John DiFiori

Khaoula Ben Haj Frej

Despite all of the attention towards concussions and preventing them, athletes continue to experience blunt trauma to the head and return to the game, particularly in football, hockey, and soccer. If a change isn’t made, a decline in participation in such sports could occur, particularly as parents steer their children away from collision sports, out of fear of brain damage and concussions.

As a major focus of his presentation, Dr. DiFiori spoke about a “vulnerable window,” a time of Increased Cerebral Vulnerability (ICV), during which one should avoid a return to the collision sport or work, or else one may experience more long-term and drastic damage (Chloe et al., 2012). After a blow to the brain, there is an increased need for energy but a lesser supply, in the form of a decrease in cerebral blood flow, normalizing only after 7-10 days. Thus, one would assume that one should wait at least that amount of time before returning to the game, to allow for normalization.

When it comes to individual cases, the hard part isn’t determining if a concussion has occurred but more so whether or not someone can return to work yet. A concussion is not a catastrophic injury in the way that other brain injuries are, although it can result in loss of brain function, loss of consciousness, or amnesia (Chloe et al., 2012). However, a misdiagnosis (or unreported case) can lead to ignoring more dangerous brain damage. Among athletic trainers and trained personnel, SCAT3 is a standardized survey of questions meant to determine if a concussion has occurred. However, not all athletes will notice or report these symptoms and 40% will go on playing, putting themselves in danger for acerbating their damage. Those who have had a concussion in the past is more likely to have another, subsequent concussion with worse and more prolonged symptoms. Often, the second concussion occurs within 10 days, which is also how long it takes to normalize cerebral blood flow, as aforementioned. Multiple studies have been made on rat models to show the impact of concussion occurring multiple times within the vulnerable window, supporting the conclusion that repeated concussions do in fact have worse and worse impacts and a new disposition for more concussions.

So, how does one decide when someone is back to normal and ready to go back to the game? Computerized neurocognitive testing is the main way in which that’s determined. It’s not as good as had been hoped; it’s faster than a complete neuropsychological battery but isn’t very reliable in terms of consistency between studies. There are too many problems with it for it to the end-all be-all approach. For example, you can easily cheat on it, since all you have to do is put forth a smaller effort before your concussion and then you look normal when concussed. Secondly, the reaction time isn’t very accurate. Someone needs to come up with something better but for now, individualized, “best practice” involves rest for a period of time before slowly training them back to the level when they can return to their sport, in a 6 step-approach (not necessarily over the course of 6 days, especially in children), according to Dr. DiFiroi and Semple et al. (2014).

He showed a lot of clips of a player hitting his head multiple times in a game, only to keep going back to play. A week later he played again and was so concussed he was knocked unconscious. A potential helpful solution is metabolic, involving implementing something like a ketogenic diet, which is being studied here at Trinity labs, or glucose supplementation. When it comes down to it however, concussions are a common problem to which a solution has not entirely been found.

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