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Sports-related Concussions and Traumatic Brain Injuries
TBI, or traumatic brain injury, is characterized as a blow or jolt to the head, or a head injury that penetrates and disrupts the brain's normal functioning. It happens when the head collides with a hard surface abruptly and violently, or when the skull is pierced and an object enters the brain tissue. It's a growing problem among young athletes in contact sports, and if left untreated, it can lead to long-term brain injury or even death. A concussion, also known as mild traumatic brain injury (MTBI), is similar to TBI but occurs as a result of less force. Mild traumatic brain injuries are often not fatal and the common effects may include a temporary change of the state of the brain, but when the trauma is severe, it may lead to long periods of coma or even death.
Concussions can be defined as a complex pathophypsychological process affecting the brain, induced by a traumatic biomechanical process. It is common for children, teenagers and professional athletes and is a common concern as it leads to neurological disorders. It can lead to early retirement of professional athletes, erratic behavior and in severe cases suicidal tendencies. Concussions can lead to serious health effects and any bump or blow no matter how unserious it seems, can lead to long term health issues. Signs that one might have suffered a concussion include; headaches, memory problems, confusion, nausea, fatigue, mood changes and sleep disturbances. Richard Hammond, a British presenter and a cohost of the BBC motoring program top gear, after his crash, suffered a head trauma injury. He stated that he had post traumatic amnesia and five-second memory as a result of the brain injury. Some symptoms may not be experienced until it is weeks or days later. Each year in the United States, approximately 1.6-3.8 million concussions related to recreation and sports are reported. Because concussions cannot be seen on x-rays or generated on computed tomographically, they become difficult to detect and treat.
Dangers of concussions have an undetermined duration of time and may solely depend on the severity of the force or frequency of the concussion. There are also threats of post-concussion syndrome which are, physical, emotional and psychological symptoms from a concussion that continue after a concussion has been maintained. Physical signs of a post-concussion syndrome include headaches, memory problems, amnesia, confusion, nausea, fatigue, mood changes and sleep disturbances. Cognitive symptoms include slow speech, memory loss and attention deficit (Yumul 1102). In a study conducted in 2016, in every 1953 youths suffering from a concussion, 1755 of them have reported symptoms resolutions and the rest lost follow up. The median of time to recover was 18 days ranging from 1-353 days. By the first 30 days 72.6% of them had recovered, by the sixtieth day up to 91.4% had recovered and by the ninetieth day a whole 96.8% had recovered. In total analysis, higher symptoms scores normally led to longer durations of symptoms and the worsening of the symptoms from the day the concussions occurred to the day clinical evaluation was carried out also led to longer periods of recovery (Heyer 38).
Concussions are a common part of an athlete’s world, occurring during practice and in the main events. In Marion county Florida, 3689 student athletes were evaluated and 34 concussions, 24 in male and 10 in female were reported in the school year 2011-2012. The concussions were reported by the athletes themselves, diagnosed by the trainers and later referred to a physician. The number of concussions sustained were calculated in every 100 participants in each academic year where the percentages of the concussions included 1.83% in basketball, 0.40% in cheerleading, 2.83% in football, 1.84% in soccer 0.44% in field and track events and 0.70% in wrestling. Ten other sports which were included in the study did not report any concussions. The total prevalence for the concussions was at 1.14% amongst male athletes and 0.63% amongst female athletes. Football had the highest prevalence followed by soccer and in sports played by both male and females, the females reported a higher number of concussions. The study highlighted that there was need to minimize the risk of concussions especially in sports that do not involve collision contacts especially amongst female athletes (Young 207). The following are the top five sports activities with the highest reported incidences of traumatic brain injuries in the US in 2009. Cycling has a prevalence of 85,389 reported cases, football with 46,948, softball and baseball with 38,394, basketball with 34,692 and watersports and recreational activities with 28,716 (ANNS n.p).
If an athlete suspects that they may have incurred a concussion, they are advised to see a doctor, who will ask questions to test their ability to learn, pay attention and remember, including how quickly your brain can solve problems. The doctor is also required to check the patient’s strength, coordination, balance, sensation and reflexes. Neuropsychological tests are now widely applied to test for concussions and they test how well one is thinking and how much he or she can remember. These tests are also used to detect any emotional or mood changes, while other tests include, Computerized Tomography (CT) scans and Magnetic Resonance Imaging (MRIs) to ensure that the brain is not bleeding or bruised.
In cases of suspected concussions, one is encouraged to see a doctor right away and even after being discharged from the hospital, there are signs that need to be checked to determine if one needs further medical care, for example, a persisting headache, decreased coordination, slurred speech, convulsions and seizures, confusion and loss of consciousness. If a child will not stop crying or refuses to eat and nurse they also need to be taken to a doctor. In the weeks or days after a concussion, one needs to allow themselves time to get well before returning to day to day activities and call the doctor regularly if they are not improving as advised. Sleep is important and so is avoiding drugs and alcohol.
About 1% of all mild traumatic brain injury patients will need surgery for their brain injury. This only occurs after constant observation and monitoring of patients and it is established that their condition is worsening, warranting the need for surgery. Therapy animals are also used to help improve the condition of athletes with traumatic brain injuries. Surgery is necessitated by excessive clotting of the blood in the brain. Also known as hematoma, it results from bleeding within or around the brain, exerting pressure on the brain, damaging the brain tissue. By use of CT scans and MRIs, hematoma is identified and surgery is required to remove the clot. Surgery is also required when repairing fractured pieces of the skull or removing the pieces from the brain. There might also be a situation whereby cerebral tissue or fluids are greatly swollen in the head, and this warrants surgery to create a window in the skull to relieve the pressure inside by draining the skull of the accumulated cerebral tissues. It can also be done to create room for the inflamed tissues.
Medication given is mainly to limit secondary damage to the brain, whereas diuretic drugs are given to the concussion patients to reduce the amount of fluids in their tissues and increase the urine output which is given through the vein. This will help to reduce the pressure in the brain. Anti-seizure drugs are a common drug given to patients who have suffered from mild to severe brain injuries as they run the risk of having seizures in their first weeks of injury. The drug will prevent secondary brain injury as a result of the seizures. In severe occasions, doctors may sometimes be forced to administer coma-inducing drugs to their patients as a comatose brain requires less oxygen for normal functioning. This will release pressure from the brain by the reduction of the blood pressure and to enable delivery of the usual amount of nutrients and oxygen to the brain.
To reduce the chances of getting a concussion, precautions like fastening a seat belt while in a car, wearing appropriate head protective sport gear, avoiding drugs and alcohol while engaging in sport activities and maintaining of the field or court should be exercised. Emergency response to a traumatic brain injury mainly focuses in making sure the person has an adequate oxygen and blood supply. It is also important to maintain the blood pressure and to ensure the patient is in a stable position to prevent further injury to the head or to the neck. In most cases, people with traumatic brain injuries have other secondary injuries which are addressed in the emergency rooms or the ICU under the care of doctors who focus on minimizing secondary damages resulting from reduced oxygen supply to the brain, bleeding or inflammation. Charlie Cox said “All we can do now is try to prevent secondary damage by relieving pressure on the brain caused by the initial injury. There is no reparative treatment for traumatic brain injury”.
People who have suffered concussions before are more susceptible to have another injury in the future especially if they had not fully recovered from the previous injury. It leads to a net negative progress as the impact will cause an increased severity of the symptoms from the previous injury. This can be fatal especially if the concussions continue and may eventually run the risk of the individual contracting depression, dementia and Parkinson disease. There may arise severe cases where concussions cause the patient to lose basic skills such as walking and talking, in which case rehabilitation services are provided to improve the ability of the patient to resume normalcy and perform daily activities.
The overall number of brain injury occurrences is still very high especially amongst youths who engage in sports and recreation activities. Though some incidences are minors, others are fatal and may have permanent neurological effects on an individual. In addition to physical damage like the inability to walk and speak coherently, there arises psychological damages including low self-esteem, self-stigmatization and inability to socialize with others freely. These factors may contribute to an individual’s inability to recover as advised and expected. Besides physical treatment, there is need for psychotherapy and mentoring to TBI victims to help recover from emotional and psychological damage. It is also very important for an individual to have the support of the family and loved ones to aid in the process of recovery.
There has also been cases whereby CT and MRI scans were misinterpreted and severely injured patients were sent home, only to be re-admitted in worse conditions and even fatalities occurred. Doctors and nurses need to be careful when scanning and giving medical advice to prevent occurrence of deaths that could have been prevented. In the field, players ought to be taken through the necessary drills in preparation for cases where one may find themselves prone to a fall, to take necessary precautions. Trainers, coaches and other field coordinators should also possess basic skills to diagnose concussions and provide first aid before seeking further medical attention. Fields should be prepared adequately prior sports activities to get rid of any objects that may lead to falls or even hurt the players. Similarly, managers in the recreational facilities should ensure that the area of operation is clear of any unnecessary and unsafe objects. In the end, occurrence of concussions cannot be entirely eradicated but it can be minimized. It takes the effort of all including parents, teachers, coaches and the players themselves to ensure that accidents that may lead to concussions are prevented.
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ANNS. Traumatic brain injury. August 2014. Web. 20 February 2017. .
Heyer, Geoffrey L., et al. "Specific Factors Influence Postconcussion Symptom Duration
Among Youth Referred To A Sports Concussion Clinic." Journal Of Pediatrics
174. (2016): 33. Supplemental Index. Web. 20 Feb. 2017
Young, Thomas E., and Mark Chen. "Topics In Sports Medicine: One-Year
Concussion Prevalence In Marion County, Florida High School Athletes." Journal Of
Chiropractic Medicine 15.(2016): 204-207. ScienceDirect. Web. 20 Feb. 2017.
Yumul, Joy Noelle, and Audrey McKinlay. "Narrative Review: Do Multiple Concussions
Lead To Cumulative Cognitive Deficits? A Literature Review." Pm&R 8.(2016): 1097-1103. ScienceDirect. Web. 20 Feb. 2017.
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