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Overview
Multiple Concussion - Brain Damage Risk
Concussion in Athletes
Sports Psychology
Neuropsychological assessment is the most sensitive objective measure of brain damage and provides measurement of ability loss. Following a concussion, the likelihood of brain damage doubles when an individual experiences a second head trauma. Should a third concussion occur, the risk of damage increases eight times.
There are two primary situations in which neuropsychology has a role in the management of sports-related concussion. A player who has suffered a grade II or III concussion should be evaluated neurocognitively for signs of impairment which would indicate incomplete recovery from the concussion. Assessment of this type is vital in preventing "second impact syndrome," a potentially fatal consequence of closely-spaced concussions.
Many athletic teams consult neuropsychologists on a regular basis. Individuals such as the parents of children sustaining head trauma are often quite interested in these assessments. Evaluation assesses not only memory, sustained attention and mental control, but in addition it is a sensitive measure of speed of performance. Establishing a baseline or evaluating an individual prior to a head injury will allow comparison.
Assistance that a neuropsychologist can provide regarding the performance of an athlete includes the visualization of a successful performance, teaching the ability to focus and relax when performing activities. Radiological technology is the diagnostic technique of choice in evaluating head injury. No information is provided, however, regarding mental functioning. Neuropsychological testing provides a standardized measure of an athlete's ability to think and process information. It is beneficial to evaluate an athlete's general status, baseline cognitive ability and speed of processing information to accurately assess an athlete's ability to return to the game following a concussion. Athletic teams are often motivated in developing a policy regarding athletic injuries, particularly when head trauma is involved (concussion). In addition, establishing a baseline measure of their ability can be used as a comparison when concussion occurs and often a profile of performance can predict the severity of impairment should a concussion occur.
Repeated Head Trauma or Concussion
Research indicates that repeated head trauma tends to have a cumulative effect in its' impact on thinking and processing of information. Even a mild concussion leaves the victim somewhat more compromised than if this had been the sole injury (Gronwall, 1989b, 1991; with Wrightson, 1975). Importantly, a single brain trauma doubles the risk for a future head injury and two such injuries raise the risk of brain damage eight-fold (Gaultieri and Cox, 1991). The effect of repeated concussion becomes more obvious in contact sports such as football, ice hockey and boxing. As a matter of fact, one of the main points of boxing is to inflict cumulative blows to the head with the goal of giving the opponent a sufficient concussion to render him unconscious. The most usual presentation of repeated head injury in boxers is the "punch drunk" syndrome, originally called "dementia pugilistica," known medically as chronic progressive encephalopathy of boxers. Gronwall, D., (1989b), Cumulative and persistent effects of concussion in attention and cognition. In H.S. Levin, H.M. Eisenberg and A.L. Benton, editors, Mild Head Injury, New York, Oxford University Press. Gronwall, D., (1991), Minor head injury, Neuropsychology 5, 253-265. Gronwall, D., and Wrightson, B., (1975), Cumulative effect of concussion, The Lancet, II 995-997.