The Future of Sports-Concussion Management

The prevalence of sports concussions, dangers associated with brain trauma and related lawsuits escalating into multimillions of dollars is forcing athletes, parents, coaches and athletic trainers to re-examine their knowledge, protocols, and culture protecting the players and games we love.

The brain is science’s new and exciting frontier. It is also vulnerable. The buttery, gel-like consistency floats unattached inside the skull. When force is applied, as it is many times in sports collisions, the brain sloshes from side to side, end to end, almost like a scrambling egg inside its shell.

The consequences could either take several minutes to materialize or are immediately evident. Science and the sports world are currently unraveling important information about how the brain is impacted. They have to because lives and futures are at stake, which until recently have not been as important as the wins and losses that usually take center stage in sports.

Athletes, young and old, are struggling with concussions and the effects of mild traumatic brain injuries. But they aren’t alone. Parents, coaches, athletic trainers, league officials, and virtually everybody else involved in supporting athletic development are grasping for answers to what can be done to ensure that athletes avoid the dangerous risk of short- and long-term cognitive and emotional impairment resulting from concussions.

The NFL and NHL are contending with multimillion-dollar lawsuits because of brain traumas, giving concussions an awareness level never seen before. While the Centers for Disease Control and Prevention estimates that more than 3 million concussions occur per year, most experts agree that incidence rates are much higher than realized. Many athletes experience concussions more often than they actually report them.

This is forcing the sports world to reexamine its knowledge about the brain and how to protect it while allowing players to enjoy the benefits of the game and their lives, long after their playing days are over.

Unfortunately, parents and coaches aren’t typically well versed in brain matters. Moreover, the sports-therapy and athletic-trainer industries have been strapped with outdated protocols, tools, and techniques. However, now is the time for technology and science to combine and allow for the integration of resources and tools necessary for clinical concussion management at all levels.

The notion of concussion management is still a relatively new concept. Most sports teams have the task of piecing together various materials, tests, and tools to create guidelines for managing concussions. These methods, which may be adequate to some degree independently, leave athletic trainers with a fragmented protocol that can delay, frustrate, and taint the objectivity needed to help prevent, detect, and protect athletes from significant brain damage. There’s the lack of a single, reliable, and practical source of information that provides expert guidance.

I’ve been studying the brain for more than 25 years, dealing with thousands of concussions and specializing in the behavioral alterations associated with brain trauma. I found that existing concussion-management information lacks depth of understanding and realistic applications. So I began creating my own protocols for education and baseline measurement, as well as detection and recovery guidance.

My conclusion is that the sports world can benefit from a seamless, thorough, and practical sports-concussion-management solution. With the connectivity of the internet, mobile applications, and advances of information technology, an end-to-end approach is now available for relieving the growing concern over athletes’ brain health. When I say an “end-to-end” solution, I’m referring to a program that can be implemented for all sports — from the beginning of the season to the end. This includes four key words in sport-related-concussion management.

Recognize. Provide proper information about the potential ravages of concussions: education that complies with state laws and preseason baseline testing that measures the full spectrum of cognitive and emotional performance tasks.

Report. Immediately assess, document, and report results of post-concussion symptoms to necessary parties. These include the athlete, his or her parents, coaching, and training staff, athletic trainers and directors, medical professionals, and, if necessary, league officials.

Recover. Guide the athlete and training staff through a progressive exertion protocol that helps determine when the athlete can be cleared for return to play, as well as for a return to academic activities.

Responsibility. Understand that concussion management is a team effort because it involves the athlete, parents, coaches, training staff, medical professionals, referees, and league officials. The health of the athlete, as well as his or her short- and long-term future, should weigh heavier than the desire to return to the field.

Internet-based computer technology offers a centralized (single source) method of accomplishing each of these steps, which has never been done before. Online video training can teach athletes, parents, coaches, and educators about concussions and can therefore optimize prevention by allowing them to recognize the presence of concussion-related symptoms. It will encourage an overall cultural shift toward prioritizing brain health over athletic competition.

Responsible adults can use smartphone technology, now at an unprecedented level of sophistication, as assessment tools to document potential concussion incidents on the sidelines. The technology also provides injured players with a convenient method to document concussion-related symptoms during and after the concussion-recovery phase. The immediate availability of email and the internet allows key individuals involved in athlete care to get instant alerts about potential concussion events. Athletic trainers and other health care providers can track injured athletes’ recovery progress in real time, making postconcussion management as efficient as possible.

In a fully integrated program, reporting takes on other forms as well. School administrators can instantly access data related to athlete and parental completion of state-mandated preseason activities, policies, and procedures. A fully integrated, computer-based system also allows for the objectivity and transparency needed for the proper management of concussions under the watchful eyes of league officials and union administrators.

Fully integrated applications should include tools for the evaluation and assessment of concussion vulnerability and/or the development of delayed effects of multiple brain traumas, correlation of concussion incidence, and severity to biomechanical measures such as accelerometer technology, and the effects of therapeutic interventions on outcome measures such as recovery time and cognitive performance.

Retired athletes can also reap the benefits of fully integrated, computer-based systems. As part of a surveillance program meant for early detection and treatment of delayed effects of multiple brain traumas, asymptomatic individuals document their cognitive performance and symptom-related brain function online. A complete concussion-management program gives the sports world a chance to have a virtual neurologist on its team, ultimately preserving athletes’ health and optimizing their performance.

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