Concussions - How Many Concussions Are Too Many - Essay Example

Running head: Concussions Concussions: How many concussions are too many? Debilitating multiple concussions are life threatening and we are only now starting to learn how dangerous concussions would be as far as the life of a sports person is concerned. Due to the increased media attention, concussions have been taken seriously by trainers, doctors, coaches and athletes at present and finally concussions acquired the respect it deserve. How many concussions are too many for a sports person? Does even one concussion leave lasting affects on athletes? What are the effects multiple concussions have on athletes? Do parents, coaches and athletes deliberately ignore the seriousness of concussions because of our “win at all cost” attitudes? Are athletes and coaches not properly informed to deal with concussions, as far as their symptoms, how to manage and identify them, and when is it safe to return to the game etc are concerned? This paper briefly analyses concussions and tries to find answers to all the questions mentioned above. Introduction “Concussion is a form of head injury that occurs immediately after a blunt force strikes the head causing the brain to move within the confines of the skull. The Latin word ‘‘concussus,’’ from which the word concussion is derived, means to shake violently” (Cobb & Battin, 2004, p.262). “Sixty-one percent of British Columbia Hockey League (BCHL) players surveyed had already experienced at least one concussion. Concussion is defined as a loss of consciousness for less than 30 minutes, post-traumatic amnesia lasting less than 24 hours” (Kent, 1999). “The study, conducted by University of North Carolina at Chapel Hill researchers and colleagues, found that retired National Football League players faced a 37 percent higher risk of Alzheimer’s than other U. S. males of the same age. When considering prevalence of previous concussions, 1,513, or 60.8 percent, of the retired players reported having sustained at least one concussion during their professional playing career, and 597, or 24 percent, reported sustaining three or more concussions. Among retired players who sustained a concussion during their professional careers, more than half reported experiencing loss of consciousness or memory loss from at least one of their concussions (ScienceDaily, Oct. 11, 2005). Concussion is a common injury suffered by the athletes and sports personalities. Players of games like, Football, Hockey, Rugby, Cricket, Boxing etc are more volatile to concussion problems. It is not necessary that a person experience the effect of concussion immediately after he suffered it. Concussions can cause severe life threatening problems in the future life of the sports personalities. Dementia and Alzheimer’s like health problems are associated with the future life of sports personalities because of concussion. Former world heavy weight boxing champion Mohammad Ali is one of the recent examples for sports personalities who are suffering because of concussion. Of the retirees surveyed in a study, who sustained at least one concussion, 266, or 17.6 percent, reported that they perceived the injury to have had a permanent effect on their thinking and memory skills as they have gotten older (ScienceDaily Oct. 11, 2005) Characteristics of Concussion “Concussion may be caused by a direct blow to the head, face, neck, or elsewhere on the body with an "impulsive" force transmitted to the head, Concussion typically results in the rapid onset of short lived impairment of neurological function that resolves spontaneously, Concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury” (Aubry et al, 2002) (Phillips, 2007) The immediate outcome of concussion might not be severe considering the future problems. The person who suffered concussion might become unconscious for few minutes and would regain his normal state after that. No visible changes would be associated with his behaviors thereafter and people might not take it seriously because of that. Some people may experience post-concussive syndrome which may last even up to six months. These problems might be physical as well as psychological. These syndromes are actually the result from microscopic shearing type lesions in the brain tissue (Cobb & Battin, 2004, p.263). “A high prevalence of single and multiple concussions exists in children between the age of 5 and 18 years. These injuries can have more severe biological and neuropsychological consequences in their immature brain than in adults” (Ives, et al, 2007, p.437). Compared to adults, children are more volatile to the concussion problems. Children even from their small ages may experience severe visible and invisible head injuries because of their childish activities. They don’t know much about the consequences and would engage in dangerous activities and will suffer severe blows to the head which they might not reveal to their parents. Such head blows can create severe problems in their future life. It is difficult for the doctors to diagnose such problems because of lack of evidences to arrive at conclusions. Up to two thirds of players had the mistaken impression that a player does not have to lose consciousness to have suffered a concussion. A quarter of adults and up to half of children could not identify any symptoms of a concussion or could name only one symptom of a concussion. About one-half of players and a fifth of adults mistakenly believed concussions are treated with medication or physical therapy. About a quarter of all players did not know if an athlete experiencing symptoms of a concussion should continue playing (ScienceDaily, June 1, 2009) Concussion: Signs and Symptoms Confusion, Lethargy, Vacant staring, Disorientation, Slowed reaction time, Slurred speech, Imbalance/incoordination, Weakness, Memory loss/amnesia, Mood swings, Blurred vision, Headache, Dizziness, Nausea/vomiting, Loss of consciousness etc are some of the signs and symptoms of concussion (Phillips,2007). These symptoms are associated with many other diseases and hence the person suffering from concussion might not realize that he is a victim of concussion. For example, confusion, mood change, headaches, disorientation like symptoms can be associated with even common and normal persons. The sports persons who have got concussion problems might not aware of the exact situation of the game they are playing. For example, a football player who got severe blow on head might not aware of the status of the game while he was playing. He may not aware of how much time left for the play to complete, what the present score is etc. He may not even realize who was at the opposite end and the importance of the game he was playing. If the concussion was severe the person may show visible physical signs such as; Loss of consciousness/impaired conscious state, Poor coordination or balance, Concussive convulsion/impact seizure, Gait unsteadiness/loss of balance, Slow to answer questions or follow directions, Easily distracted, poor concentration, Displaying unusual or inappropriate emotions, such as laughing or crying, Nausea/vomiting, Vacant stare/glassy eyed, Slurred speech, Personality changes, Inappropriate playing behaviour—for example, running in the wrong direction, Appreciably decreased playing ability etc (Aubry et al, 2002) Post-concussive symptoms can be divided into three groups: somatic, cognitive, and emotional. Somatic symptoms like headaches and fatigue generally resolve themselves quickly. However, cognitive symptoms like trouble paying attention and forgetfulness may persist longer (ScienceDaily, Mar. 4, 2009). Compared to somatic symptoms, the emotional and cognitive symptoms would be more dangerous. These symptoms may have a lifelong effect. For example, loss of memory or dementia is a cognitive symptom which may prolong in the life of the person who suffered concussion. It is difficult to regain the memory of such people using medicines. Emotional symptoms may include unexpected behavior from the patient. Sometimes the patient may even become violent at unexpected instances. For example, we have already witnessed former world heavy weight boxing champion Mike Tyson bite the ear of his opponent, probably because of the concussion he suffered from his opponent. In other words normal behaviors may decreases and abnormal behaviors may increase as a result of concussion. How many concussions are too many for a sports person? It is difficult to predict how many concussions are too many for a person. It depends on the severity of the blow or the injury sustained due to concussions. If the concussion was severe, even a single incident may result in lifelong problems and even loss of life. Even though it is difficult to predict the exact effects of a head blow or injury, one thing is sure that the synergist effect of two or more concussive blows adds up to more than the sum of the respective concussions (Webbe & Barth, 2003). Moreover, repeated brain injuries occurring over an extended period (i.e., months or years) can result in cumulative neurological and cognitive deficits, but multiple brain injuries occurring within a short period of recovery from an initial injury(Cobb & Battin, 2004, p.264). There is no point in counting the number of head blows to decide whether a sports person has reached his optimum capacity or not as far as concussion is concerned. Neurocognitive and neurobehavioural consequences of 2 concussions did not appear to be significantly different from those of one concussion (Macciocchi et al, 2001, p.303). But it doesn’t mean that each sports person can accommodate at least two concussions. The above study was also not conclusive because of the limitation in the collection and interpretation of the data. At the same time another study shows that repeated mild brain injuries in youth and adults occurring over months or years can result in cumulative deficits. High school athletes with a history of 3 concussions are 9 times more likely than those with no history of concussion to have changes in their mental status. (Marchie & Cusimano, n.d). Moreover, at approximately 2 days post-injury, athletes with multiple concussions scored significantly lower on memory testing than athletes with a single concussion. (Iverson, et al, 2004) More and more professional athletes have been forced to retire before the end of their career because of repeated concussions. In the past, probably many more should have been retired; but refused to do so because of their unawareness about the negative impact, accumulative concussions had on them. Mike Tyson and Mohammad Ali like boxing champions prolonged their careers as much as possible even though they suffered multiple concussions. Mohammad Ali is one of the living examples of concussion at present. Prevention of concussion ‘Prevention is better than cure’. The above slogan is true in the case of concussion also. It is better to avoid or stay away from sports activities which may lead to head injuries. Otherwise protective equipments must be worn always while playing games. For example, cricket and baseball are some games in which a bowler bowls a ball directly at the batsman. If the batsman was unable to hit the ball, it may strike the batsman on the head. If the batsman was without a helmet, such a blow can cause severe damages to head and serious concussion may results. Some people may think that the excessive wearing of protective equipments may damage the thrill of the game. At the same time sports personalities should realize that thrill of the game is temporary whereas the outcomes of concussion would be permanent and lifelong. It is better for the sports personalities who are less skilled in avoiding concussions to continue their career in sports. Moreover maximum possible protective equipments must be used while playing dangerous games. In the case of a head collision, even if the person doesn’t feel anything unusual, he should undergo medical check up and probably an MRI scanning. If anything found wrong in the brain or head, such people should better finish their career in sports in order to avoid the multiple threats of the possible multiple concussions. Treatment of concussions Based on the severity of impact, concussion can be classified into two groups; grade 1 grade 2 and grade 3. Grade 1 concussion is usually less fearful whereas grade 2 would be more severe and grade 3 would be the most threatening of the concussions. Grade 1 concussion usually needs some rest and observation and the sports person can return to the ground after that on the same day, probably in the same match itself. If the person suffers a second blow immediately after the first one, he definitely need to stop his activities and should seek the advice of the doctor or the trainer. Only after getting the green signal form the doctor, the person should return to the ground. In the case of grade 2 concussion, the person should discontinue his activities for the day and should be under the observation of a trained professional or doctor for a prolonged period determined by the doctor. If the problem persists, he should undergo either a CT or an MRI scan to determine the damage done by concussion. Minimum two weeks rest and treatment required for grade 2 concussions. In grade 3 concussions, the person usually loses his consciousness because of the severity of the impact. He should be immediately attended by a trained professional at the spot itself to make his life safe first. He should be immediately hospitalized for further treatment and in most cases, it is better for that person to avoid further sports activities to avoid future consequences. Neuro- medicines and sometimes neuro- surgeries would be needed to save the life of the person who suffered grade 3 concussions. Blood clotting at the brain is one of the common problems associated with grade 3 concussion which needs immediate surgery. Conclusions Concussion is a severe head injury which can affect a person’s life throughout his life span. There are no conclusive evidences for a person’s ability or capacity in withstanding multiple concussions. At the same time, studies have proved that multiple concussions may have added effect on the person’s life. Concussions may affect a person physically, mentally and emotionally. Dementia, Alzheimer’s are some of the major cognitive problems associated with concussions whereas in some cases the person who suffers head blow may even loose his life. Headaches, body paralysis are some of the physical problems associated with concussions. Violent behaviour is an emotional problem associated with concussion. Most of the symptoms associated with concussion are common to other diseases or physical problems which make the diagnosis of concussions extremely difficult. Concussions are severe injuries which can damage the whole life of a person if not attended properly. Based on the severity of impact and damage, concussions can be classified into three groups, grade1, grade2 and grade 3 with grade 1 less frightening and grade 3 most fearful. Grade 3 concussion can even take the life of the person who suffered from it whereas grade 2 can cause severe lifelong problems. We had insufficient information about how to evaluate a concussion or what steps should be taken before an athlete returns to play after concussion. Because of this, too many athletes return to play; some out of ignorance, others out of denial, only to face the long term effects of multiple concussions. It is imperative that the world of sports understand the importance of this topic and take the responsibility to implement prevention and treatment for concussions References 1. Aubry M, Cantu R,, Dvorak J, Graf-Baumann T, Johnston K, Kelly J, Lovell M, McCrory P, Meeuwisse W & Schamasch P(2002), LEADER, Concussion in sport, British Journal of Sports Medicine 2002;36:6-7; doi:10.1136/bjsm.36.1.6 Copyright © 2002 BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. 2. Cobb Sarah, and BattinBarbara, Second-Impact Syndrome, The Journal of School Nursing, Retrieved on 19 November 2009 from http://jsn.sagepub.com/cgi/content/abstract/20/5/262 3. Iverson GL, Gaetz M, Lovell MR & Collins MW (2004), Cumulative effects of concussion in amateur athletes. MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine. 4. Ives Jeffrey C, Alderman Mark and Stred Susan E (2007), Hypopituitarism After Multiple Concussions: A Retrospective Case Study in an adolescent male, Journal of Athletic Training; Jul-Sep 2007; 42, 3; Research Library 5. Kent Heather (1999), How many concussions are too many, JAMC • 23 MARS 1999 6. Macciocchi Stephen N, Barth Jeffrey T, Littlefield Lauren & Cantu Robert C (2001), Multiple concussions and neuropsychological functioning in collegiate football players, Journal of Athletic Training; Jul-Sep 2001; 36, 3; Research Library www. Journalof athletictraining.org 7. Marchie Anthony and Michael Cusimano D. (n. d) Bodychecking and concussions in ice hockey: Should our youth pay the price? 8. Phillips Lisa (2007), Head Games, Special report: Concussion, Neurology Now 9. ScienceDaily (June 1, 2009), Minor League Hockey Players Unable To Identify Concussion Symptoms, Study Says, Retrieved on 19 November 2009 from http://www.sciencedaily.com/releases/2009/05/090527121051.htm 10. ScienceDaily (Oct. 11, 2005), New Study At UNC Shows Concussions Promote Dementias In Retired Professional Football Players Retrieved on 19 November 2009 from http://www.sciencedaily.com/releases/2005/10/051011000046.htm 11. ScienceDaily (Mar. 4, 2009) New Study Shows Long-Term Dangers Of Severe Concussions, Retrieved on 19 November 2009 from http://www.sciencedaily.com/releases/2009/03/090302090226.htm Read More