Concussion and Injury Prevention in Athletes
August 17, 2011
12:00 p.m. – 1:00 p.m. (EST)
- Daniel Grobman, DO - Spine and Sports Medicine Specialist
The most accepted definition of "concussion" is an incident characterized by an immediate or post-traumatic alteration of consciousness, disturbance of vision, and equilibrium. Many contact sports have a high risk of concussion.
Cleveland_Clinic_Host: Today's Live Web Chat, "Concussions" with Dan Grobman, DO will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.
MissLyss: Do ice hockey teams for kids as well as professional NHL teams have a protocol for what goes on in terms of a player and how/when he can come back on to the ice?
Daniel_Grobman_DO: There are specific recommendations for players both in the NHL and amateur leagues regarding concussion management. Those players who do sustain a concussion should ultimately not return to play on the same day as per updated guidelines. The player should be assessed by a health care provider well versed in management of concussions. Players should only be returned to play after their concussion symptoms resolved and after they are able to do sports specific drills and be asymptomatic with exertion.
Rferrand: Can a mouth guard help prevent a concussion?
Daniel_Grobman_DO: Mouth-guards have been shown to reduce the risk of maxillofacial injuries and can reduce the risk, but no piece of equipment, including helmets, have been shown to completely prevent the risk of concussions.
RaffTaff75: Exactly what is a concussion?
Daniel_Grobman_DO: Concussions are essentially a mild traumatic brain injury usually but not always resulting from a closed head injury, causing the brain to strike the inner surface of the skull. This can results in bruising or swelling of the brain and occasionally can cause bleeding. Symptoms of a concussion can include headaches, light sensitivity, difficulty sleeping or concentrating, nausea, vomiting, dizziness/lightheadedness and occasionally can cause loss of consciousness depending on the severity.
Rferrand: Is it true that no helmet on the market now can prevent a concussion? Do you think there will ever be a helmet out there that will be capable of concussion prevention?
Daniel_Grobman_DO: That is absolutely correct. No helmet or mouth-guard available on the market completely prevents risk of concussion. I suspect that no helmet will ever completely eliminate risk of concussion, though they may further reduce risk.
RaffTaff75: How do you treat it? How do you know if it is a concussion or another serious brain injury?
Daniel_Grobman_DO: Great question. First and foremost, it's important to treat each concussion individually. Treatment of concussions requires rest and frequent follow-ups to ensure that symptoms resolve so that players can be returned to their sport safely. Various testing can be implemented (i.e. IMPACT testing and neuropsych testing) to demonstrate an athlete's improvement in symptoms. Once an athlete is asymptomatic at rest, the athletic trainer can put an athlete through sports specific drills to ensure that they have no symptoms with exertion. As you mentioned, it is important to discern concussions from more serious brain injuries such as bleeds. If an athlete sustains a concussion with progressive symptoms such as confusion, changes in speech, numbness or weakness of the extremities or changes in mentation, that they have an evaluation with an emergency room physician. In these cases a CT may be ordered of the brain to rule out more serious conditions i.e. epidural or subdural hematomas.
MissLyss: What is the connection between concussions and Alzheimer’s? Are there other neurological disorders that can result from a concussion?
Daniel_Grobman_DO: Repeated concussions over time have been shown in certain cases to increase risk of a condition called Dementia Pugilistica, which is similar to Parkinson’s. An example of this is Mohammed Ali. It can also increase risk of depression.
MissLyss: Is there an explanation for the increase of concussions from sports over the years? Do you think the players themselves are just getting rougher and tougher to keep up with the competition? What can I do if my son is a really good player, but he is really small? I know he runs a higher risk of getting a concussion than the other bigger boys.
Daniel_Grobman_DO: Concussions are more prevalent in sports for several reasons. As you mention, athletes are becoming more competitive, and athletes are participating in contact sports at a younger age. Instructing your son on proper form i.e. avoidance of spearing and proper equipment is the most effective way to reduce risk.
Rferrand: Which concussion grading scale and return-to-play guideline is the best?
Daniel_Grobman_DO: For a while, several scales have been in place to grade specific concussions i.e. Cantu scale, AAN scale, etc. The grading system became simpler after the consensus on concussion in sport conference in Zurich in 2008. Current grading is defined as those with symptoms less than or more than 7-10 days.
Ren779: Do schools/teams in this area give a baseline neurological test (like the ImPACT)?
Daniel_Grobman_DO: Universities typically implement ImPACT studies at baseline and then when concussions occur. The pro teams in the area also implement ImPACT studies. Most high schools do not utilize this, but I imagine that as there becomes more public awareness, that more and more schools will implement this testing.
Ren779: Why are precautions, like having medical personnel at all games and providing neurological testing programs often not taken?
Daniel_Grobman_DO: Different regions within the state and countrywide implement different standards of care without. Some counties enforce EMS converge at each game where others implement a physician to be available field-side. With increased public awareness of the risks of concussion, hopefully there will be more consensus state and nationwide as far as coverage.
DawsonB: Which is the best battery or combination of concussion tests to conduct?
Daniel_Grobman_DO: One of the most utilized tests is called ImPACT testing, which is a means of comparing an athlete's baseline cognition to their post-concussive state. It is a relatively easy test to administer and allows the health care provider to visualize a patient's progress. Occasionally neuropsych testing is also implemented for more complex concussions or those with multiple concussions.
Carmicat17: Are long-term cognitive deficits associated with soccer heading, and should headgear be made mandatory for youth soccer players?
Daniel_Grobman_DO: Concussions in soccer players are actually quite common for the reason you just stated. More important than the headgear is use of proper form. Though helmets and headgear have been shown to reduce risk of concussions, no data has conclusively been shown to prevent them.
Carmicat17: Are long-term deficits associated with repeated concussion?
Daniel_Grobman_DO: Repeated concussions over time have been shown to increase the risk of depression, memory loss, and cognitive changes.
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Deb50: If my son has already suffered through 1 concussion (he fell out of a tree house as a 5 year old), is he more at risk to get another one now that he is older and playing sports (he is 13 and playing roller and street hockey)?
Daniel_Grobman_DO: Great question. I do not suspect that your son is at greater risk as compared to the general population because of a remote head injury/concussion sustained that long ago.
Kerbear: How can you tell if you have had a concussion? Is it always serious? And what should you do if you have a concussion?
Daniel_Grobman_DO: Typical signs and symptoms of concussions include headache, dizziness, nausea/vomiting, slowed speech, difficulty with memory and concentration. More serious symptoms include loss of consciousness, weakness, and somnolence. If a concussion is suspected, the athlete should not be returned to sport that day, and the athlete should be evaluated by a health care provider versed in concussion management i.e. neurologist, sports medicine physician, ER physician.
DawsonB: Has there been any case of someone never fully recovering from a concussion? For example, can you suffer symptoms like lightheadedness or even slight memory loss forever? Or would this be a more serious problem?
Daniel_Grobman_DO: Repeated concussions over time have been implicated in long-term sequelae such as memory loss, depression, sleep difficulty, and loss of concentration..
DawsonB: After how many concussions should a career in sports be ended?
Daniel_Grobman_DO: There is no hard and fast rule about how many concussions should end one's career. It is very individualized to the athlete and sport they participate in.
Cleveland_Clinic_Host: I am sorry to say that our time with Dr. Grobman is now over. Thank you again, Dr. Grobman, for taking the time to answer our questions today about Concussions. To make an appointment with any of the specialists in our Spine Center or any other specialists at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.
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