Category Archives: College
Sport-related concussion, one of the most complex injuries in sports medicine, is the focus of a new special issue of the Journal of Athletic Training, the scientific publication of the National Athletic Trainers’ Association.
“Over the last 20 years, our understanding of concussion mechanics, injury assessment and management has increased dramatically. We’ve made great strides with regard to education, research and legislation,” says special issue Guest Editor Steven Broglio, PhD, ATC, director, Neurotrauma Research Laboratory, University of Michigan. “Having the right multidisciplinary medical team in place, including the athletic trainer, who plays an important role in injury prevention and treatment, is vital. Our universal goal is to reduce the risk of injury and ensure a gold standard of care should concussion occur.”
Concussions during sport and recreation occur as often as 3.8 million times a year,1 resulting in up to seven injuries per minute every day of the year in the United States. Although each patient requires individual management, 90 percent of concussed athletes recover by day seven after injury.2 Concussive injuries compose 8.9 percent of all high school and 5.8 percent of all college athletic injuries.3
Key points from select studies published in the issue:
- Head-impact sensors have limited applications to concussion diagnosis but may provide sideline staff with estimates of athlete exposure and real-time data to monitor players.
- Given that concussion risk is inﬂuenced by many factors in addition to impact biomechanics, viewing an athlete’s head-impact data may provide context for the clinician working on the sidelines, but impact sensors should not replace clinical judgment.
- Amnesia was the predictor that most inﬂuenced clinical recovery from concussion.
- Loss of consciousness, concussion history and acute symptom group did not substantially affect symptom, cognitive or balance outcomes.
- Most injured athletes recovered within the normal timelines established by the Graded Symptom Checklist, Standardized Assessment of Concussion and Balance Error Scoring System.
- Compared with high school athletes who had access to an athletic trainer, those without such access were less knowledgeable about concussion.
- Access to an athletic trainer was not linked to high school athletes’ concussion-reporting percentages. However, such access was related to 10 reasons for not reporting a concussion.
- The most common reasons for not reporting a concussion were not wanting to lose playing time, not thinking the injury was serious enough to require medical attention and not wanting to let the team down.
- Per 10,000 athlete-exposures, the rates of sport-related concussion were highest in football (9.21), boys’ lacrosse (6.65), and girls’ soccer (6.11).
- Among sex-comparable sports, the rate of sport-related concussion was 56 percent higher in girls than in boys.
- Most athletes with sport-related concussions returned to play after seven days, despite resolution of symptoms in a smaller proportion within one week.
“No sports medicine topic is more polarizing than concussion, and today’s standard of care supersedes where we were just a decade ago,” says Broglio. “With validated measures, more and more of the guesswork is being removed from the process. While many questions persist about more sophisticated diagnostic measures, rehabilitation and long-term effects of injury, we continue to make great progress, remain current on research and new techniques and provide the best possible care for our patients at any level of sport or activity.”
Other suggested articles in the special issue:
- “If You’re Not Measuring, You’re Guessing: The Advent of Objective Concussion Assessments”
- “A Multifactorial Approach to Sport-Related Concussion Prevention and Education: Application of the Socioecological Framework”
- “Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature”
1Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–378.
2McCrea M, Guskiewicz KM, Randolph C, et al. Incidence, clinical course, and predictors of prolonged recovery time following sportrelated concussion in high school and college athletes. J Int Neuropsychol Soc. 2013;19(1):22–33.
3Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among United States high school and collegiate athletes. J Athl Train. 2007;42(4):495–503.
April 2017, Vol. 5, No. 10
Timely reporting on developments and legal strategies at the intersection of sports and concussions—articles that benefit practicing attorneys who may be pursuing a claim or defending a client.
New Study Strengthens Calls for Further Investigation into CTE Links with Soccer.
Appeals Court: Use of Oklahoma Drill May Have Been Gross Negligence
Discussion on NCAA and Concussions Steals the Show at Harvard Law School Symposium
Appeals Court: What Coaches Don’t Know About a History of Concussion Cannot Hurt Them
Soccer Goalie Alleges Team Failed to Hold Him out of Practice After Suffering Concussion, Exacerbating Symptoms
BIAPA Executive Talks About Role of Organization and Membership’s Biggest Concerns
Concussion in Sport: Liability of Governing Bodies
Senate Bill 12 – An Analysis
NFLPA Assails Possible Change in Worker’s Comp Law in Illinois
Attorney Weighs in on Change to Workers’ Comp Law for Professional Athletes
Researchers have identified a new mechanism by which inflammation can spread throughout the brain after injury. This mechanism may explain the widespread and long-lasting inflammation that occurs after traumatic brain injury, and may play a role in other neurodegenerative diseases.
The findings were published in a study in the Journal of Neuroinflammation.
This new understanding has the potential to transform how brain inflammation is understood, and, ultimately, how it is treated. The researchers showed that microparticles derived from brain inflammatory cells are markedly increased in both the brain and the blood following experimental traumatic brain injury (TBI). These microparticles carry pro-inflammatory factors that can activate normal immune cells, making them potentially toxic to brain neurons. Injecting such microparticles into the brains of uninjured animals creates progressive inflammation at both the injection site and eventually in more distant sites.
Research has found that neuroinflammation often goes on for years after TBI, causing chronic brain damage. The researchers say that the microparticles may play a key role in this process.
Chronic inflammation has been increasingly implicated in the progressive cell loss and neurological changes that occur after TBI. These inflammatory microparticles may be a key mechanism for chronic, progressive brain inflammation and may represent a new target for treating brain injury.
The researchers on the paper include four University of Maryland School of Medicine researchers: Alan Faden, Stephen R. Thom, Bogdan A. Stoica, and David Loane.
“These results potentially provide a new conceptual framework for understanding brain inflammation and its relationship to brain cell loss and neurological deficits after head injury, and may be relevant for other neurodegenerative disorders such as Alzheimer disease in which neuroinflammation may also play a role,” said Dr. Faden. “The idea that brain inflammation can trigger more inflammation at a distance through the release of microparticles may offer novel treatment targets for a number of important brain diseases.”
The researchers studied mice, and found that in animals who had a traumatic brain injury, levels of microparticles in the blood were much higher. Because each kind of cell in the body has a distinct fingerprint, the researchers could track exactly where the microparticles came from. The microparticles they looked at in this study are released from cells known as microglia, immune cells that are common in the brain. After an injury, these cells often go into overdrive in an attempt to fix the injury. But this outsized response can change protective inflammatory responses to chronic destructive ones.
The findings have important potential clinical implications. The researchers say that microparticles in the blood have the potential to be used as a biomarker – a way to determine how serious a brain injury may be. This could help guide treatment of the injuries, whose severity is often difficult to gauge.
They also found that exposing the inflammatory microparticles to a compound called PEG-TB could neutralize them. This opens up the possibility of using that compound or others to treat TBI, and perhaps even other neurodegenerative diseases.