Are High School Sports Putting Children at Increased Risk of Traumatic Brain Injury?

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Children are our most precious resource and we should therefore guard the health and safety of the next generation carefully. As the 2014 – 2015 school year approaches, many high school athletics programs have already begun their practices and many youth sports teams are sure to follow. However, each year parents, coaches, athletic directors, and other administers should take some time and ask if enough is being done to protect children from serious injuries and especially traumatic brain injury.

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For fall sports like soccer, football, cheerleading and volleyball the CDC publishes a fact sheet regarding concussions and other traumatic brain injuries. While this effort is a good starting place, the question remains whether a measure like this is enough to protect the future generation from chronic and life-altering brain injuries.

Brain Injury Revelations in Public Consciousness Due to NFL Concussion Litigation

One source for the intense focus on brain injuries is the NFL concussion lawsuit. The NFL has always promoted something of a warrior’s culture where players despite serious injury go out and compete. Those who find success or even put on a strong showing are typically lionized for their fearlessness and valor. While we can debate whether an adult who plays sports professionally can act competently and freely in such circumstances, we have long understood that decisions like these should not be imposed upon children and teenagers. While the allure of momentary glory can be great, the potential long-term consequences are simply too severe when a brain injury is involved.

However while the danger of the “big hit” was grudgingly accepted, what was not necessarily understood by the public was the dangerous cumulative impact that sub-concussive, but routine, blows to the head and skull can have. These sub-concussive impacts alone or when combined with other traumas increase the likelihood of the development of chronic traumatic encephalopathy (CTE). Signs and symptoms of CTE include depression, increased suicidality, apathy, cognition problems, increased aggression, and problems with motor skills.

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While children are unlikely to develop the signs or symptoms of CTE while still in high school, repeated traumatic events can certainly result in an increased risk of the condition developing. However, there are always unfortunate and heartrending exceptions.

CTE Can Develop in Teens and Young Adults

In 2008, 17-year-old high school senior and academic and athletic standout, Nathan Stiles, died tragically due to brain injuries he sustained on the football field. His autopsy revealed that his death was due to second-impact syndrome where the brain is subjected to a second severe trauma before it can repair itself. However, what was truly remarkable and profoundly troubling was that Stiles’ brain also showed signs of severe CTE.

After their son’s death, Ron and Connie Stiles selflessly donated his brain to the VA Center for the Study of Traumatic Encephalopathy (CSTE) Brain Bank so that, perhaps, another family could be spared such a tragic situation. The Brain Bank studies the donated brains of athletes, soldiers, and those suspected of having degenerative brain conditions like CTE. What Dr. Ann McKee, the bank’s director, and neuropathologist, finds in cases like Nathan Stiles’ still shocks her.

“You expect a pristine brain. I saw a brain that was riddled with tau proteins [that are associated with Alzheimer’s disease]. I was stunned at how similar that brain was to the boxers who lived into their 70.” As the youngest documented case of CTE Dr. McKee believes, “…that we’ve really got to protect our kids. It’s not just car seats and seatbelts, but it’s making sure that when they go out to play sports that we take proper precaution and we give them proper advice.”

What Can Schools Do to Minimize the Risk?

While protective equipment can be helpful, the equipment may be used improperly or increase risky behavior without proper education and risk awareness. As a starting point, schools can ensure that parents, coaches and athletes are informed and educated regarding not only the risks of concussive impacts but also routine sub-concussive forces. A good starting point for identifying the signs and symptoms of concussions could be the guides published by the CDC. However, this is merely the starting point for education and coaches and those in close contact with athletes should receive additional training and education.

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Schools should also see that a baseline of cognitive functions for each athlete is established. Establishing this baseline record can help identify a concussion or other traumatic brain injury early. Furthermore, comparison to the baseline can also provide an objective basis for when the athlete has adequately recovered from the injury and can return to play. In the meantime, the individual should be allowed to rest both physically and cognitively. He or she may require some supportive therapy or modification to his or her daily routine while recovery is ongoing.

When the individual appears to be ready to return to physical activity, the return should proceed in an extremely cautious matter. Once the athlete is functioning at or near his or her baseline level, they may return to light exercise and then, if signs and symptoms do not deteriorate, to light to moderate sport-specific drills.  If symptoms again do not worsen after 24 to 48 hours, the athlete can then participate in non-contact sports activities. At this point, the athlete can then proceed to full-contact practice and, barring a setback, potentially return to full participation in a few days.

While we have taken steps in the right direction regarding brain injury awareness and recovery, there is still a great deal of work to be done. The only way the next generations will be protected from the consequences of brain injuries is through comprehensive action from parents and athletes along with legal, medical and educational actors.

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