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New research on concussions raises new questions

March 29, 2013

PLYMOUTH — Tragedy has brought the topic to the forefront, and preventing further tragedy has spurred greater research into sports concussions and their effect on long-term health.
It is a topic that is as important to local parents as it is in the NFL, and specialists from all over the world met recently in Zurich, Switzerland — at the headquarters of FIFA, the international governing body of soccer — to discuss recent research and developments in dealing with the problem in sports.
Dr. Stephen Simons, Associate Director of Sports Medicine at St. Joseph Regional Medical Center was in attendance at the conference and admitted that he left the conference with even more questions but also came away with a wealth of useful information to help the area’s parents and athletes.
“There has been a great emphasis put on the subject by all professional sports, but especially the NFL (National Football League),” said Simons. “That’s helped. I mean, we have to admit that everybody always pays attention to the NFL and that has brought about a lot of research and helped involve lots of people to learn more about concussions and their effect on athletes.”
Simons says the efforts have resulted in the NFL and the U.S. Army investing $100 million for research on the subject over the next 10 years. He also hopes that the extra attention will lead to another result locally.
Greater reporting
of the injury
The common culture of sports in regard to all injuries has always been summed up in the phrase “...shake it off and get back out there.”
Better information has made the impact that — with concussions anyway — that is a dangerous mindset.
“We have seen an increase in the reporting of concussion symptoms but — with boys especially — we feel like we’re only getting the tip of the iceberg,” said Simons. “We feel pretty certain that a lot of symptoms go unnoticed and unreported even though we’re getting more than we used to. We need total cooperation from everybody involved — teammates, coaches, parents — to make sure players aren’t returning to play before they are ready. It used to be that it was a heavy negotiation about allowing a player to return. That has improved dramatically with baseline testing and state law.”
Thanks to recent legislation, return to competition must be given by a healthcare professional trained in the subject of concussions. The okay of a coach or athletic trainer is no longer enough.
“Obviously the first thing you do if you suspect a concussion is remove the athlete from the risk of another,” said Simons. “One thing we need to do a better job of is once a concussion is diagnosed, the athlete needs complete physical rest but cognitive rest too. The schools are going to have to help us on this, freeing them from homework, school work, all cognitive activity to let the brain come back to activity slowly.
“After that some physical activity has actually been proven to be beneficial, like riding a stationary bike, but before they return to actual competition they need to complete the appropriate tests.”
Questions still need
to be answered
Much more is known about the long-term affects on the brain of sports concussions, the worst of which is multiple chronic traumatic encephalopathy — brought to national attention with suicides of NFL players Dave Duerson and Junior Seau. Simons admitted that he left the Zurich conference “...with as many unanswered questions.”
“How many concussions are too many?” was one such question for the Doctor,
“What is the affect of all the jostles and what we call ‘sub-concussive’ hits? Maybe you don’t suffer a full concussion, but what is the consequence of the multiple smaller hits? Currently there is no research on that topic so the answer is a complete unknown.”
“Is there a genetic factor involved?” is another question for Simons.
“There is some suggestion that some individuals are genetically more susceptible to concussion than others, but once again the amount of research is very small and I’m not sure I see a day when you’ll need to have your child genetically tested in order to play football.”
Simons is excited about the research in biomarkers to determine concussions — blood tests, tests on spinal fluid and the like — that will allow doctors to determine concussion without other tests.
“We’ve got to cut down on the emergency room visits and CAT scans on young adults,” he said. “There is far too much radiation in kids today, and we need to keep those kind of tests to a minimum.”
The Doctor is also encouraged by technological developments.
“Computer tests have become much better in helping us determine if an athlete has returned to baseline,” said Simons.
Prevention is
still a priority
Simons says that while advances have been plentiful in combating concussions in sports, more work still needs to be done in some areas.
“Rule changes can still have a big effect,” he said. “The NFL has documented a drastic drop in concussions among special teams players with the change of their kickoff rule and more of that needs to happen.”
He says that equipment also is a factor, but players need to be wary of false claims.
“We need to keep doing the research to improve equipment like helmets,” he said. “But there are some products out there that are being aggressively marketed as deterrents, but there is no scientific evidence to support the claim. The head bands they sell for soccer are an example. There is actually research to suggest that they make the (concussion) problem worse, so you need to be careful of the claims some equipment makers are making.”
Parents are the key
Simons is also happy with the information and cooperation with area athletic trainers and coaches. He still believes that parents are the key resource.
“Parents are the best to observe if their child might need to be tested for concussion,” he said. “You’re looking for any sort of change in behavior — any emotional differences, changes in attention span. Fatigue is a big issue, are they suddenly going to bed at a time they’ve never gone to bed before? Irritability. Anything you notice that is different. Are they suddenly more quiet than usual. I had one athlete that was normally almost mute who suddenly became a ‘chatty Kathy’. Parents are in an excellent position to observe those things.
“If you notice those things at the very least have them evaluated before returning to an at-risk situation.”
There are extensive tests used by doctors and athletic trainers to determine if an athlete has a concussion and its severity, but a simple checklist for parents can be helpful. Problems could arise in the first 24 to 48 hours of suffering a concussion, and if they do the athlete should not be left alone and should go to the hospital immediately if they exhibit any of the following symptoms:
- Have a headache that gets worse
- Are very drowsy or can’t be awakened
- Can’t recognize people or places
- Have repeated vomiting
- Behave unusually or seem confused, are very irritable
- Have seizures (arms and/or legs jerk uncontrollably)
- Have weak or numb arms or legs
- Are unsteady on their feet; have slurred speech

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