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“Sports-Related Brain Injuries: Is it Safe to Play?”

June 7, 2016
Monday evening concluded the Brain Health track with a very engaging session titled “Sports-Related Brain Injuries: Is it Safe to Play?” It was the perfect complement to Tuesday morning’s keynote with Dr. Omalu Bennet, who discovered Chronic Traumatic Encephalopathy (CTE).

Panelists included Carlin Senter, M.D., Assistant Professor, Internal Medicine and Orthopedics at University of California in San Francisco, David Camarillo, Assistant Professor, Bioengineering and Mechanical Engineering by courtesy, at Stanford University, Rebecca Ruiz, Features Writer for Mashable, and Alan Gilbert, Director, Global Government and NGO Strategy, GE Ventures.

Johnson & Johnson Innovation’s Jeff Calcagno, MD, moderated the session and kicked it off by surveying the crowd on how many had experienced a sports-related injury. He was surprised to see a fairly large number of hands go up.

Ruiz shared her own experience with a sports-related injury. “As a former competitive athlete and a journalist, I don’t think we hear enough from people who have gone through that experience”, she said.

She experienced a concussion in 1998 as a player for Seattle University’s Soccer team; a taller player had fallen behind her, and their bodies collided causing her chin to hit the grass. As soon as she stood up, she saw black spots and experienced what she referred to as “a feeling outside time and space.” She said, “As an athlete you know what it’s like to have complete control of your body and your movements, and how to follow your instincts, and that was absent…”

Ruiz was told at the time that her brain was bruised, which she later found was incorrect terminology. What frustrated her most was that science did not know much about concussions at the time. The emotional consequences and mood disorders that can accompany concussions had not yet been discussed. As a result, she believed she was physically fine but felt somewhat like an imposter without that vibrant hum in her brain.

She spoke about how athletes identify themselves and the pressure they feel to prove themselves, and how this can cause them to continue playing when they shouldn’t.  She believes that one form of prevention can be in empowering athletes to ask themselves if a risky move for victory is worth the injury.

Senter defined a concussion as a subset of the larger umbrella ‘mild traumatic brain injuries’. It is a change in neurological function after a blow to the neck, head or body. Symptoms typically occur within 24 hours of the blow and can include a feeling of fogginess, headaches, disorientation, cognitive issues, sleep issues, depression and sadness. They can last anywhere between 7 days and 3 weeks. Beyond that (anywhere between 6 weeks and 3 months beyond) it is referred to as Post-Concussion Syndrome. Senter also touched on the relationship between concussions and mood disorders. Concussion can unmask certain disorders and make them worse; it is unclear whether the concussion causes the disorder or merely reveals it.

Camarillo explained what happens to the brain during a concussion. He drew a verbal picture of the brain fitting tightly into the cranial vault surrounded by spinal fluid. A concussion causes the brain to twist within the fluid, thereby stretching out certain axons in fibrous tissue, causing the trauma. He surprised the crowd by announcing that bicycling is the leading cause of sports-related injuries, contrary to popular belief that football is the leading cause.

The conversation then shifted to talk about diagnosing concussions. As of now, CTE can only be diagnosed during an autopsy and unfortunately there is no one uniform protocol that trainers, practitioners and medical facilities use to diagnose concussions. Ideally, medically trained individuals would be available courtside to make the diagnosis; data has shown that identifying a concussion within the first two hours goes a long way in successfully treating it. The holy grail of diagnoses would be a blood test.

Gilbert talked about some of the initiatives that GE Ventures is taking towards finding and funding technological innovations to better and more accurately diagnose concussions. Efforts towards prevention of concussions include renovating the design of helmets (which currently do nothing to protect against them), and adding material to AstroTurf and playing fields to mitigate impacts. Studies are also being made with sensors in the hopes of one day being able to collect real time data on the field.

Panelists then discussed the question the audience came to hear answered: “When is it safe to play?” There is a three pronged evaluation that is used to determine when it is safe to play. They monitor symptoms, cognitive and neurological functions and balance. All three of these aspects must return to normal before it is safe to play.

There is not much that can be done to treat a concussion. Ruiz was simply told to hang in there; however, being made aware that her depression and inability to play was normal alleviated a lot of her angst surrounding the issue.

Overall, the panelists seemed optimistic about the future of diagnosing, treating and preventing concussions. After all, it has only been a decade that we have been able to look inside a brain, and the field of brain health has come a long way since then.