The Knockout Blow – Concussion in Underage Sport

The Knockout Blow – Concussion in Underage Sport
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The concept of concussion and the science behind it is much in line with the human body and its intricacies. At times, it can be difficult to digest the science behind why one’s brain is such a fragile organ and how a life-altering, if not life-threatening, injury can be sustained quite easily.

Gareth Reynolds examines how this can apply to underage sport in Ireland.

To demonstrate the science behind concussion, take the common woodpecker bird. On average, the bird will knock its head on a tree 12,000 times per day at a speed of 15 miles per hour. Yet, they will never sustain any head trauma, temporary or otherwise.

How is it that this tiny bird can absorb over ten times the force that a human can?

Simply put, the size of the woodpecker’s skull is proportionally much larger than its brain and its hyoid bone is found in the bird’s skull rather than in the neck, as is the case with humans. The hyoid bone acts as a harness in the case of impact, protecting the brain from impact similar to the way a seatbelt saves a passenger in a car crash.

Not Quite Child’s Play

According to the Health Safety Executive (HSE), the demographic at greatest risk of suffering concussion are children and young adults. Indeed, it is estimated that one in every 2,000 people will experience an episode of concussion requiring hospital treatment each year.

However, the actual figure could be much higher, as many people do not seek hospital treatment for concussion. Researchers from the World Health Organisation estimate that the true number of people affected by concussion each year could be as high as one in 165.

The most worrying issue surrounding this is that the human brain does not fully develop until the age of twenty-five, and while concussion is known to health professionals as a temporary traumatic brain injury (TBI), the effect of multiple concussions on an under-developed brain is more serious than the effect on a fully-developed one.

This does not mean that the damage caused by a single concussion is any more severe on an under-developed brain. What it does mean, however, is that the symptoms of concussion, such as decreased reaction times, memory and concentration problems, irritability, insomnia, and fatigue, outlast the effect of those same symptoms on a fully-developed brain. This means that coaches and parents may be clearing children to return to their sports while they’re at their most vulnerable state for re-sustaining concussion.

This is where the problem becomes extremely serious.

Tackling Harsh Realities

It has been the case in the past where concussion has been the direct cause of death to an underage athlete in Ireland. In 2011, fourteen year-old Ben Robinson died on the field of play during an Ulster schools’ rugby match. A pathologist’s examination of Ben’s brain later found that he had suffered three separate concussions, all of which are thought to have occurred in the same match.

In Ben’s case, his brain sustained too many hits in too short a time period. That being said, Ben’s death could, and should, have been prevented.

Ben’s father, Peter, has said, “For something like this to happen there have to be so many failings. And on that day, unfortunately for Ben, there were so many failings.”

It would be reasonable to think that there should have been a process to go through, or a checklist of health and safety procedures in place to deal with a situation like this. Procedures which included the players, coaches, referees and parents respectively. Had there been such an all-inclusive plan, it would have taken just one of the four previously mentioned parties to take responsibility and deal with the situation as it should have been.

Simply put, Ben’s concussion would have been spotted. He would have been taken from the pitch, and he would have survived.

The coroner said Ben was the first person in the UK to die of Second Impact Syndrome while playing rugby. Peter says he is certain Ben will not be the last.

“Will this happen again?” asked Ben’s mother, Karen.

“Yes. I would say without a doubt another family will go through what we have been through.”

Since 2006, six children and one adult have died, worldwide, from brain injuries suffered while playing rugby. Second Impact Syndrome is rare. Concussion is not. Nor are the injuries it causes.

Current Treatment Doesn’t Cut It

Five years and a substantial number of concussions to underage players have passed since Ben’s death. Yet, sport scientist, Emmet McDermott, who is currently carrying out research in Loughborough University, believes that there is still a gap in the procedure for treating concussion.

“It’s a knee jerk reaction at the minute. Governing bodies like the IRFU [Irish Rugby Football Union] or the GAA, they’re trying to set up programmes where the likes of coaches, players and even parents can be educated on concussion and become capable of handling a player with concussion in the event that it happens during a game or training.

“There’s great talk about systems being in place already but there are games going on regularly without a medical officer even present. I don’t see how a concussion can be spotted or treated if the person qualified to do it isn’t present at the game,” says McDermott.

As it stands, with or without a medical officer present, there is still no single leading test for recognising a concussion. McDermott mentions that there is no “Gold Standard” test as of yet. However, he does note that there is a considerate amount of research being dedicated to treating concussion and that universities and institutions around the world are trying to develop a reliable test.

One such university is Stanford University in California. Head Athletic Trainer, Scott Anderson, and Assistant Athletic Trainer, Matt Mills, have attempted to combine an existing cognitive test with modern technology in order to make it more accessible for the user and allow any member of the general public to have the ability to diagnose a concussion.

The existing test the two men have used is a Sport Concussion Assessment Tool. The name more commonly given to this tool is a SCAT Test. The current system in place in Ireland is the SCAT3 Test. It is a standardised tool for the evaluation of injured athletes believed to have sustained concussion.

The test can be used in athletes aged from 13 years and older. It supersedes the original SCAT and the SCAT2 published in 2005 and 2009, respectively. The SCAT3 itself was published in March, 2013.

Anderson and Mills have made the SCAT3 Test available on the Apple iPad by using their research to create an app. The introduction of this technology means that the user is not just testing in the present, but also has the capability of entering the concussed athlete’s test results into an online system.

“From there, the athlete’s cognitive ability is longitudinally tracked and monitored by the technology, therefore providing greater information and insight should that athlete be concussed again in the future,” McDermott explains.

Flawed System Fails The Test

Most notably, in the Irish form of the SCAT3 Test, each form of the test carries the following text:

The diagnosis of a concussion is a clinical judgment, ideally made by a medical professional. The SCAT3 should not be used solely to make, or exclude, the diagnosis of concussion in the absence of clinical judgment. An athlete may have a concussion even if their SCAT3 is “normal”. If you are not qualified, please use the Complete Concussion Test Tool.”

According to McDermott, even with new technology the SCAT3 does not make the grade for a completely reliable test.

“From a players point of view, the more times you take a test the greater the learning effect. If you’re doing a test and you know what brings up a positive for concussion then you have the option to avoid that result and clear yourself for resuming play. A completely reliable test would not allow for the possibility of manipulating results,” he says.

“There is very little of the test that is out of the hands of the athlete in question. For the most part, questions like ‘Headache?’, ‘Nausea?’, ‘Blurred Vision?’, ‘Feeling like in a fog?’, and ‘Don’t feel right?’, leave the door open for inaccuracies in test results because they can immediately be answered negatively and therefore skew the outcome,” he adds.

From this, it appears that the combination of information and education available to coaches and players in Ireland, combined with the tests and any technology that’s in place, is failing to protect our underage athletes.

The issue of concussion is a knockout blow which has posed too great a threat to the wellbeing of our younger generation for much too long. From the opinion of sports science professionals and the daunting effects it can have on an under-developed brain, it seems high time that greater protection be given.

Gareth Reynolds

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