head. This contact was seen as the lead cause of college football and soccer players (Delaney, Puni & Rouah, 2006). Along with the head contact being the most common, the temporal part of the head was also the most probable area to impacted in soccer and football through either a hit in football or a header battle in soccer (Delaney, Puni & Rouah, 2006). When looked at more specifically it was found that statistically, contact with an opponent’s head was the greatest mechanism of concussion within football players (Delaney, Puni & Rouah, 2006). In a similar fashion to hockey, football shares a rigid object that can aid in the contraction of a concussion in the form of a helmet. Although it is a piece of equipment made to protect the head it can also have a detrimental effect on the opposite fashion. The hard exterior makes a very dangerous weapon that can be used by a player to bring pain on to another player.

Repeat concussions and the long-term effects

Concussions although very detrimental to an athlete’s health usually don’t deter a dedicated participant’s commitment or passion to their sport. This dedication can cause a participant to become a victim to a repeat concussion or a reaggravated concussion in the case of a concussion that is not fully recovered from. When a first concussion is sustained it subjects the individual to future repeats. This is very prevalent in younger athletes that play high impact sports like hockey, football, soccer, and more. The way that the first concussion also plays a large role in the probability of increased risk for a repeat concussion (Murphy et al., 2016). The concussions that are sustained as a result of a blunt force to the head such as a helmet on helmet collision have the largest probability of increases risk to repeat concussion (Murphy et al., 2016). When looking at an older audience like the NFL players the trend is not very different. Similar to the children discussed above NFL players are no strangers to the risks of concussion among other very serious injuries. When looking at repeat concussion it was even found that some athletes sustained a repeat concussion as early as just two weeks after sustaining a first concussion (Casson, Viano, Powell & Pellman, 2011).

Along the lines of repeat concussion, a UK group performed intelligence evaluations on various jockeys ranging from those who had never had a concussion up to others that were repeat victims (Wall et al., 2006). It was found that in multiple tests of cognitive capability, ranging from a Stroop colour-word test to basic math, the jockeys that had suffered multiple concussions performed significantly more poorly than those that had not sustained a concussion (Wall et al., 2006). They concluded that those disposed to multiple concussions showed lower accuracy in high-level attentional functioning tests (Wall et al., 2006). Among these conclusions, it was also stated that the increase in the number of sustained concussions directly impacted the severity of the long-term effects. Along with this, multiple concussions at a younger age had a larger effect on long term outcomes of the injuries. Along with decreased cognitive performance, multiple concussions can cause an impact on one’s motor system. One of the measured aspects was the athlete’s cortical silent-period duration. This was a measure of the delay in motor response. In those that had sustained multiple concussions, it was seen that there was a significant delay resulting in a larger silent period (Beaumont, Lassonde, Leclerc & Theoret, 2007). This signifies a long-term effect that is heightened by a repeat injury.

Concussion prevention through protective equipment and regulations of the sport

When playing a high impact sport along the lines of either hockey or football it is known that there is a lot of equipment used for the safety of the participants. This equipment ranges from shin pads in hockey to what is referred to as pads in football that are meant for upper body protection all the way to the different types of helmets that are used in both sports. When talking about hockey the helmet like in football is a piece of equipment used to protect the head. When thinking about the fact that the head holds one of the most important organs in the human body it is surprising the at one point hockey of all sports was played with no helmets at all and that included the goaltenders that were having a hard puck shot at them. It wasn’t until goaltender Jacques Plante finally decided to cover his face that the league started to consider the safety of the player’s heads.

When considering the role that helmets play in preventing a concussion it is amazing to see the advancements that have been made over time. The helmets that were once made of just leather now can prevent serious injuries. The helmets in both sports hockey and football are designed to slow down the impact of the brain with the skull after a hit to the head (Daneshvar et al., 2011). This reduction in speed of impact helps to protect against axonal injury caused by such movements of the brain (Daneshvar et al., 2011). The helmets are constructed to compress on impact as to prolong the duration of the impact to reduce the speed of the movement (Daneshvar et al., 2011). The helmets have developed over time to be more protective and better at reducing the risk of concussion among sports players that participated in high impact sports

Along with the developed equipment, there are also regulations and rules in each sport that are in place to reduce the incidents of concussion. In hockey, it prohibited to attempt to lay a hit in which there is intent to injury. This includes a direct hit to the head with malicious intent and a lot of other hits that may place a player to an increased risk of injury as a result of that hit. When talking about football, a player cannot make a tackle that has one player making a direct helmet to helmet contact. Along with the rules, there are also punishments for those that disobey, and they can be quite serious as it is the safety of another that is at risk. In hockey, there is a penalty for minor infractions and can go up to suspensions for more severe instants. In football, there is more of the same in the form of flags, suspensions, and fines.

Summary

Throughout this review of literature about concussions, I was able to learn a lot. The ways that concussions can be sustained is a very large pool of information that varies from sport to sport and activity to activity. In hockey and football, it is a mechanism of high-velocity objects being brought to a halt through the impact of a rigid object or another human body in which contact is specifically being mad with the head (Delaney, Al-Kashmiri & Correa, 2014). This combination of actions is the leading cause of concussions in sport. The application of a blunt force to the head and more specifically the temporal region has the greatest probability of risk of a concussion (Delaney, Puni & Rouah, 2006). When looking at reoccurring injury those that have been previously injured are at an increased risk for reinjury (Murphy et al., 2016). Along with that younger people are also predisposed to a greater risk of reoccurring injury. The ability to reduce the risk of a concussion has been increased over time as a result of protective equipment more specifically helmet being introduced into high impact sports. The protective equipment allows for the impact to be prolonged as to reduce the speed at which the brain moves within the cranium after a significant impact (Daneshvar et al., 2011). Along with equipment, there are also rules and regulations that are implemented to protect the athletes. These rules and regulations come with punishments varying from flags and penalties to suspensions and fines. When first looking at the topic I chose a very broad field of research that pertained to the mechanisms of sustaining a concussion and how to prevent them. Through the review, I was able to widen my knowledge and understanding of the implications that concussions can have on someone. I now have developed an inquiry question that is, how can a reoccurring concussion be prevented to avoid the long term cognitive and motor effects through the improvement of protective equipment in high impact sports. This question and research done on it would allow for an improved understanding of how the mechanisms of the protective equipment impact the probability and risk factors associated with athletes previously diagnosed with a concussion.

References

1. Casson, I. R., Viano, D. C., Powell, J. W., & Pellman, E. J. (2011). Repeat concussions in the national football league. Sports Health, 3(1), 11-24.
2. Conder, R. L., & Conder, A. A. (2015). Sports-related concussions. North Carolina medical journal, 76(2), 89-95.
3. De Beaumont, L., Lassonde, M., Leclerc, S., & Théoret, H. (2007). Long-term and cumulative effects of sports concussion on motor cortex inhibition. Neurosurgery, 61(2), 329-337.
4. Delaney, J. S., Al-Kashmiri, A., & Correa, J. A. (2014). Mechanisms of injury for concussions in university football, ice hockey, and soccer. Clinical journal of sport medicine, 24(3), 233-237.
5. Delaney, J. S., Puni, V., & Rouah, F. (2006). Mechanisms of injury for concussions in university football, ice hockey, and soccer: a pilot study. Clinical Journal of Sport Medicine, 16(2), 162-165.
6. Daneshvar, D. H., Baugh, C. M., Nowinski, C. J., McKee, A. C., Stern, R. A., & Cantu, R. C. (2011). Helmets and mouth guards: the role of personal equipment in preventing sport-related concussions. Clinics in sports medicine, 30(1), 145-163.
7. Goodman, D., Gaetz, M., & Meichenbaum, D. (2001). Concussions in hockey: there is cause for concern. Medicine and science in sports and exercise, 33(12), 2004-2009.
8. Murphy, M., McCutcheon, B. A., Kerezoudis, P., Rinaldo, L., Shepherd, D. L., Maloney, P. R., … & Bydon, M. (2016). 199 multiple concussions in young athletes: identifying patients at risk for repeat injury. Neurosurgery, 63(CN_suppl_1), 178-178.
9. Wall, S. E., Williams, W. H., Cartwright-Hatton, S., Kelly, T. P., Murray, J., Murray, M., … & Turner, M. (2006). Neuropsychological dysfunction following repeat concussions in jockeys. Journal of Neurology, Neurosurgery & Psychiatry, 77(4), 518-520.

In Today’s sports, concussions have become very serious and it is most definitely a topic parents should consider. Concussions tend to get more common each year, they have rose 60% within the last decade. This is because people aren’t worried or even aware of them and may every think their harmless. Some of this may even fall back on how hard the child is being pushed to do good by the parent. If the child feels that they might disappoint their parents by telling them their hurt they might not even tell them. The arguments that will be discussed in this paper include the following, if the concussions that children get during their early lives affect them later in life, if the game should be changed to make it more safer, and if the parents need to be educated on this topic, and maybe even some more.

You may be thinking well what even is a concussion? A concussions is a traumatic blow to the head which causes the brain to move back and forth at rapid speeds hitting the inside on the skull. Sounds pretty bad right, well it is very bad. Some parents are even pulling their children from some of their most favorite sports because of these things. Especially the most contact ones like football, basketball, and soccer. Some may even be fighting the rules and regulations to get the games changed dues to this cause, but some tend to go against it saying that, that would make the game boring and nobody would want to watch. But concussions do affect many aspects of the brain and their is something that needs to be done. Young kids are the real issue hear because if they aren’t educated on what a concussion is they may not even know and continue to live their normal lives without anyone even knowings. That’s a scary thought.

Children need to be educated on what a concussion is, if they aren’t they will not tell you so it will never heal. They will continue to go to school, practice and even play in games if they don’t know they have one. The child doesn’t need to go to school and put stress on their mind, it may cause the concussion to turn very bad, and not to mention that their head would hurt very much. They will develop complications if this happens so that is why you and your child needs to be educated on what a concussion is and the measures you need to take if your child does happen to develop a concussion. If they do return without letting their brain heal completely, all it will do it make the concussion worse and for it never to be able to heal. Say a child has a concussions and continues to play the sport and continues to get hit in the head that would make it worse and worse. This is what will cause the child to develop problems in later life when their older. So this is why it is important that the child knows about the risk and the parent knows about the sign of the concussion because they are very serious.

A bad concussion can take an a emotional toll on the whole family. If you dont think this it true it is, and it also another reason you need to catch the concussion as it first develops so it doesn’t get really bad. The level of the concussion is a serious matter also, the worse the concussion the more it will affect the family. The child could be sick for days and days and be hurting so much and you can’t do anything about it, that would hurt your feelings right. Also if the concussion affects the child in later life this could very bad for the whole family. Memory problems are a very effective one and that used to be child that had a concussion is older now and can’t even remember your name. Not to mention it could affect your 6 senses and even cause them to get depression. These concussions also can double the chances of suicide in the child and in later life. So next time your not thinking about how it could affect your whole family think about that because your family can be affect by just one persons concussion that you thought was harmless.

Some have argued over the sporting rule aspects and what is changing. If the concussions these kids are getting from these rough sports are causing them problems in their future life then something ought to be done for it. I’m assuming you want your kid safe but other fans that don’t have children out their playing don’t really care, they like the roughness of the sport and say if it’s taken away it wouldn’t be any fun to watch anymore. People have also argued that if they start changing the sport it would change the “culture” of the sport also. That in which I agree but I also don’t think nothing should be done. Maybe just simply changing the age which the kids can start these rough sports.

A counter argument that was more popular a few years back but still a big deal today because nothing has been done would be the issue that concussions in a child’s early life can affect them later in life. Some people believe that the concussions kids get in their early years does not have any effect of later life issues. As of now there is no scientific evidence that can relate these concussions to later in life, although it could be associated with a particular type of degenerative disease called chronic traumatic encephalopathy.

Therefore there are many different opinions and aspects on this topic and they all tend to be different. But the one that is most certain one is that concussions are a very serious matter and should be dealt appropriately.

Introduction:

Through several decades the practice of contact sports has grown exponentially, especially the art of American football. The gridiron, tackling based competition fans watch has had its remarkable influence across the United States and has been prevalent worldwide. Though its dark side of the commonality of consequential injuries that can greatly affect a player’s body is evident, it is still beloved as that is the underlying basis of what makes the sport. Its roughness may take a heavy toll on the health of the people who play the game as they can lead to concussions, which if not treated appropriately may lead to deficiencies in the long run. Extensive experimentation to improve football gear to limit the impact of concussions would be the best fit rather than altering the rules of the game as the purity and pace of the game is maintained still as “american football”.

Social Lens:

As taking a hit in any football game is a commonality, the probability of sustaining an injury of any degree is high. What comes with being involved with the contact sport is that it is seen as a “manly” physical activity. Hitting opponents full force and to avoid them demonstrates their athletic ability and masculine prowess on the field. Eric Anderson and Edward Kian, Anderson being a sociologist and Kian having a Ph.D. in sports media respectively, state that asserting hegemonic status has always been connected to the sport and to “sacrifice their body for sporting glory” is essential to retain that status. Football’s perspective of the great amounts of strength and muscle, and willingness to participate in a violent environment puts it as the epitome of the “masculine hierarchy” (Anderson). Many perceive the risk of concussions only occurring in combat sports; since football players wear protective headgear they are cushioned from head trauma which is not the case. In the 2010 NFL season, Aaron Rodgers had suffered a “Grade 1 Head Cranial Concussion” and withdrew himself mid-game prioritizing health over masculinity (Anderson). The trend of chronic traumatic encephalopathy (CTE), which is a disease caused by repeated head injuries, has spread throughout the league has heightened consciousness of sacrificing toughness over well-being.

The increasing participation of football on multiple levels, not just professional but collegiate as well, translates to the escalating issues regarding health, specifically with CTE. Football “violates four biomedical ethical principles of nonmaleficence, beneficence, respect for autonomy, and justice” (Margolis). Lewis H. Margolis, who has an MPH in epidemiology, discusses how football breaks between benefits and risks through long term harm, absence of agreement between parent and athlete, and ethical issues present in football at the college and high school levels. Schools have attempted to establish methods to decrease the number of injuries such as the “Heads Up Football” coaching program but saw no significant decrease in head-related injuries. Greg Canty, who has an MD in sports medicine, pitched in to say that concussions have been “ignored by far too many by far too long” and the knowledge in how to treat them remains limited (Margolis). All of those who participate in the game should become more involved with the sport to ensure the safety of the players and maintain the masculine dominance on the field.

Scientific Lens:

With players evolving their physical capabilities and the sport becoming tougher to play, protective gear would need to be enhanced in order to compensate for this increased risk of injury. Helmets were designed to reduce the impact of players clashing heads with each other, as well as extra padding to soften each blow. Yet despite this great window of safety, preventative concussion measures simply cannot be reached yet. Regardless of helmet design, they all work similarly by “lengthen[ing] the duration of the impact, reverberat[ing] energy through various structures and materials’ rather than having all the force focused on one area (Wilson). Doctor Timothy Gay, a physics professor at the University of Nebraska, explains the great number of restraints that come with creating concussion-proof helmest but are ultimately possible. Evaluations of previous football helmets such as the Riddell VSR4 and the Riddell Revolution concluded evolution within newer designs with the “53.9% [concussion] reduction between the Revolution and VSR4” which is a step in the right direction but can be pursued more (Rowson).

The biggest issue of concussions is the inability to detect them effectively. On the field, any player is vulnerable to any hit, and through the accumulation of hits, they may receive a concussion but are not fully aware of the fact they do or the severity of their injury. Nothing in the gear allows a team’s medical staff to alert them of them being close to having a concussion. However, neurosurgeons and engineers to Prevent Biometrics have developed a mouthguard that can “detect potential concussion-causing impacts in real-time” (Nelson). The mouthguard is able to “measure the distance, angle, and force of a blow” which would then alert any abnormal impact that has been detected (Nelson). This breakthrough in sports science may open other possibilities to better signal symptoms to prevent any further damage to the brain.

Economic Lens:

While combat sports athletes suffer through a form of traumatic brain injury (TBI) hindering their ability to live leisurely, the costs of TBI-related issues may translate off it. Costs for treatment of any severity of brain damage vary from “$85,000 to $3 million” but there is no extensive way to measure the value as information is limited; info is limited due to estimated costs being in hospitals or emergency departments (Leibson). This makes athletes question if their masculinity is more valuable than the costs of maintaining good health. The process of diagnosing any severity of TBI is expensive and may only get more costly through “rehabilitation, long-term care, and clinical care [post-treatment]” (Graves). Frank Gifford, who was an NFL legend and analyst for the league, had suffered his share of concussions which resulted in CTE due to the build-up of hits taken during his career(Edmonds). Gifford was able to pay off his accommodations of rehab through his success of participating in the sport and earning incentives as well. However, not all families can do the same as they may not be financially stable and stress is built upon their emotions of sadness knowing a loved one is suffering from TBI. Though with the development of new concussion-detecting mouthguards being around $199-$299 and helmets like the VSR4 being about $300, the rates of concussion would decrease and the medical bills of injured athletes would reduce as a result. The focus of TBI treatment must be equally considered for all patients; regardless of socioeconomic status and financial stability.

Conclusion:

Alleviating the impact of players trading blows between each other through the current technology currently offered is an enduring challenge. Attempts to solve the overwhelming issue has been difficult considering the costs and effectiveness over long periods of time. Despite the deficiencies, implementing “new” technology into the NFL would be the best approach over rule changes or reevaluating concussion protocol as the foundation of the sport is retained rather than completing shifting the way countless fans currently perceive the American pastime.

Introduction

Concussions or mild traumatic brain injury has gain more attention in the past 10 years. The center of disease control describes a concussion as a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells. (Center of Disease Control and prevention, 2019). With this being said there is a glaring need for chiropractic to be at the forefront of concussion recovery now more than ever. With the discovery of what chiropractic is doing for the neurology of the brain it seems like matcha made in heaven in terms of treatment.

Methods

For this literature review I used the databases offered by life university which are PubMed and Index of chiropractic. When using the PudMed and Index to Chiropractic data bases the terms used for the review were concussion, post-concussion syndrome, sports, manipulation, mTBI(mild traumatic brain injury) and chiropractic. Each search was filtered by only looking at articles that were published in the last five years and were peer-reviewed. The purpose of this article was to look into the population that has experienced a concussion and seek out help outside of the gold standard of care whioch is to rest to decrease concussion symptoms. The last method used was the observation of YouTube videos on concussions. This was only used as means to find keywords that would help me find more keywords that could expand my research article search.

Results

When searching the PubMed and Index to chiropractic literature 4 articles were found to be of great use that match and yet challanged my topic. I was able to find two from each database. The first search gave me the article “Management of Mild Traumatic Brain Injury Symptoms in a 31-Year-Old Woman Using Cervical Manipulation and Acupuncture”. This article was found on PubMed Literature using the keywords mild traumatic brain and manipulation. This search gave me 22 articles. The significance of this article was due to its ability to give some step by step information on the process of treating concussions. It also was due to the fact that it brought about a new component in treating concussions alongside chiropractic.

The next article found in the PubMed database was “Sports-related concussion: evaluation, treatment and future direction”. This article was found using the keywords sports, concussion and manipulation. There were 3 articles found with this search. The significance of this study was the numerous amount of details and components that currently are apart of treating concussions.

The next two articles found come from the Index to Chiropractic Database. The first article was “Concussion management in an adolescent football player using individualized rehabilitation along with spinal manipulation”. This article was found using the keywords sports and concussion. There were 17 articles found with this search. The significance of this study was how it showcased chiropractic care as a treatment for concussions. This active treatment is different from the standard protocol which is to rest just.

The final article obtained was “Chiropractic Management of the craniocervical junction in post-concussion syndrome” This article was found in the index to chiropractic using the term post-concussion syndrome. There were 25 articles on this search. The significance of this study is how it goes into detail about the benefits of upper cervical care in patients with post-concussion syndrome.

Discussion

In the article, Management of Mild Traumatic Brain Injury Symptoms in a 31-Year-Old Woman Using Cervical Manipulation and Acupuncture, a 31-year-old woman presents to a chiropractor after a face first fall on ice and was knocked unconscious for 4 minutes. She gave a subjective complaint of neck pain, frontal and occipital headaches, nausea, vomiting, dizziness, fatigue, tinnitus and cognitive fogginess. Her exam consists of static rotational changes in the occiput, motion restriction of C3-C7 and no evidence of cranial trauma. After 3 adjustments for 2 weeks in a combination of trigger point therapy to the trapezius and suboccipital muscles, the patients pain reduced but there was still symptoms. The symptoms included nausea, dizziness, fatigue and tinnitus. This led to the doctor to comanaging the patients last 2 adjustments with another care provider leading to a better overall quality of life. “After 2 treatments combining chiropractic manipulation and acupuncture over 3 days, the patient reported neck and headache pain levels to be 0/10 NPS and a complete resolution of the physical and cognitive mTBI symptoms.” (Gergen, 2015) This article supports my hypothesis of chiropractic helping with concussions but only to a certain degree. The savior in this case seems to be the acupuncture in terms of the concussion symptoms. The hole in this research is that it does not inform the reader of why the acupuncture doctor was picked. Another limiting factor was the compatibility to other patients. “The findings of this case report may not necessarily be applicable to other patients with similar symptoms. More participants in a more distributed population are needed to test the results of these treatment methods with more objective evaluation measures.” (Gergen, 2015)

In the article, “Sports-related concussion: evaluation, treatment and future direction”, the article talks about post-concussion syndrome and where the feel medicine field is leaning in terms of activity recovery. It starts out with understanding the syndrome and the evaluation of post-concussion syndrome. One of the main points in this article was the perspective of active recovery. This includes submaximal aerobic therapy, treadmill exericses, visualization training and light coordination activity. The holes in this article are due to lack of explanation on what these activities are suppose to do for the patient. They do mention that activities is better than rest but in the same breathe doesn’t give an explanation. “Third, early evidence suggests that active rehabilitation may improve symptom recovery more than prescribed rest alone, and this calls for matching specific treatments to individual clinical profiles.” (Lydia McKeithan N. H., 2019) Chiropractic is nowhere to be found in this article and therefore did not support my hypothesis. This article supported more physical therapies.

In the article, Concussion management in an adolescent football player using individualized rehabilitation along with spinal manipulation, a 17 year old football player is treated after suffering a concussion at his high school football game. The patient symptoms presented red flags due to vomiting while concentrating on homework, increased headache, decreased left upper extremity strength. (Tiffanee McArthur, 2019). He also hard soft tissue tenderness, decrease orientation and memory. When he returned to the chiropractic office 3 days later her began care. The team had a team chiropractor who diagnosed and referred him. His care plan consisted soft tissue therapy to the all muscles of the neck and spinal manipulation. The text did not specific say which manipulation it was performing but did note cervical dysfunction. “The patient was given an individualized active exercise program and in-clinic treatment was geared at restoring both cervical and vestibular dysfunctions” (Tiffanee McArthur, 2019) They also talked about how they were adjusting him as well. The cervical dysfunction was addressed with high-velocity low-amplitude (HVLA) manipulation in the cervical and thoracic spine, and therapeutic exercises were prescribed that included various forms of vestibular rehabilitation exercises. (Tiffanee McArthur, 2019). By his 6th and final visit which was 27 days after his concussion, he was asymptomatic with no restriction with football or school. This article was supportive of my hypothesis. In fact that it gives hope that football-related concussions can be treated with chiropractic care. A larger sample size is needed for validity purposes as well as other factors like age, race, gender and number of concussions received prior to.

In the article, “Chiropractic Management of the craniocervical junction in post-concussion syndrome” 6 patients went through a 12-week trial of chiropractic care with a history of concussion. The patient rated from 39 to 82 years old. Before they started care they tested to ensure they had upper cervical subluxations via posture scan, leg checks, bilateral weight scale and spinal palpation. Once confirm they had patients do head, neck and concussion survey to obtain a baseline of where they were. They also talked about the type adjustment which is specific to C1. “The NUCCA adjustment consists of placing the patient in side posture on the NUCCA adjusting table with the head specifically braced using a mastoid support system, and a specific force was directed into the transverse process of the Atlas.” (James Moore, 2019). With the doctor care plan and patient compliance doctors saw a significant decrease in sign and symptoms post-concussion syndrome. In this case series of 6 post-concussion patients, there were improvements in many of the measures assessed after the NUCCA intervention. This is suggesting that trauma significant enough to cause post-concussion syndrome can also influence cervical spine function. (James Moore, 2019). This article does support my hypothesis of chiropractic care being an active source of treatment for concussions. The one thing that I didn’t find was would make this better would be a diversity in age, occupation and a larger sample size.

Conclusion

The centers for disease control (CDC) estimate that 1.6 to 3.8 million sports-related traumatic brain injuries (TBI) occur every year . This is widely regarded as an underestimation, as many people suffering from mild TBI (mTBI) do not seek medical attention. (Lydia McKeithan, 2019). With this being said it is fair to say that there are a lot of individuals with concussion-like symptoms. This includes but is not limited to disorientation, dizziness, nausea, vomiting, fatigue and neck pain. These symptoms are often times found at the onset of impact but if not, it causes issues for professionals to diagnose a cause linked to the symptoms. Better educating patients, as well as more referrals to chiropractors, is one more step to leading patients to getting better quality of care for post-concussion patients everywhere. Also putting chiropractors in the places where concussions are most common like all sports.

The majority of the articles had a substantial amount of information supporting that chiropractic care does in fact help with patients suffering from concussions. One of the major agreed points on each of the articles was that upper cervical chiropractic care give us the best results. One major difference is the route of how they diagnose concussion and they way they plan to fix them whether it be chiropractic or physical rehab. Though each article was detailed and good for the most part each one should increase their testing sample size for data validity. Another thing would be to talk more about the significance of atlas and its relationship with the brainstem. Overall this topic is one that should become addressed in the medical community. While rest is the norm with concussions, active treatment should become talked about once the patient is stable. In my practice, I will definitely love to see this type of patient and will always be aware of the occiput, atlas and axis junction first.