Concussions Part I: Recognizing the Breadth of the Problem

Recently, I had the opportunity to comment on the concussion crisis in a guest blog post for the Huffington Post.  Research into detection of concussions is one of several important lines of research at the Forsyth Institute. We’re currently looking into new ways to more accurately and quickly diagnose concussions.

An Overview of the Field

Head injuries can be devastating and their prevention and treatment is a goal for all athletes. According to the NFL, over 200 players have reported concussions (Mild Traumatic Brain Injury, or MTBI). Each year approximately 250,000 student-athletes aged 19 or younger will also be concussed while playing a sport. Additionally, over the past decade ER admission rates for head-related injuries increased by 90 percent. However, these figures almost certainly underrepresent the problem. The Center for Disease Control (CDC) estimates that 69 percent of student athletes with a possible concussion played with concussion symptoms, and 40 percent of those athletes said their coaches were not aware they had a possible concussion. Overall, an estimated 1.6-3.8 million sports and recreation related concussions occur in the United States each year.

In recent years, our understanding about the harmful effects of MTBI has significantly increased. Aside from the immediate impact, growing evidence shows repeated MTBI has long-term impacts such as reduced cognitive function, including increased risk for depression, dementia, Alzheimer’s and chronic traumatic encephalopathy, or CTE — a degenerative brain disease found in an increasing number of professional athletes.

Current State of Diagnosis

Diagnosing concussion is both difficult and subjective. The most common tests used to diagnose a concussion are cognitive function exams. However, players sometimes intentionally set low baseline scores in the preseason so they can beat the sideline tests and remain in the game, or come back to play more quickly. MRIs and CT Scans cannot accurately or definitively diagnose a concussion because MTBI are very subtle. While there are discrepancies in current MTBI testing, a simple and effective test bears further exploration. The result is that an estimated 5 in 6 concussions go undiagnosed.

The fear with undiagnosed concussions, especially on the teen brain, is that repeated trauma can lead to even worse effects. Research has shown that the human brain isn’t fully developed until at least 25, meaning that children and teens who sustain multiple concussions may be in danger of dramatically impeding their cognitive growth.

Also, while pro athletes may have these tests paid for by the team, this is often not the case with students, and there are still large gaps in coverage (hyperlink). Additionally, many policies leave students uninsured for practices that occur outside of the regular season or off-campus. At the high school level, there’s a great diversity in the way that schools approach concussion insurance, and many high schools lack a clear policy for identifying and treating injured students.

Many organizations are advocating for better processes for preventing and treating concussions, such as putting programs in place to train teachers, administrators and fellow athletes into recognizing the signs of concussion. While we still have a long way to go, current research is helping us to design and discover the tools we need to get ahead of the game.

Stay tuned for Part II, we’re we’ll look at some of the current research being conducted at the Forsyth Institute for concussion diagnosis.

Learn more about the Forsyth Institute’s Salivary Diagnostic team.

By Phil Stashenko, Senior Member of Staff and President Emeritus

Monday, May 16, 2016
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