Brain Concussions in Sports: What's the Fuss?

If you're having difficulty understanding what a brain concussion is, and how your son or daughter's head-injury affects their further participation in sports, then you're in good company. The nature and effects of concussions are still poorly understood by many athletes, parents, coaches, news reporters and, to a certain extent, even the medical community. But because the brain is a treasured organone that athletes should want to keep in good working order for the rest of their livesa good understanding of concussions is crucial.

Neurologists and neurosurgeons cringe when they hear sports-reporters make comments like, "Johnny had a CAT scan and it showed that he didn't have a concussion." The truth is that CAT scans don't show concussions. They do show other serious consequences of head injuries, like bleeding within the brain, or hemorrhages that compress the brain. But concussionswhile no less realare invisible to brain-imaging tests like CAT scans and MRIs.

So what is a concussion? If a blow to the head caused unconsciousness, a concussion occurred. Most people know this. But a concussion can occur even when there is no loss of consciousness. Other symptoms after a head-injury indicating a concussion include:

1. impaired attention, e.g. vacant stare, slowness to respond, easy distractibility
2. slurred speech, or speech that doesn't make sense
3. clumsiness or unsteadiness
4. disorientation, e.g. walking in the wrong direction, forgetting the day of the week
5. excessive emotional reaction, e.g. easy tears, overly upset
6. memory impairment, e.g. asking same question repeatedly, can't memorize new facts

Other symptoms can develop hours or even weeks after the injury, including headache, dizziness, poor concentration, irritability, impaired memory, fatigue, disrupted sleep, anxiety, depression, and a lack of good judgment or insight.

You'll notice that all these symptoms share a common featurean alteration in brain function. The normal brain processes, which depend on proper signaling among the brain's 20 billion brain cells, are out of whack.

There can also be physical damage to the brain's cells. Because brain-cells are so tiny, brain scans don't detect them. Injuries causing more severe concussions can tear apart the cells' axons (the long filaments that carry coded messages over long distances within the brain). As you can imagine, these rips in the very fabric of the brain can cause lasting impairments in brain function or require long periods of time for recovery.

One certainty about sports-related concussions is that they are very frequent. The Centers for Disease Control estimates there are at least 300,000 of them in the U.S. per year and they comprise about 20% of all head injuries. Research also indicates that the brains of high school athletes are more vulnerable to concussion than those of older athletes, and require longer periods of time to fully recover.

Individuals who have had one concussion are at greater risk for another. For example, in one study of high school and college football players, concussions occurred about six times more frequently in student-athletes who had experienced prior concussions than in those who had not. Moreover, repeated concussions can have more severe outcomes than first concussions.

A rare but particularly scary phenomenon has been called the "second impact syndrome" in which a second concussion occurring within days or weeks of an earlier concussion can produce catastrophic consequencesincluding deathway out of proportion to the apparent severity of the re-injury.

Because of the potentially serious consequences, athletes, coaching staffs and parents need to have a heightened awareness of head-injuries and their need for proper evaluation, including by medical personnel. Various guidelines have been created for decisions about when it is safe to resume participation in contact sports. These guidelines, while based more on expert opinion than on medical evidence, are still the best benchmarks we have until more studies are done.

All guidelines agree that an athlete needs to become symptom-free in all areasthinking, memory, emotions, coordination, balance, etc.before resuming play. After a first concussion, the athlete should have been normal for at least a week, and after a second concussion, for probably two weeks.

When should an athlete hang up his or her cleats and retire from the sport? How many concussions are too many? No one has a definite answer to either question. As Clint Eastwood's "Dirty Harry" might ask, "Are you feeling lucky?" Three concussions in the same seasonor even in an entire sports careershould certainly raise concern about long-term damage to the brain.

Of course, student-athletes often pressure their parents to allow them to return to play sooner than might be wise. In these circumstances it is useful to recall that many professional athletes in football, hockey, boxing and other sports have retired from their lucrative careers rather than suffer additional concussions. If these high-profile individuals were willing to give up their big paydays in order to protect their brains, then perhaps your son or daughter will be able to follow their examples when less money is at stake. However, if you are the parent and are being pressured to allow an early return to play, you just might have to stand tall, do the right thing, and say no.

For more information about traumatic brain injury see the websites of The Brain Matters and The Brain Injury Association of America.

(C) 2005 by Gary Cordingley

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Some More Random Musings and Observations on Life

Constant affirmation without accountability is a sure-fire way to cripple a child. In other words, belief in yourself without responsibility leads to a sense of entitlement.

Raise your hand if you've ever been rejected for anything, anytime, anywhere. We all have. How would you like to have a nice little four-letter word for the next time you're rejected? It's: NEXT. Next sale, next job, next date, next whatever.

Beware of people who use their own emotional pain as a tool to manipulate others instead of as a motivation to change themselves.

Parents of teens need to watch out for NMK Syndrome: Not My Kid, as in "my kid couldn't have done ___" (fill in the blank). Well, yes, they could have. Even if you have faithfully raised them not to do certain things, kids still have the power of choice, which means they can make bad choices. NMK Syndrome can blind you to something that needs immediate attention. Trust in your kids and in your parenting, and always check out what you hear.

When you receive a notice in your credit card statement that says, "Congratulations, because of your excellent payment history, there is no minimum fee due this month," it's not a time for celebration. You're still being charged interest. These people are not your friends.

It's a humbling and sobering experience to have a child who wants to be like you.

I've noticed more and more people doing what I call "caboose living."

Picture a three-car train. The engine in front we'll call facts/reality; the car in the middle is our thoughts, beliefs, decisions, choices and behaviors based on the facts; the caboose is our feelings. The facts/reality come first, then thoughts and behaviors followed by feelings.

Many folks try to run their life train with the caboose (feelings) in the lead. Feelings are interesting and important, but they cannot drive the train. Pay attention to your feelings, but let the facts/reality drive the train.

A successful marriage requires selective and strategic ignoring. The right things to ignore are little habits and irritating peculiarities that we all have. The problem comes when you select the wrong things to ignore.

I wonder if it's a bad thing to believe that football on TV is one of the first sounds of fall approaching.

Most folks live with the illusion that worrying about something can actually make a difference. The only possible way that worrying can make a difference is if the worrying motivates you to take action to do something about the subject of your worry.

People often say, "Well, I'm just going with the flow." The problem with going with the flow is that many times the flow is lost and does not know where it is going.

Best quote I've seen since last time, by Miami Herald columnist Leonard Pitts: "At some point, though, a problem ought to be defined less by our ability to explain why it happens than by our willingness to demand that it happen no more."

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