July 2010
Concussions: Brains Are Important.
We finally understand that the brain is an important organ to protect,
especially in young athletes. For those of you who have been around
long enough to watch any of the Mohammed Ali boxing matches with Joe
Frazier or George Foreman, it may have come as no surprise when Ali
developed post-concussive brain complications. At that time, concussions
were considered a minor inconvenience. Since then, we have learned a
great deal about traumatic brain injury. Professional championship
boxing matches were routinely 15 rounds, but now are limited to 12
rounds. Even in the Mixed Martial Arts (UFC) competitions that are so
popular now, referees seem to be fairly quick to end matches when a
competitor appears to be facing a severe concussion. We have learned
about the risk of life-threatening cerebral edema when a second
concussion follows the initial injury without time for the brain to recover. We have also learned about post-concussive syndrome, which can result in poor cognitive function as well as depression and mood
problems for longer periods of time after concussion. In addition, there
is evidence of late risks of Parkinson's disease and dementia, as a result of concussion(s).
In the state of Washington, this has become even more of an issue because of a bill now signed into law that mandates school age athletes receive specific care prior to returning to sports participation. The Washington Interscholastic Athletic Association (WIAA) has a web site that gives excellent guidelines to coaches, parents, athletes, schools and health care providers on the expected management.
The highlights of the guidelines and regulations are stated:
On a yearly basis, a concussion and head injury information sheet shall
be signed and returned by the youth athlete and the athlete's parent
and/or guardian prior to the youth athlete's initiating practice or
competition.
A youth athlete who is suspected of sustaining a concussion or head
injury in a practice or game shall be removed from competition at that
time.
A youth athlete who has been removed from play may not return to play
until the athlete is evaluated by a licensed health care provider
trained in the evaluation and management of concussion and receives
written clearance to return to play from that health care provider."
Fortunately we now have consensus tools for coaches and trainers to use
in the evaluation of athletes. The 3rd International Conference on
Concussion in Sport in 2008 endorsed the Sport Concussion Assessment
Tool 2 (SCAT2). The SCAT2 gives clear guidance for management of
athletes with concussion.
Most importantly, we as a medical community and the coaches and trainers
caring for athletes at practices and competitions now are aware of the
need to treat concussions as a serious problem, and we have protocols in
place to appropriately manage these athletes.
