Just a Few Knocks on the Head: The Concussion Conundrum

Jenni Ogden, PhD, Oxford University Press

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Multimedia

• Concussions can be subtle and often invisible. That's why coaches, parents, and teammates need to have a high index of suspicion.

  See more videos with Dr. Julian Bailes.

  High Index of Concussion Suspicion Needed on the Sidelines
• "Don't even try to fool me because I'm watching you!" So says Jay Driscoll, ATC / CSCS, athletic director at Washington, DC’s St. Albans School, to his student athletes, alluding to the fact that some athletes cover up a mild brain injury so as to stay in the game. With a no-nonsense attitude and a keen sense of humor, Jay talks to BrainLine about his program on injury prevention, care, and rehabilitation services as well as how he helps his athletes meet and exceed demands by enhancing their physical fitness, performance, and health.
  
  Transcript of this video. Working the Sidelines
• Playing sports has many benefits for kids, but there needs to be more awareness of the potentially life-changing effects of repeat concussion. Repeat Concussions
• A second concussion may have more dangerous consequences than a first concussion, especially in a young adult brain.

  See all videos interviews with Dr. Ann McKee.

  Why Is an Injured Player More at Risk for a Second Concussion?
• Educate everyone involved about concussion — from the player and his parents to the coach and the teammates. Importance of Concussion Education
• Science suggests that there are several factors that contribute to the relationship between symptom reporting and ultimate recovery. Why Do Some People Recover Faster or Better than Others from a Similar Concussion?
• An expert on sports-related TBI, Bailes encourages kids to play contact sports for a spectrum of reasons — from being part of a team to learning lessons on winning and losing — but not if the kid has had three or more concussions.

  See more videos with Dr. Julian Bailes.

  Dr. Julian Bailes: The Pros of Contact Sports
• Yes, some sports could be safer — and should be — but not participating in sports at all is like being a boat that never sets sail. Finding a Balance: Sports and Safety
• Blatant hits and fouls are not necessary in kids' sports; rule changes could make sports safer. Making Kids' Sports Safer
• Increased knowledge about the long-term effects from contact sports may catalyze rule changes.

  See all videos interviews with Dr. Ann McKee.

  Are Contact Sports Dangerous?
• A jarred brain needs sufficient time to rest and recover. It's simple, but makes all the difference in the long term.

  See all videos interviews with Dr. Ann McKee.

  How Can We Improve the Way Sports Handle Brain Injuries?
• A doctor/parent talks about trying to find a balance between the benefits and dangers of letting his children play contact sports. Should You Let Your Child Play Contact Sports?
• During any given season in football or ice hockey, for example, a player has a 5-10% chance of sustaining a concussion. How Common Are Concussions in Contact Sports?
• People need to know that a concussion can be a serious event, repetitive concussions even more so. Proper recovery is essential to outcome. Concussions and Contact Sports
• Skier Lesley LeMasurier was going 80 mph down the slopes when she fell. "I don't want to imagine what would have happened if I hadn't been wearing a helmet." This is an excerpt from BrainLine's webcast Concussion: Understanding Mild Traumatic Brain Injury. See full webcast here. Olympic Hopeful Lesley LaMasurier on the Importance of Wearing a Helmet
• When her concussions started to affect her on and off the ski slopes, competitive alpine ski racer Lesley LeMasurier knew something was significantly wrong. This is an excerpt from BrainLine's webcast Concussion: Understanding Mild Traumatic Brain Injury. See full webcast here. From Olympic Hopeful to TBI: Lesley LeMasurier's Story
• "If you think you have a concussion, don't hide it, report it ... I didn't know it could get this bad." Tracy's Story: The End of an Athlete's Career

This is a tale of two teenage boys who lived in the same large city but came from very different backgrounds. Jason was the eldest of two sons and lived with his well- off, white, professional parents in a large house in one of the wealthiest suburbs of Auckland. He attended a private boys’ school and at 16 was already looking forward to university in two years. Howie, also 16, was the third eldest in a family of eight children and lived in a three-bedroom state house in one of the poorest suburbs of Auckland. His Maori mother worked as a cleaner and his white father was unemployed. Howie attended a large coeducational state school where most of the pupils came from poor families and where few of the pupils went on to university.

Yet these two boys had one very important thing in common. They were both mad about sports, and in particular rugby, New Zealand’s national game. What’s more, as a result of their passion they were both up-and-coming sports stars in their schools. In fact, as I later discovered, Jason and Howie had met each other on quite a few occasions on the rugby field and at parties after school matches. Their schools may have been miles apart in their educational standards and the discretionary funds they had to spend on extras for their pupils, but they were neck and neck when it came to rugby. One year the top team — the First Fifteen — in Jason’s school would win the annual secondary school rugby competition, and the next year the honor would go to the First Fifteen in Howie’s school. Of course some years neither school would win, but invariably both would be in the top six. At 16, Jason and Howie were young to be in their schools’ First Fifteen teams; most of the players were 17 or 18 and in their final school year. Perhaps it was their physiques — both boys were tall and strong for their age — that prompted their premature selection for the top team. Certainly their size was one of the factors that made them good “locks,” the rugby position they both held and that exposed them to more risk of head injuries than many other positions on the field.

Like every boy in every First Fifteen, Jason and Howie fantasized about a career as a professional rugby player. But in reality they knew that this was a long shot, and Jason had a backup plan, to obtain a master’s degree in sports psychology. Howie’s backup plan wasn’t quite so ambitious: he thought he’d try to get an apprenticeship as a mechanic at the local garage. Messing about with vehicles was his other passion.

Sadly, for these two boys the chance of being selected for the All Blacks — New Zealand’s famous rugby team — was stymied. Before they reached their 17th birthdays they were to discover they had one more thing in common — brain damage. Of course, nobody in their families thought of it as brain damage. For many months the boys and their parents, and even their teachers and sports coaches, looked upon the mild difficulties Jason and Howie were having as unfortunate but temporary consequences of “just a few knocks on the head.”

* * *

Jason’s mother, Becky, was a “mature” student in the large undergraduate “Introduction to Clinical Psychology” course I taught at the university. I knew her by sight, as she always sat in the front row of the lecture theater and often came up after the lecture to ask me a question. So when she knocked on my office door I assumed she was there to talk about her upcoming essay assignment. But after a brief exchange when she’d explained that she had returned to university part- time now that her two boys were in their teens and she had time on her hands, and that psychology was her favorite subject, she came to the real reason for her visit. She was worried about Jason and wondered if I could help. Over the last few months he seemed to have lost his zest for life, and she thought he might be depressed. Her husband, Andrew, even wondered if Jason was experimenting with drugs, although Becky was pretty sure he wouldn’t be so silly. Two weeks earlier, the situation had come to a head when Jason became very drunk at a party after the Saturday rugby game and had been delivered home at 3 a.m., semicomatose, by two of his friends. And last week the school headmaster had asked Becky and Andrew to come in for a chat, where he told them that Jason’s work standards had plummeted over the past few weeks and he had been missing some of his rugby practices. Becky and Andrew had tried talking to Jason, but with no success; he was sullen and rude and told them to get off his back before locking himself in his room for hours. Then Jason had been called in to see the school counselor, and that had caused more upset. Jason refused to go to school the following day, saying he was sick. By this point in her story, Becky was almost in tears, and I could see this would need more than a brief discussion with me.

“Do you think Jason’s behavior might just be a case of ‘teenage angst’?” I asked her.

“I wish it were, but he’s so different than he’s ever been before that we think there must be something else going on. I think he’s depressed, and he has always been such an optimistic and balanced person. And he’s always been avidly against drugs because of his sport and keeping fit.” “It does sound as if it would be a good thing for him to see someone. Are you wondering whether he could come to the psychology clinic?”

“Yes, I think he might accept that. Having to go to the counselor at school was too embarrassing. And Andrew told him he had no option: He had to either tell us what was wrong with him or go to see someone who could help him.”

“And what was his reaction to that?”

“At first, he said he didn’t need to see anyone and went and shut himself in his room again. But in the middle of the night Andrew got up because he couldn’t sleep for worrying about him — neither of us could — and then he heard Jason crying in his room. He never cries, so it was very distressing. But thank goodness Andrew heard him. Anyway, he went in and after a while Jason did talk a bit, and said he was worried about himself. He thought he was going crazy. He said he’d never touched drugs and didn’t get drunk as much as most of his friends and didn’t know what was the matter with him. In the end he said he would go to see a psychologist as long as no one at the school had to know.”