Medical Conditions Related to Brain Injury
Concussions; High Impact Blow To Head Has Long-term Effects
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Athletes, from the "peewee" to the professional level, always want back into the game after an injury. Rub some dirt in it, our coaches told us whenever we stumbled back to the bench. For those who suffer a concussion on the verdant fields of play, though, that impulse to continue play can be deadly. Concussions, a violent blow to the skull causing trauma to the brain, can end careers or potentially leave athletes disabled long after their playing days are over.
Superstars like football's Troy Aikman and Steve Young, plus hockey's Pat LaFontaine, saw their careers collapse following concussions.
Second-impact syndrome, when one concussion is followed quickly by another without sufficient time to heal, can result in brain swelling and possibly death.
Dr. Kenneth Fine, assistant professor of orthopedic surgery and director of sports medicine at George Washington University, says concussions defy easy labels.
"There's no definite way to really diagnose it," Dr. Fine says. "If you see somebody's unconscious, they have a concussion."
But athletes can lose consciousness for very brief periods, or not at all, and still have suffered a brain injury.
The Centers for Disease Control and Prevention estimate that about 300,000 sports-related concussions are suffered each year. The main culprits are boxing, football and hockey, though athletes in basketball and baseball also can suffer concussions through rigorous play.
Symptoms can be one or more of the following: amnesia, headache, disorientation, balance difficulties and uncoordinated hand-eye movements.
Washington Capitals General Manager George McPhee suffered two moderate concussions during his playing days with the New York Rangers and New Jersey Devils.
"The strangest things go through your mind that have no correlation to what's going on," Mr. McPhee says in describing the experience.
Mark Lovell, a neuropsychologist and director of University of Pittsburgh Medical Center Sports Medicine's Concussion Program, says a concussion's severity depends on the biomechanics of the particular blow, combined with the person's medical and concussive history.
"People with concussions present [symptoms] in different ways," says Mr. Lovell, also director of the National Football League's neuropsychology program. "No two concussions are alike.
"No medications or treatments exist to help the brain heal from the concussive blow. A concussion throws the brain's metabolism "out of whack," he says. Only rest can set it right.
The problem is most common in football, a sport that demands physical contact on every down. Thomas Hammeke, professor of neurology at Medical College of Wisconsin in Milwaukee, led a study of concussions at the high-school varsity football level two years ago.
At the beginning of the football season, about 550 athletes underwent a barrage of mental and physical tests to create a baseline to be compared with post-season results. "Then, we wait for concussions to occur," he says. And they did. They always do. He says that, on average, about 4 to 5 percent of players will suffer some form of concussion each season.
Among the study's findings was that recovery rates vary as wildly as concussions do. "The physical symptoms recover at a different rate than the brain do," he says. "The cognitive symptoms recover quicker than the physical symptoms do." While concussions won't be eradicated from sports any time soon, a company in Edinboro, Pa., is trying to modify existing football helmets to try to make sports safer. The ProCap, a helmet cover molded from flexible urethane foam, absorbs energy on impact as a car's soft bumper might. Bert Straus, the device's designer, says his creation is used by more than 10,000 athletes, mostly at the high school and collegiate level. While Mr. Straus says NFL professionals like Don Beebe and Mark Kelso have used the helmet additions, he doesn't see the average player donning it any time soon.
"The players will never push for it unless it's mandated," says Mr. Straus, whose product is made by Protective Sports Equipment. "Football is a macho kind of sport. You really want to demonstrate to the coach and your teammates you can take what the world dishes out. You don't need any extra equipment." Dr. Fine oversaw a study at the District's St. Albans School for Boys about five years ago involving ProCap helmet covers.
The study had half the football players wearing ProCaps. The other half wore their traditional helmets. The findings showed a reduced rate of concussion for those wearing ProCap gear, he says. ProCaps draw suspicion in some medical circles, Dr. Fine says, because its softer surface might not deflect oncoming helmet hits as regular helmets might, causing it to jar a player's neck and head.
The initial research, though, has shown that not to be true, Dr. Fine says. Thad Ide, vice president of research and development with Riddell, the official helmet of the National Football League, says his company remains skeptical of the ProCap's claims. "It's not a device Riddell recommends using, nor do our competitors," Mr. Ide says. With its increased size and weight, "it might put players at increased risk for other injuries," he says. Initial testing, he adds, has shown it doesn't help much in preventing concussions. Mr. Lovell agrees, but offers that the nature of a concussion may make these arguments moot.
Concussions involve the brain shifting around inside the skull, and "no amount of outer protection can stop that," he says. Another relatively new product promising to reduce concussions is the Brain Pad, produced by Wipss, of Conshohocken, Pa. The item, essentially a mouth guard for both the upper and lower sets of teeth, promises to reduce concussions by repositioning and locking the lower jaw down and slightly forward, preventing the jaw from hitting the base of the skull and brain.
Doctors don't fully understand the long-term consequences of repeated concussions. Some veteran boxers eventually develop a "punch-drunk syndrome," Mr. Hammeke says, a dementia characterized by sluggish thinking and an inability to quickly retrieve information. "That occurs in a small portion of boxers," he says. "There's a good chance that the genetic underpinnings have a lot to say about who will develop it."
Dr. Nicholas A. DiNubile, orthopedic consultant for the Philadelphia 76ers, says initial findings point to some loss of delicate motor skills and agility in athletes with numerous concussions. "I have patients who were fighters. They admit they just don't feel right. Your goal [in boxing] is to create a concussion, a knockout," Dr. DiNubile says.
If a trainer suspects an athlete may have suffered a concussion, he or she should evaluate the player before the game or practice ends. Appropriate questions to ask are whether the player can repeat a string of simple words in order or if he can remember the last few plays. Without such interrogations, Mr. Hammeke warns, athletes may offer a stream of white lies to keep themselves off the bench. "Athletes are highly motivated to not report things," he says. "They want to get back in the game. Their bias is to under-report things."
Mr. Hammeke isn't sure more people are suffering concussions in sports today. It might be a matter of awareness. "People are more informed about concussion than they were 20 years ago," he says. That doesn't discount the fact that today's sports feature bigger, better trained athletes, who collide with each other with greater strength than ever before. "Concussions boil down to force and speed," he says. "The faster things happen with more mass attached, the more likely brain injury can occur."
Injuries end sports careers Concussions have prematurely ended the careers of great athletes. Dallas Cowboys quarterback Troy Aikman racked up 10 concussions before calling it a career. San Francisco 49ers quarterback Steve Young suffered four concussions in three years before he stepped down for medical reasons. Heralded New York Jets wide receiver Al Toon retired in 1992 after a series of concussions left him wondering what his post-football life would be like if he suffered any more head traumas.
New York Islanders forward Brett Lindros, brother of New York Rangers star Eric Lindros, saw his young career end in 1996 after three concussions on top of an unknown number endured during his junior hockey career. The Rangers' Lindros also has suffered multiple concussions and could be one devastating check away from early retirement. Thomas Hammeke, professor of neurology at Medical College of Wisconsin in Milwaukee, says the Lindros brothers' example may point to a hereditary link for concussions. It also could boil down to behavioral types.
Some players have a personality temperament that is more prone to risk taking, he says, and therefore more liable to suffer brain traumas. "They're on the sensation-seeking side of things," he says. Anyone who has watched Eric Lindros intimidate an opponent with his physical brand of hockey might see a connection. That said, "certain genes probably make it so some individuals don't recover as well from trauma. That indeed may account for [the fact that] some athletes can have 15 to20 concussions and don't look worse for wear," he says. "Others develop gradual dementia."
Typically, a doctor will suggest retirement when an athlete begins experiencing concussion symptoms after only mild blows and the symptoms linger longer than they did after the first several episodes.
Copyright © 2002 News World Communications, Inc. Reprinted with permission of The Washington Times.