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A Shift In How Concussions Are Detected and Treated

 

Every year in the United States between 1.6 million and 3.8 million sports-related concussions occur. Additionally, an estimated 20% of those deployed to Iraq or Afghanistan sustained a head injury with 83% of those sustaining a concussion.

 

Concussion is an injury to the brain that results in temporary loss of normal brain function, a mild traumatic brain injury. Injury may occur due to a forceful impact on the brain from a direct force known as linear acceleration or rotational forces known as angular acceleration. Concussions in athletes most commonly occur in impact sports including football, soccer, lacrosse, hockey, rugby, and basketball.

 

In the last several years, much attention has been placed on concussion research. In 2014 the National Institutes of Health (NIH) funded approximately $87 million of research on traumatic brain injuries. The NFL has given $30 million to launch the Sports and Health Research Program, as well as funded research to investigate new methods to actively treat and speed concussion recovery.

 

Concussions and concussion research has gained so much attention that it has made its way to the big screen. Concussion, a movie staring Will Smith based on the true story of Dr. Bennet Omalu and his research on the chronic effects of multiple concussions will be released in theaters on Christmas Day.

 

Despite the growing attention around concussion detection in recent years, 30% of people evaluated for a concussion report prior symptoms consistent with a previously undiagnosed episode. Additionally, much is still not known about diagnosis and treatment of this condition.

 

Most commonly, concussion testing is symptom based and includes testing for inability to focus the eyes, delayed verbal and motor responses, confusion or inability to focus attention, slurred or incoherent speech, gross incoordination, emotions out of proportion to the situation, memory deficits, repeating questions, nausea, vomiting, dizziness, vertigo, and loss of consciousness.

 

Computer-based cognitive concussion testing is now becoming more commonly used with ImPACT being used in more than 7,000 high schools, 700 colleges and universities and 200 professional sports teams. Cognitive testing relies on a baseline pre-season score for comparison. While standardization and objective parameters are a step in the right direction, scores can be swayed by a variety of factors including mental development, effort, and fatigue. A 2015 literature review examined 10 studies that utilized cognitive testing and reported the reliability to be poor to moderate.


At the forefront of research now is force detection and direct concussion monitoring devices. New technology in mouth guards hopes to alert players, coaches, and medical staff of potential concussion causing blows. Several recent studies have been published describing the forces generated at the moment of impact during youth, high school, and college football as well as female youth soccer, and premier amateur rugby. Monitoring devices such as FITGuard are currently in development and will soon hit the consumer market. This mouth guard utilizes an LED light system to alert of an impact concerning for a concussion while also transmitting force data to a computer or mobile device.

 

In addition to the progress that has been made with screening and diagnosis of concussions, recent data may also suggest a shifting paradigm in treatment. A 2015 study in the journal Pediatrics studied those age 11-22 who were either given 5 days of rest or 1-2 days of rest followed by a step-wise return to activity. They concluded that those who maintained 5 days of rest had no difference in neurologic or cognitive outcomes than those with 1-2 days of rest.

 

In October 2015 a conference of leading concussion experts, the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion, which included representatives from the NIH and the U.S. Department of Defense reached a consensus that prolonged rest does not appear to aid in recovery and that active rehabilitation may be preferred. To date no formal national treatment recommendations have been made.

 

Technology has and continues to make teaching and treatment more accessible. A recent study in the Journal of Adolescent Health found that a web-based concussion-training modules improved concussion knowledge and protocol application. Similarly, a phone-based problem solving intervention for military service members has been described for use in those who may be reluctant to seek out help or may be in a combat setting.


In recent years much progress has been made in regards to concussion awareness, diagnosis, and management. Moving forward many question still remain including how to best detect concussions in real-time and how to predict those who are susceptible to permanent brain damage known as chronic traumatic encephalopathy.

 

Ashok L. Gowda M.D. is an Orthopedic Surgeon specializing in Shoulder & Elbow, Upper & Lower Extremity Sports Medicine, and Hand Surgery. He practices in Silver Spring, MD. You can access more information at www.GowdaOrtho.com.
 

 

 

 

Last modified onThursday, 19 November 2015 18:35
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