Cobbers on the Brain

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.