How many people have PCS after a concussion?
Post-concussion syndrome
About 10% of people with PCS develop sensitivity to light or noise, about 5% experience a decreased sense of taste or smell, and about 14% report blurred vision. People may also have double vision or ringing in the ears, also called tinnitus. PCS may cause insomnia, fatigue, or other problems with sleep.
Concussions in American football
As way of comparison, a collision of 80g is a big hit in a college football game of which there might be only six per game. And the range of 80, 90, or 100g is generally where risk of acute injury and concussion begins to occur (concussion being symptoms such as feeling foggy or woozy and not necessarily loss of consciousness). An example of a lesser force of 40g is heading a soccer ball, and even with blows in this 30 to 40g range, it is not known whether these pose a cumulative risk of injury.
Concussions in sport
Concussions are also a significant factor in rugby union, another full-contact sport. In 2011, the sport's world governing body, World Rugby (then known as the International Rugby Board, or IRB), issued a highly detailed policy for dealing with injured players with suspected concussions. Under the policy, a player suffering from a suspected concussion is not allowed to return to play in that game. Players are not cleared to play after the injury for a minimum of 21 days, unless they are being supervised in their recovery by a medical practitioner. Even when medical advice is present, players must complete a multi-step monitoring process before being cleared to play again; this process requires a minimum of six days. In 2012, the IRB modified the policy, instituting a Pitchside Suspected Concussion Assessment (PSCA), under which players suspected of having suffered concussions are to leave the field for 5 minutes while doctors assess their condition via a series of questions. Players who pass the PSCA are allowed to return to play.
Sean Morey (American football)
In October 2010, Morey was named co-chair of the NFL Players Association's newly formed Concussion and Traumatic Brain Injury Committee. Morey suffered more than twenty concussions in his career. Morey's committee has two main goals: the diagnosis, treatment, and prevention of concussions and traumatic brain injuries in active players and research into the long-term cumulative effects of such injuries on NFL players.
Concussions in American football
This 2011 study measured a total 753 impacts among these seven players with a median impact of 15g. It did, however, observe 38 impacts of 40g or greater, and six impacts of greater than 80g. Fortunately, none of these youth players experienced a concussion. There is also a concern that since many young players have less developed chest and neck muscles than older players, almost every impact potentially acts likes a surprise hit.
Complications of traumatic brain injury
The risk of post-traumatic seizures increases with severity of trauma (image at right) and is particularly elevated with certain types of brain trauma such as cerebral contusions or hematomas. As many as 50% of people with penetrating head injuries will develop seizures. People with early seizures, those occurring within a week of injury, have an increased risk of post-traumatic epilepsy (recurrent seizures occurring more than a week after the initial trauma) though seizures can appear a decade or more after the initial injury and the common seizure type may also change over time. Generally, medical professionals use anticonvulsant medications to treat seizures in TBI patients within the first week of injury only and after that only if the seizures persist.
Harry Carson
Harry Carson authored his second book "Captain for Life" published by St. Martin's Press in 2011. In his book he documents his experiences with Post Concussion Syndrome. He was one of the first former professional athletes to share his own personal first hand experiences years before the long term effects of concussions and chronic traumatic encephalopathy (CTE), long before the subject became a "hot button" topic.
British Columbia Postconcussion Symptom Inventory
The British Columbia Postconcussion Symptom Inventory (BC-PSI), is a 16 item self-report inventory designed to measure both the frequency, and intensity of the ICD-10 criteria for Post concussion syndrome, which is a common occurrence in cases of mild traumatic brain injury. The (BC-PSI) asks the respondent to rate the severity of 13 symptoms rated on a six-point Likert-type rating scale that measures the frequency and intensity of each symptom in the past two weeks.
The two ratings are multiplied (how often × how bad) to create a single score for each item. These product-based scores are then converted to item scores that reflect both the frequency and intensity of symptom endorsement (range = 0–4).
Item product scores convert to item total scores: 0–1 = 0, 2–3 = 1, 4–6 = 2, 8–12 = 3, and 15+ = 4.
Concussion
Definitions of mild traumatic brain injury (MTBI) were inconsistent until the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10) provided a consistent, authoritative definition across specialties in 1992.
Since then, various organizations such as the American Congress of Rehabilitation Medicine and the American Psychiatric Association in its "Diagnostic and Statistical Manual of Mental Disorders" have defined MTBI using some combination of loss of consciousness (LOC), post-traumatic amnesia (PTA), and the Glasgow Coma Scale (GCS).
Posterolateral corner injuries
Isolated and combined posterolateral knee injuries are difficult to accurately diagnose in patients presenting with acute knee injuries. The incidence of isolated posterolateral corner injuries has been reported to be between 13% and 28%. Most PLC injuries accompany an ACL or PCL tear, and can contribute to ACL or PCL reconstruction graft failure if not recognized and treated. A study by LaPrade "et al." in 2007 showed the incidence of posterolateral knee injuries in patients presenting with acute knee injuries and hemarthrosis (blood in the knee joint) was 9.1%.
Concussion
Headaches are the most common mTBI symptom. Others include dizziness, vomiting, nausea, lack of motor coordination, difficulty balancing, or other problems with movement or sensation. Visual symptoms include light sensitivity, seeing bright lights, blurred vision, and double vision. Tinnitus, or a ringing in the ears, is also commonly reported. In one in about seventy concussions, concussive convulsions occur, but seizures that take place during or immediately after a concussion are not "post-traumatic seizures", and, unlike post-traumatic seizures, are not predictive of post-traumatic epilepsy, which requires some form of structural brain damage, not just a momentary disruption in normal brain functioning. Concussive convulsions are thought to result from temporary loss or inhibition of motor function and are not associated either with epilepsy or with more serious structural damage. They are not associated with any particular sequelae and have the same high rate of favorable outcomes as concussions without convulsions.
Second-impact syndrome
In 2002, a high-school football player from Texas named Will Benson suffered two concussions within two weeks; he collapsed shortly after the second one and died six days later as the result. He is thought to have died from SIS. Will's Bill, a law for which the father of the player had advocated after his son's death, was passed in Texas in June 2007. The law mandates basic emergency and safety training for sports officials in high schools, including education about second-impact syndrome, with a special focus on concussion symptoms.
Post-traumatic amnesia
PTA is considered a hallmark of concussion, and is used as a measure of predicting its severity, for example in concussion grading scales. It may be more reliable for determining severity of concussion than GCS because the latter may not be sensitive enough; concussion sufferers often quickly regain a GCS score of 15.
Concussion grading systems
The Colorado Medical Society guidelines were published in 1991 in response to the death of a high school athlete due to what was thought to be second-impact syndrome. According to the guidelines, a grade I concussion consists of confusion only, grade II includes confusion and post-traumatic amnesia, and grade III and IV involve a loss of consciousness.
Post-concussion syndrome
A wide range of factors have been identified as being predictive of PCS, including low socioeconomic status, previous mTBI, a serious associated injury, headaches, an ongoing court case, and female gender. Being older than 40 and being female have also been identified as being predictive of a diagnosis of PCS, and women tend to report more severe symptoms. In addition, the development of PCS can be predicted by having a history of alcohol abuse, low cognitive abilities before the injury, a personality disorder, or a medical illness not related to the injury. PCS is also more prevalent in people with a history of psychiatric conditions such as clinical depression or anxiety before the injury.
Sports-related traumatic brain injury
There are five major features in conjunction with the definition:Signs and symptoms of concussions can be hard to determine because they may not present strongly and because they may not present for several hours after the incident has occurred. There are 4 categories that symptoms of a concussion can be classified within: physical, cognitive, emotional and sleep disturbance. The most common symptom is a headache as well as the feeling of being “fog like”. Other, more subtle symptoms that can accompany headaches are emotional changes, irritability, slowed reaction times and drowsiness. Accompanying symptoms can include sensitivity to light, and noise, fatigue, dizziness, nausea and vomiting. The loss of consciousness is another identifiable characteristic of concussions but it is not a required symptom to diagnose it. The loss of consciousness occurs in only 10% of concussions, so it cannot be a reliable sign of a concussion. Other distinguishing characteristics of concussions are retrograde amnesia (loss of memory just prior to injury) and posttraumatic amnesia (impaired recall of time between the injury or resumption of consciousness and the point at which new memories are stored and retrieved).
Post-concussion syndrome
Neuropsychological tests exist to measure deficits in cognitive functioning that can result from PCS. The Stroop Color Test and the 2&7 Processing Speed Test (which both detect deficits in speed of mental processing) can predict the development of cognitive problems from PCS. A test called the Rivermead Postconcussion Symptoms Questionnaire, a set of questions that measure the severity of 16 different post-concussion symptoms, can be self-administered or administered by an interviewer. Other tests that can predict the development of PCS include the Hopkins Verbal Learning A test (HVLA) and the Digit Span Forward examination. The HVLA tests verbal learning and memory by presenting a series of words and assigning points based on the number recalled, and digit span measures attention efficiency by asking the examinee to repeat back digits spoken by the tester in the same order as they are presented. In addition, neuropsychological tests may be performed to detect malingering (exaggerating or making up symptoms) .
Rivermead post-concussion symptoms questionnaire
The questionnaire has displayed several flaws in implementation and its ability to accurately reflect test-taker experience. While the questionnaire includes symptoms non-specific to PCS, which allows for a broader range of diagnosis (i.e. of other conditions such as chronic pain), this is at the expense of precision. The questionnaire is a useful tool for assessing progress or regression of symptom severity, but it is not ideal for actual diagnosis as there is no standard criteria for what constitutes post-concussion syndrome. The only feature characteristic of PCS that is generally agreed upon among health professionals is a significant impairment of the ability to function socially. Recreational drug use, for instance, can often result in symptoms similar to those associated with PCS, making it difficult to determine the severity of a head injury if the victim is a habitual drug user. Despite this, studies have used the RPQ as a way of meeting criteria that may not be universally agreed upon, such as those found in the Diagnostic and Statistical Manual of Mental Disorders (specifically DSM-IV-TR).
Pulmonary contusion
Pulmonary contusion is found in 30–75% of severe cases of chest injury, making it the most common serious injury to occur in association with thoracic trauma. Of people who have multiple injuries with an injury severity score of over 15, pulmonary contusion occurs in about 17%. It is difficult to determine the death rate (mortality) because pulmonary contusion rarely occurs by itself. Usually, deaths of people with pulmonary contusion result from other injuries, commonly traumatic brain injury. It is controversial whether pulmonary contusion with flail chest is a major factor in mortality on its own or whether it merely contributes to mortality in people with multiple injuries. The estimated mortality rate of pulmonary contusion ranges from 14–40%, depending on the severity of the contusion itself and on associated injuries. When the contusions are small, they do not normally increase the chance of death or poor outcome for people with blunt chest trauma; however, these chances increase with the size of the contusion. One study found that 35% of people with multiple significant injuries including pulmonary contusion die. In another study, 11% of people with pulmonary contusion alone died, while the number rose to 22% in those with additional injuries. Pulmonary contusion is thought to be the direct cause of death in a quarter to a half of people with multiple injuries (polytrauma) who die. An accompanying flail chest increases the morbidity and mortality to more than twice that of pulmonary contusion alone.
Post-concussion syndrome
Education about symptoms and their usual time course is a part of psychological therapy, and is most effective when provided soon after the injury. Since stress exacerbates post-concussion symptoms, and vice versa, an important part of treatment is reassurance that PCS symptoms are normal, and education about how to deal with impairments. One study found that PCS patients who were coached to return to activities gradually, told what symptoms to expect, and trained how to manage them had a reduction in symptoms compared to a control group of uninjured people. Early education has been found to reduce symptoms in children as well.
Poliomyelitis
Between 25 percent and 50 percent of individuals who have recovered from paralytic polio in childhood can develop additional symptoms decades after recovering from the acute infection, notably new muscle weakness and extreme fatigue. This condition is known as post-polio syndrome (PPS) or post-polio sequelae. The symptoms of PPS are thought to involve a failure of the oversized motor units created during the recovery phase of the paralytic disease. Contributing factors that increase the risk of PPS include aging with loss of neuron units, the presence of a permanent residual impairment after recovery from the acute illness, and both overuse and disuse of neurons. PPS is a slow, progressive disease, and there is no specific treatment for it. Post-polio syndrome is not an infectious process, and persons experiencing the syndrome do not shed poliovirus.
Post-concussion syndrome
Some experts believe post-concussion symptoms are caused by structural damage to the brain or disruption of neurotransmitter systems, resulting from the impact that caused the concussion. Others believe that post-concussion symptoms are related to common psychological factors. Most common symptoms like headache, dizziness, and sleep problems are similar to those often experienced by individuals diagnosed with depression, anxiety, or post traumatic stress disorder. In many cases, both physiological effects of brain trauma and emotional reactions to these events play a role in the development of symptoms.
Post-concussion syndrome
It is not known what causes PCS to occur and persist, or why some people who suffer a minor traumatic brain injury later develop PCS while others do not. The nature of the syndrome and the diagnosis itself have been the subject of intense debate since the 19th century. However, certain risk factors have been identified; for example, preexisting medical or psychological conditions, expectations of disability, being female, and older age all increase the chances that someone will suffer PCS. Physiological and psychological factors present before, during, and after the injury are all thought to be involved in the development of PCS.
Post-traumatic seizure
PTS is associated with a generally good prognosis. It is unknown exactly how long after a TBI a person is at higher risk for seizures than the rest of the population, but estimates have suggested lengths of 10 to over 15 years. For most people with TBI, seizures do not occur after three months, and only 20–25% of people who suffer TBI have PTS more than two years after the injury. However, moderate and severe TBI still confer a high risk for PTS for up to five years after the injury.
Posterior cortical atrophy
There is no standard definition of PCA and no established diagnostic criteria, so it is not possible to know how many people have the condition. Some studies have found that about 5 percent of people diagnosed with Alzheimer’s disease have PCA. However, because PCA often goes unrecognized, the true percentage may be as high as 15 percent. Researchers and physicians are working to establish a standard definition and diagnostic criteria for PCA.
Concussion
In post-concussion syndrome, symptoms do not resolve for weeks, months, or years after a concussion, and may occasionally be permanent. About 10% to 20% of people have post-concussion syndrome for more than a month. Symptoms may include headaches, dizziness, fatigue, anxiety, memory and attention problems, sleep problems, and irritability. There is no established treatment, and rest, a recommended recovery technique, has limited effectiveness. Symptoms usually go away on their own within months but may last for years. The question of whether the syndrome is due to structural damage or other factors such as psychological ones, or a combination of these, has long been the subject of debate.
Concussions in American football
There has been promising evidence that blood flow restriction based exercises can be used to improve Post-Concussion Syndrome (PCS). "The leading theory supporting this is that human growth hormone is released in response to increased lactate production from exercise, enhancing the brain function and recovery". This exercise based program could potentially be used in conjunction with aerobic therapy to better improve concussion symptoms during the recovery process. Wu, Yi-Ning, "Stable recovery after aerobic exercise with limb blood flow restriction and cooling in individuals with post-concussion syndrome", Physical medicine and rehabilitation clinics of North America, p. 437-54. 2016.==
Post-concussion syndrome
Though there is no treatment for PCS, symptoms can be treated; medications and physical and behavioral therapy may be used, and individuals can be educated about symptoms and provided with the expectation of recovery. The majority of PCS cases resolve after a period of time.
Concussion
Concussion may be under-diagnosed because of the lack of the highly noticeable signs and symptoms while athletes may minimize their injuries to remain in the competition. A retrospective survey in 2005 suggested that more than 88% of concussions are unrecognized.
Fred Willis
The medical experts he works closely with have access to the most advanced cutting edge technology which can be used to show damage to the brain. This cutting edge, advanced “Fast Track Team” approach technology allows him to obtain maximum compensation for players who have not yet experienced the full effects of their injuries which could develop in the future after their case has been settled and then treatment for Post-Concussion Syndrome, to increase the quality of life of retired NFL football players and seek to examine the health conditions that affect retired NFL players and to find better ways to diagnose, treat, and prevent their most pressing medical problems.
By way of background in 2012, he set out to invest and acquire an effective treatment process and protocol for post-concussion syndrome behavior/TBI/CTE, his company HPN Neurologic has been "treating pro bono" retired NFL players for the last 3 years in cities around the country, there are now qualified licensed strategic provider treatment teams in place to treat retired players for post-concussion syndrome after the qualifying process is completed.
Post-concussion syndrome
Mild brain injury-related factors that increase the risk for persisting post-concussion symptoms include an injury associated with acute headache, dizziness, or nausea; an acute Glasgow Coma Score of 13 or 14; and suffering another head injury before recovering from the first. The risk for developing PCS also appears to be increased in people who have traumatic memories of the injury or expect to be disabled by the injury.
Post-concussion syndrome
In 1961, H. Miller first used the term "accident neurosis" to refer to the syndrome which is now called PCS and asserted that the condition only occurs in situations where people stand to be compensated for the injury. The real causes of the condition remain unclear.
Harry Carson
While Carson has acknowledged he has "managed" the long term effects of concussions he does not know if he has been affected by chronic traumatic encephalopathy (CTE). When asked, Carson is increasingly critical of the NFL and questions whether football should be played, as he believes the hazards of concussions and subconcussive hits are not an understood risk such as physical ailments are. He is quoted in this interview as saying of the NFL's $765 million settlement with former players that "the NFL has given everybody 765 million reasons why you don't want to play football."
Post-concussion syndrome
PCS, which shares symptoms with a variety of other conditions, is highly likely to be misdiagnosed in people with these conditions. Cognitive and affective symptoms that occur following a traumatic injury may be attributed to mTBI, but in fact be due to another factor such as post-traumatic stress disorder, which is easily misdiagnosed as PCS and vice versa. Affective disorders such as depression have some symptoms that can mimic those of PCS and lead to a wrongful diagnosis of the latter; these include problems with concentration, emotional lability, anxiety, and sleep problems. Depression, which is highly common in persistent PCS, can worsen other PCS symptoms, such as headaches and problems with concentration, memory, and sleep. PCS also shares symptoms with chronic fatigue syndrome, fibromyalgia, and exposure to certain toxins. Traumatic brain injury may cause damage to the hypothalamus or the pituitary gland, and deficiencies of pituitary hormones (hypopituitarism) can cause similar symptoms to post-concussion syndrome; in these cases, symptoms can be treated by replacing any hormones that are deficient.
Concussions in American football
In the 2010 season for the Canadian Football League, there have been 50 reported concussions; 44.8 percent of players reported having a concussion or concussion-like symptoms, 16.9 percent had confirmed that they had a concussion, and 69.6 percent of all players who suffered from concussions that year suffered from more than one. However, the average of 0.59 concussions per game is lower than the 0.67 recorded by the NFL in 2010. The league eventually started a concussion-awareness program with the help of Football Canada, Canadian Interuniversity Sport (CIS), the Canadian School Sport Federation, the Canadian Football League Players Association (CFLPA), the Canadian Football League Alumni Association (CFLAA), and the ThinkFirst program. The league eventually pointed out eight protocols:
Concussions in sport
Along with the classification of post-concussion symptoms, the symptoms can also be described as immediate and delayed. The immediate symptoms are experienced immediately after a concussion such as: memory loss, disorientation, and poor balance. Delayed symptoms are experienced in the later stages and include sleeping disorders and behavioral changes. Both immediate and delayed symptoms can continue for long periods of time and have a negative impact on recovery. According to research, 20-25% of individuals who have sustained a concussion experienced chronic, delayed symptoms.
Concussions in American football
On September 30, 2014, researchers with Boston University announced that in autopsies of 79 brains of former NFL players, 76 had tested positive for CTE. As of January 2017, that number had grown to 90 out of 94. A study published in "The Journal of the American Medical Association" in July 2017 showed that 110 of 111 former NFL players whose brains were examined were found to have suffered from CTE.
Rivermead post-concussion symptoms questionnaire
The Rivermead Post-Concussion Symptoms Questionnaire, abbreviated RPQ, is a questionnaire that can be administered to someone who sustains a concussion or other form of traumatic brain injury to measure the severity of symptoms. The RPQ is used to determine the presence and severity of post-concussion syndrome (PCS), a set of somatic, cognitive, and emotional symptoms following traumatic brain injury that may persist anywhere from a week, to months, or even more than six months.
Post-concussion syndrome
The DSM-IV lists criteria for diagnosis of PCD in people who have suffered a head trauma with persistent post-traumatic amnesia, loss of consciousness, or post-traumatic seizures. In addition, for a diagnosis of PCD, patients must have neuropsychological impairment as well as at least three of the symptoms marked with a check mark in the table at right under "DSM-IV". These symptoms must be present for three months after the injury and must have been absent or less severe before the injury. In addition, the patient must experience social problems as a result, and must not meet criteria for another disorder that explains the symptoms better.
Post-concussion syndrome
Not all people with PCS have abnormalities on imaging, however, and abnormalities found in studies such as fMRI, PET, and SPECT could result from other comorbid conditions such as depression, chronic pain, or post-traumatic stress disorder (PTSD). 
Proponents of the view that PCS has a physiological basis point to findings that children demonstrate deficits on standardized tests of cognitive function following a mild TBI. A few studies have shown that people with PCS score lower than controls on neuropsychological tests that measure attention, verbal learning, reasoning, and information processing, but issues related to effort and secondary gain can not be ruled out as contributing to these differences. Recovery as measured by scores on cognitive tests frequently do not correlate with resolution of symptoms; individuals diagnosed with PCS may still report subjective symptoms after their performance on tests of cognitive functioning have returned to normal. Another study found that although children with PCS had poorer scores on tests of cognitive functioning after the injury, they also had poorer behavioral adjustment before the injury than children with no persistent symptoms; these findings support the idea that PCS may result from a combination of factors such as brain dysfunction resulting from head injury and preexisting psychological or social problems. Different symptoms may be predicted by different factors; for example, one study found that cognitive and physical symptoms were not predicted by the manner in which parents and family members coped with the injury and adjusted to its effects, but psychological and behavioral symptoms were.
Post-concussion syndrome
The symptoms that occur after a concussion have been described in various reports and writings for hundreds of years. The idea that this set of symptoms forms a distinct entity began to attain greater recognition in the latter part of the 19th century. John Erichsen, a surgeon from London, played an important role in developing the study of PCS. The controversy surrounding the cause of PCS began in 1866 when Erichsen published a paper about persisting symptoms after sustaining mild head trauma. He suggested that the condition was due to "molecular disarrangement" to the spine. The condition was originally called "railroad spine" because most of the injuries studied had happened to railroad workers. While some of his contemporaries agreed that the syndrome had an organic basis, others attributed the symptoms to psychological factors or to outright feigning. In 1879, the idea that a physical problem was responsible for the symptoms was challenged by Rigler, who suggested that the cause of the persisting symptoms was actually "compensation neurosis": the railroad's practice of compensating workers who had been injured was bringing about the complaints. Later, the idea that hysteria was responsible for the symptoms after a mild head injury was suggested by Charcot. Controversy about the syndrome continued through the 20th century. During World War I many soldiers suffered from puzzling symptoms after being close to a detonation but without any evidence of a head wound. The illness was called "shell shock," and a psychological explanation was eventually favoured. By 1934 the current concept of PCS had replaced ideas of hysteria as the cause of post-concussion symptoms. British authorities banned the term "shell shock" during World War II to avoid an epidemic of cases, and the term "posttrauma concussion state" was coined in 1939 to describe "disturbance of consciousness with no immediate or obvious pathologic change in the brain". The term "postconcussion syndrome" was in use by 1941.
Post-concussion syndrome
If another blow to the head occurs after a concussion but before its symptoms have gone away, there is a slight risk of developing the serious second-impact syndrome (SIS). In SIS, the brain rapidly swells, greatly increasing intracranial pressure. People who have repeated mild head injuries over a prolonged period, such as boxers and Gridiron football players, are at risk for chronic traumatic encephalopathy (or the related variant dementia pugilistica), a severe, chronic disorder involving a decline in mental and physical abilities.
Post-concussion syndrome
While the causes of symptoms occurring immediately after a concussion are likely to be physiological, it is less evident that persistent post-concussive symptoms have an entirely organic basis, and nonorganic factors are likely to be involved in symptoms that last longer than three months. PCS may also be exacerbated by psychosocial factors, chronic pain, or an interaction of some or all of these. The majority of experts believe that PCS results from a mix of factors, including preexisting psychological factors and those directly relating to the physical injury.
Concussions in American football
Current NFL concussion protocol creates positions in each organization's medical staff who are specifically charged with identifying and diagnosing concussions. One of these roles involves an unaffiliated neurotrauma consultant who work with other team physicians and athletic trainers to conduct evaluations. Another position involves athletic trainers who are positioned in the booth at every game to spot potential concussions in players from both teams. These spotters review film throughout the game that could possibly result in concussions and are capable to call "medical timeouts" to relay that information to the medical personnel on the sidelines so that further evaluation can be conducted. These spotters have been in use since the 2011 season.
Rivermead post-concussion symptoms questionnaire
Fatigue is the most frequently affirmed symptom of PCS included on the questionnaire, while double vision is the least affirmed. Some other neuropsychological tests do not include fatigue as a symptom of PCS, giving the Rivermead Post-Concussion Symptoms Questionnaire an advantage in an "accurate" assessment of the condition. Severe fatigue has been reported in at least a third of a representative cohort of MTBI sufferers, and this symptom was associated with a significant limitation of the ability of sufferers to function normally in daily activities.
Concussions in sport
In 2010, more high school soccer players suffered concussions than basketball, baseball, wrestling, and softball players combined, according to the Center for Injury Research and Policy. According to a study in the "JAMA Pediatrics" medical journal, many girls do not get necessary care and prevention regarding concussions, and 56 percent of players (or their families) reporting concussion symptoms never sought treatment.
Concussion (2015 film)
Over the next few years, Omalu discovers that three other former NFL players, Strzelczyk (died 2004), Terry Long (died 2005), and Andre Waters (died 2006), had symptoms very similar to Webster's. He finally persuades newly appointed NFL commissioner Roger Goodell to allow him to present his findings before a committee on player safety. However, the NFL does not take him seriously, and he is barred from the committee meeting, forcing Bailes, a former NFL employee, to give the presentation in his place. However, the meeting is a set up, where the NFL claims that the players' head trauma was due to past injuries, having nothing to do with football. As he leaves the meeting, former NFL Players Association executive Dave Duerson angrily confronts Omalu and tells him to "go back to Africa."
Rivermead post-concussion symptoms questionnaire
Post-concussion syndrome is believed to be able to arise for reasons aside from sustaining a (mild) traumatic brain injury. In one study, health professionals cited organic causes in general as being most responsible for the development of PCS; however, emotional and compensatory causes have also been implicated as factors. For example, depression may contribute to the development or severity of PCS, whether triggered by a physical injury or not. PCS symptoms also overlap with symptoms associated with other conditions, such as chronic pain. Because of this, the Rivermead Post-Concussion Symptoms Questionnaire is useful in the assessment of other conditions besides MTBI-induced PCS. The questionnaire has been used in studies with a slightly altered wording in order to remove references to head injuries, so that test-takers don't assume their symptoms are (or are not) derived solely from a head injury and so the questionnaire can be more broadly utilized.
National Football League controversies
The league has also been criticized for its efforts in preventing concussions, in which eight former players have died, and have also had concussions throughout their careers. In 1994, former commissioner Paul Tagliabue created the Mild Traumatic Brain Injury Committee in order to study the effects of concussions on players. With the suicide of linebacker Junior Seau in 2012, concerns arose about the connection between player deaths and concussions. As a result, on April 9, 2013, a lawsuit involving 4,100 plaintiffs and 222 consolidated lawsuits against the NFL will be held by a federal court.
Health issues in youth sports
45 million children and adolescents participate in youth sports in the US . There are many positive and negative impacts on young athletes. Participation in sports raises energetic physical activity. The Center for Disease Control reported that in 1999 only 50% of youths engaged in regular exercise . Youth participation in sports can influence high-risk health-related impacts for boys and girls. A 2000 study showed the relationship between participation in sports and health-related behaviors in US youth athletes . Both boys and girls were more likely to eat fruits and vegetables and less likely to engage in smoking and illicit drug-taking.
Many high school students will experience some form of head injury during their experiences in amateur sports and the majority of these can be classified as concussions. Even by the beginning of high school, 53% of athletes will have already suffered a concussion. Less than 50% of them report it in order to stay in the game. Many concussions may be subtle and go undiagnosed. While the majority of these minor injuries will recover without consequence within 3 to 7 days, it is the repetitive injury that is associated with neurological sequela. Multiple concussions appear to have a cumulative effect on memory performance. If an athlete returns to competition before being completely healed, they are more susceptible to suffer another concussion. A repeat concussion can have a much slower recovery rate and be accompanied by increased symptoms and long-term effects. This “second impact syndrome” has, in some cases, been fatal. A history of concussion in football players has been linked to sports-related sudden death. The severity of complications from concussion can include brain swelling, blood clots and brain damage. Ice hockey, soccer, wrestling and basketball carry a high risk for concussion however, football is the most dangerous. Concussion causing situations that involve leading with the head, hitting head to head and striking a defenseless athlete have become subject to penalty in order to discourage players and coaches from this type of play. These rule changes have resulted in technique changes at the youngest levels of sports, and youth athletes are now being trained in methods avoiding illegal contact. Youth sport organizations have also made equipment changes to better protect players. A widespread myth is that helmets protect athletes from concussions; they are actually worn to prevent skull fractures. Facts like this have prompted trainings on proper equipment use and not utilizing helmets as an implement of contact.
Dejerine–Roussy syndrome
Of the millions experiencing strokes worldwide, over 30,000 in the United States alone have developed some form of Dejerine–Roussy syndrome. 8% of all stroke patients will experience central pain syndrome, with 5% experiencing moderate to severe pain. The risk of developing Dejerine–Roussy syndrome is higher in older stroke patients, about 11% of stroke patients over the age of 80.
In 1906, Joseph Jules Dejerine and Gustave Roussy provided descriptions of central post-stroke pain (CPSP) in their paper entitled: "Le syndrome thalamique". The name Dejerine–Roussy syndrome was coined after their deaths. The syndrome included "…severe, persistent, paroxysmal, often intolerable, pains on the hemiplegic side, not yielding to any analgesic treatment".
Orgasm
A small percentage of men have a disease called postorgasmic illness syndrome (POIS), which causes severe muscle pain throughout the body and other symptoms immediately following ejaculation. The symptoms last for up to a week. Some doctors speculate that the frequency of POIS "in the population may be greater than has been reported in the academic literature", and that many POIS sufferers are undiagnosed.
Concussion (2015 film)
Three years later, Omalu is vindicated when Duerson commits suicide due to growing cognitive problems. In his suicide note, Duerson admits that Omalu was right. Omalu is allowed to address an NFLPA conference on concussions and CTE. He informs them that he once wished he had never known Mike Webster, but by knowing him, he has the responsibility to inform NFL players of the true risks that they take by playing. He says that he holds no resentment for the NFL and tells them to forgive themselves and be at peace. Amid growing scrutiny from Congress, the NFL is forced to take the concussion issue more seriously, and in 2011, NFL players sue the league for not properly informing them of the risk of CTE. Omalu is offered a job as chief medical examiner for the District of Columbia, but as explained in closing title cards, turns it down, remaining with Prema and their two children in California, where he became a U.S. citizen in February 2015. A final montage includes reports of Junior Seau's suicide in 2012, and the subsequent lawsuit brought by players.
Prevention of concussions
Prevention of undiagnosed and repeat injury is of importance in sports-related concussions. Every three minutes, a child in the United States is treated for a sports-related concussion. Between 2010 and 2014, sports-related concussions experienced a 500% uptick. Rapid sideline testing using short neuropsychological tests that assess attention and memory function have been proven useful and accurate. The Maddocks questions and the Standardized Assessment of Concussion (SAC) are examples of validated sideline evaluation tools. The Return To Play (RTP) protocol aims to decrease repeat concussions within a short time frame to minimize second impact syndrome. It assures players who experience a concussion have complete cognitive and clinical recovery before returning to play. Best practices of RTP involve graduated activity intensification with each step taking at least 24 hours to assure full rehabilitation within one week (includes asymptomatic at rest and during exercise). In cases in which resources (i.e. neuropsychologists, neuroimaging) are available on-site, RTP may be more rapid. Baseline assessments, performed before concussion occurs, provide a comparison from which to measure severity of post-concussive symptoms. However, they have not been shown to decrease risk of injury. The U.S. based nonprofit National Safety Council included state-by-state concussion prevention efforts for youth-sports related concussions in its 2017 State of Safety report.
Post-traumatic seizure
Early PTS occur at least once in about 4 or 5% of people hospitalized with TBI, and late PTS occur at some point in 5% of them. Of the seizures that occur within the first week of trauma, about half occur within the first 24 hours. In children, early seizures are more likely to occur within an hour and a day of injury than in adults. Of the seizures that occur within the first four weeks of head trauma, about 10% occur after the first week. Late seizures occur at the highest rate in the first few weeks after injury. About 40% of late seizures start within six months of injury, and 50% start within a year.
Second-impact syndrome
The condition was first described in 1973 by R.C. Schneider, and the term second-impact syndrome was coined in 1984. In 1984, R.L. Saunders described the death of a football player who had died after a second, unremarkable concussion and hypothesized that the second blow caused a catastrophic rise in ICP, possibly through loss of vasomotor tone, because the brain was in a vulnerable state. Between 1984 and 1991, only four cases were documented. Between 1992 and 1998, reports of the condition began to be made more frequently than they had before, a fact is thought to be due to wider recognition of the syndrome by clinicians. In 1991, J.P. Kelly and others reported another football death after repeated concussions and coined the term "vascular congestion syndrome".
List of NFL players with chronic traumatic encephalopathy
As the families of many deceased players wish to keep their medical information private, the following list is incomplete. A brain injury study conducted at the Boston University School of Medicine showed that 33 of 34 players tested post-mortem showed clear signs of CTE, and additional players have so far been confirmed with CTE separately. A new list released in November 2016 mentions CTE in 90 of 94 brains of former and deceased NFL players. In July 2017, a new study showed that 110 of 111 brains examined showed signs of CTE.
Included in the list are players diagnosed with amyotrophic lateral sclerosis (ALS) who were never tested "post-mortem" for CTE but whose history appears consistent with CTE. A typical diagnosis of ALS has primarily been based on the symptoms and signs the physician observes in the patient and a series of tests to rule out other diseases and therefore, prior to the discovery of CTE as a phenomenon in ex-American football players, many CTE cases were diagnosed as ALS. The testing of CTE in deceased ex-NFL players began only after the disease was first diagnosed, in 2002, in the brain tissue of Mike Webster. After then, testing became common practice only gradually. A cohort mortality study run by the National Institute for Occupational Safety and Health (NIOSH) examined 3,349 NFL players who played at least five full seasons from 1959 to 1988. Findings showed that while NFL players lived longer than the average American male, the risk of death associated with neurodegenerative disorders was about three times higher among the NFL cohort. The risk for death from Alzheimer's disease and ALS were about four times higher among the NFL cohort.
Second-impact syndrome
Second-impact syndrome shares all the risk factors of concussion; that is, those who are at increased risk for concussion are also at higher risk for SIS. Thus, people who participate in sports such as boxing, soccer, American football, baseball, rugby, basketball, ice hockey, pro wrestling, and skiing (especially Alpine) are at increased risk. The condition most commonly occurs in American football.
Precordial catch syndrome
The Huchard syndrome was then studied more deeply by Miller and Texidor, medical practitioners at the Cardiovascular Department and the Department of Medicine at the Michael Reese Hospital in Chicago, in 1955. They reported the condition in 10 patients, one being Miller himself. In 1978, PCS was discussed by Sparrow and Bird who reported that 45 healthy patients suffered from it and that it was probably more frequent than generally assumed. PCS in American children has been discussed by Pickering in 1981 and by Reynolds in 1989. These constitute the literature available in English on PCS.
Post-concussion syndrome
The International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders" have set out criteria for post-concussion syndrome (PCS) and post-concussional disorder (PCD), respectively.
Concussion
Chronic traumatic encephalopathy, or "CTE", is an example of the cumulative damage that can occur as the result of multiple concussions or less severe blows to the head. The condition was previously referred to as "dementia pugilistica", or "punch drunk" syndrome, as it was first noted in boxers. The disease can lead to cognitive and physical handicaps such as parkinsonism, speech and memory problems, slowed mental processing, tremor, depression, and inappropriate behavior. It shares features with Alzheimer's disease.
Post-traumatic seizure
Not all seizures that occur after trauma are PTS; they may be due to a seizure disorder that already existed, which may even have caused the trauma. In addition, post-traumatic seizures are not to be confused with concussive convulsions, which may immediately follow a concussion but which are not actually seizures and are not a predictive factor for epilepsy.
Post-concussion syndrome
Common symptoms associated with a diagnosis of PCS are related to cognition, attention, and memory, especially short-term memory, which can also worsen other problems such as forgetting appointments or difficulties at work. In one study, one in four people diagnosed with PCS continued to report memory problems a year after the injury, but most experts agree that cognitive symptoms clear within six months to a year after injury in the vast majority of individuals.
Post-polio syndrome
Post-polio syndrome (PPS, or post-poliomyelitis syndrome or post-polio sequelae) is a condition that affects approximately 25 to 40 percent of people who have previously survived an acute attack of poliomyelitis, though more recent studies have shown that 80+% of polio survivors show symptoms of Post Polio Sequelae, a viral infection of the nervous system after the initial infection. Typically the symptoms appear 15 to 30 years after recovery from the original paralytic attack, at an age of 35 to 60. Symptoms include acute or increased muscular weakness, pain in the muscles, and fatigue. The same symptoms may also occur years after a nonparalytic polio (NPP) infection.
Second-impact syndrome
In 2005, Preston Plevretes, a football player for LaSalle University, had his life changed forever by second-impact syndrome. After undergoing a head-to-head hit at football practice, a university doctor diagnosed Plevretes with a concussion and two days later was told he was allowed to resume play. Three games after returning Plevretes sustained another concussion resulting in second-impact syndrome. He was rushed to the hospital where doctors cut the right side of his skull. Five years after the injury, he still struggles to do everyday activities. Because of Plevretes, the NCAA revised concussion guidelines. The NCAA strongly urges schools to have a concussion management plan. They also require that an athlete have clearance by a team doctor before being allowed to return.
Sports-related traumatic brain injury
Short-term effects deal mostly with Post-concussion Syndrome, which has no clearly defined definition. A person suffering from a single concussive incident typically has a strong recovery rate. The most common Post-concussion symptom is a persistent headache which usually disappears within 1–2 weeks. Other common short-term effects include dizziness, vomiting, nausea, sensitivity to light and sound, irritability, cognitive lapses and memory impairment. 20-90% of the persons affected develop one symptom within a month of the incident, after 3 months 40% of the affected persons show at least 3 symptoms.
Post-concussion syndrome
Depression, post-traumatic stress disorder, and chronic pain share symptoms resembling those of PCS. One study found that while people with chronic pain without TBI do report many symptoms similar to those of post-concussion syndrome, they report fewer symptoms related to memory, slowed thinking, and sensitivity to noise and light than people with mTBI do. Additionally, it has been found that neuroendocrinology may account for depressive symptoms and stress management due to irregularities in cortisol regulation, and thyroid hormone regulation. Lastly, there is evidence that major depression following TBI is quite common, but may be better accounted for with a diagnosis of dysexecutive syndrome.
Concussions in sport
As of 2012, the four major professional sports leagues in the United States and Canada have concussion policies. Sports-related concussions are generally analyzed by athletic training or medical staff on the sidelines using an evaluation tool for cognitive function known as the Sport Concussion Assessment Tool (SCAT), a symptom severity checklist, and a balance test.
Posterior cord syndrome
PCS originates from an infarct in the posterior spinal artery and is caused by lesions on the posterior portion of the spinal cord, specifically the posterior column, posterior horn, and posterolateral region of the lateral column. These lesions can be caused by trauma to the neck, occlusion of the spinal artery, tumors, disc compression, vitamin B12 deficiency, syphilis, or multiple sclerosis. Despite these numerous pathological pathways, the result is an interruption in transmission of sensory information and motor commands from the brain to the periphery.
Concussion
If the Glasgow Coma Scale is less than 15 at two hours or less than 14 at any time, a CT is recommended. In addition, a CT scan is more likely to be performed if observation after discharge is not assured or intoxication is present, there is suspected increased risk for bleeding, age greater than 60, or less than 16. Most concussions, without complication, cannot be detected with MRI or CT scans. However, changes have been reported on MRI and SPECT imaging in those with concussion and normal CT scans, and post-concussion syndrome may be associated with abnormalities visible on SPECT and PET scans. Mild head injury may or may not produce abnormal EEG readings. A blood test known as the Brain Trauma Indicator was approved in the United States in 2018 and may be able to rule out the risk of intracranial bleeding and thus the need for a CT scan.
British Columbia Postconcussion Symptom Inventory
BC-PSI items
For most patients with MTBI the cognitive, psychological, and psychosocial symptoms do not last longer than three to six months.. Those in which the symptoms persist longer may be diagnosed with postconcussion syndrome (Ruff, 2005).
PCS is recognised in International Classification of Diseases, 10th edition (ICD-10;(World Health Organization, 1992) and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV;(American Psychiatric Association,2000). PCS symptoms may include headaches, dizziness, light and noise sensitivity, nausea, fatigue, sleep disturbance, irritability, temper problems, emotional problems, poor concentration, and memory impairment.
Concussions in rugby union
A concussion, which is known as a subset of traumatic brain injury (TBI), is when a force comes in contact with the head, neck or face, or fast movement of the head, causing a functional injury to the brain. Depending on where the location of impact, depends on the severity of the injury. It is short-lived impairment of neurological function, the brains ability to process information, which can be resolved in seven to ten days. Not all concussion involves the loss of consciousness, with it occurring in less than 10% of concussions. Second-impact syndrome is when a player has obtained a second concussion when you either return to field the same day, or return to play before a complete recovery from a previous concussion. This is a result from brain swelling, from vascular congestion and increased intracranial pressure, this can be fatal to a player as it is a very difficult medical injury to control. The brain is surrounded by cerebrospinal fluid, which protects it from light trauma. More severe impacts, or the forces associated with rapid acceleration, may not be absorbed by this cushion. Concussion may be caused by impact forces, in which the head strikes or is struck by something, or impulsive forces, in which the head moves without itself being subject to blunt trauma (for example, when the chest hits something and the head snaps forward). Chronic traumatic encephalopathy, or "CTE", is an example of the cumulative damage that can occur as the result of multiple concussions or less severe blows to the head. The condition was previously referred to as "dementia pugilistica", or "punch drunk" syndrome, as it was first noted in boxers. The disease can lead to cognitive and physical handicaps such as parkinsonism, speech and memory problems, slowed mental processing, tremor, depression, and inappropriate behavior. It shares features with Alzheimer's disease.
Concussions in American football
Many concussions that occur during high school football often go untreated and are not monitored. This is a big concern because repeated trauma to the head, especially injuries with concussion like symptoms, puts a young athlete health at serious risk. A 2013 study by Cincinnati Children's Hospital Medical Center found that, despite knowing the risk of serious injury from continuing to play with a concussion, half of high school football players would still play if they had a headache from an injury sustained on the field. Researchers surveyed 120 high school football players. Of those students, 30 reported having suffered a concussion. More than 90 percent recognized the risk of serious injury if they returned to play too quickly, but more than half of those aware of the risks responded they would "always or sometimes continue to play with a headache sustained from an injury," and only 54 percent indicated they would "always or sometimes report symptoms of a concussion to their coach." Another study found that 15.8% of football players who sustain a concussion severe enough to cause loss of consciousness return to play the same day. Due to the fact that only 42% of high schools have access to athletic training services, there has been a large debate regarding the risks that high school football players face.
Post-traumatic amnesia
There is a significant link between individuals currently suffering from PTA and their performance on the Wechsler Adult Intelligence Scale (WAIS). The scores of those currently experiencing an episode of PTA were compared to individuals who had previously suffered a traumatic brain injury resulting in PTA. Those still suffering from PTA performed significantly worse on both the performance and the verbal subscales of the WAIS. Also, people in early stages of PTA have substantial impairment to anterograde memory function. For example, in the case report of a patient referred to as "JL", Demery et al. noted that his memory impairments were so severe following his injury that he had forgotten that he had attended a Major League Baseball game less than 30 minutes after returning to the center where he was being treated.
Concussions in American football
A proposed settlement was reached in the litigation on August 29, 2013. Under the agreement, the NFL will contribute $765 million to provide medical help to more than 18,000 former players. Retired players who suffer severe neurological conditions such as Alzheimer's and amyotrophic lateral sclerosis (ALS) diseases in the future will also be eligible to apply for medical help. In addition, $10 million will fund brain injury research as well as safety and education programs.
Ice hockey
The most dangerous result of a head injury in hockey can be classified as a concussion. Most concussions occur during player-to-player contact rather than when a player is checked into the boards. Checks to the head have accounted for nearly 50% of concussions that players in the National Hockey League have suffered. Concussions that players suffer may go unreported because there is no obvious physical signs if a player is not knocked unconscious. This can prove to be dangerous if a player decides to return to play without receiving proper medical attention. Studies show that ice hockey causes 44.3% of all traumatic brain injuries among Canadian children. In severe cases, the traumatic brain injuries are capable of resulting in death. Occurrences of death from these injuries are rare.
Pittsburgh Penguins Foundation
The test, which all NHL players undergo, evaluates the athlete's neurocognitive state which includes brain processing speed, memory, and visual motor skills. If the player suffers a concussion, these test results are then used in order to compare their previous neurocognitive state to that of their possible concussed state. Baseline testing is used because concussions do not show up on CT or MRI scans due to it not being a structural brain injury. Testing is necessary because symptoms vary from person to person. These symptoms range from nausea, dizziness, concentration problems and/or fuzzy vision. The testing is done by the UPMC Sports Concussion group on the computer program ImPACT.
Concussions in American football
With continued pressure to protect players, the NFL began preventing players knocked unconscious by a concussion from returning to a game or practice, a policy that applied to Detroit Lions running back Jahvid Best in . Various players have filed lawsuits against the league for the concussions, accusing the league of hiding information that linked head trauma to permanent brain damage, Alzheimer's disease, and dementia. Some teams chose not to draft certain players in the NFL Draft due to their past concussion history. According to an Outside the Lines report, the head impact telemetry system (HITS) was in question by the League, although Kevin Guskiewicz, a professor at the University of North Carolina, said the system is functional. The technology could detect and measure the impact of blows to the head in real time during a game, but no such measurement exists in the league at this time. Former Pittsburgh Steelers receiver and current NBC Sports analyst Hines Ward stated the use of the system would be "opening a Pandora's Box," and that the data recorded by the system could be used by team owners to give players lower salaries.
Post-concussion syndrome
It is not known exactly how common PCS is. Estimates of the prevalence at 3 months post-injury are between 24 and 84%, a variation possibly caused by different populations or study methodologies. The estimated incidence of PPCS (persistent postconcussive syndrome) is around 10% of mTBI cases. Since PCS by definition only exists in people who have suffered a head injury, demographics and risk factors are similar to those for head injury; for example, young adults are at higher risk than others for receiving head injury, and, consequently, of developing PCS.
Concussions in American football
A 2004 doctoral dissertation by Don Brady examined NFL Players' knowledge of concussions, studying both active and retired National Football League Players' knowledge of concussions. Brady's findings concluded: that many NFL players lacked accurate and essential knowledge pertaining to various aspects of a concussion; that the preponderance of credible experimental and clinical evidence pertaining to the adverse effects of concussion indicates that the brain is injured as a result of a concussion; that the altered cell functioning and cell death along with subtle to more visible neurological, neurocognitive, psychological, and other medical problems reflect a diverse range of lifelong negative consequences of a concussion / brain injury; and that sports team health-care personnel need to focus primarily on the athletes' health and well-being, and not minimize an injury or primarily concentrate on the players' capacity to perform on the field. This expanded focus of health care is necessary in order to avoid any real or perceived conflicts of interest emerging in the concussion research, concussion management and related return to play decision-making process.
Post-concussion syndrome
The existence of PCS in children is controversial. It is possible that children's brains have enough plasticity that they are not affected by long-term consequences of concussion (though such consequences are known to result from moderate and severe head trauma). On the other hand, children's brains may be more vulnerable to the injury, since they are still developing and have fewer skills that can compensate for deficits. Clinical research has found higher rates of post-concussion symptoms in children with TBI than in those with injuries to other parts of the body, and that the symptoms are more common in anxious children. Symptoms in children are similar to those in adults, but children exhibit fewer of them. Evidence from clinical studies found that high school-aged athletes had slower recoveries from concussion as measured by neuropsychological tests than college-aged ones and adults. PCS is rare in young children.
Concussion
Young children have the highest concussion rate among all age groups. However, most people who suffer a concussion are young adults. A Canadian study found that the yearly incidence of MTBI is lower in older age groups (graph at right). Studies suggest males suffer MTBI at about twice the rate of their female counterparts. However, female athletes may be at a higher risk of suffering a concussion than their male counterparts.
Andre Waters
Shortly after Waters' death, former Harvard defensive tackle and WWE wrestler Christopher Nowinski, whose wrestling career was ended by post-concussion syndrome and has since written a book about the dangers of concussions in contact sports, approached Waters' family and asked permission to have his brain tissue examined. After receiving permission, Nowinski had samples of Waters' brain tissue sent to neuropathologist Dr. Bennet Omalu at the University of Pittsburgh. Omalu believed, having examined the tissue, that Waters sustained brain damage from playing football: he went on to state that this led to Waters' depression. Omalu determined that Waters' brain tissue had developed chronic traumatic encephalopathy (CTE) and degenerated into that of an 80-year-old man with Alzheimer's disease, caused or hastened by the numerous concussions Waters sustained playing football.
Sexuality after spinal cord injury
The numbers of women with SCI giving birth and having healthy babies are increasing. Around a half to two-thirds of women with SCI report they might want to have children, and 14–20% do get pregnant at least once. Although female fertility is not usually permanently reduced by SCI, there is a stress response that can happen immediately post-injury that alters levels of fertility-related hormones in the body. In about half of women, menstruation stops after the injury but then returns within an average of five months—it returns within a year for a large majority. After menstruation returns, women with SCI become pregnant at a rate close to that of the rest of the population.
Pregnancy is associated with greater-than-normal risks in women with SCI, among them increased risk of deep vein thrombosis, respiratory infection, and urinary tract infection. Considerations exist such as maintaining proper positioning in a wheelchair, prevention of pressure sores, and increased difficulty moving due to weight gain and changes in center of balance. Assistive devices may need to be altered and medications changed.
Mark Aubry
Aubry stated that awareness on the long-term effects of concussions increased partially because of the injuries to Sidney Crosby, but noted that physicians in the National Hockey League still disagree on when players are healthy enough to return to play. He was one of the authors in the 2017 report "Can visible signs predict concussion diagnosis in the National Hockey League?" He assessed Senators' player Clarke MacArthur for post-concussion syndrome, and said that given MacArthur's history, it would be too risky to return to play. He also cited research that in-game concussion protocols need to be strictly adhered to, and reiterated the need to evaluate players at the first sign of possible concussion, rather than staying in the game. He recommends a proactive approach to ensure players do not return to play too soon, citing recent studies on the numbers of concussions in minor ice hockey, and specifically at the peewee age level when players are typically exposed to body checking for the first time. He also spoke at the Canadian Academy of Sport and Exercise Medicine (CASEM) conference in August 2018, to address post-concussion syndrome, and methods for diagnosis.
Concussions in sport
The National Hockey League's concussion policy began in 1997, and players who sustain concussions are evaluated by a team doctor in a quiet room. In March 2011, the NHL adopted guidelines for the league's concussion policy. Before the adoptions, examinations on the bench for concussions was the minimum requirement, but the new guidelines make it mandatory for players showing concussion-like symptoms to be examined by a doctor in the locker room.
American football
Repeated concussions (and possibly sub-concussive head impacts) can increase a person's risk in later life for CTE (chronic traumatic encephalopathy) and mental health issues such as dementia, Parkinson's disease, and depression. Concussions are often caused by helmet-to-helmet or upper-body contact between opposing players, although helmets have prevented more serious injuries such as skull fractures. Various programs are aiming to reduce concussions by reducing the frequency of helmet-to-helmet hits; USA Football's "Heads Up Football" program is aiming to reduce concussions in youth football by teaching coaches and players about the signs of a concussion, the proper way to wear football equipment and ensure it fits, and proper tackling methods that avoid helmet-to-helmet contact. However, a study in the "Orthopaedic Journal of Sports Medicine" found that Heads Up Football was ineffective; the same study noted that more extensive reforms implemented by Pop Warner Little Scholars and its member teams were effective in significantly reducing concussion rates.
Chronic traumatic encephalopathy
The lack distinct biomarkers is the reason CTE cannot typically be diagnosed while a person is alive. The only known diagnosis for CTE occurs by studying the brain tissue after death. Concussions are non-structural injuries and do not result in brain bleeding, which is why most concussions cannot be seen on routine neuroimaging tests such as CT or MRI. Acute concussion symptoms (those that occur shortly after an injury) should not be confused with CTE. Differentiating between prolonged post-concussion syndrome (PCS, where symptoms begin shortly after a concussion and last for weeks, months, and sometimes even years) and CTE symptoms can be difficult. Research studies are currently examining whether neuroimaging can detect subtle changes in axonal integrity and structural lesions that can occur in CTE. Recently, more progress in in-vivo diagnostic techniques for CTE has been made, using DTI, fMRI, MRI, and MRS imaging; however, more research needs to be done before any such techniques can be validated.
Post-traumatic seizure
The most important factor in whether a person will develop early and late seizures is the extent of the damage to the brain. More severe brain injury also confers a risk for developing PTS for a longer time after the event. One study found that the probability that seizures will occur within 5 years of injury is in 0.5% of mild traumatic brain injuries (defined as no skull fracture and less than 30 minutes of post-traumatic amnesia, abbreviated PTA, or loss of consciousness, abbreviated LOC); 1.2% of moderate injuries (skull fracture or PTA or LOC lasting between 30 minutes and 24 hours); and 10.0% of severe injuries (cerebral contusion, intracranial hematoma, or LOC or PTA for over 24 hours). Another study found that the risk of seizures 5 years after TBI is 1.5% in mild (defined as PTA or LOC for less than 30 minutes), 2.9% in moderate (LOC lasting between 30 minutes and 1 day), and 17.2% in severe TBI (cerebral contusion, subdural hematoma, or LOC for over a day; image at right).
Concussions in American football
The NFL spent years trying to deny and cover up any link that emerged connecting head injuries sustained while playing football with long-term brain disorders. The NFL Mild Traumatic Brain Committee, first formed in 1994, reported in December 1999 that the number of head injuries had remained "remarkably the same over the course of four years." The committee went a step further in 2004 when it suggested in an article published in "Neurosurgery" that "NFL players have evolved to a state where their brains are less susceptible to injury." Two months after that, MTBI publishes another article that concludes "Players who are concussed and return to the same game have fewer initial signs and symptoms than those removed from play. Return to play does not involve a significant risk of a second injury either in the same game or during the season." However, when Dr. Bennet Omalu examined the brain of former Pittsburgh Steeler Mike Webster, he discovered a new brain disease, which he called chronic traumatic encephalopathy, or CTE. He outlined his findings in a scientific paper published in "Neurosurgery" in July 2005. The NFL's MTBI committee wrote in May 2006 that the article be retracted. Dr. Omalu instead wrote a second paper in the same magazine, this time about former Pittsburgh Steeler Terry Long. Dr. Ira Casson, who was then co-chair of MTBI, denied in a televised interview that there was any link between head injuries sustained playing in the NFL and long-term brain damage. His repeated denials won him the nickname "Dr. No." In September 2009, "The New York Times" published an article of an NFL-funded study stating that former players are 19 times more likely than the general population to have dementia, Alzheimer's or other memory-related diseases. The NFL's spokesperson, Greg Aiello, publicly said, "the study did not formally diagnose dementia, that it was subject to shortcomings of telephone surveys." Two months later, Aiello told "New York Times" reporter Alan Schwarz that "it's quite obvious from the medical research that's been done that concussions can lead to long-term problems." It was the first time any League official had acknowledged a link between the two.
Post-traumatic seizure
Around 5–7% of people hospitalized with TBI have at least one seizure. PTS are more likely to occur in more severe injuries, and certain types of injuries increase the risk further. The risk that a person will suffer PTS becomes progressively lower as time passes after the injury. However, TBI survivors may still be at risk over 15 years after the injury. Children and older adults are at a higher risk for PTS.
Concussions in Australian sport
Head injuries in sports of any level (junior, amateur, professional) are the most dangerous and sickening kind of injuries that can occur in sport, and are becoming more common in Australian sport. Concussions are the most common side effect of a head injury and are defined as "temporary unconsciousness or confusion and other symptoms caused by a blow to the head." A concussion also falls under the category of Traumatic Brain Injury (TBI). Especially in contact sports like Australian rules football and Rugby issues with concussions are prevalent, and methods to deal with, prevent and treat concussions are continuously being updated and researched to deal with the issue. Concussions pose a serious threat to the patients’ mental and physical health, as well as their playing career, and can result in lasting brain damage especially if left untreated. The signs that a player may have a concussion are: loss of consciousness or non-responsiveness, balance problems (unsteadiness on feet, poor co-ordination), a dazed, blank or vacant look and/or confusion and unawareness of their surroundings. Of course the signs are relevant only after the player experiences a blow to the head.
Post-concussion syndrome
Iatrogenic effects (those caused by the medical intervention) may also occur when individuals are provided with misleading or incorrect information related to recovery of symptoms. This information may cause people to focus and dwell on the idea that their brains are permanently damaged. It appears that even the expectation of symptoms may contribute to the development of PCS by causing individuals with mTBI to focus on symptoms and therefore perceive them to be more intense, to attribute symptoms that occur for other reasons to the injury, and to underestimate the rate of symptoms before the injury.
Posttraumatic stress disorder and substance use disorders
Posttraumatic stress disorder (PTSD) can affect about 3.6% of the U.S. population each year, and 6.8% of the U.S. population over a lifetime. 8.4% of people in the U.S. are diagnosed with Substance Use Disorders (SUD). Of those with a diagnosis of PTSD, a co-occurring, or comorbid diagnosis of a SUD is present in 20-35% of that clinical population3 Prevalence of SUD and PTSD may increase depending on specific populations. For example, the prevalence of both PTSD and SUD is higher in combat veterans. Of those with a SUD diagnosis, current PTSD is present in 25-50%, and lifetime PTSD is present in 15-40%, averaging 30% overall. Though roughly a third of all people diagnosed with SUD also have PTSD, there is not yet consistent protocol for SUD treatment centers to screen for both PTSD and SUD symptomology upon intake.
Rivermead post-concussion symptoms questionnaire
The questionnaire may be self-administered, administered in person by a second party, or administered over telephone. The questionnaire can feasibly be used as any other neuropsychological test for assessment of concussions would, including following MTBI following accidents or sports-related injury. The questionnaire can also be used for the assessment of conditions that show symptoms similar to PCS, such as chronic pain.
Posterior cord syndrome
It has been difficult to make any breakthroughs in diagnosis and/or treatment of PCS as symptoms are not specific in nature and can vary based on the exact location of spinal cord lesions. In addition, the demographics of patients suffering from PCS are widespread as the onset of symptoms typically follows a traumatic event. Additionally, research has suffered setbacks because PCS is extremely rare with few documented cases, unlike anterior spinal cord injury.
Concussions in sport
Concussions, a type of traumatic brain injury, are a frequent concern for those playing sports, from children and teenagers to professional athletes. Repeated concussions are a known cause of various neurological disorders, most notably chronic traumatic encephalopathy (CTE), which in professional athletes has led to premature retirement, erratic behavior and even suicide. Because concussions cannot be seen on X-rays or CT scans, attempts to prevent concussions have been difficult.
Post-concussion syndrome
The prognosis for PCS is generally considered positive, with total resolution of symptoms in many, but not all, cases. For 50% of people, post-concussion symptoms go away within a few days to several weeks after the original injury occurs. In others, symptoms may remain for three to six months, but evidence indicates that many cases are completely resolved within 6 months. The majority of symptoms are largely gone in about half of people with concussion one month after the injury, and about two thirds of people with minor head trauma are nearly symptom-free within three months. Persistent, often severe headaches are the longest lingering symptom in most cases and are the most likely symptom to never fully resolve. It is frequently stated in the literature and considered to be common knowledge that 15–30% of people with PCS have not recovered by a year after the injury, but this estimate is imprecise because it is based on studies of people admitted to a hospital, the methodologies of which have been criticized. In approximately 15% of people, symptoms may persist for years or be permanent. If symptoms are not resolved by one year, they are likely to be permanent, though improvements may occur after even two or three years, or may suddenly occur after a long time without much improvement.
Older people and those who have previously suffered another head injury are likely to take longer to recover.
Concussions in sport
Playing through concussion makes people more vulnerable to getting hit again, and that is why most sports have test that trainers will perform to prevent getting hit a second time. A second blow can cause a rare condition known as second-impact syndrome, which can result in severe injury or death. Second-impact syndrome is when an athlete suffers a second head injury before the brain has adequate time to heal in between concussions.
Concussions in sport
Repeated concussions have been linked to a variety of neurological disorders among athletes, including CTE, Alzheimer's Disease, Parkinsonism and Amyotrophic lateral sclerosis (ALS).
Concussion grading systems
Concussion grading systems are sets of criteria used in sports medicine to determine the severity, or grade, of a concussion, the mildest form of traumatic brain injury. At least 16 such systems exist, and there is little agreement among professionals about which is the best to use. Several of the systems use loss of consciousness and amnesia as the primary determinants of the severity of the concussion.