Concussions among children playing sports are not a new phenomenon. In the decade leading up to 2009, an estimated 173,285 children and adolescents 19 and younger were treated during emergency department visits for sports and recreation-related traumatic brain injuries (TBIs). That represented a 62 percent increase in a decade. It is estimated that sports and recreational activities result in approximately 21 percent of TBIs among children in the U.S.
BlueCross BlueShield just released its Health of America Report showing that concussion diagnoses have increased 43% from 2010-2015. The rise was particularly marked in children and teens with a 71% rise in diagnosed incidences. Not surprisingly the rate in male patients during the fall season was double that of females. “Connecticut, Pennsylvania and Massachusetts had the highest rates of concussion diagnoses for patients 10-19. The study also reported an increase of 84% in post-concussion syndrome diagnoses with an interesting split–“more females then males ages 20-64 experienced post-concussion syndrome (61.3% vs. 38.7%).”
Some percentage of the increase could be attributed to a growing recognition of the long term impact of concussion, particularly the increased rate of suicide linked to the condition. However, it is disturbing that the concussion diagnoses increased in nearly every state from 2010-2015. The significant change raises questions on causation and indicates the need for more research.
A new study published in the Journal of Head Trauma Rehabilitation calls into question whether acute cognitive and physical rest improves concussion recovery times. Thomas A. Buckley, EdD, ATC of the Department Kinesiology and Applied Physiology at the University of Delaware conducted a study to determine if rest after concussion would result in a shorter recovery time in a population of college-aged student-athletes.
This hypothesis was based on the 4th International Consensus Statement on Concussion in Sport which recommends rest after injury as “a corner stone for acute concussion treatment” and outcomes. The authors noted that “rest” was achieved by discontinuing “school attendance, academic work, electronics usage and [any] exercise.” Prescribing rest was also believed to reduce the risk of repeated concussion and the “rare, but potentially fatal, second-impact syndrome.”
A study by doctors at Montefiore Medical Center and Albert Einstein College of Medicine provides additional support that use of Diffusion Tensor Imaging (DTI) may be clinically helpful to patients with mild Traumatic Brain Injuries (TBI) because it shows possible evidence of brain repair in post-injury patients. Scans conducted one year post-injury show that patients who exhibited abnormally high fractional anisotropy shortly after injury were “significantly associated” with better overall health outcomes.
The DTI scans were performed on a control group and on 39 injured subjects within 16 days of injury and one year later on 26 returning patients. According to the study, the patients were also tested for changes in cognition and symptomology. The results showed that DTI may be a “marker of compensatory neural mechanisms and an indicator of favorable outcome.” This is supportive data to an earlier study showing positive results from DTI use in pediatric patients, and an important study that used DTI to check the movement of water molecules in the brain of NFL players. In the NFL study the scans showed that those with marked deviations in fluid movement also demonstrated “abnormalities in attention and concentration, executive function, learning/memory and spatial/perceptual function.”
The ability to identify areas of damage and potential for repair are expected to inspire development of new effective treatments for patients with TBIs. Cognitive and physical effects of even mild TBIs may require extensive and long-term treatment from various healthcare providers including doctors, physical therapists, occupational therapists, and psychologists. If you or someone you know has suffered a TBI you should consult an experienced attorney to find out if you can seek reparation to get assistance with medical bills—consultations are usually free and services are often offered on a contingency basis.
In almost every case in which I represent a client who has sustained a mild traumatic brain injury (TBI), the defense courtroom doctors write that my clients have not, in fact, suffered permanent injuries as everyone who suffers a mild traumatic brain injury goes on to eventually and uneventfully recover. If that were true, then we would expect that people who sustain multiple concussion/mild traumatic brain injuries should have no long term effect, because, from this logic, each injury is self-limited and results in full recovery over a period of time.
However, a recent study, which was conducted by researchers with the Department of Veteran Affairs and Boston University, found that 96% of examined NFL players and 79% of all examined football players have suffered the degenerative disease known as chronic traumatic encephalopathy (CTE). CTE is known to be a progressive degenerative disease of the brain, which can be found in person’s suffering from repetitive brain trauma. This trauma includes both symptomatic concussions and asymptomatic subconcussive hits to the head.
Additionally, the study found that 40% of those who tested positive CTE were offensive and defensive lineman. “That finding supports past research suggesting that it’s the repeat, more minor head trauma that occurs regularly in football that may pose the greatest risk to players, as opposed to just the sometimes violent collisions that cause concussions.”
This recent study, which can be found here, should certainly put to rest the argument that everyone who suffers a concussion recovers.
Despite study after study demonstrating long term effects from mild traumatic brain injury (concussions), it is astounding that defense courtroom doctors still maintain that there are no permanent residuals from mild traumatic brain injury. A new study, Imaging Correlates of Memory and Concussion History in Retired National Football League Athletes, published in JAMA Neurology once again debunks this myth that everyone gets better.
The objective of the study, according to the abstract was “to assess the relationship of hippocampal volume, memory performance, and the influence of concussion history in retired NFL athletes with and without mild cognitive impairment.” The design of the study was a retrospective cohort study assessing differences between groups, mean hippocampal volumes, and memory performance by computing age quintiles based on group-specific linear regression models corrected for multiple comparisons for both athletes and control participants. The study utilized 28 former NFL athletes who were compared with 27 control participants. The mean age was 58.1 for the former athletes and 59.0 for the control participants.
The study found that retired athletes with concussion history, but without cognitive impairment, had normal, but significantly lower, California Verbal Learning Test scores compared with control participants. However, those with a concussion history and mild cognitive impairment performed worse when compared with both control participants and athletes without memory impairment. Among the athletes, 17 had a G3 concussion and 11 did not. Older retired athletes with at least one G3 concussion had significantly smaller bilateral hippocampal volumes compared with control participants.
The authors concluded that “prior concussion that results in loss of consciousness is a risk factor for increased hippocampal atrophy and a development of mild cognitive impairment. In individuals with mild cognitive impairment, hippocampal volume loss appeared greater among those with a history of concussion.”