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Leading Medicine Magazine, Vol 7, No 1 - 2013

These decisions — by players , coaches and even sideline physicians — were partly rooted in the culture of sports . Players are conditioned to make light of in jury , playing through pain and not letting teammates down . Schaub suffered a concussion in a 2007 game against the San Diego Chargers. Initially, says Schaub, he contested the decision to remove him from the game. “I wanted to be back out there with my team and play through it. But the doctors and coaches felt it wasn’t a smart decision, given my symptoms and the tests that they did.” Ultimately, Schaub would sit out the following week’s game, returning to play only when cleared to do so by the team’s doctors. “We had to be smart to make sure that all of the symptoms were clear before going out there,” explains Schaub. “I wanted to be out there, but ultimately it was the smart decision.” UNDERSTANDING CONCUSSION Concussion is often described as a “mild traumatic brain injury,” or MTBI. Dr. Howard Derman, a neurologist and co-director of the Methodist Concussion Center and associate professor of neurology at Weill Cornell Medical College, uses a simple analogy — a rubber ball in a cardboard box — to describe the basic mechanism of an impact concussion. “The brain sits in a vault of bone, covered by bone on all sides,” explains Derman, a team neurologist for Rodeo Houston. “The brain would be a rubber ball, and the cardboard box is like the skull. When the brain suffers a concussion, different parts of the brain hit up against the skull — just like different parts of the rubber ball hit up against the box.” Concussion can be caused by direct impact to the head, by an impact to or sudden movement of the body — as in an automobile accident, when the brain’s contact with the skull is actually the result of the body’s violent motion — or even through an abrupt rotation of the head. “If you twist the brain fast enough and in a certain number of degrees,” explains Podell, “that causes a significant strain on certain parts of the brain — and that itself can induce a concussion.” The symptoms of concussion can vary a great deal, depending on the mechanism and severity of the initial injury. In general, however, concussion produces symptoms categorized into four basic groups. Physiological symptoms can include headache, sensitivity to light (photophobia), sensitivity to sound, dizziness and balance problems. Concussion can also cause emotional symptoms, such as feeling irritable, sad, depressed or anxious. Sleep can be disrupted, with some concussion sufferers sleeping too much, and others sleeping too little. Unusual fatigue is another symptom. And cognitive difficulties are another hallmark of the injury, with concussed individuals often feeling “slow” or having difficulty concentrating or remembering. The exact way in which concussion causes these symptoms isn’t completely understood, though the nature of the impact is thought to play a role. “Different parts of the brain do different things,” explains Derman. “The back of the brain is responsible for vision, the front of the brain is responsible for memory, the sides of the brain are responsible for balance. So depending on which parts of the brain suffer the biggest insult would sort of dictate what symptoms the patient has.” CONCUSSION TREATMENT Schaub’s week off the playing field after his 2007 concussion is a good example of the accepted treatment for concussion injury. “‘Rest is best’ is still the motto,” says Podell, a team neuropsychologist for Rodeo Houston. Dr. Scott Rand, a primary care sports medicine specialist at Methodist Willowbrook Hospital and a physician for numerous high school and college programs in the Houston area, succinctly describes the importance of postconcussion rest. “The phrase I use for the parents and the athletes is that things that push more blood to the brain — like exercise — or things that require more blood in the brain — like homework, texting, video games, Batman movies, and arguing with your girlfriend — all cause your brain to require more blood and can make you symptomatic longer,” he says. Waiting until concussion symptoms have completely resolved before resuming activity is of primary importance. “The biggest concern with concussion today is truly not necessarily with the concussion that we’re dealing with, but with sure indication that the patient recovers completely before he or she could have a second concussion,” explains Derman. “We feel that if we can let the brain recover completely, the likelihood of their having longterm complications is much less.” A RETROSPECTIVE SURVEY IN 2005 FOUND THAT 88% OF CONCUSSIONS GO UNRECOGNIZED. 22 methodisthealth.com/leadingmedicine


Leading Medicine Magazine, Vol 7, No 1 - 2013
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