Concussions are a risk for young athletes in all sports -- not just football
Retrospective study reveals that younger brains take longer to heal
September 15, 2020
Science Daily/Henry Ford Health System
A recent study from the Henry Ford Sports Medicine Research team suggests that high school athletes competing, not only in football, but in soccer, hockey, basketball, swimming, cheerleading and other sports are not only at risk for concussions, but may need a longer recovery than first thought.
The study's results published by Orthopedics, a nationally recognized, peer-reviewed journal for orthopedic surgeons found that the most common sports for brain injuries were indeed football, hockey and soccer.
"We thought that concussion issues would be very short-lived," said Vasilios (Bill) Moutzouros, M.D., chief of Sports Medicine at Henry Ford and a study co-author, "That they wouldn't have as many attention issues, that they'd be able to recover for their sport much more quickly. Our study found just the opposite."
"The two sports, other than football, where concussions are common are soccer and hockey, although brain injuries can happen in any sport," said Meaghan Rourke, one of more than 30 Henry Ford athletic trainers who support sports programs at over 20 high schools, colleges and universities and professional teams in the tri-county area.
Michigan Gov. Gretchen Whitmer's latest executive order allows the high school football season to begin September 18. Football was reinstated by the Michigan High School Athletic Association (MHSAA) after initially being postponed until spring 2021. With football back in action with an adjusted six-game season, athletic trainers will once again be patrolling the sidelines and be on the lookout for signs of concussions. Other sports given the green light to compete this fall include soccer, volleyball, swimming and diving. These competitions will also present the potential for brain injuries from collisions, falls and impacts with the field of play.
"I went through a four-year period as an athletic trainer where I had at least one swimmer suffer a concussion. That's a sport you don't really think about in terms of concussions," said Rourke. She explained that in one instance a swimmer miscalculated her distance to the pool wall while doing the backstroke and bumped her head against the wall. As a result, the swimmer was out for more than a month with a concussion. Diving is another sport susceptible to brain injuries as the divers' heads impact the surface of the water at high speeds generated from their dives. In reality, all sports have the potential for concussions since athletics involve physical activity and competition.
"Competitive cheerleading is another sport where I've seen concussions happen. The kids get very high in the air, and if they slip and fall when they are coming down, they can suffer serious head injuries," said Rourke, "We usually have one or two athletes in that sport suffer concussions. Overall, I've probably had to deal with a concussion in every sport, including golf."
The retrospective study looked at Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores at baseline testing and following concussions performed by neuropsychologists. The study found that memory ImPACT scores increased as players suffered repeated concussions.
ImPACT is the brain injury testing protocol developed in the late 1990s at the University of Pittsburgh and released in the early 2000s. The testing protocol is the only FDA-approved tool for concussion assessment and is the national testing used by healthcare, educational and sports organizations to help assess and manage concussions. The protocol defines a concussion as "a disturbance in brain function that occurs following either a blow to the head or as a result of the violent shaking of the head." Symptoms of a concussion can include a combination of headaches, nausea, vomiting, balance problems, dizziness, fatigue, visual problems and a host of other brain-associated symptoms.
The study examined the records of 357 high school athletes who were treated for concussions at Henry Ford from 2013 to 2016. The athletes age averaged between 14-18 with nearly 62% being males. Football yielded the most concussions (27.7%), followed by hockey (21.8%), soccer (17%), basketball (9 %) and cheerleading (4.2%). From the study's participants, 72 played in "Other" sports and accounted for 20.3% of the total number of concussions. Overall, 14 % reported suffering from amnesia and 33 % reported a history of concussions.
Henry Ford athletic trainers use internationally approved guidelines to accurately diagnose concussions, appropriately manage the recovery process, and safely return athletes back to their game. They use sideline tools such as the Sports Concussion Assessment Tool 5 (SCAT5) to immediately evaluate cognitive function and, if needed, additional neuropsychological tests may be administered by a physician to track progression through the recovery process. SCAT5 is a standardized concussion assessment used by licensed healthcare providers when a concussion is suspected in athletes ages 12 and older.
Current MHSAA protocols call for a player showing concussion symptoms to be sidelined for at least 24 hours. Athletes at high schools staffed with a Henry Ford athletic trainer are sidelined for at least five days and follow a strict return to play protocol, "We're going to slowly bring them back," said Rourke. "We don't want to just throw them out there where they're going to get hit again, and then they're dealing with prolonged symptoms."
The Henry Ford research team found that athletes with only one concussion required at least 30 days of recovery prior to returning to their sport while others who reported a second or more concussions required more recovery time. They also learned that visual motor speed and reaction time scores decreased with recurrent concussions, and that male and female athletes with a previous history of concussion, and those with delayed diagnosis, required more time before returning to competition.
The study team hopes that the results help start the conversation on how to more safely return student athletes to their sport after a brain injury. "When you recognize that it can be up to 30 days to get a young student athlete back, you're going to change your mind-set on how you advance them, in terms of how you push them, in terms of how you test them," said Dr. Moutzouros.
Previously, it was believed that brain injuries were related to a player's age. The younger the player, the shorter the recovery time. "We need more studies on the younger athletes," said Dr. Moutzouros, "Many of us have children. We're all worried about them and we want them to be safe. So, we need to recognize that this is a problem for the youth athlete."
https://www.sciencedaily.com/releases/2020/09/200915110014.htm
Concussions associated with cognitive, behavioral, and emotional consequences for students
July 22, 2020
Science Daily/University of Texas Health Science Center at Houston
Concussions can have a compounding effect on children, leading to long-term cognitive, behavioral, and emotional health consequences, according to researchers at The University of Texas Health Science Center at Houston (UTHealth), who published their findings in the American Journal of Sports Medicine.
In 2017, approximately 2.5 million high school students in the United States reported suffering at least one concussion related to sports or physical activity in the last 12 months, according to information from the U.S. Centers for Disease Control and Prevention (CDC).
The UTHealth researchers analyzed survey data from more than 13,000 high school students in the United States. According to the authors, it is the first study to report on the association between sports-related concussions and negative health implications based on a representative sample of U.S. high school students.
"We have previously speculated that children who suffer a concussion have more behavioral problems, so this study was able to provide a more comprehensive analysis on the various cognitive and behavioral health issues that this population faces in connection with this type of brain injury," said Gregory Knell, PhD, the study's first and corresponding author. Knell is an assistant professor at UTHealth School of Public Health in Dallas and is research faculty at Children's Health Andrews Institute for Orthopaedics and Sports Medicine.
A concussion is the most common form of traumatic brain injury, caused by a mild blow to the head. Common symptoms include a headache, ringing in the ears, nausea, vomiting, fatigue, drowsiness, and blurry vision.
Participants were asked how many times they had suffered a concussion from playing a sport or during physical activity in the last 12 months. Students were also surveyed on relevant cognitive, emotional, and behavioral factors and related health outcomes, including questions on topics such as academics, suicidal ideation, and substance abuse.
The study revealed that 14.5% of female high school athletes and 18.1% of male high school athletes reported experiencing at least one concussion the previous year. These students also reported at least one factor associated to their behavioral, cognitive, and emotional health. The questions covered topics such as difficulty concentrating, poor grades, drinking and driving, carrying a weapon, getting into a physical altercation, using tobacco or marijuana, binge drinking, feeling depressed, and having suicidal thoughts or actions.
Of the male participants who suffered at least one concussion, 33.8% reported they drank and drove in the last 30 days. For the female athletes who reported suffering more than one concussion, 19% stated they had used marijuana at least once in the last 30 days. Both male and female participants who answered that they had been in at least one physical fight in the last year were significantly more likely to have reported having at least one concussion in that same timeframe.
Other associated factors that were significantly more likely in male students who reported a prior concussion included difficulty concentrating, tobacco/e-cigarette use, and binge drinking. Female students who reported prior concussions were more likely to ride in a car with a driver who had been drinking, and have suicidal thoughts or actions.
"Parents need to understand that a concussion is a very serious brain injury, one which requires treatment every time a concussion is sustained. This study has revealed this type of traumatic brain injury can have a compounding effect on children that could lead to more aggressive behavior, academic problems, and social issues," said study co-author Scott Burkhart, PsyD, a neuropsychologist at Children's Health Andrews Institute for Orthopaedics and Sports Medicine.
The research team encourages future studies to continue the surveillance on the prevalence of concussions among student athletes, as well as the severity of these injuries.
https://www.sciencedaily.com/releases/2020/07/200722163225.htm
Concussions in high school athletes may be a risk factor for suicide
November 25, 2019
Science Daily/University of Texas Health Science Center at Houston
Concussion, the most common form of traumatic brain injury, has been linked to an increased risk of depression and suicide in adults. Now new research published by The University of Texas Health Science Center at Houston (UTHealth) suggests high school students with a history of sports-related concussions might be at an increased risk for suicide completion.
The research, which recently appeared in the November issue of the Journal of Affective Disorders, examined the link between self-reported history of concussion and risk factors for suicide completion. It was the first study to include a nationally representative sample of high school students. According to the Centers for Disease Control and Prevention, suicide is the second-leading cause of death in Americans ages 10 to 34.
"It's important to remember that when it comes to concussions, there's no visual test to confirm them. Unfortunately, you can't take your child to have a lab test done to diagnose one," said Dale Mantey, the study's lead author, a doctoral student at UTHealth School of Public Health in Austin.
Common symptoms of a concussion include loss of consciousness, headache, confusion, and change in mood.
The study examined survey data collected from more than 13,000 high school students in the United States. Participants were asked if they had received a concussion related to sports or physical activity in the last year, as well as a range of questions to measure potential suicidal behaviors. Approximately 15% of students surveyed reported having suffered a concussion.
Researchers discovered that teenagers who reported having a concussion in the last year were more likely to report feelings of depression, suicidal ideations, and planned or previous suicide attempts. Of the portion of students who reported a history of concussions, approximately 36% reported they had felt sad or hopeless (compared to 31.1% of all teens) and around 21% had thoughts of suicide (compared to 17%).
Male participants with a reported concussion in the last year were twice as likely to report having attempted suicide and three times more likely to report a history of receiving medical treatment for an attempted suicide than those who did not have a recent concussion.
The study also revealed female students with a history of concussions had greater odds to report all risk factors of suicide. They were more likely to have reported feeling sad or hopeless, having suicidal ideations, a planned suicide attempt, having attempted suicide, and were twice as likely to indicate a history of receiving medical treatment for an attempted suicide compared to females who did not report a concussion in the last year. A recently published article in the journal Pediatrics revealed female high school athletes have higher concussion rates than their male counterparts.
The researchers noted that while the study did control for commonly associated suicide risk factors like sexual orientation and a history of being bullied, it did not account for other risk factors like drug or alcohol use. There were no measures of preconcussion mental health for survey participants.
"Concussions are a traumatic brain injury and they are even worse for young people with developing brains," said Steven H. Kelder, PhD, MPH, senior author and Beth Toby Grossman Distinguished Professor in Spirituality and Healing at UTHealth School of Public Health in Austin. "These injuries can have long-term effects such as memory issues and sleep disturbances."
According to the National Suicide Prevention Lifeline, warning signs of suicide can include talking about feeling hopeless, withdrawing or social isolation, extreme mood swings, and reckless or anxious behavior.
"Everyone needs to be aware of the warning signs and the risks that come with concussions -- parents, teachers, coaches, but also the students themselves," Mantey said. "If there is any concern that a child may have suffered a concussion, it is critical to seek medical attention. If a child is diagnosed with a concussion, everyone in their support network should look for changes in mood or behavior that may be warning signs of reduced mental well-being."
https://www.sciencedaily.com/releases/2019/11/191125145546.htm