It is now more clear than ever that head traumas can have tragic consequences and cannot be taken lightly. The recent loss of NFL standout Junior Seau highlights even further how chronic traumatic encephalopathy causes a lifetime of cognitive anguish and too often end in tragic consequences. Recent evidence of particularly slow recovery from brain trauma in adolescents spotlights that concussion worries are not reserved for the high profile adult athlete. Head trauma is part of sport and its consequences range from terribly trying to tragic. This all being said, games continue to be played.
Equipment manufacturers strive to create safer equipment. Sport leagues debate rules and regulations. Nonetheless incidences of head trauma on the playing field are showing little evidence of abating. The reality is concussions are not going away any time soon.
Vast resources are being put towards understanding the neurophysiology of concussion. Sports equipment experts are readily searching for the Holy Grail – concussion preventing headgear. Yet too often neglected is a keen understanding of emotional care for the concussed athlete. Perhaps it makes sense because recovery from head trauma is an invisible process – there are no broken bones, no casts, no limps, nothing tangible to the human eye. Or perhaps because helplessness is something we wisely avoid and not only does the concussed athlete feel out of control of life, but frustration oozes forth from caring and hopeful helping others surrounding the athlete. It is said many times in the head trauma literature, “Every concussion is different and it is impossible to predict how long recovery will take.” This creates a moving target for diagnosis and an unclear path to recovery… despite the face staring at the athlete in the mirror each morning looking perfectly well.
Recovery from anything beyond a mild head trauma can be a trying experience. In some regards, I imagine it is much like solitary confinement – no school (i.e. time with friends), no television or computer (the light and movement of monitors can be trying), dim lighting, and restricted from physical activity. All of this and the only thing the athlete did wrong was choose to play the game. It certainly does not make sense and it certainly is not fair.
All of this being said, on top recovery of cognitive functioning and athletic ability, the emotional impact of concussion needs to be considered. There is an emotional cost that comes with post-concussion treatment. It is socially alienating and stressful. Exclusion from social activities and concerns about future health and activity shape an athlete’s recovery.
The counseling skills necessary to aid the injured athlete can challenge a sports medicine staff and elude family and friends. The following are three foundational concepts to consider when journeying with a concussed athlete:
Empathize - Appreciate the feelings of loss, fear, and pain that come with the injury. Pep talks and optimistic thinking may sound nice, but they too often discount the challenge and trouble of significant injury. Encouraging words may be valuable, but hearing and feeling the emotion of the situation are more critical first steps to helping.
Patience – Frustration is contagious and the injured athlete likely has enough of it. No one wants to be slowed by headaches, nausea, confusion, or blurred vision. Healing is a priority. Malingering from a concussion is rarely heard of (quite the opposite fills pages of sports lore). A caregiver that is impatient only adds to the stress and highlights the helplessness of the athlete. Go slow and bear with the athlete.
Don’t Forget – Human beings are remarkable good at moving beyond trauma, especially if they were not the victims of the crime. At onset of injury, the athlete receives great attention - as time goes by teammates, friends, and supportive others return to daily living. The injured often heals slowly and the fear of re-injury lingers. A good smile and socially acceptable positive attitude does not mean the concussed no longer needs a bit of attention. Remain connected and concerned.
Head trauma renders the concussed powerless and disconnected from the healthy world. Beyond understanding the neurology of the trauma, remember to care for the human in the injury. Maintain social communication that can be disconnected and allow the athlete to have the prerogative to have emotions and a voice during the healing process. Concussions are part of play, competent caring is critical in their management.