Cobbers on the Brain

According to the Center for Disease Control, Americans sustain approximately 3.8 million concussions annually from sports and other recreational activities. The risk is particularly high for high school and college athletes who not only have increased exposure for opportunities to sustain a traumatic brain injury (TBI), but their brains are increasingly vulnerable as they are still undergoing development.
The true seriousness of concussions if often either disregarded or goes unnoticed due to the fact the damage is typically on a microscopic rather than macroscopic level. In fact, many individuals that have been concussed show little to no observable or physical changes, unless exposed to specific conditions which result in an overuse or overstimulation of the injured area of the brain.
It is for this reason that concussions are often seen as in invisible disease. They are often disregarded, or warily acknowledged at best, both of which can be detrimental for the recovery of the concussed individual.
Recovery from a concussion should be regarded with utmost importance and is not something to be ignored. Unlike a sprained ankle or broken arm, it is difficult to isolate and prevent use of the brain. To stop thinking is to stop functioning – to stop being a human, to stop living. It simply is not possible. As such, the brain takes longer to heal as it must continue to function all the while. That is not to say it should continue to function at normal (prior concussion) levels. In order for proper and expedited recovery, use of the brain should be limited when possible.
Athletes are often at the highest risk for concussions (particularly college or professional) and stand to experience the most harmful effects (on a yet developing brain) if their injuries are not treated properly. Sadly, they are also met with the most difficult situations when facing a proper and hasty recover.
All too often, a concussed athlete is met with skepticism and doubt, as well as resistance. Sadly, this is often received from their educators.  Concussions are an immediate injury and often difficult to comprehend. One day the student is fine, working on homework or taking a test, the next, they may have difficulty coherently reading a paragraph. This drastic change in ability can, understandably, be difficult to accept. However, it is imperative that we do. For the best possible recovery, most physicians suggest that student athletes take a complete break from school, following the injury. This period of time or “break” can vary in duration depending on the individual and the severity of the concussion. Following this “break” the individual typically follows a return to learning protocol, which gradually eases them back into the academic rigor they previously experienced. If the concussed individual is not supported and encouraged to follow these important recovery processes, it may prevent them from healing properly and take them far longer than it should.

Even with support, playing “catch up” after such an academic break can be daunting and perhaps impossible. Understanding that teachers/professors must be fair to all of their students, I think it is a worthy goal to search for methods (either as a professor or as a college) that can allow students who sustain a TBI to remain on track academically without having to drop a class, or be overloaded with material to catch up.
Even more important than academic support, in my opinion, is the support and understanding these concussed athletes receive from their coaches. In many cases, especially because concussions can be undetectable without significant testing, a coach may witness a potential cause for concussion and let it go unreported or unnoticed. They are not alone as many athletes may well choose to disregard the possibility of concussion, whether purposefully or unknowingly. However, in the case of concussions, all precautions should be taken. Second impact syndrome is a very real disease which occurs when a “second impact” or TBI is sustained before the healing process of the first has been completed. This can result in diffuse cerebral swelling, brain herniation, and death.

It is for this reason that a high expectation of responsibility and observation must be placed on coaches. It is difficult to bench the star player in the final minutes of a tie game, even more so if the player doesn’t feel as though they need to sit out. However, it is a coach’s duty to objectively view the situation and do what is in the best interests for the health of their athlete, whether the athlete protests or whether it costs the team the game.
It is important that we rid the stigma that can often come with concussions. Just because it may seem “invisible”, does not mean it should be treated as such, and devastating effects can occur if it is. It is imperative that we determine a method as coaches, teachers, individuals etc. to look objectively at situations involving concussions and work to provide the best care and best environment for an individual to recover and prevent further damage.

Today, we see entertainment, money, and/or temporary happiness as potential higher priorities compared to our brains. TBI’s (traumatic brain injury) like a concussion can cause detrimental molecular issues which can have short and long lasting effects on your brain and the rest of your body. I am going to write about how people are ignoring the facts of a concussion just so they can do what they want and be “successful” in their realm of work. I will first talk about how concussions can vary and you can manipulate your concussion, and secondly, I will talk about the second impact syndromes well as the effects of a concussion short and long term and how TBIs can lead to higher probably chances of issues like suicide.
As a professional athlete like Tom Brady or Canelo Alvarez, the last thing they want to do is sit out because of a concussion. For Brady, his team relies on him, he is their QB, and for Alvarez, he is practically fighting for himself but he knows if he fights he gets paid regardless and even more if he wins. These men will sometimes do whatever they need to do to make sure their involved in their sport and that may lead to providing false information on any concussion or TBI they have had. I encourage you to read up on one football players perspective on concussions found here. People today impact themselves in so many ways and the way these two men do it is through physical contact to their bodies and most importantly their brain. These men may make a lot more than the average guy, but they simple are doing their job. Their career, and unfortunately their physical degradation gives us entertainment all throughout the week on television. These men most likely also get joy and happiness through their sports, but they are missing huge key facts that concussions can cause short and long term issues as well as what happens when you don’t properly heal from a previous concussion.
Concussions commonly lead to rapid onset of short-lived impairment of neurological function that resolves spontaneously. At the molecular level hours after the concussion/TBI, hypometabolism occurs via decreased amounts of ATP, NADH/NAD, and N-acetylaspartate and this can occur up to months after a moderate or severe TBI. This gives evidence along with a high calcium influx that sets the stage for another severe brain injury after a repeated concussion—described clinically as second impact syndrome. In a general sense, symptoms and signs may evolve over several minutes to hours. Some short-term issues involved include: headache, foggy feeling, behavioral and emotional symptoms, slowed reaction times and insomnia.
According to Concussion Foundation, 87 of the 91 former NFL brains that were in a study had a progressive neurodegenerative disease called Chronic Traumatic Encephalopathy. This disease has symptoms of memory loss, confusion, impaired judgment, paranoia, and much more. The tau protein in the brain gets misfolded and causes build ups throughout the brain which cause neurons to die slowly. Another major issue found from concussions is their link to suicide. According to Canadian Medical Association Journal, someone who encounters just a mild concussion is three times more likely to commit suicide than someone who hasn’t had a concussion. Regardless of short or long term issues, concussions aren’t going anywhere soon and we as society need to be more informed on what they can do to your health over a lifetime.

When I visited the movie theatre last fall to see Concussion, I expected to receive a dose of entertainment, but I instead received a dose of reality. It told a true story about a forensic pathologist, Bennet Omahu, handles the autopsy of Mike Webster, former NFL player for the Pittsburgh Steelers. After close examination of the NFL player’s brain, he discovers that there is evidence of severe brain damage, which contrasts with the individual’s otherwise healthy body, so Omahu concludes that the death is due to chronic blows to the head, a disorder he identifies as chronic traumatic encephalopathy (CTE).
Now this movie contains action, drama, romance, and thrill, but it,arguably, more importantly sheds light on the dangerous effects of concussions.
According to WebMD, a concussion is a type of traumatic brain injury caused by a blow to the head or body, a hard fall, or basically anything else that shakes the brain inside the skull. Concussions are a unique injury, because the damage cannot necessarily be obvious. A concussion causes normal functions in the brain to malfunction. The people most susceptible to getting a concussion are athletes, with football, boxing, and soccer having higher rates of concussions.
Symptoms of concussion include headache, nausea, fatigue, memory problems, sleep disturbances, and mood dysregulation, according to the Brain Injury Research Institute. In many cases signs of a concussion appear right away, but they may not appear until a couple days later. This makes diagnosing a concussion difficult, and it leads to additional risks if it is not treated immediately post-impact.
More research on the long-term effects of concussions has investigated the dangers of repeated concussions than the lasting complications of a single concussion. Research has concluded that repeated concussions are especially damaging in regards to long-term health. Some long-term consequences of repeated concussions include

• Cognitive impairment
• Anxiety disorders (PTSD)
• Learning interference (spatial learning)
• Depression
• Motor dysfunction
• Memory deficits
• Alzheimer’s Disease
• Mood Instability

When I was watching Concussion, I was amazed to see how seriously Webster’s life fell apart. We was pictured suffering from self-mutilation and homelessness, and he ended up dying alone. Realizing that this is the experience for many people due to CTE makes the severity of concussions seem much more real.
This understanding directed my curiosity to learn more about concussions and how they affect the brain. According to a 2014 article in Neurosurgery, brain injury leads to damaged axons (part of the neuron that transmits a signal to another neuron).

The axons get stretched so that calcium and sodium ions enter into the cell, and this leads to excess excitatory neurotransmission. The mitochondria goes into hypermetabolism to try to restore the balance and ultimately goes into hypometabolism because it has entered an energy crisis. Concussion also leads to an accumulation of abnormal proteins in the brain.
The Sports Concussion Institute has developed a graduated “Return to Play” protocol that details the rehabilitation stages a player must go through to return to playing their sport after a concussion. This management plan has been challenged by the “Return to Learn” protocol, which insists that players must be reintegrated to academics before athletics after a concussion, according to the Brain Injury Association of America.
It is advancements like these that will help individuals properly heal after a concussion before being back on the field with the risk of receiving another one.
I can’t imagine how hard it would be to get a concussion as a high school athlete. I would want to keep playing, no doubt. Protecting my brain for the sake of my long-term health wouldn’t be the first thing on my mind. Then to think of a professional athlete who might have devoted teammates and millions of fans depending on him or her, that would be even trickier.
As a culture, we need to balance our passion for competition with concern for future health. This will be a step in the right direction of enhancing lifelong health and reducing diseases that get in the way.

Concussions are a not well-understood invisible injury that has no boundaries on who it can affect. A concussion may be caused by a blow, bump or jolt to the head, or by any fall or hit that jars the brain. This invisible injury disrupts the way the brain normally works by affecting mental stamina, as the brain must work longer and harder even to complete simple tasks.
Recently, researchers have figured out the neurochemical cascade that occurs in the brain after a concussion:

1. There is depolarization in the cell and release of high amounts of excitatory neurotransmittors.
2. Potassium is brought out the cells and Calcium is rushed in causing an imbalance (Hypermetabolism).
3. Increased activity of ATPase and a decreased production of ATP (Energy Crisis).
4. Axolemmal disruption, axonal swelling and possible apoptosis.
5. To much stored Calcium, no ATP for energy, no activity Hypometabolism).

This cascade shows us why patients are very tired, but also that sleep is very important to a concussed person. The Hypometabolism stage shows us why second impact syndrome is so bad, because if you receive another concussion in this state there are no chemicals of energy left to start this cascade over again.
Concussions are serious brain injuries that have a significant influence on the brain’s ability to function at its normal capacity. The key to recovery from a concussion is both physical and mental rest, followed by a gradual progression back to activity, both in athletics and in the classroom.

Concussion symptoms can have a significant impact on classroom learning and schoolwork. Physical symptoms may interfere with the student’s ability to focus and concentrate, while cognitive symptoms may impact the ability of the student to learn, memorize and process information, as well as keep track of assignments and tests. Struggles with school work may worsen the frustration, nervousness and irritability that were originally caused by changes in brain chemistry.
No two concussions are exactly the same so individualized treatment is necessary. Developing brains are highly variable; so one student’s symptoms may be completely different, and therefore, some students may need to miss school to help heal for varying amounts of time, while others will be able to continue their work with some accommodations.
Nationwide Children’s has come up with a 5 step plan for teachers to understand when helping a concussed student through school work.

1. No School: Rest with no activity, screen time and healthy meals are key to begin the healing process
2. Half-day Attendance with Accommodations: Accommodations may be limited homework and reschedule tests.
3. Full-day Attendance with Accommodations: Accommodations may be breaks in between classes.
4. Full-day Attendance, No Accommodations. No activity is allowed yet, full class load is allowed.
5. Full-day and Extracurricular Activities.

A concussed student needs to hear from educators that they understand what a concussion is and what the student may be experiencing. The student needs reassurance that he or she will not fail classes because of missed school days and homework. This sympathy, understanding and consistency from all parties involved will help to decrease stress, and in turn, help with recovery.