Biology 103
2003 Third Paper
On Serendip

Most of the little girls I knew in my childhood liked to play dress up, host tea parties, play with dolls, paint, and do other "normal" children's activities. When I was a little girl I enjoyed painting, hosting tea parties, and spent many of my weekends and school vacations competing in both national and international martial arts tournaments and exhibitions. Martial arts taught me self-discipline, self-control, and self-awareness as a child. It kept me physically fit, and made me more confident in my abilities. However, as I progressed through the ranks I spent more time training and much more time competing.

Once a practitioner reaches the level of Black Belt, all sparring matches become full contact, meaning blows to the head, neck, and below the waist are now scored as hits as opposed to fouls by sporting rules. I reached the rank of Black Belt at age eight, meaning I participated in full contact sparring matches for roughly six years. In addition to my competing as a martial artist, I was also an amateur boxer for two years- from ages 13 to 15. At the time, I didn't think about the consequences of the sport I had chosen. The daily punishment of taking one or two hard blows to the head didn't seem troublesome at the time. All competitors wore gloves in addition to protective headgear and mouthguards. In the roughly ten years in which I fought competitively I sustained several concussions, and only one in which I lost consciousness. However you may wonder, what is the clinical definition of this condition, and how are concussions diagnosed?

What is a Concussion?

When an injury to the brain is sustained, it causes the brain to bounce against the hard bone of the skull. The force of the hit against the skull might cause "tearing or twisting" of structures and blood vessels in the brain. This "tearing or twisting" deep within the brain tissue causes a breakdown in the normal flow of messages within the brain. This breakdown is the biological explanation of the concussion condition (1).

Oh No! Am I Concussed?

There are over 600,000 cases of sustained concussion in the United States alone each year. Symptoms include, loss of consciousness, dizziness, nausea or vomiting, increased size of one pupil, loss of memory, severe headache, weakness in one or more extremities, or changes in behavior. These symptoms may last anywhere from a couple hours to several weeks or months, depending on the seriousness of the injury, according to most physicians (1).

How is Concussion Severity Determined?

There are over sixteen concussion grading systems noted in medical literature however, the most widely used was developed by Dr. Robert C. Cantu in 1986. He, in 2001, revised these guidelines placing the emphasis on posttraumatic amnesia (PTA) and other post concussion symptoms as signs as opposed to loss of consciousness when determining concussion severity. The Cantu Scale goes from grade one to three. Grade one is a mild concussion in which there is no loss of consciousness, however there is PTA or post concussion symptoms which last anywhere from fifteen minutes to half an hour. A grade two concussion is described as moderate, with loss of consciousness (for no more than a minute), or PTA or post concussion lasting for longer than thirty minutes, but no more than 24 hours. The most severe concussion, a grade three, is when there is loss of consciousness for more than a minute, or PTA or post concussion lasting for longer than seven days (2).

Now, at age eighteen, I have been removed from martial arts and boxing for almost four years. In those four years I have sustained two additional concussions while playing basketball, both of which were only grade one severity. About a month and a half ago I sustained a third grade one concussion, which has since been upgraded to a grade three, as I am still experiencing post-concussion symptoms almost two months after the initial injury. The blow to my head in a routine drill, which was not even a hard hit, has also led to the end of my collegiate basketball career. Has my history of previous head trauma led to my current delay in recovery? Am I now more susceptible than other athletes to suffering a concussion? Most importantly, will I suffer long term damage from the injuries sustained during my youth and high school athletic years?

When is it Okay to Play?

One of the most frequently asked questions of physicians and certified athletic trainers is, when is it okay to play? There is no set timetable for athletes who are concussed, with regard to when they should return to the field, pitch, court, pool, or other venue of competition. Researchers at the University of Pittsburgh's have developed new technology known as Immediate Post-Concussion Assessment and Cognitive Testing system or ImPACT. The purpose of the ImPACT technology is to test the memory, reaction and processing times of athletes. A baseline assessment obtained at the beginning of a season would serve as a comparison to an athlete's performance post-concussion. The results would allow physicians, coaches, and trainers to have a more objective method of deciding the status of athletes following injury (3). ImPACT is affordable technology that is available for athletes at all levels and is currently used by the National Football League and the National Hockey League, in addition to high school, club, and middle school teams. Strict adherence to revised concussion diagnosis guidelines in addition to implementation of new diagnostic technology can help keep impaired athletes from further brain damage by allowing for ample recovery time. "On-the-field amnesia", not loss of consciousness, is most important in diagnosing concussion severity, in addition to deciding whether an athlete should be allowed to return to competition (4). With proper diagnosis in addition to allowing for recovery time coaches, physicians, athletic trainers, and other health care professionals are preventing possible long term damage.
Research by the team at the University of Pittsburgh has concluded that concussion is cumulative. Simply, the more a person is hit in the head, the more likely he or she is to recover more slowly, thus leading to a greater risk of another concussion. According to this research, I am indeed more susceptible to future concussions.

Concussion is one of the more allusive injuries in the sports medicine community. Diagnosis and treatment are hard to determine, as is the effect of concussion in the long term. These unanswered questions leave me, a victim of multiple concussions, uncertain about my future. My neurologist is unable to assure me that future problems do not lie on the horizon as the deeper, lasting impact of concussion is still a mystery.

References

1)Concussion, a guid to concusions for families provided by University of Missouri Health Care, Neuro-medicine

2)Concussion Grading Systems And
Return-To-Play Guidelines: A Comparison
By Robert C. Cantu, M.D., a resource outlining the symtoms of concussions and how they are graded

3)Serious Effects of Mild Concussions, a sports medicine article disgussing the concerns about the long term effects of concussions

4)FOR YOUNG ATHLETES WITH CONCUSSION, ON-THE-FIELD AMNESIA, NOT LOSS OF CONSCIOUSNESS, PREDICTIVE OF POST-INJURY SYMPTOM SEVERITY, an article reporting the results of a study of concussed student athlets by the University of Pittsburg Medical Center


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