When we first learn to walk, it is inevitable that we will spend a fair amount of time falling down. As the body learns to toddle, the brain is learning to help the muscles pick up legs and recognize obstacles like stairs, cracks in the sidewalks, and other hazards. As we get older and more active, we are more likely to suffer serious injury as we ride bikes, play contact sports, and otherwise have adventures that can lead to injury (rock climbing, anyone?). While a certain level of risk of injury is to be expected depending on the activity, reducing the risk of concussion and head injury by following certain safety steps is an important part of an active life.

Concussions are a traumatic brain injury that occurs when the head suffers impact, but they can also occur with violent shaking.

The brain moves violently inside the skull, stretching and twisting brain cells. This movement can change brain chemistry and hamper brain development. This is readily apparent in professional football players who began playing football before the age of 12. A study of 42 former National Football League (NFL) players with a similar incidence of concussion found that the players who began their football careers prior to age 12 performed worse on every test administered with regard to mental flexibility, memory, and general cognition.

Christopher M. Filley, MD, with the University of Colorado School of Medicine in Aurora, Colorado, believes that early head impacts that play a large role in decreased cognitive function later in life need further study:

“Given that 70 percent of all football players in the United States are under the age of 14, and every child ages nine to 12 can be exposed to 240 head impacts during a single football season, a better understanding of how these impacts may affect children’s brains is urgently needed.”

A similar study of 224 fighters (mixed martial arts and boxing) found evidence that repeated blows to the head decreased brain volume in some areas of the brain and slowed mental processing speeds. Researchers working for the British Journal of Sports Medicine used the Fight Exposure Score (FES) to calculate the length and intensity of a fighter’s career. Higher scores meant smaller brain volumes in the areas of the thalamus, which governs sensory input and motor skills, and the caudate, which is a part of the basal ganglia and is responsible for mental processing speeds. Between boxers and mixed martial arts fighters, researchers found that boxers fared much worse:

“Perhaps the most obvious explanation is that boxers get hit in the head more. In addition to trying to concuss (i.e., knock out) their opponent, martial arts fighters can utilise other combat skills such as wrestling and jiu jitsu to win their match by submission without causing a concussion.”

You don’t have to be a professional football player or boxer to suffer a concussion, but kids who play sports are at increased risk of concussion.

Approximately 300,000 high school athletes suffer concussions every year, and the number of kids in emergency rooms with concussion has more than doubled in the last decade. This may be due to increased awareness of the importance of diagnosis and treatment as well as the understanding of the potential long-term consequences of concussion.

Some of the symptoms of concussions are:

  • Head pain
  • Dizziness
  • Loss of consciousness or confusion when conscious
  • Nausea
  • Extreme fatigue
  • Slurred speech
  • Ringing in the ears
  • Slow verbal or motor response
  • No memory of the traumatic event (when the concussion occurred)

Along with standard assessments used to diagnose concussion (symptoms presented above, plus other physical exams), researchers at NYU Langone Medical Center have been studying the efficacy of simple eye-tracking software that can be used to detect not only the concussion but also gauge its severity. One of the physical symptoms of concussion is the inability of the patient to track an object with their eyes, the object usually being the doctor’s finger. This crude assessment can only guess at a diagnosis, but it is unable to gauge the severity of the injury. In the study, 64 control subjects and 75 trauma patients had 200 seconds’ worth of eye movements tracked while they watched a music video. The eye-tracking technology, formerly used to evaluate veterans of the conflicts in the Middle East with suspected traumatic brain injury (including concussion), was able to accurately diagnose severe brain injury in a simple way without complex machinery.

More elegant than following a doctor’s finger but less involved and expensive than an MRI, this eye-tracking can be used even on the sidelines of a sporting event to quickly diagnose and assess concussions. Richard G. Ellenbogen, MD, the Theodore S. Roberts endowed chair and professor and chairman of the department of neurological surgery at University of Washington Medicine and co-chair of the head, neck and spine committee of the National Football League, supports this research and welcomes the new technology:

“Traumatic brain injury is one of the most common causes of neurologic morbidity in the world today. Sports concussion, on the mild end of the spectrum of TBI, has captured the fascination of both the public and media. Since concussion affects all ages, both genders and occurs in all sports, being able to make the diagnosis quickly and accurately is essential. The challenge physicians have in identifying concussion is that the diagnosis is often based on self-reported symptoms.”

The best way to treat concussion is to prevent it, and the best way to do that is to utilize appropriate safety gear for whatever activity is being performed. Helmets for all wheeled sports are essential for safety, but they are only as good as their fit, so take the time to properly fit a helmet, and replace it after a crash or as children grow. Car crashes are another major cause of traumatic brain injury, so always wear a seatbelt in the car when you go out. Around the home, keep pathways and stairs clear and well-lit to prevent falls. Older adults should continue to exercise regularly to improve strength and balance.

Have you ever suffered from a concussion?

Image by Andrew Bardwell via Flickr

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