RUNNING HEAD: EFFECTS OF CONCUSSIONS IN ATHLETES

How Do Sports Related Concussions Affect Brain Activity and Growth in Athletes?

Sydney Dodd

Blackman High School

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Abstract
This paper introduces the basics of the mild traumatic brain injury known as a concussion, as

well as evaluate current practices, and inform the public and athletes. The methodology section

will detail my process used to choose appropriate sources to guide my research. The research

section will begin by outlining the causes and potential symptoms of a concussion, and go on to

explain the current methods of diagnosis. This paper will also give insight to how much the

public actually knows about the dangers and effects of concussions, particularly those caused in

athletes. My research explains the benefits and drawbacks to current methods as well as

explaining the process for each. I will then compare statistics and introduce the idea that

concussions are contributing to abnormal brain developments in athletes. My findings will be

addressed next in the discussion section. The paper concludes with the overall relevance and call

to action in order to make athletes more knowledgeable about concussions they may face in the

future.
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Concussions in athletes are a "silent epidemic" that is sweeping the globe. (Centers for

Disease Control and Prevention [CDC], 2003). It was first discovered after doctors were

noticing a trend of abnormal deaths in athletes, particularly football players. In 1933, the NCAA

released a medical handbook to all member schools explaining the current research about

concussions. The handbook warned about the signs and symptoms of concussions and what to

do when a player was suspected to be concussed. It recommended rest and constant supervision

as well as not returning to gameplay until symptoms had subsided for at least 48 hours. Then, in

1991, the Colorado Medical Society published a grading scale to rate the severity of concussions

and introduces guidelines for both coaches and athletes to follow. The NCAA and high school

football programs quickly adopted the policies in hopes of protecting their players. Concussions

gained a lot of media spotlight in 2002 when Dr. Bennet Omalu examined Pittsburg Steelers

sensation, Mike Webster's brain, after his unexplained death at the age of 50. Upon examination

the brain looked normal, but after thorough testing, Dr. Omalu concluded that Webster had

sustained too many concussions and diagnosed him with Chronic Traumatic Encephalopathy

(CTE). Knowledge has continued to increase over the past few decades, but there is still more to

be discovered. With my research, I believe I can help athletes in my community become more

knowledgeable about head related injuries and encourage them to report any injuries they have to

their coach in the future. How do sports related concussions affect athletes brains? According to

my research, concussions are contributing to the rise of abnormal brain disorders in athletes. The

constant head trauma is making young athletes steadily more susceptible to being diagnosed with

Alzheimers and Parkinsons disease later in life.

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Methodology
To begin my research, I developed a driving question: How do sports related concussions

affect brain activity and growth in athletes? I chose to do my paper over concussions after a

career ending accident with my teammate at softball practice. Because I am a high school

softball player, I am at high risk for getting a concussion. Through my research, I determined

credible sources were those whose url ended with .org, .gov, and .edu, as well as databases made

available to me through my school library. Some of the keywords I searched heavily include,

concussions, CTE, sports concussions, and brain trauma. I also have not used studies

older than 20 years old because medicine is always changing and a source that old is considered

out dated. After finding credible sources, I annotated them for key information and main ideas

that I could use in order to help gain knowledge as well as find information to include in my

paper. I have compiled a bank of sources and my personal knowledge in order to develop this

paper.

Research/Results

Causes and Symptoms

"The Centers for Disease Control and Prevention (CDC) defines concussion as a

traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or by a hit to the body

that causes the head and brain to move rapidly back and forth. This sudden movement can cause

the brain to bounce around or twist in the skull, stretching and damaging brain cells and creating

chemical changes in the brain" (Brain Injury Association of America [BIAA] 2015). For
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different sports, concussions can occur in a multitude of ways. For example, a football player

could go to make a tackle, but hit his head against the other player. In soccer, a player could head

the ball and the pure force of the ball could cause a jolt to brain. For softball, a batter could take

a wild pitch to the helmet. In all three scenarios, there is a chance for a concussion. Boxing, in

particular, is a sport where the basic goal is to give the opponent a concussion. "Imagine a boxer

in a 12-round fight, getting hit by a 12-pound, padded wooden mallet going 20 miles per hour.

A punch in boxing equals that. And over 12 rounds, thats a lot of damage...the American

Association of Neurological Surgeons say 90 percent of boxers suffer some kind of brain injury

while boxing. Because of these brain injuries, boxers are more prone to mental deterioration

during their later years that can lead to Parkinsons or Alzheimers." (Mancini 2015). According

to the CDC, 1.7 million traumatic brain injuries (TBI's) occur each year in the United States

alone.

See Appendices A

As seen in Appendices A, concussion rates were broken down by sport per 100,000 athletic

exposures. The National Collegiate Athletic Association (NCAA) defines an athletic exposure

as, "one athlete participating in one practice or competition in which he or she is exposed to

the possibility of athletics injury." The leading sport for concussions is football at 18 percent,

next is boy's ice hockey at 15 percent, and following for third place is boy's lacrosse at 11

percent. Those are only the cases that are reported. Although knowledge of concussions has

grown exponentially over the past few decades, many people (athletes in particular) are unaware

of the signs and symptoms of a concussion so it goes unreported. Athletes will often go without
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reporting an injury no matter if it is head related or not, simply due to the fact that they do not

want to go to the doctor just to get told that they cannot compete. Athletes need to be more

aware of the consequences of not reporting head related injuries so they will be more likely to

report them in the future. There are many symptoms one may experience after experiencing a

concussion, some of the most well-known being:

Headache

Dizziness

Amnesia to events immediately preceding the blow

Disorientation to date, time, and place

Nausea and vomiting

Double vision

Ringing in ears

The person may or may not lose consciousness

Diagnosis and Treatment

There are different methods in which to test for a concussion. Most of the tests

require athletes to take a pretest before the season begins in order to get a personalized

baseline. The test typically includes memorization, reaction time, balance, and physical

examination. When a concussion is suspected, the athlete will then take the test again. The

results from the baseline and from the latest test are compared in order to determine if there

is a concussion. Results are typically viewed by looking for major differences in sections of

the test. For example, in the balance section of the test, if the athlete was able to stand
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straight up on both feet without leaning or falling with their eyes closed, but then on the

repeat test they fall as soon as they close their eyes, they would be suspected of being

concussed.

See Appendices B

Appendices B shows one form of testing known as a SCAT3 test. SCAT stands for Sports

Concussion Assessment Tool. It includes eight sections of testing that a medical

professional will present as the athlete answers. It includes questions to ask, instructions, as

well as basic information about a concussion. The test uses a point system in each section.

At the end, the tester will tally the points received out of the total points possible in order to

determine if the athlete has experienced a concussion. If they failed the test, they are

diagnosed with a concussion and each institution will have a protocol as to how often the

athlete needs to retest. Retesting also depends on severity of the concussion. Retesting

could occur as often as every few days or as few as once per week until full recovery. Once

the athlete has recovered, they will be slowly integrated back into practice and games to

ensure the player's safety.

Another form of testing is computerized. Blackman High School uses a computerized

testing software known as ImPACT Testing. It has the same basic procedure: athlete will

take a pretest to gain a baseline then repeat the test when a concussion is expected. This test

is mostly memorization and reaction whereas the SCAT3 is primarily physical condition

based.
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See Appendices C

Appendices C shows the sensitivity of the ImPACT as compared to other forms of

neurological testing. Sensitivity means the capability of the ImPACT test to detect a

concussion, which according to the graph, the test is 90 percent correct. The only downfall to

this test is that it is taken on a computer, but when someone is diagnosed with a concusion,

they are told to avoid screen use (cell phone, TV, computer, etc). Some doctors will argue

that the screen exposure for the test will not hurt the victim, but others believe that because

the test has to be taken so shortly after the incident, it is causing more damage.

Two more ways of testing for a concussion are a Computed Tomography (CT) scan

and a Magnetic Resonance Imaging (MRI) test. A CT "...is a special computerized x-ray that

provides images of the brain and is sometimes used to look for suspected bleeding or

swelling." (Brainline, 2012). An MRI is different in the sense that it creates images of the

brain using magnetic energy instead of radiation. A problem with these forms of testing is

that they are typically expensive and exclusively found in hospitals with other patients. This

means that there are other patients ahead of the athlete which in turn, prolongs wait time and

ultimately delays diagnosis. If the hit was hard enough and the athletic trainer on scene

believes there is possibility of a brain bleed, the athlete will be pushed to the front of the line

and not have to wait.

Treatment at this time is somewhat basic, but new advances are being made each

year. Right now, the best advice given is to rest. Physical rest and mental rest is the best

way to recover. This includes cutting down on physical exertion such as sports and exercise.

Mental rest is avoiding anything that causes critical thinking, mental strain, and intense

concentration. This could be cell phone use, social media, TV, video games, and computer
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use. Doctors may also recommend a lightened load for school and work or even shortened

days of attendance. Once symptoms begin to disappear, patients will be advised to slowly

integrate back into his/her normal routine (Mayo Clinic 2017).

Discussion

Connection to Brain Disorders

After sustaining multiple concussions, it is highly likely for the victim to develop brain

disorders due to the repeated blows to the head. The condition is known as chronic traumatic

encephalopathy (CTE). The Brain Injury Research Institute states, "The brain of an individual

who suffers from chronic traumatic encephalopathy gradually deteriorates and will over time end

up losing mass. Certain areas of the brain are particularly liable to atrophy, though other areas

are prone to becoming enlarged. Another aspect of CTE is that some areas of the brain

experience an accumulation of tau protein, a substance which serves to stabilize cellular

structure in the neurons but which may become defective and subsequently may cause major

interference with the function of the neurons." This disorder was formerly only suspected in

boxers and was referred to as "dementia pugilistica." Symptoms of CTE are similar to those of

Alzheimer's and Parkinson's disease, making it more difficult to diagnose. Those symptoms

include: loss of memory, behavioral issues such as aggression and depression, difficulty with

balance, etc. "CTE has been diagnosed in several notable cases which received widespread

media attention, including the suicide deaths of NFL player Junior Seau, and professional

wrestler Chris Benoit who committed suicide after murdering his wife and son." (Brain Injury

Research Institute 2017). With these cases gaining so much media attention, viewers should

evaluate their own symptoms and possibly even consult their doctor to get checked for CTE.

The American Medical Association performed and published a study in 2017 where donated
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brains of deceased football players were examined. Out of the 111 brains of former NFL

football players, 110 were found to have CTE. That means a whopping 99 percent of the brains

were affected. The same study also noted that "...researchers examined the brains of 202

deceased former football players at all levels. Nearly 88 percent of all the brains, 177, had CTE.

Three of 14 who had played only in high school had CTE, 48 of 53 college players, 9 of 14

semiprofessional players, and 7 of 8 Canadian Football League players. CTE was not found in

the brains of two who played football before high school."

Conclusion

Continuous blows to head and body are not helping athlete brain growth in a positive

way. Once sustaining one concussion, an athlete increases their chances of contracting another

by almost three times (Science Line, 2008). I have concluded that concussions are the leading

cause of CTE in athletes. This is a silent epidemic that is spreading all over the country and even

the world as doctors are attempting to discover exactly how concussions work and are

developing new technology in order to diagnose them as well as prevent them. NFL players in

particular are in the spotlight as researchers are focusing on them to tackle this epidemic. As

knowledge increases, younger athletes will be exposed to proper assessment and treatment for

head related injuries in order to reduce the number of CTE victims in the future. Multiple forms

of testing have been invented such as the SCAT3 test, CT, and MRI scans. CTE can cause life

threatening injuries that are detrimental to players and their families. Parents, coaches, and

athletes must keep the future in mind while playing sports because Alzheimers and Parkinsons

are both very real and could affect the athlete later in his or her life. Both diseases are fatal and

will cost time, money, and stress. No person deserves to be affected with a brain disorder if it

could have been prevented. My purpose in writing this paper is to bring awareness to this rising
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issue and continue to gain knowledge on this topic in order to educate myself, teammates, and

general public so we will not become another statistic.

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References

B. (2012, June 19). What Should You Do If You Think You Have Had a Concussion?

Retrieved August 06, 2017, from https://www.brainline.org/article/what-should-you-do-if-you-

think-you-have-had-concussion

B. (2015). BIAA Concussion Information Center (CIC). Retrieved August 05, 2017, from

http://www.biausa.org/concussion/concussion-information-center

Concussion. (2017, July 29). Retrieved August 02, 2017, from

http://www.mayoclinic.org/diseases-conditions/concussion/diagnosis-treatment/treatment/txc-

20273167

Harrison, E. A. (2014). The First Concussion Crisis: Head Injury and Evidence in Early

American Football. American Journal of Public Health,104(5), 822-833.

doi:10.2105/ajph.2013.301840

Heger, M. (2008, April 28). Is it true I am more likely to get a concussion after already

having one? Scienceline. Retrieved August 05, 2017, from http://scienceline.org/2008/04/ask-

heger-concussion/

Mancini, N. (2015, May 14). 90 percent of boxers suffer brain injuries; only sport without

concussion policy. Retrieved August 06, 2017, from http://www.thenewsoutlet.org/90-percent-

of-boxers-suffer-brain-injuries-only-sport-without-concussion-policy/

Mez J, Daneshvar DH, Kiernan PT, Abdolmohammadi B, Alvarez VE, Huber BR,

Alosco ML, Solomon TM, Nowinski CJ, McHale L, Cormier KA, Kubilus CA, Martin BM,
EFFECTS OF CONCUSSIONS IN ATHLETES Dodd 13

Murphy L, Baugh CM, Montenigro PH, Chaisson CE, Tripodis Y, Kowall NW, Weuve J,

McClean MD, Cantu RC, Goldstein LE, Katz DI, Stern RA, Stein TD, McKee AC.

Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American

Football. JAMA. 2017;318(4):360370. doi:10.1001/jama.2017.8334

NCAA Injury Surveillance System Summary. (2007). Retrieved July 25 , 2017, from

http://www.wou.edu/~kiddk/PE%20359/2013_Handbook/HealthCareAdmin/View_Read/Injury

%20Rate%20&%20Patterns%20.%20.%20FOLDER/NCAA_InjurySurvey

Sports-Related Recurrent Brain Injuries -- United States. (1997, March 14). Retrieved

July 30, 2017, from https://www.cdc.gov/mmwr/preview/mmwrhtml/00046702.htm

What Is CTE? (2017). Retrieved August 02, 2017, from

http://www.protectthebrain.org/Brain-Injury-Research/What-is-CTE-.aspx
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Appendix

Appendices A

http://www.ttujournalism.net/classes/j4370/?p=5987
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Appendices B

http://innervate.exblog.jp/20173616/
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Appendices C

https://www.impacttest.com/about/