Thoughts on Reducing the Incidence of Traumatic Brain Injuries (TBI’s) in Athletics

It is a truism that athletics, especially competitive sports, play a large role in American life. A 2014 Harris Poll reported that, for at least 30 years, NFL football was the most popular sport in America according to a sampling of individuals over 18 years old. The same poll determined that other sports ranked after NFL football in the following order:

• Major League Baseball (14%)
• College football (11%)
• Auto racing (7%)
• NBA basketball (6%)
• NHL hockey (5%)
• College basketball (3%)[1]

While the potential for head trauma exists in all of the 6 athletic activities that were rated by Harris as the most popular, the risk of traumatic brain injury clearly also exists in many other athletic activities including:

• Gymnastics, where falls may occur
• Wrestling, where an individual’s head could be hit by an elbow or upon the hard surface of a mat or floor
• Boxing, where punches and jolts to the head are common, if not encouraged
• Cycling, where an individual may collide with another cyclist or fall from his or her bicycle for some other reason
• Various types of winter sports including skiing, snowboarding and snowmobiling where falls, collisions or ejections can occur onto hard surfaces.

Here are a few tips for athletes to follow, regardless of the athletic activity in which they participate. These tips are not intended as an exhaustive list, but instead, are offered to help athletes avoid traumatic brain injuries, of which a concussion is but one type:

• Buy and use approved helmets of the correct size all of the time. This applies to all sports
• Ensure the supervision of participants in athletic activities and do not allow them to use sporting equipment unsuitable to the sport or to their age or ability level
• Do not dive into water less than twelve feet deep in above-ground pools
• Do not wear clothing that interferes with vision or hampers the movement needed for the sport
• Discard and replace equipment and protective gear that is damaged or that no longer fits[2].

There have been rule changes applicable to organized professional and collegiate sports activities intended to prevent head and neck trauma. For example, The National Collegiate Athletic Association (NCAA) has adopted rules intended to diminish the frequency of “head-down” contact and “spearing.” This is contact where a player uses a helmet to inflict punishment upon an opponent; it can be helmet-to-helmet, helmet-to-body or otherwise.

Based upon the dynamics of some of the athletic activities discussed, mild traumatic brain injuries, also called concussions are frequent. Therefore, it is important not to minimize their significance. It is a brain injury in every sense of the term, despite sometimes being placed on the lower tier of the seriousness spectrum. It results from a jar or a blow to the head which is the encasement of the brain. Therefore, by definition, it is brain injury and must be treated as such.

In the context of athletics, sports teams have adopted new protocols than those of the past in dealing with even mild traumatic brain injuries. A significant change is that the athlete who has sustained a concussion will not be allowed to play again that day and until the severity and the impact of head trauma have been assessed and treated. The absence of this prohibition could result in a catastrophic injury to the player due to that which is called “second impact syndrome” or SIS. This condition arises from the occurrence of another head trauma before the brain has fully healed from the first. A minor trauma can cause SIS, and it does not even have to be one to the head. All that has to happen is that the second blow snaps the head enough that the brain rebounds within the skull. Because the brain has become vulnerable from the first insult and has not fully healed, the results of SIS can be catastrophic. The brain’s ability to self-regulate the amount of blood volume to the brain is damaged. That can result in increased cerebral blood volume which can result in brainstem herniation and death[3].

When an athlete sustains a traumatic brain injury such as a concussion, acute care must be rendered immediately. Thereafter, depending upon the seriousness of the concussion, residual symptoms and the results of objective testing, post-acute care may be needed. For example, if the concussion causes psychological or cognitive problems, the elements of a Client Goal Plan of post-acute care may include:

• Neurorehabilitation
• Rehabilitation of cognitive deficits
• Neurologic rehabilitation
• Short-term care
• Residential services

Upon becoming a Client of NeuLife Rehab in Mount Dora, Florida an individual undergoes a functional evaluation by a multi-disciplinary team of professionals which may include:

• Board Certified Neurologist
• Board Certified Behavior Analyst
• Board Certified Physiatrist
• Neuropsychologist
• Psychologist
• Board Certified Psychiatrist
• Speech Language Pathologist/Cognitive Therapist
• Physical Therapist
• Occupational Therapist
• Nurses
• Certified Rehab Counselor

The multidisciplinary team assembled for the Client’s post-acute rehabilitation is uniquely equipped to help the Client with post-acute rehabilitation from a mild traumatic brain injury. The goal, always, is to assist the Client in attaining that degree of independence that his or her physical and mental abilities allow.

Proper and timely post-acute rehabilitation that may determine the difference between disability and independence is what NeuLife refers to as the “platinum post-acute period” —  the crucial window following acute care that is needed to nurture the whole person to health with specialized, clinically relevant services.

NeuLife’s philosophy is that healing, wellness and personal fulfillment are best achieved in a positive and uplifting therapeutic environment where caring staff encourages, assists and supports each client so he or she may achieve specific goals. NeuLife believes personal fulfillment is equally as important as goals to achieve function and independence.

NeuLife, in Mount Dora, Florida, is an accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with Traumatic Brain Injury
(TBI), Spinal Cord Injury (SCI), Amputations, Burns and other Catastrophic Injuries and Challenging Diagnoses.

2725 Robie Avenue

Mount Dora, Florida 32757

[1] http://espn.go.com/nfl/story/_/id/10354114/harris-poll-nfl-most-popular-mlb-2nd

[2] http://www.aans.org/patient%20information/conditions%20and%20treatments/sports-related%20head%20injury.aspx

[3] http://www.sportsmd.com/concussions-head-injuries/second-impact-syndrome/