In the past, there has been little research done on concussions and what is actually going on in the brain, until recently. Neuroscience research has grown and with that the research on concussion has taken a keen interest. The importance of finding the effect concussions have on the brain is a major contributing factor on how treatment should be done and how the Return to Play (RTP) protocols should be handled in order to properly heal and avoid a secondary impact.
The standard misperception on what happens as a result of a concussion is neuronal (cell) death occurs which causes the symptoms. However, what actually goes on in the brain is a change in the biological pathway. What is thought to occur is axonal damage of the neurons results in an influx of sodium and calcium and efflux of potassium. Compensation occurs by way of oxidative stress within the mitochondria and an ATP need increase causes hyper-metabolism. Axonal transport is affected as well. Later, hypometabolism occurs. This is where the problems with most RTP protocols are. A longer duration of time is needed for this phase of the injury to heal. It is essential to avoid a secondary impact during hypo-metabolism. The brain is low on energy already and a second impact would cause it to go into hyper-metabolism again. Lastly, accumulation of abnormal proteins occurs along with inflammation.
In order to avoid concussions, a change needs to be made. Within secondary school, a change can be made in the Return-To-Play (RTP) protocol with an addition of Return-To-Learn (RTL). In California, there are schools which implement completion of the RTL program before starting the RTP. This allows the student to catch up with school work that has been missed while they had their concussion and lessens the chance of the individual receiving a secondary impact before completely healed. Another change that can be made is the awareness of concussion occurrence at a younger age and education to coaches of primary school sports. Adults’ and parents’ awareness of concussions are shown within a high school, but often it is not thought about with elementary or middle school.
One problem faced when dealing with concussions is the awareness of the severity that can result in no matter the age, how hard the impact, and if not healed properly. Unmyelinated neurons are more susceptible to injury, children are growing and have a higher percentage of unmyelinated neurons and therefore, may be more prone to concussions. Although children may heal faster, it is important to be aware children can give and get concussions as well. Another problem faced is the thought that it must be a hard impact in order to receive a concussion. This is not true; individuals can receive multiple small impacts and get a concussion. Lastly, if the concussion is not healed properly and a second impact occurs, it will result in a worse injury than initially. In other words, it is better to sit out and wait to be healed than get in the game too early and set yourself further back.
