Participating in sports and recreational activities can be tremendously beneficial in that it involves exercise, social cooperation, and in most cases takes place outdoors in the fresh air. But it also comes with the risk of bodily injury; anything from a blister on the foot or a skinned knee to a broken arm or leg. Injuries to the head are the most traumatic.
A Silent Epidemic
Head injuries sustained while playing sports run the gamut from a mild injury like a lacerated scalp or contusion to a severe or traumatic brain injury such as a concussion that results in bleeding on the brain or a lapse into a coma. The most serious sports injuries are traumatic brain injuries (TBI) which are defined as any blow, jolt, bump to the head or injury that penetrates the skull resulting in the disruption of brain function, and despite the use of helmets, many of which are state-or-the-art, TBIs are occurring in such large numbers that they have been granted a category of their own — sports-related traumatic brain injuries.
Sports-related traumatic injuries have been called both a public health concern and a silent epidemic. A public health concern because1.6 million to 3.8 million sports-related TBIs are sustained every year; making up 15% of high school high-impact sports-related injuries. A silent epidemic because these numbers reflect only those that get reported. The Korey Stringer Institute (KSI) of the University of Connecticut has found that 55% of pediatric athletes who were later found to have sustained a concussion had not been treated in a healthcare facility and 42% of adults failed to seek medical attention at the time of the injury.
High Impact Sports-Related Traumatic Brain Injuries
High impact sports like football contribute to the growing incidence of TBIs, but so do soccer, baseball, motorcycle riding, bicycle riding, skateboarding, skating, and skiing. A traumatic brain injury can occur any time a person’s head suddenly and violently collides with a hard object, be it another player’s helmet, a home run, line drive, a bat, or the ground, even a tree, as when skiing.
Symptoms of a Traumatic Brain Injury
TBI symptoms, depending on the extent of the injury suffered by the brain, can be mild, moderate, or severe. A mild traumatic brain injury may cause a brief transitory change in a person’s mental state such as confusion or a momentary loss of consciousness. A severe brain injury can result in an extended loss of consciousness, a coma, or even death.
Traumatic brain injuries can be grouped into five different modes:
- Motor: inability to control or coordinate movement or difficulty in maintaining balance
- Sensory: changes in vision; ringing or buzzing in the ears; loss or distortion of smell or taste; heightened sensitivity to sound or light.
- Speech: slurring speech; difficulty in expressing thoughts or in finding the correct word
- Pain: recurring or constant headache`
- Cognitive: confusion or disorientation; easily distracted; shortened attention span or inability to concentrate; difficulty in following instructions or processing information
Concussions constitute a TBI subset of their own, and result when the brain is shaken as a result of a high impact hit or collision with a solid object. According to the National Center for Biotechnological Information (NCBI), concussions are the most prevalent, accounting for 90.0% of TBIs.
A person who has suffered a concussion may be referred to as having been concussed and may exhibit any of the symptoms outlined above. Before diagnosing a concussion, alcohol, drug use, and medication need to be ruled out, as should other injuries or coexisting conditions.
A coma can be defined as a deep or profound state of unconsciousness during which a person is alive but unable to respond to environmental stimulation. Basic vital functions like breathing and circulation remain intact, but higher functions like thought are suspended. Comas are very complex in that they vary in scale. Some are very deep in which the individual remains impervious to any type of stimulation. In other cases, a comatose person may move, respond to pain, or make noises but is unable to respond to simple verbal commands like “stick out your tongue” or “tell me how many fingers I am holding up.” Both of these are commonly used in diagnosing a coma, but the Glasgow Coma Scale has become the definitive tool.
The Glasgow Coma Scale
Also known as GSC, the Glasgow Coma Scale is a test that is used by paramedic first responders and emergency room medical personnel in order to establish a baseline of consciousness, eye movement, and motor functions. Scores range from 3 to 15, the lower the number the more severe the injury. It is imperative that the GCS be administered immediately upon admission and repeated periodically in order to assess whether the patient’s condition is improving or deteriorating. Brain imaging tests can also provide important assessment information
Brain imaging studies are valuable in that
- Computerized Technology (CT aka CAT Scan) can rule out a lesion or hematoma that may be putting pressure on the brain.
- Magnetic Resonance Imaging (MRI) can reveal subtle changes missed by the CT scan
Worst Case Scenario: Chronic Traumatic Encephalopathy
Chronic Traumatic Encephalopathy (CTE), often found in persons who engaged in high impact contact sports and suffered a succession of repeated head injuries or concussions in the past, is a progressive degenerative disease. Its symptoms can take years or even decades to develop. And when they do, they are substantial and may include
- Memory loss
- Loss of inhibitions
- Proclivity to violent reactions
- Suicidal thoughts.
And the worst thing is that these are often but a way station on the way to progressive dementia accompanied by unstable balance, slow movement, continuous muscle spasms, contractions, and tremors, and other Parkinson-like characteristics. Research carried out at Boston University in 2017 found that out of 202 brains of deceased football players who had suffered repeated high impact blows to the head, 177, or 87% displayed evidence of having CTE.
For this reason, it’s imperative that players from a very young age wear protective gear; and that athletic organizations, from Pop Warner and Little League on up to the AFL, NFL, and Major League Baseball strengthen their rules against overly aggressive behavior.
And until that day, and perhaps forever, since symptoms take so long to develop before changing lives for the worse, if victims are ever to be compensated, it’s imperative that high impact sport head injuries be immediately evaluated as a baseline for proving that a brain injury occurred.