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Cumulative Concussions

“Injuries are part of a professional hockey player’s life. I’ve had several major injuries and many minor ones, but the one that changed my life happened in October 1996 when I was playing with the Buffalo Sabres. It was a major concussion that forced my family and me to put hockey, life, and what really matters into sharper focus,” writes National Hockey League Hall of Famer Pat LaFontaine, who was forced to retire prematurely as a result of a series of concussions suffered during his career.

Pat LaFontaine is not an anomaly. According to the Centers for Disease Control and Prevention, an estimated 1.6-3.8 million sports- and recreation-related concussions occur in the United States each year. [Continued Below...]

“The line leadership all the way down to the platoon level is saying, you will do this … you will get evaluated for concussion …” says Dr. James Kelly, director, National Intrepid Center of Excellence.

And in the military arena, official figures show that more than 266,810 soldiers from the Iraq and Afghanistan wars have suffered mild traumatic brain injury since 2002, although the numbers could be significantly higher since many concussions go unreported. Because TBI has become such a prevalent casualty of these conflicts, the military has implemented a culture change that includes taking significant preventative steps regarding brain injury, For example, soldiers who have sustained three concussions now receive a more detailed, mandatory evaluation before being released back to combat.

Many service members and athletes are sustaining multiple concussions, or something called cumulative concussion, which can have life-long and sometimes debilitating effects.

Definition

A concussion is a blow or jolt to the head that can change the way your brain normally works. Cumulative concussion — or repeat blows to the head — can have long-term implications because oftentimes the brain does not have the chance to recover fully before another insult … and damage then piles upon damage. Recent studies on the cumulative effects of concussion in sports are showing that even mild concussions can result in serious long-term problems, especially if an athlete is allowed to return to play too early or has a history of previous concussions.

“What I try to balance as a parent [and brain injury scientist] is the enjoyment of what my son or daughter might experience from the sports participation, the lessons they may learn, and the safety of their participation,” says Dr. Michael McCrea, executive director, ProHealth Care Research Institute and NeuroScience Center.

One of the most tragic sides to cumulative concussion, though rare, is second-impact syndrome, a condition in which the brain swells rapidly and catastrophically after a person suffers a second concussion before symptoms from an earlier one have subsided. This often deadly second blow may occur weeks, days, or even minutes after an initial concussion, and even the mildest grade of concussion can lead to second-impact syndrome.

Symptoms

Signs and symptoms of a concussion can show up right after the injury, or they may not appear until days or even weeks afterward. Concussion symptoms can include:

Sometimes people complain of “just not feeling like themselves.” And it’s crucial to understand that a concussion does not mean that a person necessarily loses consciousness.

As for repeat — or cumulative — concussion, the symptoms are the same, but can become exacerbated or last for longer durations of time with each concussion. In fact, neurological damage can become permanent, causing a person to have consistent memory problems, difficulty with concentration and organizing thought, or even experience significant personality changes or early onset dementia, for example.

Diagnosis and Treatment

Most people who sustain a concussion or mild TBI are back to normal by three months or sooner. But a small percentage can experience long-term problems remembering things and concentrating.

The diagnosis of brain injury involves looking for signs of brain injury, either through scanning devices like computer assisted tomography (CAT scans), magnetic resonance imaging (MRIs), and X-rays, or through screening tools — usually in the form of simple tests — that measure various areas of a person’s speech, movement, memory, and thought.

And because of increased awareness about the dangers of repeat concussion, baseline testing is becoming more prevalent in the sports arena as well as for the military.

“What we do know is that an immature brain does not recover as quickly as a mature brain. And this flies in the face of what we know about children …” says Dr. Jeffrey Barth, director, Brain Injury and Sports Concussion Institute, University of Virginia School of Medicine.

Identifying concussion earlier offers an opportunity to intervene earlier. This can make a marked difference in a person’s recovery and ultimate outcome.

To date, there is no magic pill or powder to treat cumulative concussion. However, research and increased awareness have not only helped better diagnose and monitor the problem but, in turn, helped people make more informed decisions.

Simple rest of the body and brain until symptoms subside is essential for a successful recovery. If a person’s symptoms of concussion persist, he should seek further evaluation by a neurologist and/or a neuropsychologist.

Prevention

In the last several years, concussions in sports have received a lot more attention and scrutiny — so much so, that rules in certain games are changing, and return-to-play laws and concussion guidelines are being implemented to keep athletes of all ages and skills safe — especially when it comes to cumulative concussion.

Significant changes are also being implemented in the military, especially regarding the effects of blast injuries and how they may be different from those of an injury sustained in sports or in a car crash. Specifically, under a recent policy change, troops caught within 165 feet of a blast — about half the length of a football field — must be pulled from the battlefield for at least 24 hours and examined for evidence of a concussion. The same goes for troops in a vehicle or building struck by a bomb. In addition, soldiers who have sustained three concussions will receive a more detailed, mandatory evaluation before being cleared to return to combat.

Current Research

“It doesn’t take an expert, a doctor, or a pathologist … anyone can see that they don’t want those brown, ugly spots on their brains,” says Dr. Ann McKee, director, Brain Banks.

In conjunction with the growing awareness about the sometimes debilitating long-term effects of cumulative concussion, a great deal more research has been underway. In fact, research spearheaded by Dr. Ann McKee and her colleagues at The Center for the Study of Traumatic Encephalopathy and The Sports Legacy Institute has provided the first pathological evidence that repetitive head trauma experienced in collision sports is associated with chronic traumatic encephalopathy, a slowly progressive brain disease and degeneration manifested by cognitive and behavioral problems.

With more findings, the nature of how we play contact sports, fight in wars, or make decisions about the activities in which our children — and ourselves — participate may change. Each of us is only born with one brain.

 

 Comments [6]

Im around 25 and when I was younger about 15 I was attacked by 4 grown men that were about 10 years older then me at the time. They surrounded me because I was defending my best friend who has downs syndrome(he is highly functional) but they were throwing glass bottles at him from there car. I stood my ground as I was a fat kid at the time and there was no way to run from my attackers. One of them the man in front was cussing at me and making threatening movements and I put my hands in front of me to defend myself when suddenly I woke up on the ground with the men still surrounding me. I got up and again tried to defend myself and they all ran to there car and I for some reason thought I scared them off. I started to walk too my disabled friend and felt warm on the side of my head (my ears were ringing I believe as well) I started to freak out when I realized the warm feeling was blood and when I tried to find the wound I felt my skull. I ended up with about 15 staples in my head but I don't ever remember them saying I had gotten a concussion(being memory loss is part of it they may have but I cannot remember everything) My disabled friend told me that while the one man was threatening me the other hit me with a baseball bat. Now almost 10 years later I get terrible headaches specialy when im laying down and trying to sleep or I push myself to hard doing really anything. I don't know what to do as the hospital that treated me has long been closed and the doctor passed away. What should I do?

Nov 9th, 2013 4:34pm

I certainly understand what is being said here. It\\\'s just not all sport related injuries as previously thought. After several hits to my head over my life time, I\\\'ve experienced migraines (since the age of nine) that put you under the bed for days at a time. I\\\'ve seen every professional within our area and we\\\'ve driven countless miles to hospitals and other professionals. I have a wonderful husband that cares for me the best he can. I\\\'ve been to pain management treatments, Biofeedback and the MRI\\\'s all show these spots on my brain. I\\\'ve gotten more grief over these headaches than one could imagine. Just a way not to go to school, or work, take care of a special needs child, and help my husband with daily activities. I forget names, start sentences without completing them, start all types of projects and can\\\'t complete them. I can\\\'t work on my books or poetry any longer because the words get stuck and I loose concentration, and have started having seizures. I\\\'ve had countless tests, thousands of pills to stop the pain and nothing works. Now it\\\'s just easier to call it Chronic Pain and live with it. Like most of you I have forgotten what it\\\'s like to live in the now and not make future plans. Sometimes I\\\'ve forgotten all my medical background I went to school for all those years. What a waste of good money!

Jul 1st, 2013 1:35am

+I was held hostage for 13 years and sustained repeated blows to the head each attack, having my head hit repeatedly on the wall at least 3-5 x per week on average sometimes every day. I ended up in a coma for months on end and in and out of a coma for two years. when i escaped with my child with help of friends because i was still in a vegative state from starvation and torture and kicks to the head etc... i could not remember my own name for more than 3-5 mins. I knew who i was but had no words to cognatively think of my name so could not relay. even when i did know a word within a few seconds it was gone. It is now15 years later and i got my first computer and learning to use it the last few months. before that i could not concentrate to even read or do paper work at all and i still dont and i have people on my back all the time because of it. I could not concentrate or remember anything to learn anything. I now work with activists advocating against domestic violence but I still struggle. Last week I slept the whole week. When i get fatigued i can not put a sentance together that makes sense. people on the ph talk to me like im only 4. I am in a wheel chair from head and spinal injuries and am hearing impaired through the blows to my head. I have significant problems with memory and have several large amounts of amnesia and lots of bits missing. I often cant find the right words to say what i want and am always telling people to put stuf in the rubbish when i mean washing etc people get abrupt with me and wont give me time to speak or concentrate and when i went to court the perpetrators lawyer had a slinging match with my disability. It reminded me of when his client would hit my head on the wall floor and door screaming at me to die, holding my head under water until i blanked out, strangling me etc.Pushing me from 2 story windows. But amazingly I survived and although its horrible to suffer these things we have to find what we can do now and work with that. If it means that today all i can do is go to the bathroom and sit up in bed i accept that now but i got myself the most vibrant duvette and pillow cases i could find in hot futchia pink, lime green, orange purple tufquoise yellow red etc...(by the way vibrant colours help children with interlectual dificulties and down syndrome) I dont know if they can help me persay but they sure make me feel really good. when I go into my room I love it and I want the rest of my house to be happy colours too. I say work within your limitations, love yourself the way you are, surround yourself with your fav colours with everything you do and be thankful for that. because the fastest way to recovery is relaxing and letting go of tension having a healthy diet ,exercise within our limitations and love our selves in a possitive way like you would if it were your daughter grand child or kid brother. be kind to yourself.There is a course in NZ called Theraputic leisure specialists they use leisure and fun things to improve peoples lives now, in doing so alot of people improve because they feel better about life so its easier to cope when we are happier and I dis this for myself unaware the course existed just doing stuf I remembered from my nursing days and it worked. especially massage.It worked amazingly with the severe pain too. I found that all the years i would beat up on myself made me worse and more sick. when i finally learnt to let go with a near death experience i have improved so much, A wise man once told me....find something that you can do better than an able bodied person and practise it untill you excell at it. this man painted with his mouth because his limbs did not work at all. He became so good at it he told our social security to take a hike and he made himself rich with his paintings. His name was Alex I hope this is encouraging...

Sep 21st, 2011 4:48am

Im 17 years old andI got my seventh major concussion this year , which came less than 3 weeks after my 6th one. I was stupid enough to go back to soccer with symptoms and i got illegaly hit when running with the ball. The other player elbowed me in the side of the head and jumped up at the same time causing me to land on my head. The first thing i remember is waking up screaming saying "i cant see" while lying on the field. I still have symptoms 3 months later, im so scared this is the end of being me. I just cant find who i am anymore. I slurr my words together and sometimes say the words I was going to say in a different order. I get angry over small things and just want to snap, sometimes i blank out in the middle of conversations. I feel so stupid now, my memory is shot and i just fell dull. I missed exams and 3 weeks of school so now i have to get amazing marks this year and im not sure i even can handle the stress of that. If anyones reading this with their first concussion please give up the rough sports or even just be careful, i wish id had more sense and listened to my parents when i got my first few.

Sep 2nd, 2011 2:09am

I am currently in Neuro Rehab due to a mild TBI received in an auto accident. I also have moments where I tend to get lost in space. In the middle of a conversation I will suddenly "appear" and have no clue what the conversation was about. There are no physical anomilies, just a blank stare. I am blessed with a wonderful PCP and a team of Neuro doctors/therapists. I wish you luck on your journey and know that you are not alone. Try to find a support group, which in turn may give you a lead on a doctor you are comfortable with.

Jan 28th, 2011 6:52am

What about waking in mid sentence, not knowing where I am or how I got there and being told that I never lost consciousness? This has happened to me in the case to two blows to my head. The first time approx. 2 hours had passed. The second time approx. 12 hours had pass. In both instances I was told that I appeared fine with no symptoms. And later when symptoms did arise I was fed pill after pill with brief or no relief and given more psychiatric labels than I can count. Lazy medicine is the order of the day as far as injuries to the head are concerned. I'm now 53 years old and have to hold on to walls, railings or anything I can find to stabilize myself. The Veterans Hospital had me walk approx. 4 ft. forward, turn and walk back and that was the extent of their testing. Their diagnosis was no head injury. The multitude of doctors I've seen are frauds in my personal experience. Frauds who charged great amounts of money to give me the equivalent of bar-room neuropsychology!

Jan 21st, 2011 9:47pm

 


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