Introduction and Relevance to College Students
Concussions in sports is a topic that is important to college students because many college students either participate in athletics in college or participated in them in high school. Also, there are a variety of intramural opportunities that involve different sports activities. Concussions are increasing year by year, and they are currently a hot topic when it comes to player safety in sports. This wiki will inform people about the symptoms of a concussion, and how concussions affect different types of people. The goal of this wiki is to increase awareness about concussions in hope of preventing further damage and avoiding serious consequences.

What is a concussion?
A concussion is a type of mild traumatic brain injury. When there is a violent blow to the head, the brain wallows back and forth like Jell-O. While doing so, the brain tends to smash into the front and back of the skull (Barr, W.B., & Munro Collum, C, n.d.).
This motion causes stretching and tearing of brain cells, damaging the brain's connective tissue. As a result of this damage, chemical changes occur in the brain and cognitive function is impaired(Davies, S.C., n.d.).

external image 2008346377.gif

external image 2008346377.gif

What are the symptoms of a concussion?
The common assumption is that you have to lose consciousness in order to sustain a concussion. That is simply not the case. In all actuality, most concussions (90 percent) actually occur without loss of consciousness(Davies, S.C., n.d.), and sometimes you may not even realize that you have sustained a concussion because symptoms may not show up until hours or even days after you have had a concussion. Concussions are a problem with the function of the brain, not the structure of the brain. Therefore, CAT scans and MRI's are generally ineffective in detecting concussions. This is the reason why detecting and diagnosing concussions can be challenging.

Common physical symptoms of a concussion include:
(Barr, W.B., & Munro Collum, C, n.d.)
  • headacheexternal image Orange_concussion_chart.jpg
  • nausea
  • dizziness
  • fatigue
  • sensitivity to sound and light
Common cognitive symptoms of a concussion include:
(Barr, W.B., & Munro Collum, C, n.d.)
  • confusion
  • difficulty focusing
  • slower processing
  • memory problems

Treatment
There is no specific treatment. The student athlete should avoid participating in any physical activity until the brain heals. Mental activity and environmental stimulation should be reduced in order to aid in the recovery process.This includes video games, television, computers, texting, light and sound stimulation, and homework. The student should not return to school until they have retained the ability to focus attention for at least 45 minutes without experiencing any symptoms. The best treatment is just to simply rest and give the brain time to heal. The recovery time varies from one person to another. Some people may recover within one or two days, some within a week to ten days, and some may take a few weeks to recover. (Ryan, T, n.d.)

Statistics
Prevalence
(Theye, F., & Mueller, K.A, 2004)
  • Nearly 1.5 Million head injuries occur each yearin the United States
  • Estimated that 300,000 (20 percent) of those head injuries are sport-related concussions
  • 173,000 children and teens land in the ER due to a concussion from sport-related activity(Eisenberg, M., & Yeates, K, 2013)

Multiple Concussions
A study was done on 280 11-22 year olds treated at the Boston Children's ER for a concussion.
21 of the patients had sustained a concussion over the past year.
The study revealed that these patients typically required a recovery time that was three times longer than the patients with no previous history.
(Eisenberg, M., & Yeates, K, 2013).

Males vs. Females
A study, led by Tracey Covassin of Michigan State University's Department of Kinesiology, looked at nearly 300 athletes from various states over a two year period. The study found that females performed worse than males on visual memory tests, and reported more post-concussion symptoms as well. Many coaches and parents that she talked with did not realize that concussions are just as big of a risk and concern for females as they are with males. Covassin suggests that increased awareness is important in combating this issue.
(Michigan State University, 2012)

Reasons for increased susceptibility in adolescent athletes
Immaturity of Nervous System
There are multiple theories as to why younger brains are more susceptible to concussions. These theories include decreased myelination, a greater head-to-body ratio, and thinner cranial bones. The immaturity of the nervous system provides less protection for the brain and the developing nervous system. There is also a difference in physical maturity, because younger athletes tend to have a lower level of physical fitness, which also contributes to their susceptibility to brain injuries (Theye, F., & Mueller, K.A. 2004).

Recognition
The lack of recognition that a concussion has even occurred is another problem that contributes to the increased susceptibility for concussions in young athletes. There is an inconsistent use of terms and guidelines related to concussions, and there is also a lack of objective,quantifiable methods for measuring concussions. This makes it challenging to identify the occurrence of a concussion, and the lack of recognition leads to head injuries being taken lightly by coaches and athletes leading to the perception that concussions are just a part of contact sports (Theye, F., & Mueller, K.A. 2004).

Three Ways Failure of Recognition leads to increased susceptibility
(Theye, F., & Mueller, K.A. 2004)
1. Second Impact Syndrome is a rare event that is caused by a student-athlete receiving a second blow to the head while still experiencing symptoms from the initial concussion. This event causes massive swelling of the brain which usually ends up being fatal.
2. Post-Concussion Syndrome is a less serious condition than Second Impact Syndrome, but it still has a great effect on student athletes. This condition is when the symptoms of a concussion continue to occur for more than six weeks.
3. There is evidence to suggest that concussions have a cumulative effect. It is important to know the past history of concussions with each student athlete. The lack of recognition can make it difficult to know exactly how many concussions each student athlete has sustained, which can lead to serious injuries in the future.

Self-Report
In order to determine the progress of the student athlete and the amount of time the he or she must sit out before returning to play, the school relies on the student athlete's report of their own symptoms. There are two problems with this: lack of reliability, and the athlete's lack of knowledge about concussions and potential consequences that they have. Athletes may be reluctant to report symptoms of a concussion for fear of missing playing time. In a study of more than 1,500 student athletes who had reported concussion symptoms, less than 50 percent reported their symptoms to either their coach or athletic trainer. This suggests that there are many concussions that go unreported. The most common reason for why they did not report their concussion, is that they were unaware of how serious the injury was and did not think that it warranted attention (Theye, F., & Mueller, K.A. 2004).

Cumulative Effects
Concussions have a cumulative effect. An athlete with a past history of concussions is more likely to sustain another concussion. In addition, the severity of the concussion increases with multiple concussions. Three studies were conducted in order to provide evidence to support the assumption of the cumulative effects of concussions. The first study involved 60 high school athletes who had no prior history of concussions and 38 who had suffered at least three concussions in the past. The athletes with the prior history were nine times more likely to experience a loss of consciousness and more severe symptoms following their concussion. A second study showed that athletes with a prior history of concussions were seven times more likely to show drops in memory. A third study was conducted at the collegiate level. This study followed over 2,900 football players throughout a period of three years, and concluded that having a concussion increases the risk for future concussions and also leads to slower recovery of cognitive functions (Theye, F., & Mueller, K.A. 2004).

Assessment
imPACT Testing
imPACT Testing is a computer software program that is used by many schools and athletic organizations as a tool for concussion management. The student athletes take a baseline test before the season, and future tests can be taken after a concussion and compared to the baseline results. It is a good tool for concussion management, but it is not the primary solution. This type of testing should be used as an aid to the assessment of concussions, but should not replace medical evaluation and treatment (Davies, S.C., n.d.).

Problems with Neuropsychological Testing
Neuropsychological testing, such as imPACT Testing, is becoming more and more common in the management of sport-related concussions. However, the results of a variety of studies have shown that these tests may not be as reliable as they seem. Tests and studies have been conducted on a variety of neuropsychological tests. These studies involve a system of criteria that is necessary for validating neuropsychological tests. The criteria involves five components: test/retest reliability(stability), sensitivity, validity, reliable change scores and an algorithmic formula for classifying impairment, and determining the detection of impairment in the absence of symptoms. Studies were done on CogSport, Headminder Concussion Resolution Index, and ImPACT Testing. These are three of the most well known computerized screenings for concussions. In conclusion, the studies found that none of these tests met all of the necessary criteria for routine clinical application
(Randolph, C., &McRea, M., & Barr, W.B. 2005). More studies have recently been done specifically on ImPACT Testing, which is the most popular brand of testing. This additional research has concluded that ImPACT Testing is unreliable in determining the return to pay after a concussion. ImPACT Testing was shown to reveal false-positives for a concussion. For example, in a 2007 study, ImPACT Testing incorrectly identified 38 percent of athletes who had been concussion free for over six months as still having some form of a concussion
(Keating, P., 2012). In another study, published a year earlier, research was conducted on a group of 122 student athletes who had concussions and 70 who did not(Keating, P., 2012). Thirty percent of the control group generated problems in their test results that revealed a false-postive. Between these two studies, ImPACT Testing reveals a false-postive about one third of the time. Studies also revealed problems with the consistency of the test. There are additional problems with neuropsychological testing. Athletes will sometimes sandbag on the baseline test so that their post-concussion test results will not prevent them from being cleared to play. Also, athletes tend to take the baseline tests in groups, whereas the post-concussion test is taken individually. These neuropsychological tests are a step in the right direction, but have many flaws that prevent them from being the primary solution. Their results should be looked at conservatively, and there are other ways to assess concussions.

Multilateral, Multi-Method Assessment
This is a method of assessment that involves observation and testing from a variety of people in a variety of ways. Parents, teachers, coaches,and the student use standardized methods to analyze a variety of different functions. These different methods include standardized testing procedures, structured symptom-based observations, interviews, and structured symptom-based rating scales. The analysis involves the self-report of symptoms from the student athlete, as well as observations of different symptoms that are observed at home or in school. (Davies,S.C., n.d.)

Awareness and Prevention
Improving awareness is the key goal in preventing future concussion problems. There is a lack of understanding when it comes to concussions, and informing people of the truth about concussions will help the general public become more aware and involved in making a difference.
Gerard A. Gioia, PhD, is the chief of pediatric neuropsychology at Children's National Medical Center in Washington, D.C, and has become involved in increasing the awareness of coachesand parents. Giola is one of the main authors of "Heads Up: Brain Injury in your Practice", a toolkit that provides help on evaluating and caring for concussions. Giola has also developed an app, the "Concussion Recognition and Response" app, that walks people through the steps to take if they know someone suspected of having a concussion (Clay, R.A. 2011).

Educating Athletes
Athletes need to be educated on the long-term effects that concussions can have on their brain, and they need to be taught that toughing out a head injury can have serious consequences. Playing through head injuries can lead to an increased risk of injuries in the future, and even permanent brain damage. Coaches and team staff members also need to be aware of the history of any injuries that have occurred to the head, and how past injuries play a role in the risk and susceptibility of the student athlete (Davies, S.C., n.d.).

Changing Perception
The entire perception of concussions needs to be changed. This goes along with educating athletes. Athletes need to know that concussions are a big deal, and are not to be taken lightly. This will help students be more cautious when participating in sports, and inform them of the importance of wearing protective gear (Davies, S.C., n.d.).

Intervention
Neuropsychologist
A neuropsychologist is a licensed psychologist with expertise on how behaviors and skills are related to brain structures and systems. A neuropsychologist is beneficial in two ways: assessment, and treatment. The neuropsychologist can conduct a neuropsychological evaluation to assess memory, attention, reasoning, and other cognitive skills. The results of this assessment can help determine any ongoing cognitive impairments and the areas that have been most effected. The neuropsychologist can then educate the patient on common concussion symptoms and the correct recovery patterns (Barr, W.B., & Munro Collum, C., n.d.).
external image iStock_000005516563XSmall.jpg
Legislationexternal image iStock_000005516563XSmall.jpg
Giola has testified at the state level in Maryland's General Assembly, Virginia's General Assembly, and Washington D.C.'s city council. His goal is to get legislation passed in every state that requires three principles: create programs that educate students, parents, coaches, and schools about concussions, adopt a policy that removes athletes showing signs of a concussion from the playing field, and
requires that student athletes return to the game only after they have been evaluated by a neuropsychologist or other health-care professional trained in concussion management(Clay, R.A. 2011).

Conclusion
Concussions have always been a big issue, but this type of injury has really come into the spotlight due to increased awareness around the country. Sport-related concussions are becoming a big concern as parents and coaches become more informed about the potential dangers that are associated with head injuries. Concussions are a tricky injury to deal with because they are tough to detect, and often times rely on self-report for diagnosis. Athletes, particularly in football, have traditionally been taught to tough their injuries out. This has created a problem with athletes and head injuries, because athletes are less willing to report head injuries or even unaware they they have sustained a concussion. Awareness is the most important thing for preventing long-term problems with brain injuries. Athletes, coaches, parents, and schools need to be trained and taught about information related to concussions. There should also be laws that are made in order to establish a set of rules that will protect future athletes in relation to head injuries. The issue of concussions needs to be addressed early on in athletic careers, so that everyone is informed before long-term consequences begin to take effect.

Here is a video about two psychologists talking about how psychology relates to sports, in particular concussions.


Here is a link to an extension activity. This website has training courses for concussions, which will help people become more informed on the important information related to concussions.
http://www.cdc.gov/Concussion/

Works Cited

Theye, F., & Mueller, K.A. (2004). Heads Up: Concussions in High School Sports. Clinical Medical Research, 2, 165-171. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069089/

Randolph, C., &McRea, M., & Barr, W.B. (2005). Is Neuropsychological Testing Useful in Management of Sport-Related Concussions?.
Journal of Athletic Training, 40, 139-152. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1250250/

Clay, R.A. (2011). Giving a Heads Up on Concussion. American Psychological Association, 42, 54. Retrieved from
http://www.apa.org/monitor/2011/11/concussion.aspx

Barr, W.B., & Munro Collum, C. (n.d.).Concussions: How a Neuropsychologist Helps. American Psychological Association. Retrieved from
http://www.apa.org/helpcenter/concussions.aspx

Davies, S.C. (n.d.). Concussion Awareness: Getting School Psychologists into the Game. Communique, 39. Retrieved from
http://www.nasponline.org/publications/cq/39/7/concussion-awareness.aspx

Eisenberg, M., & Yeates, K. (2013). Kids with Past Concussions Take Longer to Recover. U.S. Department of Health and Human Services.
Retrieved from http://healthfinder.gov/News/Article.aspx?id=677189

Michigan State University. (2012, May 8). Female and Younger Athletes Take Longer to Overcome Concussions. ScienceDaily.
Retrieved from http://www.sciencedaily.com/releases/2012/05/120508124551.htm

Keating, P. (2012). Concussion Testing May Not Be Panacea. ESPN. Retrieved from
http://espn.go.com/espn/otl/story/_/id/8297794/neuropsychological-testing-concussions-not-panacea

Ryan, T. (n.d.). Concussion Management. ONS Foundation. Retrieved from
http://www.ons-foundation.org/education/injury-prevention/concussions-and-neuropsychological-considerations-for-returning-to/