Sports Concussion Flashcards
CDC estimates ___ concussions occur during sports/recreation annually
1.6 – 3.8 million
Incidence rates across studies have huge variation:
Under-reporting = lying to continue playing
Clinical diagnosis = We don’t have a gold standard test to measure to identify - constellation of symptoms
12x more ___ concussions than ___ related in ER
non-sports related
sports
- Falls, MVA, Military
Top 3 concussion rates in high school sports:
1) football (10.4)
2) girls soccer (8.19)
3) boys ice hockey (7.69)
Media Bias and Coverage:
sensationalize the dangers of concussions, leading to heightened fears among the public
exaggerate risks or focus on worst-case scenarios, which can contribute to misinformation
some media outlets may underreport the risks or downplay the severity of concussions, especially if they have ties to sports organizations or advertisers
Sport-Specific Focus:
Contact sports like football and hockey often face more scrutiny and criticism compared to non-contact sports
Advocacy groups and former athletes have played a significant role in raising awareness about the dangers of concussions
Media Bias: N= 42
Only 42 = not a big sample size
association between participation in tackle football prior to age 12 and greater later-life cognitive impairment measured using objective neuropsychological tests
incurring repeated head impacts during a critical neurodevelopmental period may increase the risk of later-life cognitive impairment
if replicated with larger samples and longitudinal designs = findings may have implications for safety recommendations for youth sports
Media Bias: N=891
None of the parameters were significant
Early first exposure to contact sports = NOT associated with greater symptoms or worse cognitive functioning
absence of significant findings does not completely rule out potential risks; it may indicate that other factors are at play or that the effects are not as pronounced as previously thought
Myth: Concussions cause CTE.
CTE is associated with repeated head impacts, it does not require a diagnosed concussion to develop
CTE can be linked to various forms of head trauma, including non-concussive impacts like those experienced from soccer headers
relationship between head impacts and CTE is complex and involves cumulative exposure rather than individual concussions
Myth: Concussions caused CTE, and CTE caused football players to kill themselves/others.
CTE has been found in the brains of some football players who have died by suicide or exhibited violent behavior - CTE alone does not explain these outcomes
CTE is found in players who had significant neurological symptoms before their deaths, suggesting a complex interplay of factors rather than a direct cause-and-effect relationship
CTE may contribute to behavioral and mood changes, but it is not the sole factor in such extreme outcomes
Bonus Fact: All of these players had significant neurological symptoms before their death.
It is true that many players diagnosed with CTE post-mortem exhibited severe neurological symptoms during their lives = symptoms can include cognitive decline, mood disorders, and behavioral issues
presence of significant symptoms suggests that CTE is associated with substantial impairment, but does not imply that all individuals with CTE will experience the same outcomes
Bonus Fact: There are thousands of former NFL players who likely have CTE. We don’t know the rates of neurological symptoms, however, 99.99% have not killed themselves or others.
majority of former NFL players who may have CTE do not exhibit severe or violent behaviors
prevalence of CTE in the general population of former players and its correlation with severe neurological symptoms are still under study
extreme cases that have gained media attention do not represent the experience of all individuals with CTE
Myth: The evidence is clear
current evidence shows associations between repeated head impacts, CTE, and neurological impairment but does not establish a direct cause-and-effect relationship
Most studies have focused on high-risk populations, such as those with severe neurological impairment or those who have died early
prevalence of CTE in the general population and its specific associations with neurological impairment are still uncertain
Where Media and Society Get It Wrong:
Media coverage often simplifies complex scientific findings, leading to the assumption that concussions directly cause CTE, and CTE directly causes extreme behaviors
High-profile cases of former athletes with CTE who have exhibited severe symptoms or engaged in violent behavior are often highlighted, which can skew public perception
ack of nuanced understanding in public discourse about the difference between association and causation = show correlations but does not always clarify causative mechanisms
Media coverage may not fully address the limitations of current research, such as small sample sizes, the focus on extreme cases, and the absence of longitudinal data tracking individuals over time
The majority of concussive symptoms resolve ___
___ have persistent symptoms/impairments
within 3 months
5-58%
Recovery, like all other injuries, is not always linear =
Exacerbations occur and can be acute or delayed (24 hrs)
Factors such as age, pre-existing conditions, genetics, and overall health can all influence recovery trajectories
Some individuals might experience fluctuating symptoms—improvement followed by setbacks—rather than a steady progression towards recovery
Acute Exacerbations:
sudden worsening of symptoms shortly after the initial injury or during the early stages of recovery
can happen within hours of the concussion or after resuming activities
Factors such as physical exertion, cognitive strain, or emotional stress can trigger acute exacerbations
might involve a sudden increase in headache intensity, dizziness, nausea, sensitivity to light or noise, or cognitive difficulties
Delayed Exacerbations:
symptoms worsen or new symptoms appear 24 hours or more after the initial concussion or after seemingly stable periods
can be caused by factors such as delayed physiological responses, additional head impacts, or cumulative stress
might involve increased headaches, cognitive fatigue, balance issues, or mood changes
Post-concussive syndrome =
3 months or greater
collection of symptoms that persist following a concussion or mild traumatic brain injury (TBI)
Difficulty with concentration, memory problems, and cognitive fatigue
Persistent headaches, dizziness, balance problems, and sensitivity to light or noise
Mood swings, irritability, anxiety, depression, and sleep disturbances
Post-concussive syndrome diagnosis:
Diagnosis is based on a history of concussion and the persistence of symptoms beyond the typical recovery period
no specific test for PCS
It’s important to rule out other possible causes of the symptoms, such as other neurological or psychological conditions
Subtle (sub-clinical) impairments may continue =
2x risk for MSK injury after concussion
Sub-clinical deficits in motor control, coordination, reaction time
2x risk for MSK injury after concussion =
lingering impairments in motor control, balance, and coordination, which can affect how an individual moves and reacts, leading to a higher likelihood of injuries such as sprains, strains, or fractures
Sub-clinical deficits in motor control, coordination, reaction time =
difficulty with fine motor skills or the ability to perform complex physical tasks
Coordination deficits may lead to problems with balance and spatial awareness, impacting an individual’s ability to perform activities that require precise movements or balance
MOI
Direct Impact to the Head
Indirect Impact
Rotational Forces
Repeated Impacts
Falls and Collisions
Direct Impact to the Head:
irect blow to the head, such as from a helmet-to-helmet collision in football, a hit from a stick in hockey, or a headbutt in soccer, can cause a concussion
severity of the concussion can vary based on the force of the impact and the specific location of the hit on the head
Indirect Impact:
strong impact to the body, such as a tackle in football or a fall, can cause the head to whip back and forth (acceleration-deceleration forces)
rapid acceleration and deceleration of the head and neck can cause the brain to move within the skull, leading to the injury even if there was no direct hit to the head
Rotational Forces:
Rotational or angular forces can be particularly damaging
cause the brain to twist or rotate inside the skull
shearing of brain tissue, which contributes to the disruption of brain function
Repeated Impacts:
Repeated, sub-concussive impacts (impacts that do not cause a concussion but still affect the brain)
risk of developing chronic conditions such as Chronic Traumatic Encephalopathy (CTE)
accumulation of these smaller impacts over time can contribute to the overall risk of a concussion
Falls and Collisions:
Falls or collisions where the individual hits their head against the ground or another object
context in which the fall or collision occurs (e.g., speed, angle, and surface) can influence the likelihood and severity of a concussion
Acute Diagnosis
Ontario Guidelines
Clinical Testing
Imaging = Only necessary if skull fracture, subdural hematoma/hemorrhage, or cervical spine instability is suspected
Ontario Guidelines
If ANY of the following signs/symptoms are noted following an impact/force that involves the head, concussion should be suspected:
Any loss or decreased level of consciousness
Any lack of memory immediately before or after injury
Any alteration in mental state (confusion, disorientation, foggy etc)
Any headache, vestibular, weakness, loss of balance, dizziness, visual changes
Clinical Testing:
Sport Concussion Assessment Tool 5 (SCAT5)
SCAT5 can pick up acute concussion but normalizes 3-5 days after
Athletes report symptoms such as headache, dizziness, nausea, and sensitivity to light or noise. The severity and number of symptoms help assess the impact of the concussion
Evaluates cognitive functions such as memory, attention, and orientation
Tests balance and coordination through exercises such as the Balance Error Scoring System (BESS), which includes standing on one leg and performing tasks on different surfaces
tasks to assess coordination and motor control, such as finger-to-nose or heel-to-shin tests
Imaging: fracture
visible deformity of the skull, palpable tenderness over the skull, or signs of a basilar skull fracture
CT scan is typically used to quickly evaluate for skull fractures due to its speed and effectiveness in detecting bony injuries
