Brain Injuries and Concussions in Young Athletes

Recent studies have indicated that brain injuries and concussions in youth correlate with a history of crime later in life. If this is the case, it is important to be aware of our young people's head injuries and concussions when they play contact sports such as football.

A retired doctor from Dover, New Hampshire recently proposed there be a ban placed on high school football because of the potential dangers to young people. He said in football, the head is used as a battering ram. Obviously controversial, some say then we should keep our children from riding in a car because that can be potentially dangerous as well.

However, common sense states that the dangers of brain injuries and concussions are significantly higher while playing football or other high contact sports. Especially considering that in a single season, a football player can receive over 900 hits. And it is estimated that one out of four players suffer a concussion during the season with many more going unreported because they don't want to be taken out of the game.

Added to that is the recent study finding that head injuries for young people with maturing brains can cause some 'misfiring' and disruption in the development of self-restraint, social judgment and impulse control. Studies have also shown that the prevalence of brain injuries among prisoners is as high as sixty percent with a large percentage having the potential to re-offend. After further studies, it was discovered that juvenile offenders suffering brain injuries were significantly higher than the group who didn't have injuries.

Perhaps it is time that parents, coaches and the school system find a way to identify and manage concussions and brain injuries early so that young people receive the right neurorehabilitation.

Football is a collision sport but perhaps there are also ways to make it safer for young people to play. Hockey in recent years has also become more aggressive. Maybe it's time to think about the potential consequences to our youth playing these sports and the concern about the increasing number of concussions and possible brain injuries.

Possibly some of the following rules for children playing sports cvould be considered: - That they no longer use their heads as battering rams while playing football.

- That tackle football be abandoned. At the high school level of football, impact is often 20 times the force of gravity.

- No more heading in soccer for young people.

- And no more full body checking for children playing hockey.

We shouldn't doom our children to a life of crime, lifetime cognitive problems or early Alzheimers because of our love for these contact sports or for the hope of a university scholarship. A child's safety should always be first and foremost.

Concussions - Children and Adolescents

A concussion changes how the brain works. It can be only a bump, a jolt or a significant blow to the head or body which will cause the brain to move rapidly back and forth. Even a mild bump to the head can be serious in some cases and particularly in young children.

Symptoms can show up immediately or not until sometime later. Symptoms are: being dazed, confused or forgetful; having a headache; feeling nauseated or vomiting; problems with dizziness or balance and clumsy movements; being sensitive to noise or light; memory problems; being unconscious, even briefly; one pupil being larger than the other; feeling drowsy; having seizures or any other changes in behavior.

If a concussion is suspected, the child should immediately be pulled from the game so that an assessment from a health care professional can be obtained before the child is allowed back to play. Rest is imperative if a child or teenager has suffered a concussion. Brains take time to heal so as to avoid further complications. Until a young athlete has completely recovered from the first concussion, a second injury is more likely to occur. This should be avoided because second, and subsequent concussions take longer to heal than the first ones.

My young seven year old grandson plays soccer and loves the sport. He recently told me proudly that he had 'headed' the ball to keep it from going into the goal. He had no ill effects from this but I do believe that in a child so young, even 'heading' a ball is something to be aware of and concerned about, in spite of the fact that soccer isn't considered to be one of the rougher sports.

The International Conference on Concussion in Sports believes that when it comes to concussions in children and teens, different treatment is required. If a concussion has been identified, it is important that the child or teenager not be allowed to return to the field to play, not to go to school and definitely not to engage in cognitive activities of any kind until they are completely healed. Cognitive rest is particularly important for a successful recovery.

It is important also that children and teenagers be strictly monitored during this recovery time. There is a realization that the developing brains of young people require special consideration. They may need a long period of rest with a more gradual return to activities than adults require.

The onus therefore, is on parents and coaches to ensure that these safeguards are heeded when it comes to children and adolescents. And it is good to remember that it is better to miss a game than to miss a season, or worse still, to live with lifetime consequences because of not taking the proper care when it should have been taken.

Strokes - An Acquired Brain Injury

In order to optimize stroke recovery, it is paramount to have early diagnosis and appropriate and immediate medical care. When this is done, a patient's treatment and rehabilitation can begin.

Recognizing the symptoms of a stroke are important though so that immediate action can be taken. They are: numbness or weakness of the face, arm or leg, especially on one side of the body; sudden confusion, trouble speaking or understanding; trouble seeing out of either one or both eyes; difficulty walking, dizziness or loss of balance, or a sudden, severe headache.

If a stroke is suspected you must immediately call 911 or an emergency response system in your area. There is a very limited window from the onset of symptoms to when therapy can successfully be used. To determine whether it is a stroke or not, have the person smile. Their face should move symmetrically. Also ask them to raise both arms so that any evidence of paralysis will be evident, and to speak a simple sentence. While waiting for the ambulance to arrive, the person should lie flat to allow the blood to flow to the brain. If there are definite stroke symptoms, do not give them aspirin in case there is any bleeding.

Once a stroke patient has become medically stable, rehabilitation can begin which will initially teach him/her how to manage their own personal hygiene, feed themselves, get in and out of bed and to use the bathroom on their own.

Further rehabilitation may include a physical therapist, occupational therapist, speech and language pathologist, psychologist and recreation therapist depending on the severity of the stroke. This type of rehabilitation will help to promote independence in their daily lives. Responses to treatment and their overall recovery will, however, depend mainly upon themselves and their own personalities. Part of early recovery is spontaneous which are natural abilities that will automatically begin to come back, especially during the first few weeks following a stroke. But significant recovery can be made even years after a stroke. Rehabilitation works best when stroke survivors and their families work together.

After rehabilitation in either a formal rehabilitation program or as individual services, the person will eventually be able to return to community living. During this stage they may have to learn to do common tasks in a different way. It may be that they will have to use their opposite hand to write or do things they originally did with their other hand. They may require velcroe on their shoes instead of laces or if it has been a serious stroke, they may require the use of a wheelchair.

Strokes can affect the body, mind and feelings. And because a stroke is an acquired brain injury, they may have many of the same deficits that those who have suffered a traumatic brain injury have been faced with. They may be unaware of their injury, have problems with their memory, experience lack of judgment and motivation as well as other cognitive problems, and fatigue and depression.

The most important thing in having a successful outcome following a stroke is that there is an early diagnosis, with immediate therapy and treatment. Without early treatment, there is the risk of life-long consequences to the patient such as disabilities that could possibly have been prevented.

Can Brain Injuries and Concussions Age the Brain?

Studies indicate that brain injuries and concussions may have an affect on the way a brain ages, even thirty or more years after the fact. Concussions are a better indicator because there are fewer deficits than those who have suffered from a brain injury.

Early acute findings following an injury are only the tip of the iceberg as researchers discover post-concussion that there is a decline in memory, inability to update their memories, attention difficulties, executive function problems and slowing of movements. These are all indications of the difference between those who have previously had a concussion and those who have not.

Post-concussion symptoms may show, even months or years later as: attention deficits, impulsiveness or irritability, low frustration levels, temper outbursts and mood changes, dizziness and headaches, and learning and memory problems. Brain injuries, depending on the severity, may show additional deficits such as: lack of motivation, problem solving difficulties, cognitive deficits, emotional and behavioral problems, short term memory loss and lack of judgment to name some of them.

As those who have a history of concussions age, they may have difficulty in how quickly they remember names and places, an inability to quickly come up with specific words or to recall events. Research indicates that the concussed brain seems to be biologically older than the non-injured brain. Tests show that a fifty year old who had a concussion, even thirty years previously, has a similar brain to that of an uninjured sixty year old.

There appears to be a premature aging of the brain as a consequence of past concussions, however, even a lone event can impact the brain. To ward off this accelerated deterioration of the brain, it is important to do brain training, i.e.: exercising, reading, puzzles and learning new things.

Considering the seriousness of even a single concussion, those who play football are at an even greater risk. Football players receive an average of 950 hits to the head each season. Hockey players, and all those who play contact sports, are also at risk.

Because of these high risk factors, researchers are conducting tests to determine whether those who have received concussions or brain injuries have an increased chance of getting Alzheimer's Disease when they get older. Dementia is also considered more of a risk for those who have received either injury.

The lesson to be learned in this is to do all that can be done to avoid concussions or brain injuries by taking safety precautions in everything that is done. But if one should occur, it will be important to do all that is required to become healthy again by resting, taking rehabilitation and following a doctor's instructions.

Brain Injuries and Communication

Communication involves not only speaking but listening to words, observation of facial expressions, hand movements and comprehension. Many brain injury sufferers have difficulty with communication because of cognitive and memory problems as well.

Often brain injury sufferers will have difficulty in maintaining a topic in conversation, they may use an inappropriate tone of voice, i.e.: possibly speak in a belligerent manner; have difficulty determining the difference between a sarcastic remark and a serious comment, or have a problem understanding a fast-paced conversation. Others may have difficulty taking their turn in conversations or may not be able to find the correct word to express themselves in either speech or the written word, or they may have difficulty understanding not only conversations but with comprehension when reading books or newspapers. Following the story line in a movie may also be hard for them to do. Some may also become overemotional when communicating with others or be unable to respond to another person's body language.

For others, their thinking skills may have been affected which will in turn make communication difficult. Memory problems will also affect their communication abilities because the thread of a conversation may be lost. Or they may have trouble concentrating if there are distractions. Their ability to process what others are saying if they speak too quickly may make understanding more difficult as well. Organizing their thoughts and becoming confused easily may hinder communication also. Social situations may become more difficult because of communication problems. In some cases, they may place the blame for these difficulties on the person to whom they are speaking.

Other problems with brain injuries and communication which may exist are: difficulty when given too much information at one time and therefore, have an inability to understand the meaning; have difficulty paying attention when others are speaking; problems following instructions; may take jokes, etc. too literally, or they may repeat the same thing over and over again.

Difficulties with communication after suffering a brain injury will depend on the severity of the injury and what part of the brain was affected. What can the brain injured sufferer do to help himself/herself?

They can make an effort to remain calm when understanding is a problem; they can ask others to speak more slowly; plan ahead what they want to say; turn off the television and other distractions; repeat what has been said to them to make sure they understand, and ask for an explanation if they don't.

What can others do to assist someone when communication is a problem? Give them time to speak, don't make them feel rushed, don't speak for them, encourage them, don't force anyone to speak if they are reluctant to do so, use short and simple sentences, don't interrupt them when they are speaking and include them in general conversations.

Communication is probably one of the most important skills we can possess. Cognitive and memory difficulties can affect communication so it may be necessary to deal with those problems first in order to be able to resolve communication difficulties. Just like it takes a village to raise a child, the brain injury sufferer will require assistance with his/her communication problems as well.

Brain Injuries and Self-Awareness

A brain injury can make it very difficult for sufferers to understand their impairments and limitations. Often a lack of self-awareness is a form of denial but it can be much more than that too.

Self-awareness is the ability to understand the difference between the deficits they now have and their pre-injury self. A lack of self-awareness makes it difficult to understand what their current deficits mean to their future and to the goals they may have once had.

It is the ability to monitor and correct behavior; self-awareness is not only the ability to recognize and understand their cognitive deficits but their physical and social behaviors as well. Those with this deficit cannot perceive themselves in an objective manner, often not realizing that they, in fact, have any limitations or impairments.

This lack of self-awareness will cause them to be unmotivated and they will see no need for their therapy and rehabilitation. They may lack judgment or make unrealistic goals which will make rehabilitation difficult. A lack of self-awareness may appear to be a denial of their deficits.

Those with more self-awareness will be willing participants in their rehabilitation and therefore, will be more successful in coping with their deficits and becoming integrated into the community. However, with self-awareness there is the possibility of depression when realization of their disabilities is fully recognized.

Many with brain injuries are more aware of their physical disabilities than they are of their social and emotional ones. Memory deficits can also affect the ability to be self-aware because they may not remember their behaviors and think of themselves as they were pre-injury not realizing there's a difference.

To help someone who may be suffering from lack of self-awareness, allow them to do what may be beyond their capabilities, when it is safe to do so, giving them the opportunity to learn through trial and error situations. Give them realistic and supportive feedback in a non-judgmental way, help them to set realistic goals and develop plans towards accomplishing these goals, and have them keep track of their progress.

When lack of self-awareness is a problem, making mistakes and looking for others to blame is common. Failing in their job performances may be another example of their lack of awareness. Therapists will try to get those lacking self-awareness to see the difference between their perceived levels of functioning and their actual levels of performance.

The deficit of impaired self-awareness is the most difficult to overcome and can take a long time before improved self-awareness will be noticeable in brain injury survivors.

Memory Strengthening Techniques

Our brain's memory improves with mental and physical stimulation. With this stimulation we are protected against cognitive decline.

The ability of our brain to adapt and rewire itself, growing new neurons, will continue even into old age by constant mental and physical stimulation. The old adage, 'use it or lose it' applies as much in the case of our brains as with anything else.

It is important to retain a lifelong curiosity and to accept challenges such as learning an instrument, a new language or any other new skills. To force our brains to think differently and therefore create new neurons, do activities such as switching hands to do things like dialing the phone, using your computer mouse, eating, brushing your hair or teeth, applying face cream, setting the table or even while doing physical exercises.

Working with modeling clay encourages our brains to grow new connections by promoting agility and hand-brain coordination. Learning to play Scrabble, chess or a complex card game such as bridge, where strategy is involved, will help too. Travel also helps to expand the brain because we are seeing and learning new things. Everything new we expose ourselves to and learn not only protects us against cognitive decline but helps to strengthen our memories as well.

Using both our physical and emotional senses at the same time in unexpected ways is another technique that will help to strength and grow new brain cells. An example of this could be doing familiar things such as getting dressed and eating, with your eyes closed. Or perhaps listen to classical music and write poetry.

Other things that will help stimulate the brain and assist with memory are to watch less television and read more, on a daily basis. Physical exercise also stimulates the brain. Walking is extremely good for the brain because it increases blood circulation and the flow of oxygen causing cerebral blood vessels to grow. This improves memory skills, learning abilities and concentration. Studies indicate that walkers are less likely to experience age-related memory loss. Running is also an extremely good brain boosting activity but may not be particularly suited to most seniors.

Other techniques to boost memory is to memorize a series of numbers and then repeat them backwards, increasing the speed of repetition each time. Or make lists of things and memorize, i.e.: shopping lists and things to do lists. It is important when memorizing, or in everyday situations, to involve all of your senses. The more senses involved, the more likely and easier it is to remember. Studies indicate that the brain will become stagnant if it doesn't continue to learn new things. There is no threshold for what the brain can learn as it can keep rewiring itself with each additional piece of information it learns.

Additionally, studies show that those who are socially active have slower rates of decline in memory and cognitive performance. Connections with others opens up avenues for learning.

To keep our brains agile, the techniques of continuous lifelong learning along with mental stimulation and physical activity will help prevent cognitive decline as well as memory loss.