Historically, research efforts focused primarily on injury prevention, incidence, diagnosis and management in male athletes, but research has begun to shed light on the consequences of concussion and recovery course in female athletes. Studies show that females suffer concussions at a higher rate than male counterparts in gender-equivalent sports, such as basketball and soccer.
After suffering concussions, females experience longer recovery times, ranging from a few days to months. Females also are more likely to require treatments such as vestibular therapy and prescription medication and need academic accommodations during recovery. The old saw of “what is good for the goose is good for the gander” may not apply in the management and care of concussions.
Hormonal differences may contribute to these gender differences. Jeff Bazarian, M.D., M.P.H., at the University of Rochester reported that women injured during the two weeks before their period recovered slower and experienced poorer health one month post-injury compared to women injured during the two weeks after their period or those on birth control pills.
Biomechanical differences may also contribute to gender differences in recovery. Females have weaker neck muscles, smaller head-to-neck ratio and greater angular head acceleration, which may increase vulnerability for injury upon impact to the head.
Sociocultural and environmental differences between males and females may also exist that contribute to differences in concussion recovery. Males may perceive more barriers (e.g., social role expectations) to reporting concussive symptoms, and it may be more socially acceptable for females to vocalize symptoms or pain. Males also may rely more on sport participation to sustain their livelihood.
In addition to sex, pediatric age, history of prior concussion, migraines, learning disability, attentional disorder and anxiety/depression have been identified as risk factors for prolonged recovery following sports-related concussion. The complexity of these preexisting factors calls for specialty evaluation and care post-concussion in which psychologists provide needed assistance.
Psychologists have played key roles in sports for a long time. Sport psychology draws on knowledge from many related fields, including biomechanics, physiology, kinesiology and psychology. It involves how psychological factors affect performance and how participation in sport and exercise affect psychological and physical factors.
Sport psychologists use their know-ledge and skills to address the optimal performance and well-being of athletes.
Another psychology specialty is neuropsychology. A neuropsychologist is a licensed psychologist with expertise in applied science, specializing in how behavior and skills are related to brain structures and systems. When it comes to concussion and recovery, neuropsychologists have three main roles:
*Assessment. The first step in determining why symptoms persist is to review the concussed patient’s background. Is there a history of previous concussions, attentional disorder or learning issues? Is the athlete prone to depression, anxiety or sleep issues? These and other factors may be slowing recovery or masquerading as concussion (e.g., headaches and dizziness caused by cervicogenic issues). In some cases, symptom maintenance may serve as a means to avoid return to play, particularly if the concussed athlete is fearful of re-injury or was yearning to quit the sport prior to injury.
A neuropsychologist can conduct a neuropsychological evaluation to assess memory, attention, reasoning and other cognitive skills. Personality and mood tests can help the neuropsychologist understand if other psychological factors are at play. This evaluation will help identify strengths and impairments and specify abilities most affected by the concussive injury or whether cognitive recovery has occurred.
*Treatment. A neuropsychologist can provide counseling and psychoeducation, teaching patients about common concussion symptoms and normal recovery patterns. Even a single session may stop patients from wrongly attributing normal memory slips or other everyday problems to concussions. When patients develop an abnormal focus on symptoms or other problems and exhibit difficulties adjusting to their injury, cognitive behavioral therapy (CBT) can help. Neuropsychologists may also provide recommendations regarding the return-to-learn process and help identify types of academic adjustments the student-athlete will require during recovery.
For patients with lingering cognitive deficits, neuropsychologists can recommend a rehabilitation program. In this kind of therapy, patients work on exercises and incorporate compensatory strategies to improve areas such as attention, memory, reasoning and other cognitive skills. Sports psychologists can utilize CBT, a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people’s difficulties, and so change the way they feel.
*Consultation. The inclusion of psychologists by professional sport organizations, universities and high schools to assist in return-to-play decisions following sports-related concussion has become commonplace.
In addition to clinical contributions, psychologists may be utilized by sports teams to provide outreach education to the players and their families, establish a player monitoring program, develop clinical protocols or conduct research. Neuropsychologists have led several large-scale studies that have helped shape the assessment and clinical management of concussion in athletes.
Concussions occur in males and females of all ages and in all sports. Recognition of pre-injury risk factors and gender differences in injury occurrence and outcomes should prompt providers to examine their clinical practice and anticipate varying aspects of treatment with consideration of the concussed athlete’s sex.
Psychologists, by virtue of education and training, which includes cultural and gender sensitivity, are uniquely qualified to address many variables of concussion treatment and recovery.
References available from authors
Summer D. Ott, Psy.D., is assistant professor in the Department of Ortho-paedic Surgery at the University of Texas McGovern Medical School in Houston and director of the Memorial Hermann IRONMAN Sports Medicine Institute Concussion Program. She serves as the neuropsychological consultant for the Houston Texans, Houston Rockets and teams from numerous universities and school districts throughout Texas. Her email address is: Summer.D.Ott@uth.tmc.edu. Mark Herceg, Ph.D., is commissioner of mental health for Westchester County, N.Y. In 2016, as chair of the county’s 28-member Concussion Task Force, he was lead author of “10 Best Practices for Concussion Management,” which was endorsed by the Brain Injury Association of America. He is assistant professor of psychology in clinical neurology at Weill Cornell Medical College and a lecturer at New York Medical College. He is also a member of the Big Ten/Ivy League TBI Research Collaboration. His email address is: email@example.com.
February 5, 2020
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