Tackling the Concussion Problem
By BJ Bennett
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The reach of developing concussion information has the potential to be immeasurable.
Football is a game of clear and constant measure. Situation and circumstance, winning and losing included, are teamed with how far, how many and how much. Data is fluid, separated and shipped like post office parcels. Accumulated totals grade players, teams and guide perception's ebb and flow. For a sport bound by statistics, certain facts and figures remain difficult to detail. They are, without exception, the most important.
In many respects, football's most stunning numbers are those based in neurology. According to the Centers for Disease Control and Prevention, high school football has consistently shown in studies to be the sport with the greatest proportion of concussions. There are roughly 67,000 mild traumatic brain injuries diagnosed annually in the United States at the prep level alone. The National Academy of Sciences reports that the high school concussion rate, per athletic exposures, is higher in football than soccer and wrestling combined. From 1st-and-ten, to, now, 1st-and-when.
The evaluation and ensuing observation of mild traumatic brain injuries is absolutely vital for athletes of all ages. Considerable strides have been made in recent years in terms of proper training becoming more mainstream. That said, the challenge continues. The timing of symptom identification and the duration of related inactivity are absolutely critical. The consequences of mishandling head collisions can be quite severe.
"One concussion can lead to long-term effects for some people and it could be the tenth one that does that for others. There is a lot of variability in how people present and I think researchers are still trying to figure out what the long-term effects to that are," acknowledged Shannon McGuire, a physiotherapist in the Outpatient Acquired Brain Injury Program at St. Joseph's Parkwood Hospital in London, Ontario.
Such discussion has become a leading storyline at football's highest levels. Negligence lawsuits have been filed against both the NCAA and the NFL and the admission of head injury health concerns have become more prominent with current and former players. With the headlines have come a bright spotlight on concussions and related subsidiaries. Talking points have ranged from equipment and technique, to protocol and science.
The diagnosis of mild traumatic brain injuries is the obvious step one in a process that is ever-delicate. The actual treatment of concussions, with further research, is rounding into form. Per numerous reports, how well one recovers from a concussion dramatically impacts both the likelihood and severity of subsequent recurrences. McGuire, an often-cited resource in her field, is among those incorporating fresh ideas with established philosophies.
"The gold standard for treatment of a concussion, right after a concussion, is rest," she explained. "The problem is that it is really hard for patients to do nothing and also understand how to come out of rest. We give our patients a really good education on how to make decisions about what types of activity to do and how to gradually return to activity in a way that allows their brain to heal and allows them to get back to functioning."
Inter-connectivity is the theme of the human body and that complexity is now being fully appreciated when dealing with even minor brain injuries. The reading of pre-programmed responses offers a great gauge as to where an individual may be in relation to what the demographic mean is. Even basic reactions can serve as strong indicators in the recovery process. As is the case with a football player perfecting his craft, progress is based on performance.
"We started seeing a lot of patients being referred to our program with more of a mild TBI or post-concussion syndrome. We had already done a lot of work around vision rehabilitation with the moderate to severe patients and we started applying some of those principles to the mild patients because they complained of having some of the same symptoms such as difficulty reading, disliking being in busy spaces, words moving on a page, light sensitivity; a lot of visual issues," McGuire continued.
Due to the competitive nature of athletics, there is often personal and public pressure to rush the recovery and, thus, return to the field. A numbers crunch of expectations and time, given the framework, looms daunting. Legislative changes are being made to help prevent quick decisions. Along with the suspension of interactivity and proper instruction, time can sometimes be the best medicine.
Seemingly-innocuous tasks like watching television, talking or texting provide stimulated engagement and can stress a brain in need of recuperation. These simple activities can significantly delay a return to asymptomatic behavior. Respecting the importance of the right type of rest is as key as recognizing the initial injury. Medically-paced training can aide in that progression.
"Within two-four weeks, 80% of people who have symptoms related to concussions get better," McGuire stated. "There is a certain 20% who can have lingering effects for months to years. I'm hopeful that if people receive good education about how to rest, how to come out of rest and what good exercises are early on that we can decrease the amount of people that have these lingering symptoms."
For patients who fit those parameters, there are specialized tests used to calculate improvement and help treat physiological dysfunction. McGuire is among those who administer such assessments. While individual results may vary, the program provides a point of relativity for sufferer and counselor alike.
"We graph it out for people," she nodded. "We have a point system for people who are really struggling to get their symptoms under control. Each activity is assigned a point and patients are only allowed so many points a day, similar to a Weight Watchers diet. This gives very hard and fast structure to our patients. Once the symptoms are under control, then we start to increase the number of activities they are allowed to do. Often we pull them back initially, then start to build them up."
A variety of innovative models are used by McGuire and her team. The introduction of bi-nasal occlusion, the use of tape on either eyeglasses or empty frames, to the patient, helps organize the vision system. This steadying of perception can limit headaches, nausea and dizziness and make riding in a car or grocery shopping much easier. Benefits have also been found through the use of a weighted compression vest, perforate neoprene, that has helped patients feel less anxious and better balanced. These advancements have led to more thorough testing results in addition to the necessary practical applications.
Dr. Jacques Beauchamp of Spine & Sport, who founded the practice with Dr. Eric Bull in 2004, has brought a similar philosophy to Georgia's coastal empire. With seven locations in and around Savannah, Beauchamp is developing concussion management for southeast Georgia with the treatment of persistent mild brain trauma injury symptoms. His premise follows McGuire's lead. Connect Savannah's "Best Physical Therapy" award winner for each year since 2009, Spine & Sport is utilizing neurological strategies along with physical therapy in a local outpatient setting.
A multidisciplinary perspective on concussions, prominently featuring physical therapy, is helping to advance a treatment paradigm that has already made great strides.
"This is a field that is evolving daily," Beauchamp affirmed. "There is a ton of research being poured into how we can better diagnose and treat people so that they aren't, quite honestly, held up in a room away from society for months at a time because of the lingering effects of repeated concussions."
The reach of developing information has the potential to be immeasurable. Physiotherapy has long been a fixture in the rehabilitation of more significant brain injuries; its role with less severe trauma is off and running. The aforementioned principle of the bonds within the body is well-established. Physical therapy was, in fact, created following the polio epidemic, a neurologically-based issue. In today's climate, football players could be a leading beneficiary.
"'Concussion' seems to be the big buzz word in sports, football, today," Beauchamp remarked. "We took it upon ourselves to look out into the field of medicine to try and figure out what more we could do as far as the treatment of concussions goes. It seems there is some lacking information. Everyone is well-aware of how to diagnose. There is a percentage of the population that does not respond to just rest and taking it easy. We offer treatment."
That breakthrough approach is now available for patients, student-athletes included, in the southeast Georgia region.
"We are doing baseline testing now so that if someone might have ever sustained or had a concussion episode we will be able to clearly assess it, prove either yes or no and, from there, suggest a permanent medical handling," Beauchamp concluded.
The introduction of mild traumatic brain injury therapy at the local level has the potential for grand multiplicity. Making youth and high school sports safer through specialized care sets the tone for transition and reduces the risk of future complications. Professionals like McGuire and Beauchamp are championing that cause.
Statistically-speaking, the head injury tally has reached unprecedented levels. This, however, is far from an age of salt pills and finger-counting. It's one of transparency, instead. This game isn’t won between the white lines, it’s won between the ears.