Taking Concussions Head-On: Part I

Recognizing the Breadth of the Problem and the Search for Answers

The release of the movie Concussion brings an even greater focus to an issue that has been debated more and more heatedly in recent years. Head injuries are devastating and their prevention is a goal not just in professional sports, but for athletes at all levels. Year after year, the NFL has reported pre-season and regular season concussions (Mild Traumatic Brain Injury, or MTBI) totaling over 200 players. This is a high profile situation that has placed a spotlight on the problem. More importantly, each year approximately 250,000 student-athletes aged 19 or younger will also be concussed while on the field of play, with higher concussion rates among high school than college students. Additionally, over the past decade ER admission rates for head-related injuries increased by 90 percent, as reported by CBS News.

However, these figures do not tell the whole story, as the Center for Disease Control (CDC) estimates that 69 percent percent of student athletes with a possible concussion played with concussion symptoms, and that 40 percent of those athletes said their coaches were not aware they had a possible concussion. Overall, an estimated 1.6-3.8 million sports- and recreation-related concussions occur in the United States each year.

Devastating Long Term Effects of Concussions
Concussions are nothing new, but in recent years, our understanding about the detrimental -- and quite often destructive -- consequences of repeated MTBI has greatly increased. A CDC fact-sheet states that the immediate symptoms include headaches, nausea and dizziness, blurry vision, sensitivity to light, extended grogginess, and concentration or memory problems. In serious cases, a concussion can also result in convulsions or seizures. These symptoms may last for days, weeks, or -- in the cases of MLS phenom Taylor Twellman and NHL All-Star Marc Savard -- years.

The long-term impact of concussions on the brain is still being determined, but a growing body of evidence points to reduced cognitive function, including increased risk for depression, dementia, Alzheimer's, and chronic traumatic encephalopathy, or CTE -- which is a degenerative brain disease found in an increasing number of professional athletes. Twellman is now an advocate for concussion awareness and has even pledged to donate his brain to a long-term CTE study at Boston University.

The Difficulty with Diagnosis
A 2005 study estimated as many as 88 percent of concussions go unrecognized. In the sports arena, a 2013 study found that one third of athletes interviewed reported having concussion symptoms that went undiagnosed. The study also pointed out that this number may be far higher in high school football players, with over half reporting experiencing undiagnosed concussion symptoms. Although education and awareness has increased over the last decade, the most common tests used to diagnose a concussion are cognitive function exams.

Rugby player Rory Lamont -- who was knocked unconscious ten times in his career and by his own admission suffered "dozens" of concussions before retiring -- wrote an eye-opening essay for ESPN in 2013 about the efforts of athletes to out-smart cognitive testing. The truth is, players often intentionally set low baseline scores in the preseason, so that they can beat the sideline tests and remain in the game, or come back to play more quickly.

MRIs and CT Scans cannot accurately or definitively diagnose a concussion. Unlike a broken bone on an x-ray, the signs of MTBI are much more subtle. Oftentimes, these tools are used to rule out major brain injuries or skull fractures that may have resulted from a big hit. We hear about pro athletes having these tests paid for by their team, but that's not the case with students. While most universities offer secondary sports insurance, there are still gaps in coverage and many students are still left uninsured. From 2013 to 2014, some university premiums for secondary sports-related insurance doubled -- costs that were passed directly on to families. Additionally, these policies leave students uninsured when it comes to practices that occur outside of the official season or lasting injuries that extend beyond the student's enrollment at a university.

Tackling Concussions from Multiple Fronts
As we continue to learn more about the harmful health implications of sustaining a concussion, as well as the startling frequency with which they occur, it's clear that this is an issue that must be tackled on multiple fronts.

Recently, a whole host of new products ranging from wearable helmet and mouthguard technologies, materials designed to reduce impact, and even mobile apps for assessing concussion symptoms are hitting the market. However, continued education will also be key. A 2013 study led by the University of Pittsburgh found that education, more so than reduced contact at practice time, is an important component to reducing game time concussions at the youth football level. New blood tests are also being developed, and researchers at SUNY are studying the effects of exercise on concussion treatment.

Whether the focus is on prevention, diagnosis or treatment, there are opportunities throughout the innovation ecosystem to get involved to resolve this issue and protect this generation of athletes.