Returning to "Athlete" after Concussion

In Neurobiology, we are currently learning about acquired brain injuries, or ABIs. Acquired brain injuries are damages to the brain that were not present at birth and can further be divided into traumatic brain injuries and non-traumatic brain injuries. For this assignment, I wanted to focus on the traumatic brain injury (TBI) side of an ABI, specifically concussions. Being a former collegiate soccer player, I have experienced my fair share of blows to the head. My position was defender, which meant that at every practice I would have to practice heading the ball away for a significant amount of time. "Heading" is basically knocking a ball away from your body with your head. To practice this, my coach would kick balls high up into the air, and I would have to head it far up and away from myself. We are taught "safe" ways to do this, with instructions including "don't let the ball meet you, you have to meet the ball" and "hit the ball with your forehead, not the top of your head". While these instructions worked most of the time, there were some instances where I would not be completely focused or I'd be tired from the drills before practicing heading, which put me at a high risk for developing a concussion. 

I actually suffered a concussion as a result of these training drills. My coach had punted the ball far up into the air and instructed me to head the ball to the right. I was so focused on trying to figure out if the coach meant my right or her right (lol) that I was too distracted and just let the ball hit the top of my head. That might not sound bad, but the force of that ball felt like a ton of bricks. I remember stumbling a bit, experiencing extreme dizziness and nausea, and being very disoriented after. I attempted to play it off that I was just tired from the heat, and chose to "walk it off". At the time, my team was in the midst of preparing for an important game, so I chose not to tell anyone in fear of being forced to sit the game out. The next couple of days were miserable. I had constant headaches, lights were so bright that I was constantly squinting, and I found myself extremely irritable and subject to intense mood swings. I still chose not to tell anyone, and found myself in a starting position the morning of gameday. 

The game was played in a torrential downpour. The field condition was so bad that even if I kicked the ball as hard as I could, it only traveled 5 ft. In addition to the ball not being able to travel far, the ball also felt even heavier when I had to head it. I played the entire game with my concussion, but I remember barely any of it. After the game, I told my trainer that I thought that I had a concussion from a practice a couple of days prior. I remember her being extremely upset with me and her telling me about the seriousness of Second Impact Syndrome and how I could have died as a result of my stupidity. I wish that I had known then what I know now. If so, I would have told my trainer about my concussion the moment after it happened.

Following this incidence, I have always been extremely interested in concussions in athletes. This interest led me to watch a Ted Talk by Jaclyn Stephens, titled "Returning to "Athlete" after Concussion". This Ted Talk was made even better when I discovered that Jaclyn is an occupational therapist! In this Ted Talk, Jaclyn discusses how everyone has their own roles, or occupations, in life. She then further explains that for an athlete, they believe that their sole role in life is "athlete". When an injury occurs and an athlete is forced to sit out of practice or games, to them it feels as if they no longer have an identity. Being an athlete is how they find purpose and meaning each day, and to have that suddenly taken away can feel like the end of the world. Because of this, an athlete is more likely to lie about their injury or underplay it so that they can continue to perform their occupation. 

Jaclyn further goes into detail about concussion protocols for collegiate athletes. Often when an athlete experiences a concussion, they have to go through Return-to-play Evaluation Tests. This evaluation includes self-reported symptoms, cognitive tests, and motor skill tests. Jaclyn explains how little these tests actually do to determine if an athlete is actually safe to return to playing. Often times an athlete will lie during the self-report so that they can ensure a quicker return, and the motor skill and cognitive testing is not challenging enough for a high performance athlete. As a result, athletes are sent back into practices and games too early, where they are 3x more likely to sustain another injury, especially another concussion. After discovering this, Jaclyn was determined to come up with a safer and more effective test to determine when it is actually safe for an athlete to return to play.

Jaclyn came up with the Reduction in Automaticity Hypothesis. To test this hypothesis, she had both athletes with and without a concussion. She hooked each of them up to an EEG cap and tested their reaction times as they pressed a button when they heard a certain sound. From this test, she discovered that athletes who had a concussion had a significantly slower reaction time than athletes who did not have a concussion. Surprisingly, all of the athletes that she used for the test who had a concussion/slow reaction time had already been cleared by their trainer to return to play. 

Based upon her discovery, she then moved on to propose her Insufficient Challenge Hypothesis. She hypothesized that if the concussion tests that trainers used were actually challenging, rather than having the athlete stand on one leg for 30 seconds, they would be able to more accurately determine when it is safe for an athlete to return to practice. She proposed the idea of using virtual reality to test concussed athletes. In this virtual reality, the athletes would be placed in an environment that mimics real-time practice and game situations. This virtual reality would be able to test balance, scanning, reaction times, and much more without the possibility of the athlete getting hurt. She showed an example of what the virtual reality would look like, and from my own experience with a concussion, I know I would not have passed. 

If Jaclyn's proposal were to actually be put into effect in sports programs across the nation, I believe that there would be a significant decrease in the number of athletes who sustain further injuries/concussions. With this technology, athletes might not be able to return to play as quickly as they'd like to, but they'd be able to return healthy and able to perform more optimally. 

I found this Ted Talk extremely interesting and I suggest that anyone who is interested in concussions in athletes go and watch! 

https://youtu.be/i4Q-x29NbP4