Dr. James Kelly is professor of Neurosurgery and Physical Medicine and Rehabilitation at the University of Colorado Denver School of Medicine and associate director of the Colorado Area Health Education Center System. This is BrainLine's exclusive interview with Dr. Kelly recorded on July 11, 2008.
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There is some evidence that it may be worse
for a youngster whose brain is developing
and then sustains a concussion
than for others that are already mature in their
development neurologically.
Here's what we think is happening.
The young brain is continuously not only
growing and evolving physically, physiologically,
but is engaged in the process of learning
in such a way that in school performance and so forth,
that is part of what has to happen
for the brain to actually develop fully.
And so if the injury interrupts the process
of the environmental engagement of that brain,
it's not only a physiological disruption for that
span of time during recovery, it may skip
developmental stages.
And so the individual may suffer
more protracted
cognitive or other deficits as a result.
Some people talk about youngsters brains
being more plastic, more able to
regenerate and so forth.
And while that may be true, there is
at least some evidence that the other
problem is also true.
The other issue is true.
That the developing brain actually can be
impaired in a long-term sense that
then ultimately creates a different track
of trajectory where that individual ends up.
We could let our kids play contact sports if,
in fact, we have ways of making them safer.
I'm all for healthy,
active lifestyles and engagement for kids,
but I think we need to look at what the risk factors
are and reduce them.
There are plenty of places we can do that, plenty of ways
we can do it in skiing and in the
contact sports we've talked about with football and hockey.
We can do it better with baseball.
We can do it with a whole variety of sports that kids should be encouraged to play.
But I think that we need to look specifically at
rule changes and equipment changes and so forth
that are improvements that can actually
create the outcomes we're looking for.
The helmet has to be designed around what
the potential injury issue might be.
So, for instance, on a bicycle helmet,
that helmet is almost
unlikely to ever come into play.
Most people will wear those things for years riding their bikes.
And except for when they drop it on the floor, it doesn't even have a nick in it.
But when it comes into play, it's a big-time
mechanism.
They're launched over the handle bars and
landing on asphalt or something similar.
So this isn't just a simple blow to the head
from an elbow in hockey or something like that.
It's a big-mechanism injury, so that
actually has to serve that one time.
It can be disintegrated, but it has to serve the
maximum impact absorption that
any helmet can under those circumstances.
The material they're made of, which is essentially a kind of
Styrofoam--it's an expanded polystyrene--
those are designed to do that.
They're little airbags.
They're little air cells, and they crush, but then
they disintegrate.
So the helmet itself is no longer integrated in the way it had been
in the original form, but it did
the job.
It dispersed the energy.
So that particular helmet design is absolutely the best
head protector, brain protector, we have.
But it's impractical for football and hockey and various other
kinds of activities because you can't throw that away every
play and come back in with another one.
So there has to be some resilience built into the helmet.
It's always a trade-off how much of the
springback is going to be
damaging ultimately, because it's
pushing, then, the head in the other direction versus being absorbable
than the softer materials
that actually can absorb the impact itself.
And so materials are always being
looked at by the people, the engineers mostly,
mechanical engineers,
and helmet designs evolve.
But there is no perfect helmet.
The problem with helmets in general is
that the concussion effect primarily occurs
because of a rotation of the head, not because of a blow
that actually can be absorbed in one spot.
So the helmet rotates, too.
And as a result of the head rotating and the brain moving more
on the outside than on the inside, there's torque.
And so the helmet can't do much about that.
It can if in fact
it's so glossy
that the blow doesn't stick to it, doesn't connect to it,
like football helmets are designed that way.
They're very hard and very slick, so a lot of things just glance off
and the head doesn't move much.
But when people historically had leather helmets,
or they started putting in dentable
foam rubber caps on football helmets, they actually
grabbed elbows and knees and
created more rotational injury, so the helmet became a problem,
under the circumstances.
So now that they've gone to these very hard-shell helmets,
that technology, I think,
has been most helpful in
preventing a force that could have been applied
in a problematic way that then glances off.
One of the things that I've seen is that
it's often that a concussion occurs in a sport
that you would not have anticipated risk of concussion.
Wrestling--there's a good example.
Wrestlers wear helmets on their ears
to protect from cauliflower ear and so forth.
But wrestling at the collegiate level
is actually third, usually, in the incidents
of concussion.
I had no idea of that until I started looking into that
and the data that others gathered.
So maybe there's something about that that we can
help figure out.
Are they falling off the mat?
Are they colliding as if it's no longer the same sport that it had
been historically and there's a different element to it now?
I'm not sure, but that's
the kind of thing I think that we need to consider is that concussions
can happen in any sport,
not just the ones that have collisions inherent in them.
There is some evidence, at least in certain sports,
to support that, that girls do have more
per capita, if you will, per engagement
risk of concussion than boys.
I've seen so many young female
athletes in basketball in particular
having concussions than boys do
at the same age levels.
I don't really understand why that is.
People talk about, gee, they're just not as skilled,
they collide with each other because they're not slick in
getting away from each other.
I don't know if that's true or not.
People talk about how the neck muscles of the male athletes
are stronger and can reduce the amount of head movements
when there's bodily contact of some kind
that the girls don't have.
The truth is I don't know.
I'm concerned about that because a lot of times
the female athletes
aren't even wearing helmets in the very same sport that the men are.
I don't understand that.
I think that our concern has to be elevated there.
Well, my advice to parents would be to take this whole thing
seriously if your child has a concussion,
or you think they have a concussion.
Look into it in some detail and make sure
in your community you know what is
the route to the proper healthcare professional in order to get
that care that you need.
For the athlete specifically, again, it's
take this seriously.
Make sure that you don't take risks that are unnecessary.
Protect yourselves.
The other part of it is the concern that I
have about collisions.
I think that we should aggressively go after
that as an issue and say this is inappropriate.
We need to not do that.
You can tackle somebody without knocking him out of the stadium.
And the pro players that I do have
access to, I'm trying to convince to do that
with limited success, because
that's what's celebrated in their world.
But once they understand the actual
bodily damage and the long-term effects on them and the others
and the fact that their
modeling what is the wrong behavior
and the adverse influence that has
on youngsters, once they get onto that these people are really
very serious about it.
And many athletes have come on board with saying exactly what it is we need them to say.
James Kelly, MD,
James Kelly, MA, MD, FAAN, a neurologist who is one of America’s top experts on treating concussions, serves as the director of the National Intrepid Center of Excellence (NICoE). While serving as NICoE’s Director, Kelly is on a leave of absence from his position as professor of neurosurgery and physical medicine and rehabilitation at the University of Colorado School of Medicine.
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