In recent years the stories and information regarding sports-related concussions and their aftermath have become a hot topic in the media, even rising to the level of an “epidemic” in some articles.
Given the significantly large number of children and adolescents involved in recreational and competitive sports and the visibility of college and professional sport athletes, sports-related concussions are an experience that touches athletes, families/parents, coaches and teams.
Sports-related concussions are estimated by the Centers for Disease Control to occur to as many as 3.8 million athletes. The real number is really not known due to lack of knowledge of symptoms for identification and under-reporting/minimizing by athletes in order to continue participation.
A concussion (or mild traumatic brain injury) is a complex pathophysiological process affecting the brain and is induced by traumatic biomechanical forces secondary to direct or indirect forces to the head. It is typically not a brain structure injury, but rather a neurometabolic dysfunction, and may or may not involve a loss of consciousness. Symptoms can emerge in the physical, cognitive and emotional modalities.
While most recover completely, some individuals will have persistent symptoms. Some of the symptoms, such as headache and fatigue, impact academic and social functioning. Cognitive symptoms, typically involving slowed processing, attention and concentration problems and memory issues can have an impact on school or work.
Concussed athletes may be unable to attend school for a period of time and when they return they may require reduction in the work load, work pace and perhaps modification of the school day. This can lead to significant stress regarding their academic success and future academic goals. For example, students who are in the middle of applying for college or preparing for college entrance exams may be concerned that their plans will be derailed.
Emotional symptoms are generally tertiary to physical and cognitive symptoms, but nonetheless important aspects of an athlete’s adjustment and recovery. Athletes often experience mood issues, increased irritability and anxiety. For some athletes, the injury experience and recovery process create significant disruption in social networks and schedules. They feel isolated and stressed.
The injury symptoms and the recovery process often have an impact on the athlete’s family and friends. Unlike physical injuries which have observable signs (e.g., a cast, crutches), the symptoms associated with a concussion are not accompanied by physical markers. This can sometimes cause confusion on the part of teachers, parents and friends who may have a difficult time understanding the subjective experience of the concussed athlete.
While neuropsychologists have been involved in the evaluation, management and treatment of traumatic brain injury for decades, the emerging area of “Sports Neuropsychology” (see books by Echemendia and Webbe) provides an opportunity for psychologists to focus their skills on this sports population.
There is considerable work being done by psychologists obtaining baseline assessments of athletes to better identify and manage the sequela of concussions. Clinical and sport psychologists have long been involved in helping athletes deal with injury and recovery issues that impact not only performance, but also adjustment.
Sports-related concussions provide excellent opportunities for psychologists to use their skills to support medical providers dealing with behavioral and emotional symptoms, provide input to schools and school counselors regarding accommodations if needed, help athletes with the transition back to pre-concussion schedules and address the parental or family issues that often arise within the context of these injuries.
Psychologists can provide the concussed athlete with support during recovery as they may be able to help track improvement (in cognitive, physical or emotional symptoms) and help them deal with the sense of vulnerability and worry from being injured and “not like themselves.”
Further, psychologists can provide support for the general impatience with recovery that occurs and the concern over future performance levels. Athletes with a history of multiple concussions (and other risk factors) and persistent symptoms often experience longer, more distressing recovery times and may even face a discussion (with medical and psychological providers) regarding removal from participation for the season or longer or retirement from the sport.
Sensitivity to the meaning of the sport and sport involvement to the athlete, attention to family dynamics and issues and general skills in helping individuals cope with the emotional and behavioral aspects of stressful events, make psychologists well-suited for work with the aftermath of sports-related concussions.
David B. Coppel, Ph.D., is director of neuropsychological services and research for the Seattle Sports Concussion Program at Harborview Medical Center and Seattle Children’s Hospital at the University of Washington. His email is: firstname.lastname@example.org
David Breiger, Ph.D., is director of the neuropsychological consultation service for Seattle Children’s Hospital and the Seattle Sports Concussion Program and a member of the University of Washington faculty. He may be reached by email at: email@example.com