The Silent Epidemic
Understanding Concussions
Note: Much of the content for this blog was covered in an interview with Jamie King August 31, 2020 on CBS Sports Radio
While football season is going to be missed by many, especially parents who long to watch their children play, what remains is a serious topic — TBI related to sports injuries.
How I Became Interested
For over 15 years my work has focused in a sub-specialization of trauma psychology dealing with car accident trauma. Increasingly, I saw how the forces involved in a car accident caused injuries to the brain which impacted every area of functioning: cognitive, emotional, social, occupational. Many times, in the emergency departments injury to the brain is not evaluated beyond looking for brain bleeds and many kinds of brain injury are not detected with current imaging methods.
I dedicated myself to learning as much as I could about brain injuries and what can be done with respect to prevention and treatment.
Incidents
Brain injuries have been called “a silent epidemic” because they often go unrecognized and untreated. There is an estimate 5.3 million Americans who live with long-term disabilities due to traumatic brain injuries. The Department of Defense data indicate around 400,000 soldiers have some level of TBI.
Brain Injury Defined
The Veterans Administration and the Department of Defense defines a traumatic brain injury as a “traumatically induced structural injury and/or physiological disruption of brain function as a result of external force.”
Brain Injury and Football
One thing that sparked my interest in brain injuries as it related to car accident survivors, was the movie Concussion in which Will Smith played the neuropathologist Dr. Bennet Omalu, who discovered the effects of cumulative head trauma resulting in later life dysfunction including depression and in some cases suicide. Based on his work with professional football players, Omalu coined the term Chronic Traumatic Encephalopathy or CTE which is defined as a progressive degenerative disease of the brain resulting from repetitive head trauma. A similar mechanism of progression was recognized much earlier in professional boxers, known as boxer’s dementia or dementia pugilistica or punch-drunk syndrome identified in the 1920s. In CTE there is an abnormal build up in brain tissue of a specific protein called tau.
According to the Boston University CTE Center the common symptoms of CTE include memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, suicidality, parkinsonism and eventually progressive dementia. What is particularly disturbing is that CTE has been found in young athletes who were not professional football players but who had experienced asymptomatic, sub-concussive head traumas.
Harvard’s Sports Concussion Medicine Symposium
A few years ago, I attended Harvard Medical School’s Sports Concussion Medicine Course and one of the professors who lectured was Dr. William Meehan. He wrote a ground breaking book by the title Kids, Sports, and Concussion. In his book he identified five medical findings that changed how we think about sport-related concussion.
1. Concussions result in measurable brain dysfunction that can persist for months or longer.
2. Brain dysfunction often continues even after the athlete believes they are free of symptoms.
3. Having had one concussion places the athlete at an increased risk of future concussions.
4. There is a cumulative effect of multiple concussions
5. Effects may not become apparent into later in life from earlier concussions.
Unrecognized Injury
A question that is always asked is was there a loss of consciousness in the accident. But the real issue is was there an alteration of consciousness, i.e., being dazed, confused or disoriented. Being hit by an airbag deployed, can result in trauma to the brain. Often the effects of a brain injury go unrecognized and untreated for months or in some cases years.
What is a Head Injury?
There has been a lot of confusion about head injuries due to the different terms used to describe trauma to the brain: head injury, concussion, traumatic brain injury, post-concussion syndrome. Any injury to the brain can have significant impact on functioning.
Interesting Developments
There has been some very promising work regarding treatment and prevention of TBIs. I would encourage your audience to check out a new movie by Jerri Sher called Quiet Explosions that show cases the recovery of a number of people who were experiencing severe dysfunction as a result of brain injuries. The movie is based on the book by Adam and Andrew Marr Tales from the Blast Factory. The point for people to remember is that brain injury does not have to be a death sentence or a involve a life of dysfunction. With the right treatments for many there can be very positive results.
Primary and Secondary Injuries to the Brain
What is often not recognized is there can be continued trauma to the brain that unfolds after the initial assault to the brain tissue from an external force. The endocrine system can be impacted which can result in hormonal and metabolic changes that results in symptoms such as anxiety, social isolation, depression, sleep disturbance, cognitive difficulties, sexual dysfunction and a poor quality of life. The last one, poor quality of life, is something many studies do not address but in my opinion needs to be central when looking at meaningful treatment outcomes. Dr. Mark Gordon is reporting very promising results with improved quality of life from addressing the issue of neuro-inflammation and the use of nutraceuticals and hormone replacement therapy. Dr. Michael Lewis has also reported very promising results with treatment and prevention using his Omega-3 protocol for brain health.
Brain Injuries and Personality Changes
Bottom line: Many people who experience brain injuries feel they have changed in some way and no longer feel like themselves. In one of the earliest reported cases of severe brain injury to the frontal lobe from a penetrating wound through the head, people who knew Phineas Gage were reported to comment “Phineas is no longer Phineas.” Neuroscience has come a long way since the 1840s when Phineas Gage physically survived a devastating injury, but lost essential characteristic of himself.
I would like to end with a quote by Lynnette Duncan that touches on the issue of personality change following trauma. “Maybe you’re not healing because you’re trying to be who you were before the trauma, that person doesn’t exist anymore, cause there is a new person trying to be born. Breathe life into that person.”
Suggested Reading
Michael D. Lewis, MD (2016). When Brains Collide. What Every Athlete and Parent Should Know about the Prevention and Treatment of Concussions.
William Paul Meehan, III, MD (2011). Kids, Sports, and Concussion. A Guide for Coaches and Parents. Santa Barbara, California: Praeger
James F. Zender, PhD (2020). Recovering from Your Car Accident. The Complete Guide to Reclaiming Your Life. New York: Rowman & Littlefield.
