Posted tagged ‘traumatic brain injury’

The best helmet to prevent football concussions is….

November 17, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Marshall wrote in: “My son has just had his 6th concussion this season in football. What’s the best helmet to use? I want to keep him safe.”

Marshall, football helmets are there to protect the scalp and the cranium—the bones outside of the brain. They prevent scalp lacerations (cuts), and probably prevent skull fractures. But helmets do not protect the actual brain. There is no helmet, and has never been a helmet, and never will be a helmet, that actually prevents brain injury from concussions.

Concussions aren’t caused by the head hitting another head, or a head hitting a wall. They occur inside the skull, when the brain slams into the inside of the cranium during a rapid deceleration. The brain is a soft, squishy, and very important organ suspended in essentially a bowl of water. If you drop that bowl off of your roof, say, the bowl might shatter on the ground (like a skull fracturing). But even if the bowl doesn’t break, the brain suspended in the water will suddenly go from moving very fast to not moving at all as it slams against the side of the bowl. That causes brain damage, and that’s what a concussion is. It’s not a broken bowl. It is a broken brain.

We diagnose a concussion if there’s been a blow to the head immediately followed by a period of altered brain functioning—dizziness, headache, foggy thinking or disrupted memory, or sometimes a loss in consciousness. Most concussion do not knock the athlete out—the immediate symptoms are more subtle. Even without unconsciousness, any concussion means that there has been brain damage. The damage is on the cellular level—you can’t see it on a CT scan or MRI, and those tests are not helpful and not needed after an ordinary concussion unless there’s a suspicion of a skull fracture or other problems.

The brain damage from a concussion will often heal, with appropriate rest and rehab; but repeated concussions or concussions with little time for recovery will lead to permanent brain damage. With more concussions Marshall’s son will develop lifelong problems with depression, fuzzy or easily-distracted thinking, movement disorders, and a genuine, marked drop in IQ. Good sleep and normal mood regulation can become impossible. These symptoms are, by and large, untreatable.

Marshall, your son will probably need his brain to work well as he grows older. If you’re serious about protecting his brain and mental abilities, he doesn’t need a new helmet. He needs to quit football.

Related posts:

Football and your child’s brain

Protecting your child from concussions

Football and your child’s brain

May 20, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Eat your vegetables. Be good to your momma. Change your underwear.

Good, solid advice. Maybe we need to add: “Don’t damage your brain. You’re going to need it someday.”

More and more evidence is accumulating that football, or at least football as it’s currently being played in high schools and colleges, is causing irreversible brain damage. The latest study was published in JAMA this week. Researchers looked at 25 collegiate football players (who had played in high school), and compared both brain imaging and cognitive performance with students who hadn’t played college. They correlated their findings with the number of years of football experience, and the number of recalled concussions.

Bottom line: concussions correlate with a loss of brain volume in the hippocampus, an area of the brain involved with memory recall and the regulation of emotions. Not only were concussions correlated, but  the number of years playing football also correlated with this change in MRI scans and with deficits in cognitive testing, including tests of reaction time and impulsivity.

The study itself wasn’t large, and relied only on the students’ recall of concussions. And it does not establish causality—maybe people with smaller hippocampi are more attracted to football, or tend to have more concussions (though no other research suggests this). Still, studies like this add to the considerable evidence that the kind of high-impact head trauma that occurs during football is causing real damage to real brains.

What can we do about it? There are steps individual families can make to protect their own children, especially by recognizing and treating concussions when they occur. Beyond that, we’ll have to see if coaches, athletes, and families are willing to risk brain damage to continue traditional football programs. Are the benefits worth the risk? It’s time to talk about it.

Protecting your child from concussions

November 7, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

A concussion is a brain injury resulting from a blow to the head. Not the kind of injury you can see on a CT scan or MRI—there’s no broken bones and no squashed or visibly damaged brain. But nonetheless, the brain is damaged. Symptoms tell you immediately after a concussion that the brain has been affected. Sometimes, a person is knocked out cold, but a concussion can occur without unconsciousness. Milder symptoms can include disorientation, confusion, and problems with memory and balance. With time and rest, these symptoms will usually improve, especially after a first concussion.

But sometimes concussions can cause real, lasting brain damage. After a concussion, athletes (both professional and student) can suffer from poor attention, headaches, memory problems, and depression—symptoms that may or may not get better with time. Unfortunately, young athletes may be more at-risk than the pros. Young brains are still developing, and are more likely to be injured. There’s also some genetic variability—some people are more resilient than others to the effects of concussions. Repeated concussions can be dangerous to anyone, and a “second hit” after a concussion that hasn’t completely healed can be deadly.

As I tell the teenagers: “Protect your brain. You may need to use it later.”

What can parents and coaches do to help keep their kids safe?

  • Provide good training so young athletes know how to play safely. Support coaches who teach student athletes well, and take potential brain injuries seriously.
  • Make sure that athletes have good protective equipment, including helmets and mouth guards. These don’t prevent all (or even most) concussions, but using them consistently and correctly is still important.
  • School systems should have mandatory, science-based concussion management systems, developed in accordance with national guidelines.
  • Officials and referees need to call fouls, and discontinue play when it’s dangerous. Players who put themselves or others at risk should be sent off the field without hesitation.
  • Coaches on the sidelines need to look for even subtle signs of concussion in their players, and pull them out of the game if there are any signs at all. When in doubt, players should sit out.
  • Players themselves need to know that they should never tough it out—any “dinger” needs to be reported, even if that means they’ll be pulled from the game. Brains are far more important than scores.
  • If your child does have a concussion, be sure to follow the guidance of his physician. A gradual return to sports should begin once symptoms have improved. It’s not necessary — and may be a bad idea — to wait until all signs and symptoms of concussion have resolved. If symptoms worsen with activity, back off again.
  • If your child has had more than one concussion, or a concussion with prolonged symptoms, consider working with a neurologist to ensure that there’s no lasting damage.


Updated 2/5/2017