|Wednesday, September 29
When 49ers quarterback Steve Young was knocked out in a game last year against Arizona, viewers, players and fans held their collective breath until he regained consciousness and walked off the field under his own power. But that doesn't mean that Young was as good as new. In fact, he was diagnosed with his fourth concussion since 1996 and missed the rest of the season, and his NFL future remains uncertain.
Concussions are not limited to the professional arena. The Centers for Disease Control and Prevention estimates that 1 million Americans with Traumatic Brain Injuries (TBIs) are treated and released each year from emergency rooms. Head trauma is a leading cause of disability in children, adolescents and young adults. And as athletes continue to get bigger and faster, simple mathematics and physics say that the numbers of these types of injuries probably will increase.
Getting a handle on the exact nature of concussions, however, is not that easy. "Any time you disrupt the function in someone's brain, that is a significant event. Yet there is not a lot known about concussions because it is very difficult to measure alteration in brain function," says Dr. Charles Burke III, team physician of the Pittsburgh Penguins and a member of the Association of Professional Team Physicians (PTP). "Something serious has occurred, but we can't measure it other than to look at the symptoms." We asked Dr. Burke to explain the basics of the injury and the steps that can be taken to prevent these potentially serious injuries.
What is a concussion?
Dr. Burke: Concussions, or what we're now calling mild traumatic brain injuries, by definition cause some change in brain function. Due to a trauma to the body, not necessarily the head, there is an alteration in mental status that is represented by symptoms -- confusion, "seeing stars', wooziness, short-term memory dysfunction, unconsciousness, or long-term memory loss. But because the brain is a very complicated organ, we don't presently have diagnostic tests or measurements other than looking at the symptoms.
What are the causes and symptoms of concussions?
Dr. Burke: Any time a body is in motion, the head obviously also moves, leading to two types of concussive injury. One is as a result of a direct blow to the head where the brain can collide with an area where the impact has occurred. Another is when the head quickly decelerates, even in the absence of a direct blow, and the brain continues to move until it hits the other side of the skull. It's called either a coup or contra coup injury, where the trauma occurs either at the point of impact or at the direct opposite area of impact.
There can be a wide array of symptoms. Short-term symptoms can be confusion, memory dysfunction, loss of consciousness, sensitivity to light and noise, ringing in the ears, blood pressure changes, numbing and tingling in certain areas. We also see such long-term effects as sleep disturbances, personality changes, headaches and memory loss.
Are there levels of severity with concussions?
Dr. Burke: There is a grading system for concussions established by the American Academy of Neurology (see below) and it is important, especially for people unfamiliar with the symptoms of concussions. For example, the grading system can assist recreational athletes and coaches in recognizing the symptoms and guiding them as to when athletes who have suffered concussions can return to their activity. We fully support that. On a professional level, we have the ability in the NHL to collect data on every concussion that occurs. Our goal is to discover what the most important and consistent symptoms are and to see how we can translate these into diagnosing and treating the players.
What is the prognosis for concussions?
Dr. Burke: One of the things we do know is that multiple concussions usually produce more problems than single ones. Generally, it's worse to have had five concussions than one although we don't know why someone with one concussion may end up with post-concussive syndrome and someone who has had five may not. The only way to find answers to these and other questions is through further study and the development of more precise tests to measure how the brain functions
Are athletes today more at risk for concussions than ever?
Dr. Burke: As an orthopedic surgeon, I look at forces exerted on the muscloskeletal system. Force equals mass times acceleration. So as athletes get bigger, stronger and faster, the forces increase. As the forces increase, especially in contact sports, the potential for all injuries increases, including head injuries. It's a standard principle of physics, with a little statistics thrown in.
Can you offer any prevention advice?Dr. Burke: People should always wear helmets when playing contact sports or riding their bicycles and motorcycles. Another vital element is educating the general public. So if someone is faced with a situation where a head injury occurs, he or she can know how and where to seek appropriate advice as to diagnosis and treatment. Decisions on returning to play after a concussion should be made by experienced professionals. If someone is allowed to compete with a concussion whose symptoms have not cleared, they're risking a potential catastrophic situation called second-impact syndrome, which can be fatal.