WESTBOROUGH, MA June 1, 2014 On May 29th President Barack Obama held the first summit for concussion and its management. Mr. Obama convened a group of plenty to discuss the true impact of concussive brain injury and who is at risk and why. President Obama hosted the Healthy Kids and Safe Sports Concussion Summit in May at the White House to address the growing risk of concussions in youth. The president believes that concussion is a growing theat to public health – especially to children. He is correct especially among athletes whose brains may continue to develop for years to come. “Concussive injury has the potential to derail the trajectory of normal development and is fully preventable,” according to Michael Sefton, Ph.D., Director of Neuropsychology at Whittier Rehabilitation Hospital in Westborough, MA. At a conference for public school nurses, Sefton espoused the importance of cognitive and physical rest in the days following a concussion. “For this reason alone no athlete should return to the field of play until they are fully healed from concussion” according to Sefton. The return to school must be carefully controlled as well to avoid the exaccerbation and prolongation of symptoms.
REPEAT CONCUSSION SHOULD BE AVOIDED
The growing base of knowledge about the cumulative effects of brain injury has people worried. It is an intuitive notion that concussion should be avoided and more is not better. Data are being presented almost weekly about the long term impact of repeat concussive injury. The Boston University School of Medicine now has a collection of brains that were donated by athletes with a known history of concussion. They have exposed damatic changes in the pathophysiology of brain tissue and hypothesize a correlated change in functional viability that evolve from the forces of sport. Until recently, chronic traumatic encephalopathy or CTE could be diagnosed in postmortem analysis brain tissue only. It shows a marked change in morphology, atrophy or shrinkage, and tell-tale sign of Tau proteins consistent with progressive cellular degradation and programmed cell death as seen in the brains of Alzheimer’s patients after death. There is a blood test currently being studied to measure the antemortem amount of this protein in patients. The published data has been dramatic. The stories associated with each brain is a testament to the substantive change is behavior and affective stability that may utlimately be attributed to concussion and other brain injuries. Athletes everywhere suddenly realize they may not have seen the last of the effects of concussion.
REGRET, FEAR, AND HOPE
During one parent information session – held at a local high school, a gentleman pushing the floor mop volunteered his own story. During high school he played on the school football team. In one game, a particularly violent contest he was knocked out cold for a few moments. The symptoms quickly evaporated and he was put back into the game. This happened 3 more times and 3 more times the player was allowed to return to the game as a lineman. It was an important game and during his time it was a testament to toughness to return to the field of play after injury. Only now, he lives with regret, fear, and hope that he will not develop a debilitating brain disease as he gets older. But he knows this could happen. These days, players are taught to recognize the symptoms of concussion and are designated mandated reporters. If they know of someone playing through an injury like a concussion they must notify a coach or trainer. In 2014, parents for their part are being educated about the risks of not resting after being diagnosed with concussion and planning for the return to school once healed. In 2010, the Massachusetts Interscholastic Athletic Association or MIAA has mandated education and training for all athletes, parents, coaches, and trainers about the potential long term consequence of concussion. Schools were responsible for concussion protocols and policies for injured student athletes. School nurses were cast into the role of managing student symptoms by providing tylenol, ice, and rest breaks on Monday mornings following a weekend injury – sometimes with little or no warning. They are on the front line for intervention with students struggling with this invisible injury.
WHITE HOUSE SYMPOSIUM
The May 29, 2014 Symposium on concussion undoubtedly included nationally known experts like Mickey Collins, Ph.D., ImPACT Testing – University of Pittsburgh, Gerry Gioia, Ph.D. from the Children’s National Medical Center and perhaps Bob Cantu, M.D., internationally known neurosurgeon and concussion expert from the B.U. Medical Center in Boston. Dr. Cantu published Concussion and our Kids in 2012 and often is heard to say that young children should not be playing contact sport. These three experts are both knowledgeable, approachable and kind. I respect their work greatly. The goal of the symposium was to raise awareness about the dangers of concussion and generate initiatives to minimize the long term consequence of this public health problem. The AP’s Darlene Superville wrote the summit “signaled an effort by Obama to use the power of the presidency to elevate a national conversation over youth concussions.”
President Obama, like presidents before him, takes particular interest in certain topics – in this case concussion and recently the scurge of elder abuse. There was a previous White House symposium on school safety in the wake of the spate of school shootings in the mid 2000’s. Like this one, I had made an attempt to get on that guest list so that I might add my viewpoint. Arguably, The Evil that Kid’s Do (Sefton, 2005) was a book written to address the issue of childhood violence from the clinical point of view may have made a worthy discussion point and added to the collective conversation.
President Obama suffered a concussion while playing youth football. Then, Secretary of State Hillary Clinton sustained a concussion as a result of a fall while serving in 2012.
Sefton, M. (2005). The Evil that Kid’s Do. Exlibris, Philadelphia.