Special Report: 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...]

And in the military arena, official figures show that more than 361,000 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.

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:

• Headaches
• Memory problems
• Weakness
• Numbness or dizziness
• Decreased coordination or balance
• Confusion
• Problems with sleep and fatigue
• Slurred speech
• Nausea
• Changes in mood or behavior

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.

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

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 Concussion Legacy Foundation 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.