Concussion Literature Review

All athletes must be aware of the looming risk of concussion—especially adolescents who are at an increased risk of sustaining permanent damage. In addition, athletes must understand the harm of a concussion and not take the matter lightly. Concussions have been studied extensively for decades, shining much-needed light on the previously unexplored subject. Being knowledgeable of all signs and symptoms, cognizant of effects lasting one day to a lifetime, and informed of all return to play guidelines is imperative to the safety of every athlete. This review will cite many articles including, “Blood Biomarkers for Brain Injury in Concussed Professional Hockey Players”, “Pediatric Sports Specific Return to Play Guidelines for Adolescents and Children”

and Zurich 2012 Consensus Statement, the leading concussion article right now. This article will support my study by proving the authenticity of my subject by citing several studies professional researchers before me have conducted. My own data will compliment these other studies and add to an extensive repertoire that will aid adolescent athletes in the future.
There are many signs and symptoms shown in concussions: the following points will further clarify all the signs and symptoms that may occur in the scope of a concussion. Firstly, the more distinct signs have been observed and recorded in numerous prior studies. Signs differ from symptoms because they are the actual indicators, such as heart rate, breathing, oxygen saturation. The article “Concussion Symptoms Scale and Sideline Assessment Tools: A Critical Literature Update”, written by J.T. Eckner and J.S. Kutcher, identifies many signs, which include. In the same study, researchers conducted an experiment using the Standardized Assessment of Concussion. The Standardized Assessment of Concussion (SCAT) asks the potentially concussed athlete the Maddock’s questions (time, place, year), assesses memory recall, neurologic assessment including strength, and finally a delayed recall. 96.4% of the athletes immediately recall scores of 5, but only 36.9% had a delayed recall score of 5. Of all the cumulated athletes, a large amount, 91.6%, were able to recite the months backwards and 51% were able to recall complete sequences of six digits. Interestingly, gender prevalence was different as well as difference between first-time concussed athletes and those with a history of multiple concussions. This study solidifies the assumption that males incur more concussions and those with a history of concussions see more long-term or even permanent consequences.
As was stated earlier, signs are the objective indicators of a problem.

Symptoms, alternatively, are subjective and can only be described by the person feeling them. The “Concussion Symptoms Scale and Sideline Assessment Tools” article mentions every symptom, obvious or minute. Symptoms include, headache, pressure in head, neck pain, dizziness, sensitivity to light, sensitivity to noise, feeling slowed down, state of being “in a fog”, overall just don’t feel quite right, difficulty focusing, difficulty with memory, low energy, puzzlement, sleepiness, anxiety, insomnia, or even sleeping more than usual are all potential symptoms that can indicate a concussion. It is important to remember that all concussions show at least one symptom, but the other symptoms may not be apparent. As of right now, there is no technological test that can diagnose a concussion. Many inventions have been tested, but there is no equipment that has been able to detect concussion. This is why the sideline assessment immediately following the impact is so critical. Interestingly, a study conducted in association with the concussion symptoms scale article mentioned above made a connection between exercise and symptoms. It states, “[the research team] recently studied the effects of fifteen minute bursts of moderate to high intensity exercise on common concussion symptoms in a sample of sixty healthy participants aged 18 to 35. They found significantly increase symptoms following intense exercise, with a

trend toward increased symptoms following moderate intensity exercise”. Although this study was limited by the inability to draw cause-and-effect conclusions, the trends led authors to conclude that activity level after concussions increases the severity of its symptoms. However, signs and symptoms are not sure indicators of concussion, so some researchers have turned to subtler ways of diagnosis. In the article “Blood Biomarkers for Brain Injury in Concussed Professional Hockey Players”, the researchers attempted to find an association with higher levels of biochemical markers in blood to concussion. In addition, researchers tested whether the plasma levels in the blood can predict return to play for professional ice hockey athletes. The biomarker studied in this study is called total tau. The twenty-eight participants were tested in preseason then again during the playing season. Total tau levels were significantly higher in post-concussion samples compared with preseason samples. There was no significant increase in the levels of S-100B and NSE in postconcussion samples when compared to preseason samples. On the other hand, levels of total tau skyrocketed immediately after a concussion compared to a preseason sample. The highest levels of total tau were measured during the first hour after concussion. Slowly, total tau levels declined but and remained elevated 144 hours after the concussion. The results of this experiment show that levels of astroglial (end of nerve), and axonal (nerve fiber), injury biomarkers S-100 calcium-binding protein B, and total tau, respectively, were also increased in players with sports-related concussion. The highest biomarker concentrations of total tau and the S-100 protein were recorded immediately following a concussion, and decreased during rehabilitation. The results conclude that sports-related concussion in pro hockey players is associated with acute axonal and astroglial injury, possibly severing many nerve connections. It has been discovered that these injuries can be monitored using blood indicators. Hopefully, in the future, the biomarkers will be developed into clinical tools to guide sport physicians in the medical counseling of athletes. While concussions cannot be correctly diagnosed and treated as of today, all concussions will continue to exert some short, intermediate, or even long term implications for the athlete.
Concussions have numerous short, intermediate, and long-term effects that can impact the mental stability of a person – perhaps permanently.

These effects may fade, but will surface over time. Short-term implications are defined as lasting three weeks or less. One of the most prevalent of these effects is amnesia. Amnesia is defined as a deficit in memory. In a study conducted by M.R. Lovell and V. Fazio, titled “Concussion Management in the Child and Adolescent Athlete,” analysis of patients suffering from amnesia indicated higher symptom scores and decreased neurocognitive data. Evidence supports the conclusion that amnesia can be more severe in adolescents. The same study addresses the peculiarity of the claimed symptom of ”fogginess” related to neurocognitive functioning. “Fogged” patients tested for higher symptom scores compared to those not feeling “fogginess.” These athletes also scored significantly lower on measures of memory functioning, processing speed, and reaction time. Previous studies have said that collegiate athletes recover from concussions in 1-2 weeks, recent research says that younger athletes take considerably longer to recover. In an investigation of high school football players, 25% of athletes took four weeks to fulfill recovery requirements. Varying rates of recovery is very common in adolescents and children and research ahs indicted a number of factors that potentially affect a child’s recover rate. Clinical experience shows that middle school

and elementary athletes can take as long as 1 month or more to become symptom-free. In a nutshell, the younger a patient is, the longer the recovery period. When short-term effects exceed a certain time, they become intermediate. The intermediate period spans approximately one month to a year. Intermediate effects of concussion include the same effects of the short-term, just longer-lasting. Multiple concussions increase the possibility of recovery time stretching into intermediate times. The more concussions sustained, the longer and longer times will take. Depression begins to surface in patients after a time. Depression has been credited to the restriction of activity and competition. In addition, a research study explained in the “Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2013” state that neuroimaging studies using fMRI suggest that a depressed mood following concussion may reflect an underlying pathophysiological abnormality consistent with a limbic-frontal depression model. Although such medical issues may be multifactorial by nature, it is suggested that the standing physician take these issues into consideration in the management, evaluation, and treatment of all concussed patients. Another startling effect of concussion is motor inhibition and convulsive phenomena. A variety of immediate motor restriction or convulsive movements may accompany a concussion. In rare cases, the occurrence of convulsions may last for weeks. Although they are dramatic, these clinical features are generally benign, or harmless, and require no specific management beyond the standard treatment of the concussion. The long-term effects of concussion are the easiest to know – largely because they are extremely prevalent later in life. Alzheimer’s Disease is one of the most controversial and studied long-term effects. Alzheimer’s Disease is the most common form of dementia, a category of brain diseases that cause long-term loss of memory coupled with the ability to think and reason clearly to the point it is severe enough to impact a person’s daily functioning. Alzheimer’s Disease, specifically, is infamous for mental deterioration that affects memory, thinking, and behavior. Victims lose their ability to perform daily activities like eating and they may forget the existence of friends and family members. Victims become a shell of themselves. Multiple brain traumas have been connected to the early onset of severe Alzheimer’s disease. Football players are known to sustain more concussions than any other contact sport. In fact, former NFL players are three times more likely to contract Alzheimer’s in life. In the journal Neurology Reviews, researchers analyzed information from a study population of 3,439 players who played at least five seasons in the National Football League. Although the overall football player mortality rate was less than that of the cumulative general population of all United States men, the study indicated that football players had a significantly elevated death rate for all neurodegenerative causes together—three times higher than the general population. Furthermore, compared to the rest of the United States males, football players were at a 400% higher mortality rate for both Alzheimer’s and ALS (amyotrophic lateral sclerosis). However, mortality rates for Parkinson’s disease increased slightly, but not significantly. Chronic traumatic encephalopathy (CTE) represents a distinct tauopathy, a class of neurodegenerative diseases related to the aggregation of the tau protein in human brains, with an unknown incidence in athletic populations—especially at the professional level. It was further consented that a cause and effect relationship has not yet been realized between chronic traumatic encephalopathy and concussions to contact sports. As of right now, the interpretation of causation in the modern CTE case studies should proceed with utmost caution. It is important to address the fears of all of those impacted by the threat of concussions from media pressure related to the possibility of chronic traumatic encephalopathy. As a whole, post-concussion syndrome (all symptoms), has no viable cure. However, certain symptoms can be treated. Of course, simple headache can be treated with Aleve. Other symptoms can be alleviated with the consumption of medication. Unfortunately, there is no immediate treatment for mental illnesses like Alzheimer’s disease. The only possible solution is physical and behavioral therapy, which does not guarantee a complete recovery. There are a few conditions that will increase the chance of PCS and longer-lasting concussive effects. These include preexisting medical or psychological conditions, disability expectations, being female, and older age all raise the chance that someone will suffer from post-concussion syndrome. There are two tests that can measure deficits in human cognitive function. The neuropsychological Stroop Color Test can foresee the development of problems caused by post-concussion syndrome. The other test, the Rivermead Post-concussion Symptoms Questionnaire, is a collection of questions that measure the severity of sixteen separate symptoms. This test can be administered by the patients themselves or by any interviewer. A common form of long-term brain damage occurs when the injury damages the hypothalamus or the pituitary gland. Pituitary gland damage can cause deficiencies of hormones, therefore causing hypopituitarism. The treatment of this condition is the replacement of missing hormones. Another protocol of PCS treatment is psychotherapy – about 40% of patients partake in this. This therapy tries to aid in the painstaking return to athletic competition and other preinjury activities. Cognitive behavioral therapy is a type of psychotherapy that attempts to influence disturbed emotions by improving the patient’s thoughts and behaviors.
The major objective of all these treatments is to get the player back in competition as quickly as possible. One of the most critical parts of this entire process is the return to play guidelines. These guidelines can differ in a hundred ways – every conducted study differs in some way. RTP, or return to play, is the time