{"id":2271,"date":"2015-11-24T23:53:50","date_gmt":"2015-11-25T04:53:50","guid":{"rendered":"http:\/\/web.colby.edu\/cogblog\/?p=2271"},"modified":"2020-02-07T09:36:02","modified_gmt":"2020-02-07T14:36:02","slug":"have-a-concussion-lets-make-it-worse-and-find-out","status":"publish","type":"post","link":"https:\/\/web.colby.edu\/cogblog\/2015\/11\/24\/have-a-concussion-lets-make-it-worse-and-find-out\/","title":{"rendered":"Have a Concussion? Let\u2019s Make it Worse and Find Out."},"content":{"rendered":"

\"ScreenThe world of sports is a dangerous place for athletes.  <\/span>The speed and power of athletes can sometimes result in collisions and injuries that can leave athletes sidelined anywhere  <\/span>from a few minutes to an entire season\u2026 or worse.  <\/span>But, only the injuries that we can see on the outside are easy to diagnose and treat.  <\/span>Injuries, with equal severity (if not more), happen frequently and can go unnoticed.  <\/span>An athlete’s brain is at constant risk of injury during sports.  <\/span>Even a small bumping of heads with another athlete can result in concussion.  <\/span>These brain injuries can leave people with a loss of memory, dizziness, blurred vision, and sometimes completely knocked-out.  <\/span>Diagnosing concussions can be tricky because athletes often do not show immediate or significant symptoms. According to Tracey Covassin, Bryan Crutcher, & Jessica Wallace (2013), the way athletic trainers and doctors assess whether or not an athlete is concussed or cleared for activity requires increasing concussive symptoms. So is there another way, or is the injured athlete\u2019s depressing reality just a pro-longed road to recovery? <\/span><\/p>\n

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So what exactly is a Concussion? <\/b> <\/span><\/p>\n

\"ScreenCovassin, Crutcher, & Wallace define a concussion as \u201ca complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces\u201d (2013)\u2026ok, but what the hell does that mean?  <\/span>Basically, a concussion is a type of traumatic injury to the brain that is caused when the head or body is hit, jolted, or whiplashed, causing the brain to smash into the inside of the skull.  <\/span>When this happens,  <\/span>the brain can swell and chemical changes occur in order to protect and recover from the blow.  <\/span>These chemical changes are what cause the negative side affects such as headache, dizziness, feeling tired, nausea, memory loss, loss of balance, and in some cases loss of consciousness.  <\/span>Along with these physical side effects, the brain\u2019s ability to preform cognitive tasks is also inhibited (2013). <\/span><\/p>\n

Cognitive Tasks and Concussions<\/b><\/span><\/p>\n

Cognition is the process our brain uses in order to learn and make sense of the world around us.  <\/span>Cognitive tasks include everything from identifying faces and patterns, to remembering the meaning of the word \u201csports.\u201d  <\/span>It is how we make sense of our experiences in life, and teach ourselves how to respond to certain events.  <\/span>It is how we assign meaning to the words \u201cdog\u201d and \u201ccat.\u201d and how we are able to remember what those two animals are.  <\/span>So, when the brain is affected by the chemical changes induced by a concussion, causing decreases in brain activation, all the seemingly simple and automatic everyday tasks become difficult.  <\/span>Remembering what two plus two equals changes from the difficulty of kindergarten level math, to the difficulty of an undergrad calc class (maybe not to that extreme but you get the point).  <\/span>But, that’s not the worst part\u2026  <\/span>The worst part is this: in order to assess the severity of a concussion, or to understand if a person is still concussed, the injured person has to take a simple Post-Concussion Assessment and Cognitive Test (ImPACT) which entails a bunch of memory, click on the dot, and remember the shape type tasks.  <\/span>Wait, that seems pretty easy, right? Well, no, not right. <\/span><\/p>\n

Tracey Covassin, Bryan Crutcher, & Jessica Wallace wanted to see if  <\/span>this simple ImPACT test was actually making concussion symptoms worse after completion (spoiler alert: it does).  <\/span>Not much research had been done on this topic, so these three psychologists designed an experiment in 2013 to answer the following question: <\/span>Does a 20 minute cognitive task increase concussion symptoms in concussed athletes (2013)? <\/span><\/p>\n

High school and colligate athletes (concussed athletes) were recruited for their experiment.  <\/span>These athletes were given an ImPACT test 3 and 10 days after rattling their brain.  <\/span>Covassin, Crutcher, & Wallace then observed a number of symptoms from the athletes who reported increases or decreases in their symptom severity on a 1-7 scale (Likert scale, where 1 is low and 7 is high).  They used the ImPACT test because it is standard athletic protocol for athletes with head injuries to complete an ImPACT test.  This test utilizes span tasks and non-verbal problem solving sets to measure an array of cognitive functions such as attention span, selective attention, working memory, response variability, problem solving and reaction time (click here<\/a> for the full ImPACT test and website).  <\/span>After collecting the data from the athletes participating in the study, the experimenters then compared the results to a baseline concussion assessment, which were the athletes\u2019 ImPACT scores from a pre-concussion, or perfectly healthy, test (2013).  <\/span>What they found is concerning for athletes recovering from a concussion.<\/span><\/p>\n

The results of this study revealed that the post-concussion assessment test administered in order to figure out if an athlete can safely return to the field, court, or mountain, does in fact increase some concussive symptoms.  <\/span>Covassin, Crutcher, & Wallace found increases in symptoms that are typical of concussions such as headache, nausea, dizziness, visual problems and mental fogginess. In the table below, you can see significant differences in these symptoms from before and after the concussion\/assessments. \"Screen<\/span><\/p>\n

What Does This Mean for Athletes with Head Injuries?<\/b><\/span><\/p>\n

<\/b>As if concussions weren\u2019t bad enough, it seems that the only way to continue along the road to recovery is to go backwards at times.  <\/span>The fact of the matter is that these cognitive tasks and assessments (like the ImPACT) are standard and necessary for determining where an athlete is along his or her road to recovery.  <\/span>That means that just when an athlete starts to feel better, we can only truly tell by making symptoms worse again.  <\/span>Is this really the only way to assess concussions? <\/span><\/p>\n

Being an alpine skier who has suffered from multiple concussions, and gone through the process of straining my already beat -up brain doing tedious ImPACT tests, I want to believe there is some other way to assess a concussion without making symptoms worse.  <\/span>Maybe there is way to image the brain instead of forcing it to complete tasks that make your head spin and hurt.  <\/span>I think figuring out another way to assess concussions, with little brain activity required by the athlete, could speed up recovery and get athletes back in the game quicker than before.<\/span><\/p>\n

Click here<\/a> to read\/download the full article.<\/p>\n

Check out this other interesting article about assessing the cognitive consequences of concussions here<\/a>.<\/p>\n

Covassin, T., Crutcher, B., & Wallace, J. (2013). Does a 20 minute cognitive task increase concussion symptoms in concussed athletes?. Brain Injury, 27(13-14), 1589-1594. doi:10.3109\/02699052.2013.823656<\/span><\/p>\n

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