Dr. Neha Raukar is an assistant professor of emergency medicine in the Warren Alpert Medical School, and is director of the Center for Sports Medicine at the University Emergency Medicine Foundation and a physician in the Lifespan Health System. In addition, she co-authored the Institute of Medicine Report on Sports-Related Concussion in Youth and is a consulting physician for Brown University athletics. Find her on Twitter: @AcuteSportsDoc.
PBN: The science of concussions has changed drastically in recent years. What have been the biggest developments?
RAUKAR: While much remains to be elucidated, we certainly have learned that a concussion is not a “nonevent.” Using animal models, intensive neuropsychologic testing, advanced imaging techniques and helmets outfitted with accelerometers, invented in part by Rhode Island’s own J.J. Trey Crisco, we have learned that concussions, and even hits to the head that do not result in a concussion, disrupt the structural and functional integrity of the brain. There are adverse biomechanical and functional changes that occur with these mild but consequential head injuries. Among the short-term effects are headaches, sleep disturbances, and deficits with the oculomotor and balance systems. In a small population of people, these symptoms do not resolve.
PBN: What is the average recovery time for an average sports-related concussion, understanding that each is different, versus the average recommended recovery time 20 years ago?
RAUKAR: Twenty years ago, we had no idea how long it took to recover from a concussion. With crude reporting systems and data collection methods, we have been able to ascertain that, in general, adults take less time to recover than children, women take longer than men, and that there are underlying medical and psychiatric conditions that can prolong recovery from a concussion. The negative effect of cumulative concussions is an area of growing interest. Also, we now know that anyone who sustains a head injury that could be a concussion should never return to play the same day and should be evaluated by a physician who is knowledgeable about concussion treatment and recovery.
PBN: What major changes in the protection of athletes against concussions are you seeing already?
RAUKAR: At this time, the intervention that has led to the most dramatic reduction in concussion rate is rule changes, such as limiting the number of contact practice days, and prompt removal and evaluation of any athlete suspected of sustaining a concussion. Educating coaches, athletes, and parents on the signs and symptoms of concussion helps identify injured athletes and mandatory removal from play helps to prevent the progression of symptoms, and prevents the athlete from being hit in the head while already concussed.
PBN: What improvements have been made in protective gear?
RAUKAR: Unfortunately, clever marketing has outpaced the dissemination of scientific knowledge. Many companies have created products that claim to prevent or reduce the incidence of concussions. Science teaches us, though, that this is not yet possible. The forces that result in a concussion are not mitigated by current helmet, helmet guard, headband, or shield technology. Even helmets that are deemed to be “superior” to others have not been shown to decrease in the incidence of concussions. However, in an effort to keep their kids safe, parents fall prey to this marketing and purchase these products thinking they will make a difference; meanwhile, all too frequently, these products give the athlete a sense of invulnerability that can result in an increase in injuries.
PBN: What major changes in the protection of athletes do you anticipate in the next several years?
RAUKAR: This past January, the Institute of Medicine published a report on concussions in youth sports. In the report, we identified that a significant barrier to concussion prevention and treatment is the culture of head injury among athletes, parents, coaches, and sports in general. Every member of a team and every bystander at a game has a responsibility to protect the athlete, even from themselves. There is no incentive for athletes to report their symptoms after sustaining a head injury. In fact, the current culture is to play through the pain. Real change will occur when athletes can be honest with their teammates, coaches, and parents without fear of consequence.