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Apple-tab-span {white-space:pre}Numerous types of injuries occur in sports, and some of the more serious sports injuries include sports related head injuries.  The most common type of sports related head injury is a concussion, which is a type of traumatic brain injury (TBI).  Concussions can cause constant or recurring headaches, motor dysfunction, depression, loss of ability to hear, taste or see, dizziness, sensitivity to light or sound, cognitive dysfunction such as difficulty staying focused or understanding information, disorientation and confusion, and other neuropsychological deficiencies.  Concussion evaluations include a list of symptoms from the athlete and several neurological exams, such as short-term and long-term memory recall.  The effects of repetitive or multiple concussions include the development of an injury known as second impact syndrome and diseases such as chronic traumatic encephalopathy (CTE), Parkinson’s disease, and Alzheimer’s disease.

  Traumatic brain injury is very serious and can impair mental function, cause diseases later in life, and can even be fatal. Traumatic brain injury is a blow to the head that can damage the brain and disrupt normal brain function.  These injuries can cause serious neurological, psychological, and emotional problems.  Sports in which concussions are common are boxing, cheerleading, cycling, football, snow skiing, snowboarding, and soccer.

  Causes include blows to the head from punches, falls, tackles, etc.  Violent blows to the head can cause the brain to hit the inside of the skull, causing bruising and bleeding in the brain tissue.  The athlete’s head may not appear to be injured from the outside, but there may be bleeding or swelling inside the skull.  Depending on the extent of damage to the brain, symptoms of a concussion can be mild, moderate, or severe.  These symptoms can range from brief changes in mental state or consciousness, to extended periods of unconsciousness, coma, or death.  There are many other symptoms that can be caused by concussions, such as constant or recurring headaches, motor dysfunction, depression, loss of the ability to hear, taste or see, dizziness, sensitivity to light or sound, cognitive dysfunction such as difficulty with staying focused or understanding information, disorientation and confusion.  The most severe symptom of concussions is death.

  The American Association of Neurological Surgeons states that, “Although sports injuries rarely contribute to fatalities, the leading cause of death from sports-related injuries is traumatic brain injury.” (AANS, “Sports-related Head Injury”).  The effects of concussions can also lead to substance abuse and suicide.  Concussions are a form of traumatic brain injury caused by a severe blow to the head that cause numerous serious and life-altering effects.   Repetitive concussions can lead to the development of diseases such as Alzheimer’s disease, Parkinson’s disease, and chronic traumatic encephalopathy (CTE).  Repetitive concussions can cause Alzheimer’s disease by damaging the white matter in the brain (which contains axons, which are extensions of neurons.  Many of these axons are surrounded by a covering called myelin sheath.

  Myelin protects nerve fibers from injury and improves the speed and transmission of electrical nerve signals) which causes damage and swelling to axons.  Damage to the axons impairs neural transmission and results in the abnormal production of toxic proteins.  These toxic proteins accumulate in the brain tissue as plaque, mostly in cortical regions of the brain, which are responsible for memory and learning.  Another disease that concussions can cause is Parkinson’s disease.  Repetitive concussions cause damage to and degeneration of dopaminergic neurons, which leads to losses of dopamine (the “reward chemical”).

  Repetitive concussions can also cause the production of ?-synuclein Lewy bodies in the surviving dopamine neurons, as well as inflammation and mitochondrial dysfunction.  An increase in the ?-synuclein protein in the cerebral cortex and in the cerebellum contributes to neuronal tissue demyelination.  As a result, neural processing is impaired in the cerebral cortex, which covers the cerebellum and the cerebrum.  The cerebellum controls movement, coordination, and balance by processing data through neurons and relaying information between the areas of the cerebral cortex involved in motor control and the body’s muscles.

  The cerebrum is involved in understanding and producing language.  Also, most information processing occurs in the cerebral cortex.  In addition, chronic traumatic encephalopathy (CTE) is a progressive degenerative disease caused by repeated concussions that usually begins showing symptoms later in life.  Chronic traumatic encephalopathy can cause cognitive disorders such as memory disturbance, learning disabilities, and other disturbances in higher brain function; mental disorders such as irritability, apathy, depression, and suicide attempts; and behavioral disorders such as impulse control disorders and violent behavior.

  As the disease progresses, abnormalities such as dysarthria, balance disability, and extrapyramidal disorder start to appear.  In the advanced stage of the disease, patients start to exhibit brain atrophy in the basal ganglia, parietal and frontal lobes, and mammillary bodies (which are involved with the limbic system).  Symptoms begin to appear around the ages of 30 to 50 years old.  Chronic traumatic encephalopathy diagnosis is difficult since symptoms can mimic other diseases such as Alzheimer’s disease and Parkinson’s disease.

  There are three stages of this disease.  The first stage typically features symptoms such as depression, irritability, and aggression.  During the second stage, memory loss, erratic behavior, social instability, and early signs of Parkinson’s disease appear.  Worsening dementia and severely impaired motor control characterize the third stage.  Repetitive concussions can also cause second impact syndrome, which is a rare condition that results in rapid and severe brain swelling caused by receiving a second concussion before a first concussion has completely healed.  The second concussion does not have to be severe and can occur within a matter of days or weeks.  Also, if the athlete is not removed from the game after receiving the first concussion, second impact syndrome can occur in the same game.  Usually, symptoms, such as unconsciousness, respiratory failure, etc.

, begin immediately after the second impact and progress rapidly.  Most of the time, second impact syndrome is fatal, and death usually occurs minutes after the second impact.  The effects of repetitive concussions can cause neurological diseases such as Alzheimer’s disease, Parkinson’s disease, chronic traumatic encephalopathy, as well as the injury second impact syndrome. Evaluation of a traumatic brain injury is different than an evaluation of other sports injuries.  When an athlete is suspected of having a concussion, members of the sports medicine team conduct a psychological rather than physical evaluation.  This assessment includes a list of symptoms given by the athlete and an attention assessment, such as asking the athlete to recite the months of the year backwards.

  It also includes an assessment of short-term memory in which  the athlete is asked questions about the event, opponent, and play in which the injury occurred.  Furthermore, the athlete is asked questions such as their name, birth date, etc. to assess long term memory.  In addition, the Pocket Concussion Recognition Tool, the Sport Concussion Assessment Tool, and the ImPACT test are check lists of symptoms of concussions used by medical personnel to determine if an athlete has a concussion.  These tests should be compared to the athlete’s baseline neurocognitive tests, which the athlete should have completed prior to sports participation.  A baseline neurocognitive test is a computerized test taken before injury to show the function of an athlete’s brain in normal, everyday conditions.  After an athlete has received a concussion, they should not be allowed to return to sporting activities until their symptoms have completely resolved.

  In addition, the athlete should be monitored continuously for about several hours after receiving the concussion.  It is encouraged that a head computed tomography (CT) scan or magnetic resonance imaging (MRI) be performed on the athlete to examine if organic lesions have developed.  Also, the brain may not be completely healed even if symptoms are no longer present, and determining if the brain has fully healed from a concussion is difficult.  Recently, physical examinations have begun to be incorporated into concussion evaluations.  These include the assessment of cranial nerves, pupillary reactivity, and visual acuity.  Reflexes, proprioception, posture, and balance should also be assessed.

  The head, facial bones, and cervical spine should be palpated for trauma or tenderness.  In addition, the range of motion of the neck is evaluated actively and passively in extension, flexion, and rotation.  Pulse and blood pressures are also assessed to evaluate intracranial pressure which might be increased due to a brain hemorrhage.  A cervical spine injury should be suspected if the athlete loses consciousness.  Most concussion assessments are mostly psychological, although recently, physical assessments have begun to be added to the assessment of concussions. There are several forms of treatment for recovering from a concussion.  The most important treatment for a concussion is rest.  Activities that can make symptoms worse, such as sports, physical activities, and activities that require mental concentration, such as watching TV, reading, etc.

should be avoided.  A gradual return to activities that require mental concentration may be made as symptoms improve.  Tylenol may be taken for headaches, however, pain relievers including Advil and aspirin should not be taken as they can increase the risk of bleeding.  A medication known as Sertraline has been shown to reduce depression and improve memory and cognitive efficiency in athlete’s suffering from a concussion.  In addition, a doctor’s approval is needed before light physical activity is resumed.  Some research has shown that, after receiving medical clearance, light, non-contact aerobic exercise may aid in the recovery from a concussion.

  Exercise causes a decrease in oxidative stress, which can cause impaired brain cell function and cell death.  It can reduce cognitive dysfunction, neuroinflammation, and depression.  Exercise can also increase the production of brain chemicals that promote neurogenesis and neuroplasticity.  An athlete may only return to play after they have been cleared by a doctor, and this must be done in a gradual manner.  Recovery from a concussion may last as long as a few days, weeks, months, or an athlete may never fully recover from a concussion.  Social support from family and friends is important in psychological and emotional recovery.

  Also, psychotherapy may be beneficial to an athlete’s psychological recovery.  Treatment of concussions includes avoiding activities that can make symptoms worse, medications, a doctor’s clearance for physical activity, light aerobic exercise, social support, and most importantly, rest. Concussions, a type of traumatic brain injury, are a serious type of sports related-head injury that can damage the brain and impair neurological, psychological, and emotional problems both short term and long term.  Severe concussions can also cause death.

  Repetitive concussions can lead to the development of neurological diseases including chronic traumatic encephalopathy (CTE), Parkinson’s disease, and Alzheimer’s disease and an injury known as second impact syndrome.  Concussions are caused by a blow to the head which can cause bruising and bleeding in the brain tissue.  Also, repetitive blows to the head can damage the myelin sheath and axons of neurons, impairing their function and causing an abnormal production of proteins that damages parts of the brain such as the cerebral cortex, which includes the cerebellum and the cerebrum.  Another effect of repetitive concussions is the atrophy of the basal ganglia, parietal and frontal lobes, and mammillary bodies of the brain.  Evaluation of concussions includes a list of symptoms given by the athlete, an assessment of short-term memory, long term memory, and an attention assessment.  Also, check lists of symptoms of concussions are used by medical personnel to determine if an athlete has a concussion.

  Recently, physical examinations have begun to be incorporated into concussion evaluations, which include an assessment of reflexes, cervical range of motion, proprioception, visual acuity, posture, and balance.  Avoiding activities that can make symptoms worse, medications, light aerobic exercise, social support, and rest are types of treatments for concussions.  An athlete must receive permission from a doctor before returning to play, and must make a gradual return to physical activity and sports.

  Some research has shown that, after receiving medical clearance, light, non-contact aerobic exercise may aid in the recovery from a concussion.  Concussions can impair mental function and even cause death, and both the athlete and medical personnel must be very careful during the recovery process to prevent further brain damage and the development of neurological diseases later in life.