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Despite the fact that all 50 states and the District of Columbia have enacted state legislatures to address youth sports-related concussions since 2007, the prevalence and potential repercussions of these kinds of head injuries is more concerning than ever before.

Since their brains and bodies are still developing, young athletes are more susceptible to concussions and the adverse effects associated with them. In fact, well over half of emergency room visits for children (ages 8 to 13) are tied to sports-related concussions, with each incident exposing the child to potential brain injury or damage.

In fact, a recent study published in the journal “Radiology” suggests that children may experience measurable brain changes playing contact sports without even being diagnosed with a concussion.

This study looked at 25 male football players ranging in age from 8 to 13. All head impact data was analyzed, and participants were evaluated before and after the football season using advanced Magnetic Resonance Imaging (MRI) techniques, such as diffusion tensor imaging (DTI), which can be used to identify minute changes in a brain’s white matter.

None of the participants showed signs or symptoms of concussions, but researchers noted a distinct relationship between the typical head impacts the players experienced during the season and low fractional anisotropy (FA) rates in their white matter tracts and tract terminals. While this study was small, it does point to young athletes’ susceptibility to incurring brain changes from even minor head impacts and the critical need for researchers to use more advanced imaging techniques, like DTI, to gain a better understanding of not only concussions, but also the brain’s subtle inner workings.  

Concussions in youth sports

Recent studies have shown that youth athletes experience concussions with alarming frequency. A study from Fair Health noted that for youth athletes under the age of 22, the rate of concussions diagnoses increased by 500 percent from 2010 to 2015.  

Most of these concussions occur during the fall sports season, and high schoolers were the athletes most likely to experience a concussion, with athletes between the ages of 15 to 18 accounting for 46 percent of the diagnosed concussions.

It’s estimated that, for athletes under the age of 18, 1.9 million sports-and-recreation-related-concussions (SRRCs) occur each year.

Young athletes who suffer from concussions may experience long term effects ranging from attention problems to nerve deterioration, and these effects can last for decades.

Despite the serious implications associated with head impacts and the growing prevalence of reported concussions, there are still a number of reasons why laws surrounding concussion protocols are falling short.

While almost all states require training on signs of concussions to look out for, only 20 states mandate that coaches receive this type of training.

Considering the fact that they are on the front lines of this issue and are most likely to make the call regarding whether a player should sit out and seek medical attention or keep playing, this is very concerning.

Furthermore, while most states require that an athlete stop playing as soon as a concussion is suspected and receive an evaluation by a healthcare professional, only a little over half of state laws require that the medical professional be trained specifically in Traumatic Brain Injury (TBI).

A critical tool: Advanced Imaging Techniques

Detecting the effects of concussions requires a specific set of tools, namely advanced imaging techniques and devices. Usually, an initial MRI scan is not enough to detect early or subtle brain changes — additional testing is often required to identify micro-bleeds, for instance.

While microbleeds can be visualized by using routine MRI, research has shown the use of another advanced MRI technique, susceptibility-weighted imaging, (SWI) may have increased sensitivity in the detection of hemorrhagic lesions. In other words, routine testing and imaging is usually not enough to detect important issues within the brain.

As the study published in Radiology noted, youth athletes may experience brain changes without experiencing major head trauma, and detecting those microstructural changes within the athlete's’ white matter required a very specific and advanced imaging tool — DTI. Youth athletes experience brain changes from even minor head impacts, and detecting those changes requires more than a routine CT or MRI scan.

Additionally, these advancing imaging tools can be used to gain a better understanding of the brain’s overarching recovery process following an injury. A recent study conducted by researchers with the Albert Einstein College of Medicine and Montefiore Health System noted that certain advanced imaging techniques could be used as effective recovery prediction tools.

The study focused on a group of patients who had suffered from concussions, and the researchers used imaging techniques to measure the uniformity of water movement (called fractional anisotropy, or FA), which can help predict the recovery from a concussion.

Conventional imaging techniques like CT or MRI can provide a broad perspective of the brain, but they are not designed to pick up on small or “invisible” changes. But DTI, the researchers discovered, could be used to measure FA, and in effect, predict which patients were likely to make a full recovery.

Researchers also learned more about the brain’s internal mechanisms for repairing injuries, a key issue being that over 70 percent of concussion patients often get better on their own over time. The brain, of course, is a sensitive and critical component of the body, and understanding its workings completely requires a very particular and sophisticated set of tools.

Looking forward

The young, developing brain is particularly vulnerable to concussions, and as recent studies show, even minor head impacts without an actual concussion diagnosis can cause measurable changes to the brain. With the right imaging tools, researchers can not only gain a better understanding of how both minor and severe impacts affect the brain, but they can also learn more about the brain’s projected recovery on an individual basis — a key step in coming up with tailored treatments and therapies.

Combining this with more strict and comprehensive state laws surrounding concussion training and protocols will undoubtedly help to curb this public health issue. While we are still only scratching the surface, applying more advanced imaging techniques and pushing our knowledge of how concussions and impacts affect the young brain will allow us to make critical discoveries that will ultimately save lives and prevent irreversible damage from occurring.

Barry Southers, MEd, is an associate professor and MRI program director of the University of Cincinnati Advanced Medical Imaging Technology (AMIT) program.

This article first appeared in The Hill.

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