I thought the presentation by Dr. DiFiori on Concussion Awareness Day was very informative. Although he did not get to give us his full presentation, he focused on an extremely important aspect of concussion injury; the recovery. One of the most difficult aspects of concussive injury today for doctors and sports scientists is determining the best time for an affected athlete to return to play.
When a football or hockey player experiences a hard hit, their brains experience a phenomenon known as cerebral rotation, where the rotational force of their head, in response to the hit, causes axons to tear in a process known as axonal shearing. The shearing of the axon can cause excitotoxicity, where a series of chemicals, normally confined by the axon, are released into the cytoplasm of the brain. The tearing of the axons and release of chemicals can result in significant cognitive impairment. Dr. DiFiori alluded to the fact that some players recover quicker than others, but most concussion victims do not see a significant improvement in their symptoms until 8-10 days after their incident, as he also states in the article.
After hearing that the recovery time is usually 8-10 days after the incident, I thought that, if a player were to get a spinal tap, their results would show a high amount of chemicals in CSF. These chemicals would come from the tearing of the axon and the breaking of the microtubule filaments, which would release damaging tau proteins. This process would also alert the astrocyte cells of the nervous system, which would release S100B molecules, in addition to the cytokines, APP and TDP-43 molecules being released. The release of tau proteins and glutamate causes neuronal cell death. In one of Dr. DiFiori’s articles titled, “A pediatric perspective on concussion pathophysiology”, it is stated that the release of glutamate and other excitatory neurotransmitters causes an ionic flux. Essentially, NMDA and AMPA receptors are activated by the neurotransmitters causing a massive calcium and sodium influx into neurons and surrounding glia. This ionic imbalance can also facilitate the degradation of the axons.
I think the fact doctors and athletic trainers are cracking down on coaches who want to put their injured players back in the game is a good thing for the safety of the players. Coaches and doctors, like the ones at UCLA, should be working cooperatively to deduce not only when their players get concussions, but also when the best time is for them to return to play. Watching the video footage of the University of Washington quarterback getting hit and still playing was a perfect example of what not to do when faced with a situation like that. The first hit that he sustained was quite alarming, as he tried to get up and fell down 3 times, all the while holding his head. It was quite alarming watching him attempt to stand, but his limbs would simply crumble beneath him. It is as if his whole IPO (Input Processing Output) was not functional. He knew he was trying to stand up, but through a confusion of stray neural processing, most likely in the cerebellum and motor cortex, he was not able to properly stand.
Hopefully, through the use of new fMRI technology and various other imaging techniques, neuroscientists will be able to convince coaches, players and families of players of the dangers of concussions. If a recently concussed player gets a concussion, it can be assumed that his brain scan in an fMRI may show signs of neuronal cell death. These images of damaged brains should cause players, families and football fans to really consider helmet safety and TBI. Dr. DiFiori’s talk should be nationally distributed by the NCAA to warn players of what can happen if they get a concussion and worse, lie about the symptoms