Many parents of high school athletes are aware of the dangers of concussions. Research now shows that even one concussion can cause permanent damage according to recent research studies. However, there is another condition that parents need to be aware of when their child plays sports. This disorder is CTE. CTE is Chronic Traumatic Encephalopathy (CTE) it is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head.
Our brain sits in our skull surrounded by fluid. Therefore, any time anyone hits their head or their head is jarred around, the brain moves in this fluid hitting the front and back of your skull or the sides of the skull depending on what direction the force came from. When the brain hits the skull it can cause bruising and microscopic tears of very fine nerve fibers. Nerve fibers that are too small to be seen on an MRI or a CT scan.
Physicians have known that CTE effects boxers for many years, however, it was just a few years ago that evidence showed that football players are at risk too. This was the main focus of the movie, Concussion, starring Will Smith. The NFL did everything they could to stop the filming of this movie. The movie shows how CTE results in the patient becoming severely depressed and psychotic. Many of the patients with CTE commit suicide. Also many CTE patients were professional football players who started playing in High School.
Why is this important for parents to know? It is important because CTE is caused by chronic head injuries. Head injuries that date back to when a teenager was playing high school sports. Therefore, it is important for parents to ensure that their teenager’s school is using the latest safety gear, especially for the head, and to take any head injuries seriously. There is no way to tell what will happen when these teenagers become adults.
For many years, football and schools have reported that they are developing helmets that protect the head better. However, these safer helmets are not being used in high schools or professional football. Schools and professional football are monitoring players closer after a head injury, but still little to nothing is being done to protect the brain prior to an injury. Furthermore, this week evidence was uncovered showing that professional football players may not receive an adequate evaluation for a concussion if they are hit during a game. In fact, it is believed that even with all the information we have regarding concussions that many professional football players continue in games even though they have a concussion.
This issue game up during the week when a player for the Miami Dolphins suffered a hit and was assessed not to have a concussion. He resumed play and four days later sustained another hit and was diagnosed with a concussion. He was believed to be suffering from second impact syndrome. “What we currently believe second impact syndrome to be is a second blow to the head or second concussion prior to the resolution of a first one. And that can result in uncontrolled swelling of the brain,” explained Steven Broglio, director of the University of Michigan’s Concussion Center. Broglio is a certified athletic trainer and is a lead author on the National Athletic Trainers’ Association position statement on management of sport concussion (CNN). It is estimated that it takes approximately 14 days for the brain and the brain chemistry to return to normal after the brain sustains a hit causing a jarring motion of the brain. Often these injuries have no symptoms (CDC).
If professional football players are being allowed to play with concussions and are developing second impact syndrome, what are happening to high school athletes? Researchers such as, Neuroscientist Julie Stamm, a clinical assistant professor in the Department of Kinesiology at the University of Wisconsin-Madison, are questioning the protocol being used to assess athletes for concussions (CDC). If professional athletes are not being adequately assessed and now developing a new condition, second impact syndrome, what is occurring with high school athletes?
As an adolescent psychotherapist who has been practicing for 25 years, I am seeing more evidence of student athletes sustaining head injuries every year. Every year I am seeing more teens with Post Concussion Syndrome. This may occur after a concussion and can be associated with headaches, mood swings and memory difficulties. The teenagers who experiences this Syndrome become very frustrated because they are aware of the changes and because no one can say how long the symptoms will continue. In fact, no one can guarantee that the symptoms will disappear.
This becomes very frustrating to the teenager and their parents. Some teenagers are so overwhelmed that they start self-medicating with drugs and alcohol. Anything that they think might help. Others become so depressed because they fear that the symptoms are permanent that they become suicidal and may attempt suicide.
For many years these head injuries in teenagers were down played because there was not enough evidence to indicate that teenagers could be impacted by head injuries. Well the research clearly indicates that teenagers can suffer long term results from a single concussion. Additionally, this can create symptoms that are overwhelming for the teenager and their family. Imagine being a parent and you see your child suffering with Post Concussion Syndrome and there is nothing you can do to stop it. Parents also become depressed and nervous that their child may never recover.
Another issue to consider, athletes can develop second impact syndrome which can lead to CTE, causing patients to have mood swings and feel like they are going crazy. They do not understand what is happening inside their head. Many teenagers who act out often report the same feelings and the fear that they are going crazy. Many of these teenagers have had head injuries. It is possible that teenagers may also suffer from second impact syndrome, post concussion syndrome or developing CTE?
Everyone’s brain is different and so is the recovery process. This means we have no way of knowing how many Concussions or head traumas it takes before CTE is started in someone. It also means we have no way to determine how long it will take for someone to recover from a concussion or if they will have permanent impairments. If we are unable to adequately assess concussions, how many players are developing second impact syndrome? We only can tell after it occurs not before.
We do know that patients recovering from Post Concussion Syndrome or dealing with CTE can benefit from psychotherapy. Often this option is not given to teenagers because again many people believe teenagers are very unlikely to suffer with these issues. However, if you look at the research it indicates that teenagers can and do suffer from Post Concussion Syndrome and teenage head injuries can cause CTE.
As a psychotherapist who treats teenagers with head injuries, I strongly encourage every parent to watch the movie, Concussion. Also before your child starts playing any competitive sports, such as football or soccer, go online and research head injuries and signs and symptoms of concussions. Also if you teenager does sustain a head injury while playing sports or just playing have them evaluated. You never know how severe a head injury is by just looking at someone. A few years ago an actress fell in the snow and her friends said to go to the doctor she said she was fine. Two hours later she was dead. When she fell she caused her brain to bleed and she died.
Above all, use your best judgement as a parent. Do not be afraid to ask for a CT scan or an MRI if your child suffers any type of head injury. If your teenager does sustain a concussion and you notice a personality change or memory issues do not hesitate to seek psychotherapy for your child and for yourselves. Also don’t hesitate to talk to your teenagers high school. If the teenager is having problems concentrating after a head injury, the school may need to provide them with accommodations until the child recovers.
This can be an overwhelming and frightening topic to consider but the more you educate yourself, the easier it will be to manage. If you have additional questions regarding the personality changes or neuropsychological changes with head injuries, please feel free to contact me.
Dr. Michael Rubino has been treating children and teenagers for over 25 years. Dr. Rubino specializes in treating children, teenagers, trauma victims including first responders. He also has training in neuropsychology. For more information about Dr. Rubino’s work or private practice visit his website at www.RubinoCounseling.com or his website that deals with accommodations at school www.LucasCenter.org.