Concussions 1

Running Head: Concussions

Concussions: The Long Term Health Effects

Hannah M. Student
Glen Allen High School

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Introduction:
According to the Center for BrainHealth, a Traumatic Brain Injury (TBI) affects almost
four million people in the United States annually; it is the leading cause of disability in the U.S,
contributing to about 30% of all injury deaths. A TBI caused by external force, though, can be
separated into five categories: concussions, contusions, coup-contrecoups, diffuse axonal, and
penetration. These five often have characteristics of the other or can combine in a diagnosis, but
this collection of research will focus on concussions of athletes and non-athletes. Through this
Capstone Project, audiences of all ages will be educated on the danger of head injuries and the
impact they have on physical and emotional health while encouraging steps toward safety
precautions.
A concussion is a blow to the head, causing the brain to slam against the interior of the
skull; it either temporarily or permanently disrupts or alters brain activity (The American
Association of Neurological Surgeons, 2014). This sudden movement within the head causes
brain cells to stretch and tear, shifting the electrical and chemical balance vital to cell function
and communication. Next, these cells spring into action, having to work harder in effort of
returning to the correct chemical state; this puts the cells in a state of high stress, leaving them
unable to function correctly or even survive. Sometimes, this is referred to as an energy crisis
for the brain cells (TBI: Get the Facts, 2016). In addition, the rapid stretching from concussions
causes axons, the long fibers brain cells use to communicate with one another, to swell. This is
harmful for the brain because the swelling compromises the ability of the cells to send signals,
sometimes permanently. So, within minutes and hours of receiving the head injury, symptoms
can range from loss of consciousness or disorientation to nausea, dizziness, and vomiting.
Generally, these symptoms will subside within a week or two, but for some (especially those

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who have had repeated brain injuries) persistent headaches, sleep disturbances, difficulties with
cognitive functioning such as memory and concentration, and sudden personality fluctuations
will continue for a while longer (TBI: Get the Facts, 2016).
Although concussions are usually associated with contact-sports, especially football,
many people can receive head trauma in every-day life. However, one neurodegenerative
disease called chronic traumatic encephalopathy (CTE) can only be found in the brains of
deceased athletes or war veterans who either experienced multiple concussions or those who
played a high-impact position. As stated by Ann McKee, a neuropathologist at Bedford VA
Medical Center, brains of athletes with CTE have unique, abnormal patterns of protein tangles
and cell loss. While doctors cannot truly diagnose someone with CTE while they are alive,
symptoms of this disease include increased irritability and impulsivity early on, and dementia
later in life (Traumatic Brain Injury: Hope Through Research, 2016).
Overall, whether a concussion is achieved through athletics, an innocent fall, abuse, in a
car accident, or any other instance, it has the ability to cause permanent damage and changes in
physical and emotional aspects. No matter if a concussion causes short-term or long-term
symptoms, they are still more than difficult to get through in an optimistic manner; both athletes
and non-athletes feel setback and thwarted post-concussion because they are unable to learn,
think, playgenerally operateas they were once able. Because of the typical defeat most
neurology patients feel, depression and anxiety diagnoses and suicides greatly increase in
likelihood post-concussion.
Although research on brain injuries has greatly improved over the last few years, there
are still a great number of facts on the impact of concussions on living beings, including the
length of recovery, physiological changes of the brain, and long-term cognitive, emotional, and

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physical fluctuations. Not only are concussed patients frustrated, scientists are as well; however,
researchers are painstakingly, diligently working toward discovering more about brain injuries,
especially through the studies of living rats, brains of deceased humans, and surveys answered by
sufferers of one or multiple concussion injuries.
Sports Related Concussions:
Sports Concussion Institute estimates 1.8 million to 3.8 million concussions will occur
each year in the United States (Traumatic Brain Injury: Hope Through Research, 2016). This is a
shocking, even overwhelming, number. In smaller terms, five to ten percent of athletes will
experience a concussion in any given sports season. Of these, 78% of concussions occur during
games as opposed to practices, and astonishingly yet predictably, 47% of athletes do not report
their symptoms after a concussive blowthey suck it up and hide their symptoms. Although
the media usually only reports concussions from professional [male] football players, females are
twice as likely to sustain a concussion as males in sports such as basketball and soccer. The
reason for this is unknown, but some have theorized that female athletes have weaker neck
muscles and a smaller head mass than male athletes, or males are just less likely to report
concussions in fear of seeming fragile or of being removed from competition. This doesnt
conclude, though, that more females than males actually get concussions, because more studies
show more males than females intentionally expose themselves to risky situations, like engaging
in more hardcore sports (Nordqvist, 2015).
Most of society considers football to be the most dangerous sport, but 125,661 people in
the United States were hospitalized in 2009 from cycling accidents, followed by 68,826 people
who were hospitalized for football-related injuries. Of the reported hospitalized patients, 57.9%

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of them were between the ages of 14 and 18, and 16.8% were 11 to 13 year-olds (Nordqvist,
2015).
Further, a disease that is now coming to light in the media, called Chronic Traumatic
Encephalopathy, or CTE. CTE is a progressive, degenerative disease found in the brain of
[mostly] athletes with a history of repetitive brain trauma. Excessive disturbances to the brain,
like concussions, prompt progressive degeneration of brain tissue, including the buildup of tau
an abnormal protein. The change in the physiological brain either temporarily or, in some cases,
entirely adjusts ones memory, state of mind (impaired judgment, confusion, aggression,
depression, anxiety, dementia, other emotions), and impulse control, for example. Startlingly,
these alterations occurring in the brain can come about months, years, or decades after the
concussion; this is extremely nerve racking, especially because what seems to be improvement in
how one feels post-concussion can be deceptive (Carr, 2003).
Lastly though, an important fact to bring to light is that damage can be done to the brain
by repetitive hits to the body which then pushes the brain into the skull, not just when theres a
direct blow to the head (Fainaru, 2016). According to Representative Jan Schakowsky, DIII, of
the U.S. House of Representatives' Committee on Energy and Commerce, football is a high-risk
sport because of the routine hits, not the diagnosable concussions. Further, Schakowsky firmly
stated that the American public needs honesty about the risks involved with head injuries,
especially sports-related contact sports, and as a society America clearly needs more research
(Fainaru, 2016). But how do we collect more research on concussions if we dont yet have the
methods or tools to study the unknown?
Non-Sports Related Concussions:

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Most do not associate concussions with activities outside of sports, but head injuries can
occur through falls, motor vehicle accidents, assaults, and more. In fact, car crashes are the
leading cause of fatal head trauma among teens, and motor vehicle crashes are the third overall
leading cause of concussions. The most common non-sports related incident where a concussion
is received, at 40.5%, is a fall that either directly causes a blow to the head, or involves such a
huge jerk to the body that causes the brain to slam against the skull. Further, 10.7% of
concussions received by non-athletes are through assault, 75% of which occur in persons ages 15
through 44. Among concussion-related deaths between 2006 and 2010, men were nearly three
times as likely to die as women, and rates were highest for those over 65 years of age. The
leading cause of fatal head injuries varied by age: falls for persons 65 years and older, motor
vehicle crashes for those between five and 24, and assaults for children ages zero through four.
There is only a slight change in the ages for those who do not die through these instances: those
15-45 years of age had the most hospitalizations from motor vehicle crashes, and falls affected
children 0-14 years of age and adults over 45. All in all though, adults ages 31 and over
experience the most concussions by 46.3% (TBI: Get the Facts, 2016).
Outlook:
Jennifer Carr, a technician in the neuroscience lab of University of Pennsylvania, does a
lot of research on the long-term health effects of those who experience concussions. Through
several rounds of experimenting and further already-published research, she has found that
concussions cause the brain to function in a highly stressful state, as it takes much more energy
to perform as they were once able to; so, those who are concussed, or have post-concussive
syndrome-- a complex disorder in which various symptoms last for weeks and sometimes
months after the injury that caused the concussion (Carr, 2012). Additionally, cells that help the

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brain send communicating signals can be permanently lost, further explaining the great amount
of energy one must exert after receiving a brain injury. Because patients are worn out from even
the smallest tasks, this is one major reason concussion they lose motivation and optimism in their
road to recovery.
The Road to Recovery
Unfortunately, there are no treatments for concussions specifically, but primary care
doctors, neurologists, and psychiatrists can treat symptoms experienced after a concussion; the
types of symptoms and their frequency are unique to each person depending on the severity of
their condition. For instance, common headache and migraine medications can be used for
alleviating the head pain of concussion victims. Aside from high doses of ibuprofen or
acetaminophen, the most effective of these medications include Amitriptyline, Topiramate, and
Gabapentin as they help ease headaches as well as other symptoms such as irritability, dizziness,
and depression. Just like all medications, though, side effects are something worth considering
before takingcognitive problems can temporarily worsen while on the medication, which
defeats the purpose in attempting to treat the symptoms experienced after a concussion. It really
all comes down to if whether the side effects are worth the mitigation of the symptoms the
medications are treating.
Depression and anxiety are often obtained post-concussion because of occasional
psychological and mood changes within the brain, but mostly because of the frustration patients
experience while waiting weeks, months, or even years to get well. The symptoms of postconcussion syndrome usually improve after the affected person realizes that there is a cause for
his or her symptoms, and that they will most likely improve with time (Caldwell, 2012). Time
is a frustrating concept to grasp, especially because doctors cannot tell patientsd specifically

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when they should be normal again. Educating the patient on their post-concussive state can
ease a persons fears in the disorder and provide them with a greater peace of mind. There are
methods readily available for those suffering from anxiety and depression after their head injury,
including psychotherapy and medications. It has been proven to be helpful for people to discuss
emotional states, as well as concerns about their physical and mental health with a certified
psychologist or psychiatrist who have experience in working with people with similar conditions.
Medications with antidepressant, mood stabilizers, or atypical antipsychotic components can be
prescribed as an additional or different treatment option; Celexa, Lexapro, Cymbalta, and Zoloft
are a few of the most common medications recommended to people who are ready to give
medicine an attempt (Caldwell, 2012). Health care providers can determine which drug(s) are
right for their patients and hopefully relieve someor allsymptoms, or at least reassure
patients that they can eventually see improvement in their behavior and physical feelings.
In regard to cognitive deterioration, temporary or permanent, there are unfortunately no
medications specifically for treating these issues. However, certain types of cognitive therapy
could help, including focused rehabilitation that provides training in using a pocket calendar,
electronic organizer, or other techniques to work around memory deficits and attention skills
(Caldwell, 2012). In addition, concussion patients can use applications with games that are
created to help in strengthening concentration, memory, reaction time, and other skills. Lastly,
relaxation therapy, like massages, acupuncture, and yoga, have also been proven helpful
(Caldwell, 2012).
Referring back to Jennifer Carrs research, she gives her and researchers opinions on
bringing an end to the concussion cycle in Hard Knocks: The Science of Concussions. She
explains that not one scientist or doctor has yet been able to determine the length of a concussed

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individuals recovery time as, thus far, there arent many noninvasive techniques to recognize
people who need longer to make progress from concussions. However, Carr does make clear
though that researchers are persistently working toward discovering a way to be able to
determine this as well as the relationship between concussions and the deterioration of the brain
down the road.
In some cases, concussions cause bleeding of the brain, excessive swelling of the brain,
or serious physical injury to the brain. Circumstances like these often require surgery or other
major medical procedures. However, patients who are this badly harmed in an accident arent
very common (Caldwell, 2012).
In order to assess cognitive deterioration [or lack thereof], tests can, and should be,
conducted. The most common evaluation is called the ImPACT Test, a 25-minute computerized
test. It is composed of tests that will show reaction time (measured to a 1/100th of a second),
attention span, response variability, non-verbal problem solving skills, processing speed, and it
measures verbal and visual memory. In addition, it measures symptoms of the test takers. The
ImPACT Test produces a comprehensive report of test results that assists clinicians and athletic
trainers in determining the severity of their concussions and making return-to-play decisions.
This assessment is also useful in creating a baseline, especially for athletes, in order to compare
original cognitive functions to those after a concussion; it can also help determine if a concussion
is even received based on the results (ImPACT Test, 2016).
Overall, concussions have the ability to cause major behavioral changes and cognitive
impairments temporarily, but also permanently, which scientists hope to further understand with
more research. Because of the severity patients can experience, it is vital that athletes and non-

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athletes are careful in everyday life, even seemingly non-harmful scenarios; theres no way to tell
when a single happening can change ones life for the rest of their years.
Reason for Writing:
In my lifetime of only eighteen years, Ive already had five major [diagnosed]
concussions, two of which had me on homebound for months and one of which I am currently
still recovering from. Because of all the brain damage I am endured, along with the difficult
tasks Ive had to overcome post-concussion, I have created this capstone project in order to
inform the general public on the potential long-term effects of concussions and to promote
caution and safety in order to protect the most important organ in the bodythe brain.
In the summer between my sixth and seventh grade year, 2011, I received my first
concussion because of reckless horseplay at practice-- someone threw a softball directly at the
back of my head. I wasnt knocked out from this blow to the head, but my eyes did roll to the
back of my head and I was uneasy walking around. After a few hours in the hospital, I was
released to go home and was only out for a week before I was able to return to play.
A few months later, in October of 2011, I acquired my second concussionone that
actually knocked me unconscious for several minutes. This occurred because of a drillI
tripped over my feet when backpedaling and flew backward hitting my head first, then again. As
I laid in the middle of the basketball court, my teammates stood over me, tears falling from their
faces, wondering if I would wake up. This particular injury had me in a neck brace and an arm
cast, out of school for 13 weeks.
On the first day I was released to play sports again, my father had passed away the
previous day; therefore, I wanted to go out on the field for my first tournament back, without

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practice for months, to play in honor of him. Of course, in the first play, the ball was smacked
from the bat directly at my face, throwing my body backward and to the ground. I noticed that
my reaction time was slowedI couldnt put my glove up in time to catch the ball like I would
normally be able to do. In hindsight, I realized my reaction time was also slowed when warming
upI would catch the ball at the last second, and wouldnt hit very well; I just thought that these
inconsistencies in my way of play were from being out of practice.
After this, I just received a minor blow to the head in softball practice. The ball hit my
head so lightly that one wouldnt expect me to have even gotten a concussion. However, because
I had already experienced such a large amount of brain trauma, the easier it wasand always
will befor me to get a concussion.
Lastly, the concussion-- which I am on month seven of recovery-- was in a motor-vehicle
accident. Although I was already badly injured, I worsened my condition by refusing medical
care and attempting to overcome the pain I suffered during my usual rigorous schoolwork and
volleyball practices. From this, I was diagnosed with a Traumatic Brain Injury. In addition to
the head pain, cognitive impairments, and whiplash, my eye movements were negatively altered,
causing the necessity for me to undergo physical therapy. After my eye movements improved, I
continued physical therapy in order to test my bodys ability during specific activities and
differing heart rates. Last week, I finished the last stage of concussion therapy, but my cognitive
abilities worsened instead of the expected progression. Given that it has taken me over six
months to have my cognitive functions increase from the first percentile to the thirtieth, I have
been extremely discouraged. Like many doctors predicted, I was diagnosed with depression and
anxiety because of the changes occurring within my brain, as well as the emotions that come
with having to deal with my condition day-by-day. Although I am unhappy that I couldnt have

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avoided these mental disorders, and have allowed myself to get down, unmotivated, and
pessimistic toward several undertakings, I am now realizing that this is just temporary and could
have always been so much worse than it turned out to be. Because I am living today, I am
grateful, and I am blessed with the opportunity to preach the importance of protecting the brain
and for outsiders to attempt to sympathize with those suffering from concussions around.
Conclusion:
There hasnt been any research yet proving one way of receiving a concussion more
negatively impacts the brain than another. Jennifer Carr, a technician in the neuroscience lab of
the University of Pennsylvania, explains that no one can yet determine how long it will take one
to recover post-concussion since there arent yet many noninvasive techniques to recognize
people who need longer to recover. In fact, brain damage immediately after the injury is too
difficult to study in living humans, even using standard imaging procedures like CT scans or
MRIs; so, often times rats are used (TBI: Get the Facts, 2016). However, researchers are
working toward discovering a way to be able to determine the length of recovery based on each
scenario, as well as the relationship between concussions and the deterioration of the brain down
the road.
With continued research and propagandizing on head injuries, the public will be far more
educated on the symptoms and dangers of concussions. This is vital in recognizing a TBI, as
well as preventing one from occurring.

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References
11 Ways To Grow New Brain Cells And Stimulate Neurogenesis. (2013). Retrieved March 02,
2016, from http://mentalhealthdaily.com/2013/03/05/11-ways-to-grow-new-brain-cellsand stimulate-neurogenesis/
Caldwell, E. (2012). Research and Innovation Communications. Retrieved March 13, 2016, from
http://researchnews.osu.edu/archive/tbidepress.htm
Carr, J. (2012, October 3). Hard Knocks: The Science of Concussions. Retrieved February 28,
2016, from http://www.brainfacts.org/diseasesdisorders/injury/articles /2012/hardknocks-the-science-of-concussions/
Concussion. Retrieved March 02, 2016, from
http://www.brainhealth.utdallas.edu/research/research_topic/concussions
Fainaru, S. (2016, March 15). NFL acknowledges, for first time, link between football, brain
disease. Retrieved March 20, 2016, from http://espn.go.com/espn/otl/story/_/id/1
4972296/top-nfl-official-acknowledges-link-football-related-head-trauma-cte-first
ImPACT Test. (2016). Retrieved April 19, 2016, from https://www.impacttest.com/products
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Nordqvist, J. (2015, June 9). Concussions Cause Long-Term Effects Lasting Decades. Retrieved
February 29, 2016, from http://www.medicalnewstoday.com/articles/256518.php
Post-concussion syndrome. (2014, August 19). Retrieved March 13, 2016, from

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http://www.mayoclinic.org/diseases-conditions/post-concussion syndrome/basics/
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TBI: Get the Facts. (2016, January 22). Retrieved April 06, 2016, from http://www.cdc.gov/
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The American Association of Neurological Surgeons. (2014, August). Retrieved March 20,
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2016, from http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm