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Addressing Head Injuries in Athletes of All Ages

Changing the conversation about concussions

In a recent speech at the Harvard School of Public Health, NFL Commissioner Roger Goodell spoke of the cultural shift needed within the league to help reduce the risk of head injuries and significant brain traumas.

“Changing the culture in a way that reduces the injury risk to the maximum possible extent — especially the risk of head injury,” he said. “We want players to enjoy long and prosperous careers and healthy lives off the field. So we focus relentlessly on player health and safety, while also keeping the game fun and unpredictable.”

I am passionate about bringing more awareness to the issues of brain health and what we can be doing to improve cognitive performance – not just for professional athletes but for athletes of all ages.

Fear has been a common theme in the discussion of concussions in athletes – particularly in our youth. Dr. Robert Cantu recently published an editorial in The New York Times where he argued that children under the age of 14 should not be playing tackle football, heading a soccer ball should be against the rules until age 14, body checking should be banned in ice hockey until age 14 and headfirst slides should be eliminated in youth baseball and softball.

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While the conversation about concussions and their effects is a good one to have, it should not be clouded by overwhelming fear. Here are my thoughts on this often controversial subject.

  • Player safety is of upmost importance. Proper equipment and rules and regulations need to be in place to protect not only the head safety, but the overall safety of athletes of all ages. Return to play rules need outlined and enacted if a head injury is suspected. One of the biggest contributors to concussions is the brain’s environment. While no headgear is going to fully protect the brain from being injured by the skull’s protruding inner surfaces that act like weapons of destruction as the brain rams against them, protecting player safety is paramount.
  • Get a comprehensive benchmark and baseline measurement of brain function. Having a brain benchmark measurement allows medical professionals to monitor brain changes with the developing brain or before or after injury. Athletes get routine annual complete physicals; it is more crucial to get a comprehensive BrainHealth Physical.
  • Strength training is key. Athletes of all ages need to be involved in strength conditioning; in particular, it is important for children who play contact sports to strengthen their neck muscles.
  • If a concussion is suspected, seek medical attention. Head injuries take time to heal and that is especially true in the case of children and young adults. See a qualified medical professional, preferably a neurologist with experience in concussions, for diagnosis and treatment. Medical care and player safety trumps all else.
  • Rest and restrict. Whereas physical activity is often restricted after a concussion, cognitive rest is a key factor in brain injury recovery as well. Limit the use of computers, cell phones, video games, television time and schoolwork.
  • Fourteen is not a magic number. While Dr. Cantu recommends restricted play for children under the age of 14, there is nothing magical about that age in terms of brain development. In fact, the brain is undergoing continuous development throughout our lifetime. Specifically, the brain’s frontal lobes – often the most injured part of the brain during a concussion – develop until late 20s. Delayed sports training may dampen the development of critical physical skills to excel in sports.
  • Monitor and mitigate long-term deficits. For particularly young children, the long-term effects may not be evident until later developmental stages. My team was first to document this neurocognitive stall in pediatric patients who suffered a brain injury. Additionally, whereas previously children who had a concussion (i.e., “mild” brain injury) were thought to recover cognitive function within the normal range in the long term, there is increasing evidence that full recovery after concussion may not extend to all children, especially when more complex cognitive functions are considered. Center for BrainHealth researchers have found that some children (as many as one in five) who had a concussion demonstrated comparable difficulties to children with severe brain injuries in higher-order reasoning skills, even as late as two years after the injury. Disrupting this development because of a concussion can lead to long-term problems with processing information, problem solving, decision-making, judgment and emotional control. These deficits, if properly managed, can be largely reversed, given appropriate and timely treatment and proper brain training, no matter time period since injury.
  • Harness the power of plasticity. The brain is the most modifiable part of the whole body and it can grow, change, heal and be trained in health or after injury. The brain is remarkably regenerative, but proper training is required to harness its intrinsic capacity to be rewired.
  • There is no time limit. It was previously believed that the window for brain recovery was at most one year after injury; my research has shown that the brain can be repaired months and years after injury if the right interventions are applied. If an athlete suffers a concussion, brain training can maximize cognitive performance. Unacceptably, the hundreds of thousands who have suffered concussions are living with less than their personal best, not rebounding to their maximum, high-performance potential.

 I am inspired by the words of a Navy SEAL with whom I recently worked.

 “Advances in modern medicine, science, and exercise physiology have taken our athletes to accomplishments that ten years ago were considered impossible. Ussan Bolt ran faster than any human alive at the Olympic games. Mark Inglis climbed Mount Everest on two prosthetic legs. We are growing stronger, and going faster, longer and higher than ever before.

Do you realize that the winner of a contest whether it is physical or mental is the one that has endured the most pain in training? The champions of the world are the ones that accept the idea that no matter the cost they will sacrifice everything to win. Champions want to be champions, and winners are winners no matter what they are doing at the time. How far can we take the ability of our brains if we actually focused on training it like we do our bodies?

My training at the Center for BrainHealth taught me many things. One, that anyone can think smarter. Two, you can join the fight sharper than before. Three, none more important than this, I will not fail, and I can be better, stronger and smarter. Why? Because it’s up to me, and I will succeed."

We can achieve far greater good by training the brain in health and by repairing and retraining the brain after injury – even years after injury than by banning sports. Team sports provide positive benefits for individuals of all ages; team sports are a cost effective avenue and training ground for socialization, fun and important life lessons. Sports may be one of the most important activities to promote physical activity and to counteract the vulnerability and risk of addiction which is becoming all too common in early adolescence. The conversation surrounding concussions must change from one of fear, doom and gloom to one of resilience, recovery, safety and hope.

Sandra Bond Chapman, Ph.D., Founder and Chief Director of the Center for Brain Health at The University of Texas at Dallas, is committed to maximizing cognitive potential across the lifespan.

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