Continuing Concussion Confusion

As football-related concussions and chronic traumatic encephalopathy get more media coverage than ever before, the NCAA and the U.S. Department of Defense are co-sponsoring $15 million in grant money for research and education about how concussions are reported.

“It’s time to listen to the athletes, which we haven’t done until now,” said Deborah Craig, Ph.D., program director of athletic training at Northern Arizona University in Flagstaff, Arizona.

“We’ve just thought, ‘We’ll tell them how bad concussions are and their behavior will change.’ Instead, athletes continue to outsmart concussions, making it clear that knowing the dangers of concussions isn’t enough to influence their reporting behaviors.”

Craig was awarded $400,000 in research grant money, along with three associates: Monica Lininger, Ph.D., and assistant professor of physical therapy and athletic training at NAU, and NAU psychological professors Ann Huffman and Heidi Wayment. The group will study four NCAA division 1 collegiate football teams over the next two-and-a-half years.

“We can’t take concussions out of the game of football,” Craig explained to LifeZette. “What we need is an improved understanding of concussion reporting behaviors in order to adapt the landscape to keep athletes safe.”

“There’s a health crisis in our country and I think it’s specific to American football,” said Craig.

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Concussions, which are hallmarked by changes in brain functioning after a traumatic blow to the head, may result in a loss of consciousness or changes in a player’s mental activity.

But diagnosing concussions is not a cut-and-dried process. The NCAA points out that there are “often few objective findings for diagnosis or physiological recovery that exist for clinical use, and there often remains a significant reliance on self-report of symptoms from the student-athlete.”

[lz_bulleted_list title=”Why Concussions Aren’t Reported” source=”http://www.aap.confex.com”]Feeling it wasn’t a serious injury (56.9)|Didn’t want to be pulled from competition (47.7%)[/lz_bulleted_list]

When the U.S. instituted mandated concussion reporting laws, the hope was to see greater concussion reporting — but the research hasn’t shown that it’s happening. Craig said that everyone’s efforts are in vain if concussions remain undetectable and underreported.

“The most accurate thing we have so far is a symptom list — and it’s very subjective,” said Craig. “If an athlete has a headache and wants to go back in the game, they have one clear answer: no. We don’t have a way to measure that, and it confounds the problem.”

In Craig’s pilot study last spring, athletes shared reasons why they had not reported concussions: “I didn’t want to come off the field. I didn’t want my coaches to lose respect for me. I didn’t want the team to do poorly, or affect the outcome of the game. My backup isn’t as good as I am.”

Former NAU quarterback Kyren Poe told LifeZette, “I think that football has a resistant culture for reporting concussions, because it hasn’t been until just recently that concussions became such a hot topic.”

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He added, “Growing up and playing football, you just assume that getting rocked was part of the game and you were supposed to deal with large hits and get back up. You gained respect by being the toughest dude on the field.”

Football players are the most widely researched athletes because they experience the most concussions; the frequency is easier to study — it gives us more data, Craig told LifeZette. She added, “Football is also the most resistant culture — and it’s testosterone driven.”

Craig’s research will focus on Football Bowl Subdivision and Football Championship Subdivision schools. She explained: “FBS players may be more resistant to reporting concussions because their medical records will follow them to the NFL, which may look more reluctantly upon athletes with previously documented concussions.”

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Every institution has a concussion management policy — and they are all fairly similar. If players present with one symptom, they usually have to sit out for seven days after the last symptom goes away.

“If an athlete has a concussion, his/her brain needs time to heal. While an athlete’s brain is still healing, s/he is much more likely to have another concussion,” according to the Centers for Disease Control and Prevention. And it takes much less impact for the brain to bleed out with a second hit — second impact syndrome has just under a 50 percent death rate.

“When in doubt — sit it out,” Craig says. The most important thing we can do right now is to allow recovery time. Brain rehabilitation is vital, and Barrow Neurological Institute in Phoenix, Arizona, is focusing their efforts on this area as grant recipients.

While researchers, such as those from the University of Minnesota, are investigating more objective concussion markers in blood, urine, and saliva, we are in a holding pattern.

“Our athletes would tell you if there’s a way that they could go to the sidelines, spit in a cup, do a dipstick — and it says yes or no — they would do it every single time,” said Craig.

Poe agrees. “It’s hard to tell what a concussion is and what isn’t. I feel like there would be a huge change if there were measurable and more accurate ways to identify concussions — players would be more apt to report them.”

By creating intervention strategies that affect the culture and redefine it toward safety, the strategies can then be adapted to other sports as well.

Jewels Doskicz is an Arizona-based registered nurse with 20 years of experience. A passionate patient advocate and health consultant, she has lived with Type 1 diabetes since she was 13.