Every year, between 3 million and 4 million Americans suffer concussions in sports and recreation. Head impacts and concussions caused by contact sports are a quickly growing epidemic among young athletes. According to the Centers for Disease Control and Prevention, between 2001 and 2009 nearly 175,000 patients under age 19 were treated annually in hospital emergency rooms for concussions related to sports and recreation activities. (For more additional data and resources about concussions, please visit: http://www.cdc.gov/headsup/)
Concussions are mild traumatic brain injuries (TBI) caused by a sudden bump, blow or jolt to the head that disrupts normal function of the brain, according to the CDC. Whiplash and violent head movements without impact may also result in concussion. In addition to sports and activities, other leading causes of TBI and concussions are car and bicycle accidents, work-related injuries, falls and fighting.
Some concussions can cause serious and permanent damage, especially when the patient has suffered a previous head injury or multiple concussions. Cumulative concussions have been shown to increase the likelihood of permanent neurologic disability by an astounding 39 percent, according to CDC statistics.
St. Luke’s concussion specialist Maheep P. Vikram, MD, says factors that indicate long-term complications include the following:
- Age of patient
- Very young have developing brains.
- Older may have pre-existing health conditions.
- Pre-existing neurological or psychological disease
- Frequency of concussion (the time between concussions or impacts)
- History of prolonged concussion recovery in the past
- Intensity of initial injury
“An evaluation and concussion test should be performed at the first impact, whether that impact is on a playing field, car accident or fall. Recent research indicates that there could be a link with long-term neuro-degenerative changes like Chronic Traumatic Encephalopathy (CTE) from repetitive concussions,” said Dr. Vikram.
CTE is the condition Dr. Bennett Omalu, a forensic pathologist, discovered and researched following the suicide of Mike Webster, a professional football player for the Pittsburgh Steelers. The movie Concussion starring Will Smith as Dr. Omalu tells the story about Dr. Omalu’s discovery.
Dr. Vikram said that the research done by Dr. Omalu with autopsy patients was mirrored by a study at UCLA with live patients using PET scans finding traceable dye in the same cluster areas of the brain.
“Concussions can happen in any position and in any sport, both contact and non-contact,” said Dr. Vikram. “While helmets reduce the intensity of contact and may reduce the impact of head injury, helmets do not fully protect the brain from concussion.”
Dr. Vikram stresses that honest and prompt reporting of an impact or suspected injury is imperative for successful treatment of concussion. The first 10 days post-concussion are crucial for two key reasons: first, the concussive person is more prone to re-injury then, and secondly, the next injury will have an increased potential to cause severe complications. In fact, “second impact syndrome” may cause swelling in the brain and, in some cases, may lead to death.
Concussions are different for each person, according to Dr. Vikram, and as such, each patient would require an individual assessment and recovery plan for each injury.
The recommended evaluation and treatment include minimal screen time with phones, televisions and computers, and the avoidance of bright, busy environments for at least the first 48- 72 after the injury.
“Prolonged withdrawal from school or work beyond two or three days is not always necessary for concussion recovery,” said Dr. Vikram. “Keeping life as normal as possible as the patient can handle based on his or her symptoms is the best way to keep patients on track.”
Monitoring concussion recovery is very important, added Dr. Vikram, because some symptoms may persist beyond the average two-to-three week recovery. When this occurs, an experienced team is consulted to treat the “post concussive syndrome.”
While doctors and researchers do not necessarily agree on what actually happens in the brain during a concussion, most believe that the brain chemistry is altered. For some, this lasts a few days or a few weeks, while other patients may notice a new onset of migraines, new onset of depression or worsening of depressive symptoms or the onset of ADHD. Dr. Vikram noted that concussion not only affects the inter-neuronal connections in the brain, but also may involve brain-neck junction and inner ear / eye motion disturbances.
Dr. Vikram offers encouragement to patients suffering from prolonged concussive symptoms and said that with the right team of vestibular and occupational therapists, primary care sports medicine physicians, neuropsychologists, psychologists, athletic trainers and neurologists, treatment is very successful with a proactive approach to monitoring of symptoms for however long recovery happens to be.
“Proactive monitoring and working with each patient individually to return to normal life as symptoms allow is the goal of St. Luke’s Concussion Management program,” concluded Dr. Vikram.