Two Excellent Researchers Discussion Concussions

10 Sep

If you get the chance you should take the time to read the research that has been done by David Hovda, PhD and Kevin Guskiewicz, PhD, ATC; not only is it good information but it has been some of the leading information.  These two gentleman do a great job of explaining the issues and making them more tangible for everyone.

On September 6th, both Hovda and Guskiewicz had a real-time chat about concussions on ScienceLive;

ScienceLive, Science magazine’s weekly web discussions with experts in various fields, will examine the issue of sports- and combat-related head injuries during a web chat at 3 p.m. Eastern today. Guests include Kevin Guskiewicz of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at The University of North Carolina at Chapel Hill and David Allen Hovda, the Director of the UCLA Brain Injury Research Center.

You can click the link above to go and read the replay of the chat, a must for those looking for information and would be a good idea if you have kids playing sports now.  Below are selected comments from the chat;

Comment From Jill  Are the signs and symptoms the same regardless of the location of the “hit” i.e. falling and hitting the back of the head (hockey) or the front or side of the head (football)?

Kevin Guskiewicz:  Because the brain most often rebounds off the under-surface of the skull when impacted, different regions of the brain are disrupted, so there is no relationship to the impact location and the location of pathology or s/s.

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Comment From Nebulosa  Can you speak (write) about any recent progress in treatment?

David A. Hovda, PhD:  The number of proposed treatments, has expanded over years as the recognition of problems associated with concussion has become more poppluar. About 80% of indviduals recover spontaneously from a concussion in less than 14 days. This is, of couse, as long as they are kept away from additionll head contact. In about 15-20% of people the post concussive symptioms last for a long time and we do not know the reason. People have tried increases in exposure to oxygen, drugs that stimulate the brain and different forms of exercise. At this time we do not have hard data to support these. We know that diet and exercise increases chemicals in the brain that help it to recover and regoranize after injury.

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Comment From Greg W  Any thoughts on why there can be such a long time lag between time of injury and neurological problems that develop later in life?

David A. Hovda, PhD:  In many cases the neurological signs and symptoms of concussion begin immediately. However, the state that an indivual is in during the event impacts what they feell and or recognize as a problem. For example in the middle of a game an athelete may be so dedicated that they ignor their symptoms. When asked, athelets and miltary personal do not tell the truth. After several days (and perhaps weeks) people who have sustained concussion may discover new symptoms as their beging to challange their brain to do things other than what they were doing on the field of play or in the battle field. This is a normal response and reflects how differenct areas of the brain are used for different functions.

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Comment From Anonymous  Are there statistics showing the percentage of retired football players that suffer from depression, mood disorders, memory decline, and other s/s associated with recurrent mTBI?

Kevin Guskiewicz:  Our 2007 UNC study of ~2,600 retired NFL players (50 yrs and older) found that 21% of those with 3+ concussions during playing career had been diagnosed with depression, compared to only ~7% of those without a concussion history. So this represented about a 3-fold increase. we also found a 5-fold risk of mild cognitive impairment in the same group.
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6 Responses to “Two Excellent Researchers Discussion Concussions”

  1. A Concerned Mom September 10, 2012 at 08:23 #

    I thought it was a great chat. I wish Hovda would have expanded on his comment regarding the recovery rate for concussion though. When he said 80% recover in less than 14 days, I’m not sure if that statistic only holds for adults, or if it is intended to also apply to children and teens. Based on comments from other experts, I was under the impression that recoveries tended to take longer in younger athletes (that their normal recovery range would be longer than that for an adults).

    One question I’ve had about any research which asks athletes about the number of concussions they’ve sustained in the past, is that the number may not be accurate for a variety of reasons. Athletes may not remember every injury, plus our definition of concussion seems to have changed with time. With increased knowledge, it would seem that athletes would now end up reporting more concussions, but that doesn’t necessarily mean they’re sustaining more injuries than athletes did in the past.

    • Dustin Fink September 11, 2012 at 06:56 #

      In my experience the rate of recovery for HS aged kids is roughly this number by Hovda, the only caveat being WITH PROPER MANAGEMENT, meaning time off from school, out of activity, etc… In fact our recovery time for kids at our school are:

      Kids that don’t come to school x 3 days (or until symptom free) after concussion, then 1/2 day, then graded return to play = 12.3 days
      Kids that come to school after concussion then graded RTP when symptom free = 28.9 days

      You be the judge…

      • A Concerned Mom September 11, 2012 at 09:16 #

        Okay, So the kids who take time off from school come back on average in 12 days, while those who don’t take time off come back in 29 days. That seems to be very convincing evidence for taking some time off along with 1/2 days. (Although I will note that the feedback I got on my son was that for the under 10 age group, the standard recovery period could be longer than 14 days.)

        Based on your observations, do the kids who don’t take any time off tend to appear to have more mild symptoms immediately after injury?

        Thanks!

  2. elder September 11, 2012 at 20:09 #

    I disagree wholeheartedly. The brain does not heal fully, it remodels and compensates, even
    after one concussion. The scientists I have spoken with now say you need up to
    one full year of rest at least and still the body as a whole is altered physiologically.

    • Recovery vs functional recovery…

      A Preliminary Investigation of Active and Retired NFL Players’ Knowledge of Concussions (D. Brady (2004)

      Dissertation excerpt…

      Discussion, Conclusions, and Recommendations

      The preponderance of credible experimental and clinical evidence pertaining to the adverse effects of concussion indicates that the brain is injured as the result of a concussion. The adverse and destructive consequences of a concussion may follow a continuum from subtle to grossly overt. Altered cell functioning and cell death along with subtle to more visible neurological, neurocognitive, psychological, and other medical problems reflect a diverse range of lifelong negative consequences of a concussion. Symptomatic concussions may also create a fertile environment for the Second Impact Syndrome and possible death of the concussed athlete.

      Since a concussion results in brain injury, the term functional recovery–rather than recovery–should be employed when discussing an athlete’s “recovery” from a concussion. The term recovery implies full recovery of the brain from the sustained injury with no residual effects. Functional recovery implies partial and sufficient recovery of the brain to resume various daily life activities. Gronwall (1991) pointed out that typical postconcussion test scores should not be viewed as a return to a typical and pre-concussion level of functioning. It is possible that the concussed person expended an unusually higher amount of energy to achieve these scores. Furthermore, the cumulative effect of concussions supports inferential conclusions that the brain sustains further permanent injury when multiple concussions occur. That there have been numerous professional athletes who sustained multiple and, eventually, premature career-ending concussions, provides further support and clinical evidence for the adverse cumulative effect of concussions.

      The Need to Develop More Sensitive and Comprehensive Assessment Techniques
      A growing body of relatively recent literature has documented adverse effects of concussions in animals and humans. Furthermore, boxing-related research originated the concept of “punch drunk,” and eventually concluded that boxing causes traumatic brain injury via the cumulative effect of concussive and subconcussive blows to the head (Martland, 1928; Jordan, 1998; Corsellis, 1989; Charnas & Pyeritz, 1986)…. .

      ….In the same vein, Reitan and Wolfson (2000) expressed concern regarding the validity of many contemporary neurocognitive approaches utilized for evaluating concussions. They particularly noted that: ….

  3. concussion therapy September 13, 2012 at 00:55 #

    I believe that concussion is not something that you could heal in just a short period of time not unless is a very mild one. If the symptoms are already recurring, you need to have an intensive treatment from time to time. But being under a long concussion therapy program does not assure full recovery if the patient is not cooperative enough.

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