Brain Injuries in Sports

The theory of neuroplasticity holds that the brain will change and adapt to different conditions including to childhood injuries. This theory is often challenged and sometimes referred to as a “myth.” However, a new study by Seena Fazel and colleagues from the Department of Psychiatry at University of Oxford in the United Kingdom delivered data that supports the claims of neuroplasticity theorists. Fazel’s conclusions reveal that the later a mild TBI is sustained, the worse the health and social outcome is for the patient. The study also found a causal effect between childhood Traumatic Brain Injuries (TBIs) and the risk of brain impairment and social dysfunction at later stages in life.

Continue Reading New Study Debunks Claim that Neuroplasticity is a Myth—the Later the Onset of Mild TBI, the Worse the Outcome

Following a concussion, patients are instructed to rest for twenty-four to forty-eight hours beginning any type of return to normal activities.  Many doctors recommend an even longer period of rest so as to reduce the risk of re-injury during recovery from the concussion.  Some clinicians even advocate “cocoon therapy” which “restricts patients to several days in a darkened room before slowly returning to activity.”

A new study out of the Department of Pediatrics at the Medical College of Wisconsin calls into question the efficacy of cocoon therapy.

Danny G. Thomas, M.D. and his colleagues conducted a study of patients aged between eleven  and twenty-two years who presented to a pediatric emergency department within twenty-four hours of having sustained a concussion.  Participants underwent neuro cognitive, balance and symptom assessment in the emergency room and were randomized to strict rest for five days versus the usual care of one-two days rest followed by stepwise return to activity.  Patients were asked to complete a diary to record physical and mental activity level, calculate energy exertion, and record daily post concussive symptoms.

Ninety-nine patients were enrolled and eighty-eight completed all study procedures.  Post discharge, both groups reported a 20% decrease in energy exertion and physical activity levels.  As expected, the intervention group reported less school and after-school attendance for days two to five post concussion.  However, “there was no clinically significant difference in neuro cognitive or balance outcomes.  However, the intervention group reported more daily post-concussive symptoms and slower symptom resolution.”  The conclusion of the researchers was “recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care.  Adolescents’ symptom reporting was influenced by recommending strict rest.”

This study can be downloaded from pediatrics.aappublications.org.  The study is entitled “Benefits of Strict Rest after Acute Concussion:  A randomized controlled trial, Thomas

Space, DG, APPS JN, Hoffman RG and McCrea M, and Hammeke T.  Pediatrics, Vol. 135, No. 2, February 2015.

If you or a loved one have suffered from a brain injury and have legal questions, contact Stark & Stark today.

A new study out of the University of Colorado-Denver found that regardless of the location of impact of high school football players who sustained a concussion, there was no difference in the outcome.  Researchers, noting that “little research has examined concussion outcomes in terms of impact location (i.e., the area on the head in which the impact occurred), utilized the National High Schools Sports-Related Injury Surveillance Study dated between 2008/2009-2012/2013 to calculate rates and describe circumstances of football concussion (e.g., symptomatology, symptom resolution time, return to play) resulting from player-to-player collisions by impact location.”

Not surprisingly, the researchers found that most concussions resulting from player-to player collisions occurred from front-of-the-head and side-of-the-head impacts.  While a larger proportion of football players who sustained concussions from the top-of-the-head impacts experienced loss of concussion than those suffering concussions in other locations of the head, concussions outcomes were generally independent of impact location. 

Dawn Comstock, the lead author of the study, was quoted as saying “we can’t predict which athletes are more likely to have more severe symptoms or worse outcomes based only on how their injuries occurred.  Every clinician needs to take every concussion very seriously.”  “What we can say is that these findings definitely support the call to take the head out of the game if you will.” If you or a loved one has suffered an injury, contact Stark & Stark today.

An evidence– based guideline from the AAN for evaluating and managing athletes with concussions recommends that athletes who are suspected of having a concussion be removed from the game immediately and not be returned until assessed by a licensed health care professional trained in diagnosing and managing concussion. The new guideline, which replaces a 1997 AAN guideline on the same topic, was published in Neurology® electronically ahead of print on March 18, 2013. It has been endorsed by several athletic, medical, and patient groups.  Click Here to read the guideline.

“Among the most important recommendations the Academy is making is that any athlete suspected of experiencing a concussion should immediately be removed from play,” said co– lead guideline author Christopher C. Giza, MD, with the David Geffen School of Medicine and Mattel Children’s Hospital at UCLA. “We’ve moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually. There is no set timeline for safe return to play.”

The guideline also addresses sports with the highest risk of concussion, protection provided by helmets and headgear, increased risk after having a concussion, the relationship between multiple concussions and permanent or lasting impairments, and other issues.

Read the guideline, access clinician and patient resources, and download the new AAN Concussion Quick Check app. For more information, contact Julie Cox or (612) 928– 6069.

A new study published online at PLOS One found that “the brain degeneration observed among professional football players could result from an out-of-control immune response, similar to what multiple sclerosis patients experience. “Consequences of Repeated Blood-Brain Barrier Disruption in Football Players, Nicola Marchi, Jeffrey J. Bazarian, Vikram Puvenna, Mattia Janigro, Chaitali Ghosh, Jianhui Zhong, Tong Zhu, Eric Blackman, Desiree Stewart, Jasmina Ellis, Robert Butler, and Damir Janigro.

In its “preliminary” study, the researchers showed:  “That elevations of serum S100B indicating blood-brain barrier disruption occur in football players who experience sub-concussive head hits below the threshold for a diagnosis of concussion.  We have also shown that players who during a season experience the most significant repeated elevations of S100B are also those with the highest titer of serum S100B auto-antibodies.”

In an article published in Science Daily, Jeff Bazarian, one of the authors stated: “although the awareness of sports-related concussions is much higher, we still know very little about the long-term consequences and what happens inside the brain” ….Our theory is plausible as an explanation for how routine head hits that come with playing football can lead to severe neuro degeneration later in life.”  Click Here for a link to the story published in Science Daily.

Sports Illustrated also reported on the research.

The November 14, 2012 on-line issue of the Journal of the American Medical Association (JAMA) contained a research letter authored by Inga Coerte, M.D., Birgit Ertl-Wagner, M.D., Maximilian Reiser, M.D., Ross Zafonte, D.O., and Martha E. Shenton, Ph.D. from Harvard University.

The researchers, interested in whether frequent sub concussive blows to the head in soccer players could lead to traumatic brain injury, evaluated concussion-naïve soccer players using high resolution DTI, which “is highly sensitive for detecting alterations in white matter architecture.” The researchers utilized forty soccer players, all right handed males, from two training groups of an elite-level soccer club in Germany.  All had been trained since childhood for a career in professional soccer.  A comparison cohort of swimmers was recruited from competitive clubs to match on age, handedness, and sex.  Those with a prior history of concussion or any other neuropsychiatric disorders were excluded. 

The researchers utilized diffusion tensor imaging (DTI).  Wide differences between groups were found with increase radial diffusivity in soccer players.  The researchers commented that “this study found differences in white matter integrity in a small sample of soccer players compared with swimmers.  Although only participants without previous symptomatic concussion were included, advanced DTI revealed widespread increase in radial diffusivity in soccer players, consistent with findings observed in patients with mild traumatic brain injury and suggesting possible demyelination.” 

This demonstrates that DTI is being used in the diagnosis and research of persons with mild traumatic brain injury. This is further support for the use  and the admissibility of DTI in trial of patients with mTBI.

A recent article in WOUB Public Media talks about Ohio University’s attempt to determine ways to reduce the risk of injuries, including lessening the risk of sustaining a concussion.  Ohio University was one of the universities selected to work with the Datalys Center and USA football.  Licensed athletic trainers have been documenting player health and looking for ways to increase safety for youth football players.

Dr. Brian Ragan, assistant professor of athletic training at Ohio University, is collaborating with the US Department of Defense, National Institute of Health, and Centers for Disease Control and Prevention, to develop and improve a database to track personal injury information over long periods of time. 
 

A recent article in the New York Times highlights how researchers are working on a new, relatively inexpensive way to spot injuries and monitor brain diseases using magnetic sensors that can spot changes in brain waves.   This compact and portable detection device, part of the field of optical magnetometry, is constructed as a form of headgear roughly the size of a sugar cube, and works by having sensors measure changes in the brain’s magnetic field.  The device’s size, portability, and affordability allow for a wider range of applications that may someday be mass produced and used on athletes to monitor collisions and subsequent brain injuries in sports.
 
The compact magnetic sensors were developed by the Commerce Department’s National Institute of Standards and Technology, and they are working to offer an alternative to the costly and inflexible technology currently available, called superconducting quantum interference devices (“Squids”), which require cryogenic cooling which cannot be used at room temperature.  
 
Optical magnetometry has been used as an alternative to superconducting devices to monitor the magnetic fields of the heart rather than the brain.  The institute’s new compact technology, though still in prototype, has enormous potential for transforming the ways doctors and researchers can analyze the progression and status of diseases, as well as for the ability to control prosthetics using brain signals.  

Traumatic brain injury (TBI) is among the earliest illnesses described in human history and remains a major source of morbidity and mortality in the modern era. More than 2% of Americans currently lives with long-term disabilities as a result of a previous brain injury, and incidence and prevalence rates are even higher.

One of the most common and devastating consequences of suffering from a brain injury is dementia. Studies have shown that suffering from a TBI early on in life, is associated with an increased risk of dementia later on in life.

Studies show that moderate and severe brain injuries increase the risk of dementia between 2- and 4-fold. It’s not as clear if mild traumatic brain injuries, like concussions, leads to dementia, mainly due to the fact that mild TBIs are often not well documented. However, studies have also shown that that multiple mild brain injuries, such as those sustained by professional boxers and football players, are associated with a high risk of chronic traumatic encephalopathy (CTE), a type of dementia with distinctive clinical and pathologic features.

The recent recognition that CTE is common in retired professional athletes, such as boxers, ice hockey and football players, has increased interest in this condition. Additionally, military personnel also experience extremely high rates of brain injuries due to combat blasts. These injuries may have a similar syndrome and long-term effect.

It is presently unknown whether dementia in TBI survivors is pathophysiologically similar to Alzheimer disease, CTE, or some other form of long-term brain damage. Such information is critical for developing preventive and treatment strategies for a common cause of acquired dementia.
 

As the number of females participating in youth soccer programs continues to increase, so does the number of sports-related concussions for females under the age of 18. Of the more than 3 million kids registered to play youth soccer in the US, girls make up 48% of that group.

A new report shows that girls are reporting nearly twice as many concussions as boys in the sports they both play, including soccer. The number of girls suffering concussions in soccer accounts for the second largest amount of all concussions reported by young athletes, according to the American Journal of Sports Medicine.  (Football tops the list.)

Though most people believe soccer is a relatively safe sport when discussing the chance of sustaining a concussion, “heading” has led to more concussions in the past few years than most would imagine. When heading, players attempt to use their foreheads to direct the ball, often jumping with opposing players. This move can lead to collisions between players, bumped heads and strained necks.  Heading is one of the most dangerous parts of soccer because players often collide.