Dan Ellis, Steve Young, Troy Aikman. The concussions suffered by these high-profile athletes have raised public awareness about the risks associated with sports participation. But according to the Centers for Disease Control and Prevention, there are 300,000 concussions per year in the United States in both sports and recreation.
As a result, trainers, coaches and physicians often are left with the difficult decision of determining when athletes can return to competition.
"Basically [a concussion] is a mild amount of brain swelling," said Dr. Joe Chance, associate director of general medicine at Elson Student Health Center.
Swelling is an indication of a mild concussion. More serious injuries may display bruising or bleeding, Chance explained.
According to Dr. David Perrin, chair of the department of human services at the Curry school, post-concussion symptoms include difficulty concentrating, headaches and memory loss.
"With repeated concussions, instead of being transient, the effects are permanent," Chance said.
Dr. Kevin Guskiewicz, director of the Sports Research Laboratory at UNC-Chapel Hill, received a $500,000 grant from the CDC to evaluate several concussion assessment tools related to cognitive functioning and balance.
The project is based at the Injury Prevention Research Center at UNC-Chapel Hill and is slated to begin next fall. Testing in the project will last about two-and-a-half years.
The research will test interscholastic athletes from Virginia, Maryland, North Carolina, South Carolina, West Virginia and the District of Columbia.
Perrin will coordinate the Virginia and Maryland data collections.
"Hopefully, the team physicians and athletic trainers will use these tools to assist them in grading the injury and then deciding how long to hold an athlete out," Guskiewicz said.
The full battery of tests will include a Standardized Assessment of Concussion and a balance error scoring system. Athletes will stand on one foot, both feet and then one foot placed before the other. Tests will take place on a normal, firm surface, a foam surface and a balance box - a spring-loaded platform. The assessment concludes with a brief neuropsychological test battery - tests of cognitive functions such as attention, concentration, orientation and memory.
Perrin said the tests may be used to establish baseline scores for athletes before they are injured, may help establish the severity of concussions and indicate when it is safe for athletes to return.
If athletes perform well on their neuropsychological tests, if their ability to balance returns to normal and if they are free of all post-concussion symptoms, then trainers and physicians can feel more confident about their decisions to give them permission to play.
"We believe [the tests] will take some of the guesswork out of these decisions, which are often made based on very subjective information," Guskiewicz said.
Guskiewicz and Perrin said they hope the results from this project will corroborate with their own data presented in 1996.
That study isolated the contributions of the three sensory systems that make up balance: visual, vestibular - or equilibrium - and somatosensory.
Subjects were tested with their eyes open or closed, and then wearing a visual conflict dome, which is a mesh helmet that eliminates reference points for vision. Participants were tested on a firm surface and then on a foam surface.
Researchers examined the subjects' postural away - movement away from their center of balance. They repeatedly tested the athletes to monitor their return to normal balance following a concussion. Their findings revealed an increased sway three days after injury, which indicates a balance deficit.
Once a person sustains a concussion, the tendency is to have repeated concussions with less force. The post-concussion symptoms can last longer, Perrin explained.
"The danger of returning an athlete too soon, in the presence of post-concussion symptoms, is the catastrophic outcome of the second-impact syndrome," he said.
Athletes also can suffer from second impact syndrome, which is the rapid swelling of the brain following a second head injury. The swelling increases intracranial pressure and can lead to brainstem failure within two to five minutes. Mortality rates of 50 percent have been reported for this condition.
Scientists said they hope the new research will help prevent tragedies like the recent death of a San Jose, Calif., high school football player following his second concussion this season.
"I hope that our findings will offer some credibility to the use of more objective measures," Guskiewicz said. "If the findings are positive in this regard, I would hope that all colleges and high schools would consider implementing baseline testing at their institutions, followed by subsequent testing of any athlete who sustains a concussion during their respective season."
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