A Sideline Story: The Effect a History of Concussions has on both Cognitive Ability and Injury Recovery Time In Collegiate Athletes
If you had asked the high school version of myself about some of the parents of my peers not allowing their children to play football because of the sports dangers, I would have laughed at the idea. To me this was the greatest game in the world, a game that teaches the values of hard work, perseverance, and a humbleness that is hard to learn other places in life. How can you simply tell someone who has dedicated countless hours and years to their craft that they can no longer do the thing they love the most? But the dreaded “C word” whispered in both high school and college locker rooms across the country is doing just that, as the length of recovery for athletes with a history of concussions is being questioned.
The current wave of criticism comes from growing research and reports of approximately 300,000 sports related concussions occurring in the US each year. A concussion can be defined as any altered mental state that impairs cognitive ability either directly or through symptoms such as dizziness, lack of focus etc. Previous studies done by Gukiewicz et al have even found both that repetitive concussions in professional football players can cause for long-term dementia like symptoms, and that collegiate football players with a history of 2 or more concussions were at 3 times a greater risk to receive a concussion than those without concussion history. Even with a large amount of research being done on concussions, most of that research revolves heavily around football and has created disagreement between professionals on safe to return to play protocol.
Though a recent study done by Covassin et al used participants from a wide range of different collegiate sports to look at the neurocognitive effects on concussed athletes with a history of two or more concussions when compared to concussed athletes without a history of concussion.
The different athletes (displayed above) were evaluated and tested using the computerized Immediate Post-Concussion Assessment Cognitive Testing (ImPACT), which is used to asses neurocognitive function and concussion symptoms through 6 tests that evaluate attention, verbal recognition memory, visual working memory, visual processing speed, reaction time, and learning. The scores of these tests were then compared to the baseline scores of the athletes pre-concussion. This is actually the same testing system used by our athletic department here at Colby to evaluate concussions.
Overall, the study found that when compared to athletes without concussion history, athletes that had history of concussions scored lower in both verbal memory and reaction time on day 5 of post-injury testing. This suggests that athletes who have received multiple concussions show cognitive detrimental effects of these concussions for longer periods of time than athletes with no concussion history. The average return time for a concussion is about a week barring no noticeable symptoms of the concussion. Though this study raises the question whether concussion protocols should incorporate the history of previous concussions into the recovery period for athletes.
On the other side of two years of participating in a college sport, I can now start to understand why students prematurely end their careers due to the possibility of receiving multiple concussions. I’ve watched multiple teammates have their careers ended due to concussions that they still have symptoms from two years later. Is the risk of long-term cognitive deficits really worth a sport that will never give you a paycheck? I’m not entirely sure the answer to that question is a black and white as I once thought it to be. In college you are student and an athlete, but how can you expect to perform in the classroom if what happened on the field the past is still effecting your cognitive abilities in the future?
Sources:
Covassin, Tracey;Stearne, David;Elbin, Robert
Journal of Athletic Training; Mar/Apr 2008; 43, 2; ProQuest Social Sciences Premium Collection pg. 119
Guskiewicz KM, McCrea M, Marshall SW, Bailes J, et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005;57(4):719-726
Image 1 : http://tsukinegradprogram.blogspot.com/2015/07/concussionscte.html
As an athlete who has suffered from multiple concussions it is interesting to read about the neurocognitive effects that make the second or third concussion worse than the first. The increased risk factor after receiving a concussion is a scary for any athlete who has already hit his or her head once. This is an understandable and valid reason to leave their respective sport.
But, the question I pose is this: do the cognitive tasks of the ImPACT test increase the risk factor due to the increase in cognitive function and stress to the brain after a concussion? In other study by Covassin (I wrote about this in my blog post “Have a concussion? Let’s make it worse and find out”), he found that the ImPACT test did in fact make concussion symptoms worse 3 days, and 10 days post concussion. So, do these cognitive tasks in the ImPACT, used to diagnose and assess concussions, further increase the risk of receiving the second or third concussion? This might be a tough question to answer, but I think there is a relation and effect. It may just be necessary sacrifice in order to safely move forward in your sport.