Concussions in Athletes
Patrick Austin
DeVry University

Concussions in Athletes Junior Seau, a favorite player of many professional football fans, committed suicide in 2012. Although Seau seemed to have everything going his way, he quietly suffered from depression, one of the many symptoms of repeated concussions Those close to Seau knew something was not right the man they all knew and loved. Some of them just chalked it up to him adjusting to life after football. Many players go through an adjustment period after stepping down from a glorious career in the limelight. However, this was not the case with Seau. He was suffering from chronic traumatic encephalopathy, CTE. What is unique about Seau’s suicide is he shot himself in the chest. The common belief is he did this to preserve his brain for scientist to study how it was affected by suffering many concussions during his 20 year football career. And, eight months after his death, the scientists who examined his brain announced they had found evidence of CTE (chronic traumatic encephalopathy), a dire neurological disease linked to concussions, which has been a factor in the deaths of many other NFL players (Penn, 2013). The fact that a player would kill himself because he was suffering from symptoms of repeated concussions speaks to the importance of properly diagnosing and treating head injuries. Other players have suffered from the symptoms of brain trauma. Some, like Dave Dureson, have even taken their own lives. These two incidents are on the extreme end of the spectrum what can happen to an athlete that has suffered multiple concussions and may not have received proper treatment. However, these two incidents bring to light the need for a clinically trained neurologist to lead a medical/training staff who is responsible for the diagnoses and treatment of athletes who have been concusses. And, this staff has the final say on when it is safe for the athlete to return to the field. Sports, especially professional football, is a big part of the American culture. Americans enjoy watching these massive athletes compete regardless of the potential harm they are exposes to by participating in such a violent sport. However, the safety of these players should not be taken lightly. We have seen the devastating results of concussions.
As a fan, I feel it is imperative that every precaution is taken to ensure that the athletes who compete for our entertainment is provided the best medical attention out there.

Problem Analysis

Concussion has a long and interesting history spanning at least the 5 millennia of written medical record and closely mirrors the development of surgery and neurosurgery. Not surprisingly, much of the past and present experimental head injury and concussion work has been performed within neurosurgically driven laboratories or by several surgically oriented neurologists (James L Stone, 2014). The issue is how does a team’s medical staff take these laboratory findings and apply them to help make real-time, real-live decisions. In today’s multimillion dollar sports industry, there is need for the ability to properly diagnose and treat concussed athletes. Properly diagnosing a concussion is undoubtedly the single most important step in keeping a player safe. The problem is every athlete is different in how they are affected by an injury. Some bounce back quicker than others. And, some athletes have a higher pain threshold. The difference between other injuries and concussions is the ability to bounce back and tolerate pain should not be taken into consideration when it comes to treating the players. Brain function and an athlete’s responses to certain cognitive test must be employed by a trained physician to help determine the player’s ability to return to normal activities. One of the most important aspects of concussion management is determining when it is safe to return to play (Roya Saffary, 2011). This determination should be made after the athlete has gone through an intense protocol established by a neurologist. Another aspect to concussion management is preventing the athlete from being exposed to multiple concussions. Suffering a second concussion before fully recovering from the first injury can be very problematic for the athlete. Long term effects of multiple concussions are currently being studied by researchers around the globe. Not only can multiple traumatic incidents contribute to the development of mild cognitive impairments (MCI's), chronic traumatic encephalopathy (CTE), and other adverse outcomes, but a storied concussion history can also cause post-concussion syndrome (PCS) (Sports Concussion Institute, 2015). It is imperative that a person fully recover from one concussion before risking a subsequent one. Failing to do so adequately can lead to additional neurologic damage.
Solution

In recent years, concussion has received significant media attention as high-profile athletes have come forward to share their experiences and long-term struggles with this specific type of traumatic brain injury. Concussions are not your run of the mill injury because it can effect an athlete long after their playing days. For this reason, it is imperative that teams make sure that head injuries are properly diagnosed and treated. To do this, a neurologist should be employed by all teams. According to the National Academy of Neuropsychology, clinical neuropsychologists use specialized knowledge in brain behavior relations in the ‘‘assessment, diagnosis, treatment, and/or rehabilitation of patients across the lifespan with neurological, medical, neurodevelopmental and psychiatric conditions, as well as other cognitive and learning disorders. The clinical neuropsychologist uses psychological, neurological, cognitive, behavioral, and physiological principles, techniques and tests to evaluate patients’ neurocognitive, behavioral, and emotional strengths and weaknesses and their relationship to normal and abnormal central nervous system functioning.’’ (R J Echemendia, 2009). This specialized training is precisely why a team needs a neurologist on its medical staff.
Concussions are not new to the world of contact sports. In the past, it was called getting your bell rung or suffering a stinger. The truth is concussions are a complex pathophysiological process affecting the brain induced by traumatic biomechanical forces (Roya Saffary, 2011). A concussion needs to be handled by the most qualified physician available. And, a formal procedure needs to be in place to diagnose and treat an athlete who suffered from an obvious head injury. This will help to prevent compounding the injury by suffering a second concussion. Concussions that are unrecognized or are mismanaged put athletes at considerable risk of potentially catastrophic sequelae from re-injury. Repetitive head trauma from participation in contact sports such as boxing, football and ice hockey can lead to a permanent decrease in brain function, including: * Memory loss * Early Alzheimer's disease * Movement disorders such as parkinsonism * Emotional disturbances
(Mayo Clinic, 2015). The potential risk an athlete faces from mismanaged concussions is yet another reason teams should have a neurologist on their staff.
Benefits
Neuropsychologists have directed their attention to defining and grading concussions as well as to understanding the neurometabolic changes associated with concussions. In the area of clinical neuropsychology, advancements have been made in terms of concussion assessment and diagnosis, as well as concussion management, rehabilitation, and return-to-play decisions. Accordingly, neuropsychologists have become an integral part of the sports-medicine team involved in the care and the study of athletes with sports-related concussions (Prosje, Leary, Zillmer, & Tinker, 2005). Baseline neuropsychological testing is a technical procedure that can be conducted by technicians under the supervision/guidance of a neuropsychologist. Post-injury assessment requires advanced neuropsychological expertise that is best provided by a clinical neuropsychologist (R J Echemendia, 2009). The benefits of having a neuropsychologist on hand cannot be overstated. It takes a person with the training required to become specialist in brain functionality. The neuropsychologist should lead a training/medical staff that has the final word on when an athlete is allowed to return to play after suffering a concussion. Once an athlete is asymptomatic and has normal neuropsychological measures, he or she can begin a functional return-to-play process. This process involves gradually increasing cognitive and physical challenges in a systematic, stepwise fashion, over the course of about five days. If the athlete has symptoms at any time, he or she rests again until the symptoms stop. Then the athlete can resume the protocol on the level at which he or she was symptom-free (Mayo Clinic, 2015).
Conclusion

The Centers for Disease Control and Prevention estimate that approximately 1.6 million to 3.8 million sports-related concussions occur annually in the United States, although the true incidence is probably much higher. Under-reporting may be due to the fact that athletes, coaches, trainers, family and even some health care professionals are unaware of the symptoms and treatment options for concussion (Mayo Clinic, 2015). In order to reduce the problem of under-re porting and properly treating those who has suffered a concussion, I implore you to hire someone who specializes in the science neurology. By doing so, you are giving the player a better chance of walking away from a violent sport with normal brain function.

References

James L Stone, V. P. (2014, October). The History of Neurosurgical Treatment of Sports Concussion. Neurosurgery, 75, s3-s23. Retrieved June 19, 2015, from http://journals.lww.com/neurosurgery/Fulltext/2014/10001/The_History_of_Neurosurgical_Treatment_of_Sports.2.aspx
Mayo Clinic. (2015, June 07). Retrieved from http://www.mayoclinic.org/medical-professionals/clinical-updates/general-medical/diagnosing-treating-sports-related-concussion
Penn, N. (2013, September 01). GQ.com. Retrieved June 19, 2015, from http://www.gq.com/entertainment/sports/201309/junior-seau-nfl-death-concussions-brain-injury
Prosje, M. A., Leary, M. W., Zillmer, E. A., & Tinker, J. (2005, December 1). BOOK REVIEWS. Applied Neuropsychology, 12, 232-235. doi:10.1207/s15324826an1204_8
R J Echemendia, S. H. (2009). Who should conduct and interpret the neuropsychological assessment in sports-related concussions. British Journal of Sports Medicine, i32-i35.
Roya Saffary, L. S. (2011). Sports Medicine: Concussions in Sports. American Journal of Lifestyle Medicine, 1-8. Retrieved June 07, 2015, from http://www.researchgate.net/profile/Lawrence_Chin/publication/241643227_Sports_Medicine_Concussions_in_Sports/links/02e7e52ce13aa96250000000.pdf
Sports Concussion Institute. (2015, June 20). Retrieved from http://www.concussiontreatment.com/concussionfacts.html#sfaq8