Concussion controversy: Traumatic brain injury gets more attention after NFL player incident

Do you know {that a} concussion is a kind of traumatic mind damage?

After Miami Dolphins quarterback Tua Tagovailoa was transported to the hospital on Sept. 29 after his head slammed into the bottom throughout a sport in opposition to the Cincinnati Bengals — the second blow to his head in a span of 4 days — the analysis and administration of head accidents ignited a nationwide dialog about how greatest to handle concussions, in keeping with a number of studies. 

Roughly 7% of kids have had signs of concussion or a mind damage of their lifetime.

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But the chance will increase with age — from 2% in these 5 years and youthful to an estimated 12% in youngsters aged 12–17, in keeping with the Nationwide Middle for Well being Statistics. 

An estimated 29% of adults self-reported experiencing a concussion of their lifetime, in keeping with a current analysis examine. 

Here is a deeper dive into the difficulty.

What’s a concussion?

“A concussion is a kind of delicate traumatic mind damage (or delicate TBI),” mentioned Dr. Mitul Kapadia, medical director of pediatric rehabilitation and co-director of the sports activities concussion program at UCSF Benioff Youngsters’s Hospital, San Francisco. 

“It occurs when a blow to the pinnacle or an damage makes the pinnacle transfer forwards and backwards with a number of power,” he mentioned.

“Sufferers who’ve skilled a concussion present a fancy vary of neuronal and metabolic adjustments, and the mechanism of damage is probably going related to shearing of nerves.”

He informed Fox Information Digital that this causes chemical adjustments within the mind and typically harm to the mind cells. 

“Sufferers who’ve skilled a concussion present a fancy vary of neuronal and metabolic adjustments, and the mechanism of damage is probably going related to shearing of nerves,” added Dr. Oren Gottfried, professor of neurosurgery and scientific vice chair within the division of neurosurgery at Duke College in Durham, North Carolina.

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Lack of consciousness shouldn’t be a requirement for a prognosis of a concussion — however a concussion is graded as delicate, reasonable or extreme, relying on the length of consciousness and reminiscence loss, or amnesia, that persists after the damage, in keeping with a number of studies. 

Indicators and signs of concussion

Signs as skilled by the affected person can fluctuate from “simply not feeling proper” or “feeling down” to having a headache, blurry imaginative and prescient, issue concentrating, feeling dizzy or feeling sluggish, in keeping with the Facilities for Illness Management and Prevention (CDC).

Indicators are what an observer, comparable to a dad or mum or coach, can see.

The indicators can embrace: showing shocked, confused, answering questions slowly, experiencing persona adjustments or having issue in following directions.

Miami Dolphins quarterback Tua Tagovailoa (#1) goals a move through the first half of an NFL soccer sport in opposition to the Buffalo Payments, Sunday, Sept. 25, 2022, in Miami Gardens. 
(AP Picture/Rebecca Blackwell)

“The Concussion in Sport Group has outlined the indicators and signs under as ‘purple flags,’ that means that if an athlete experiences/shows them, they need to be transported to a hospital — these indicators/signs can point out an damage extra extreme than concussion,” mentioned Dr. Steve Broglio, director on the College of Michigan Concussion Middle.

He famous these signs embrace neck ache or tenderness, double imaginative and prescient, numbness, extreme or worsening headache, seizure or convulsions, lack of consciousness, vomiting or being more and more stressed, agitated or combative.

When to hunt medical consideration

“The only greatest factor is to take away any athlete from play who’s suspected of getting a concussion till that particular person will be evaluated by a licensed medical supplier,” Broglio informed Fox Information Digital.   

If dad and mom assume their teen might have a concussion, the CDC recommends first eradicating the teenager from play, maintaining the teenager out of play on the day of damage — and having the teenager evaluated by a well being care skilled.

“A well being care skilled will inquire concerning the particulars of the damage and likewise carry out a complete bodily examination to find out whether or not additional workup is required.”

“As a neurosurgeon who treats head accidents, I might advocate that anybody who has suffered a trauma leading to any interval of lack of consciousness that’s witnessed — or in the event that they had been alone and are obscure or confused on the main points of the damage — to get assessed by a physician in pressing care, [be seen] within the [emergency department], or [make a] same-day go to to your doctor,” Gottfried informed Fox Information Digital. 

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“Additionally, anybody who didn’t have any lack of consciousness however has persistent signs together with complications, neurological [issues] or any of the [symptoms] related to post-concussive syndrome must be assessed,” he added.

When is it OK to return to play?

A well being care skilled will inquire concerning the particulars of the damage and likewise carry out a complete bodily examination to find out whether or not additional workup is required, Gottfried famous.

“The supplier has the coaching to completely consider the athlete and resolve if they’ll return or not,” Broglio added.

Washington turned the primary state within the union to require a “elimination and clearance for Return to Play” amongst younger athletes in Might 2009 — however now all 50 states have an identical regulation, in keeping with the CDC.

Who ought to get a CT scan?

After a affected person is evaluated, a well being supplier might typically resolve to order a CT scan for the particular person.

“A CT scan of the mind takes photos to create photos of the mind and might present if there’s a fracture or bleeding,” Kapadia informed Fox Information Digital.

Not everybody who’s evaluated would require a CT or MRI, mentioned one medical skilled — however solely a supplier skilled in head accidents ought to make this resolution. 
(iStock)

“A CT scan can not present in case you have a concussion — and [these scans] are usually not routinely ordered for concussions until a physician has concern for a fracture or bleed.”

Gottfried famous that not everybody who’s evaluated would require a CT or MRI, however solely a supplier skilled in head accidents ought to make this resolution. 

Monitor the affected person for indicators and signs

The signs of a concussion usually happen proper after the damage, however typically the signs might not present up till hours later, in keeping with the CDC.

The company recommends monitoring for indicators of a concussion quickly after the damage and for a number of days later. If the indicators of signs are worsening, then the particular person needs to be taken to the emergency division instantly.

What’s second affect syndrome?

Concussions should be handled appropriately as a result of the preliminary damage reduces the mind’s “resilience” and alters its means to compensate, Gottfried mentioned.

However a second damage to the pinnacle earlier than the mind has had time to utterly get better will be deadly typically. “Second affect syndrome (SIS), also referred to as repetitive head damage syndrome, happens when a person experiences a second head damage earlier than full restoration from an preliminary head damage,” Gottfried mentioned.

“The most typical situation is in athletes that suffer a concussion and return to their sport too early.”

Some elements may also delay restoration from a concussion, comparable to a earlier concussion, neurological problems, studying difficulties or psychological well being points. 

He famous a subset of individuals are genetically predisposed to an overactive response to concussion in addition to a secondary damage.  

Some elements may also delay restoration from a concussion, comparable to a earlier concussion, neurological problems, studying difficulties or psychological well being points — in addition to household or social stressors, per the CDC.

“The catastrophic second affect damage outcomes from the lack of regular regulation of blood move to the mind, resulting in large mind swelling,” Gottfried added.

“The rise in stress is fast and might even consequence in mind herniation and loss of life.” 

NFL modifies its concussion protocol

The NFL and NFL Gamers Affiliation (NFLPA) agreed to switch the league’s concussion protocol after Tagovailoa suffered repeated head trauma final month. 

“Following the entire overview, the events concluded that whereas the step-by-step course of outlined within the Concussion Protocol was adopted, the end result on this case was not what was meant when the protocol was drafted,” a joint NFL-NFLPA assertion mentioned.

The concussion protocol will add the symptom of “ataxia” to “no-go” signs, during which a participant will likely be prohibited from returning to the sport and can obtain follow-up care outlined within the protocol if a participant is recognized with this situation.

It defines ataxia “as [the] abnormality of stability/stability, motor coordination or dysfunctional speech brought on by a neurological concern.”