Head Injuries

September 18, 2012

Head Injuries: TBI, Concussion and PCS
What does all this mean and why should we care?

Alison Epperson, Ph.D.
Assistant Professor, Health Ed.
Murray State University

TBI – According to the Centers for Disease Control and Prevention (www.cdc.gov), “a traumatic brain injury is defined as a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain.” The American Association of Neurological Surgeons (www.aans.org), categorize TBI as mild, moderate or severe depending on the extent of the damage sustained to the brain. A person who sustains a mild TBI may only exhibit brief changes in mental state or consciousness, whereas a person with a moderate to severe damage can lapse into extended periods of unconsciousness, a coma, or die.

TBI symptoms — Constant or reoccurring headache; inability to control or coordinate motor functions or balance; changes in ability to hear, taste, see, dizziness and hypersensitivity to light or sound; shortened attention span; easily distracted, overstimulated by environment; difficulty staying on task, following directions or understanding information; feeling disoriented or confused; difficulty finding the ‘right words,’ expressing thoughts or slurred speech.

Concussion – The AANS has defines concussions as “the shaking of the brain within the skull, and if severe, can cause shearing injuries to nerve fibers and neurons.” There are essentially four “grades” of concussions, a number of related symptoms, and guidelines as to when an athlete should return to play.

•  Symptoms — confusion, headache, lack of concentration, mood swings and sleep difficulties.

• Grade 1 — Brief period of confusion, appears dazed without a loss of consciousness, incorrect responses, symptoms disappear within 15 minutes..
  – Guideline – Return to play after athlete has been free from symptoms for one week.

•  Grade 2 — Confusion can last from five minutes to an hour, even without a loss of consciousness.
  – Guideline – Return to play after athlete has been free from symptoms for one week.

• Grade 3 — Unconscious for more than 30 seconds.
  – Guideline – Athletes who sustain a Grade 3 concussion should be sidelined for a month.

The AANS states a player who has sustained a concussion is three to six times more likely to sustain another concussion. Regardless of how minor the first injury appeared to be, sustaining a second one can be life-threatening if it occurs within days or hours of the first, otherwise known as Second Impact Syndrome (SIS). SIS occurs when the brain is not allowed to fully recover from the first impact. As a result, the brain can experience vascular congestion and increased pressure within the skull. The risks for SIS is substantially higher for sports such as ice or roller hockey, football, baseball, basketball, soccer, snow skiing, and boxing.
Post-Concussion Syndrome — persistent symptoms of concussions past the period of time the individual should have recovered (three weeks), which then qualifies as a TBI.

Quick explanation — Concussions can be viewed as an injury sustained by a blow to the head in which a person is able to fully recover. A TBI is a permanent alteration of brain function even though the individual may appear asymptomatic.

Twenty-one percent of all traumatic brain injuries (TBI) among American children and adolescents are the result of participation in sports and recreational activities (AANS, 2011).
Additionally, the CDC reports the following statistics;

• 1.7 million people sustain a TBI annually in the US
• 52,000 die, 275,000 are hospitalized, and 1.365 million are treated and released from the emergency room.
•  Males are 1.5 times more likely than females to sustain a TBI
• The two highest age groups for TBI are 0-4 and 15-19 year olds

The AANS lists the sports and recreational activities with the highest number of ER visits in 2009 as follows;

• Cycling: 85,389
• Football: 46,948
• Basketball: 34,692
• Soccer: 24,184
• Fitness/Exercise/Health Clubs: 18,012
• Hockey: 8,145
• Rugby/Lacrosse: 5,794

How does this affect Campus Recreation programs? While all programs should already be using a waiver and liability release form for all participants to sign prior to participation, at what point does the program become responsible for allow or prevent a participant who sustains a blow to the head re-enter the game or event?

At the very least, it is critical for intramural and club sport programs to adequately train and certify supervisors, officials, scorekeepers, etc. (at least one person per field), in identifying and understanding the potential long-term side effects of head injuries. Whether it is an isolated or repeated TBI, when the brain experiences an impact, it can potentially change a person’s entire personality and impair cognitive ability. We’ve long embraced the importance of CPR/AED certification, and the connection between our response time and skills to a person’s chance of survival from a cardiac event, it is now time to embrace the importance of our ability to save a life by protecting their head.

What can your staff do? Educating your staff to be aware of the significance of head injuries is of upmost importance. With the increased media attention in large part to the National Football League’s policies on helmet-to-helmet contact and sideline policy regarding concussions, the trickle-down effect is to essentially reverse our tendencies to “shake it off” and assume everything is ok, if a person never loses consciousness, “appears to be okay,” or claims that they feel fine; it’s not always okay to allow the participant to re-enter the game.

The AANS Position Statement on TBI in Sports from March 2011, suggests:
For sporting activities organized through educational and municipal institutions, as well as in professional settings, guidelines should be readily available and utilized routinely by coaches, trainers, athletes, and parents of minor athletes. Public education regarding the importance of these injuries should be advocated by government, professional organizations, educational institutions, and professional athletic associations.

Evaluating your intramural and club sports programs to determine the level of risk by sport, and your emergency response plan is critical to the ensuring the safety and long-term risk reduction for your participants. Likewise, utilizing resources such as the National Athletic Trainer’s Association, the Standardized Assessment of Concussion (SAC), or ImPACT test can provide additional information or basic assessment skills using short cognitive and physical skills which can be indicative of an injury. In the end, it’s your attention to detail that matters the most.