American football is not a contact sport. It is in fact, a
collision sport. It is a sport in which athletes, who are in the peak of their
physical strength, collide with each other with little regard for their bodies.
Often times leading with their heads, the most venerable part of their bodies.
These collisions that are shown in the highlight reels on Monday morning result
in brain injuries that lasts much longer then the 15 second clips on EPSN’s Top
Ten.
The skull, cerebrospinal fluid,
and layers of meninges protect the brain. However, excessive forces and
acceleration on the head can result in traumatic injuries to the brain by
pressing it against the skull and causing excessive rotation on the midbrain
and brain stem. This results in Mild Traumatic Brain Injuries (mTBI), colloquially
known as concussions. mTBI can have long lasting effects such as cognitive degradation,
depression, and other neurological diseases such as Parkinson’s disease. On a
physiologically level, mTBI can result in effects ranging from changes in
neurotransmitter hemostasis, changes in the blood brain barrier, and
alterations to the neuro-immune system. Glial cells, supporting cells of the
nervous system, are most affected by mTBI and are inflamed as a result of
excessive forces to the brain or spinal column. One of the support cells are
microglia cells, which are the immune cells of the CNS and are highly active
after an mTBI event. Microglia are activated by the release of ATP by damaged
neural cells, and are thought to have a complex pathway of inflammation that
includes the release of pro-inflammation mediators, cytokines, and chemokines.
These pathways are being studied, but it is unknown whether or not microglia
cells act as pro-inflammatory or anti-inflammatory cells. What adds to the complexity of the cascades
are the interactions of cytokines and chemokines and the toxic substances they
release into the cellular microenvironment. The positive and negative up-regulations
of these substances can cause several symptoms ranging from headaches to
depression and can be acute or have long lasting effects. The action of microglia
cells is just one of the many complex pathways and actions of the cells that
are associated with the nervous system. This complexity results in little understanding
about the pathogenesis of neurological diseases associated with mTBI, especially
in athletes that are at a higher risk of incidences for mTBI events.
So what is the NFL doing to
protect its players from such traumatic injuries with such long lasting
effects? In March 2013, the NFL announced that it has committed $60 million in
a 4-year program to study mTBI. It will focus on screening and dialogistic
technology. In the past, the NFL will has also donated at least 30 million
dollars to the National Institute of Health for the study of spinal cord and
brain related injuries. Research into new helmet design is critical in the
prevention of mTBI injuries. However, the large forces of the impacts in the
sport of football still underscores the need for more research into cures and
therapeutics that will provide a positive advancements in treatment of brain
and spinal column injuries.
A Frontline documentary of the
history of mTBI in the NFL and the league’s action about brain injuries can be
viewed in its entirety at the following link. Please comment on your views and
position on what the NFL can do in the future to prevent concussions and whether
or not the NFL is responsible for the long-term injuries of its players. Should
the players have known about the short and long-term risks associated with playing
football? Knowing the risks associated with American football and other contact
sports, would you participate or let your children participate in such sports
and activities?
Citations:
Mayer CL, Huber BR, Peskind E.
Traumatic Brain Injury, Neuroinflammation, and
Post-Traumatic Headaches.
Headaches 53(9): 1523-1530. 2013
Konrad C, Geburek AJ, Rist F,
Blumenroth H, Fischer B, Husstedt I, Arolt V, Schiffbauer H, Lohmann H. Long-term
cognitive and emotional consequences of mild traumatic brain injury. Psychol
Med 41(6): 1197-211. 2010.
Underwood E. NFL kicks off brain injury research effort.
Science 339(6126): 1367, 2013.
This topic of traumatic brain injuries hits close to home for me. Last August, my mom was in a bike accident and is still suffering the effects of it to this day. Seeing my mom struggle daily due to her TBI, really makes me support the NFL’s pursuit to make the game safer. One of my mom’s biggest struggles is the impact her head injury had on her vision. She is an avid tennis player but has been sidelined from competitive play since her accident because she often sees “double”. This not only has affected her tennis play, but also she was unable to drive for 6 months and has trouble reading. This blog post inspired me to learn more about traumatic brain injuries and the effect on vision.
ReplyDeleteAccording to several studies, my mom’s vision problems are pretty normal. A study done in 2007 reported 74% of patient’s with a TBI complained of vision problems (Gutierrez 2012). Of these patient’s, 30% complained of binocular vision dysfunction or diplopia (Gutierrez 2012). The eyes normally work together to produce one image. However, an injury can cause disruption of this eye “teamwork” and lead to seeing “double”. Diplopia is a result of injury to the efferent visual pathways (Cockerham et al 2009). Damage to cranial nerves III, IV, or VI occurs in patients with diplopia (Cockerham et al 2009). Luckily my mom has intermittent double vision, which is said to occur due to reduced ability, but not total deficient, in maintaining binocular fusion or eye “teamwork” (Cockerham et al 2009). Typical treatment for this condition is prisms (Cockerham et al 2009). Prisms are able to correct the double image by altering the pathway of light (Gunton and Brown 2012). They move images onto the fovea of the injured eye thus allowing the fusion of the images as seen in a normal person (Gunton and Brown 2012). My mom had to wear prisms on her right eye for several months. She was often very frustrated with the prisms and feels that a patch may have been a better treatment route. However, since her oculomuscles were also damaged, the doctor felt prisms were the best way to make her muscles strong again in order to help aid eye movements.
Cockerham GC, Goodrich GL, Weichel ED, Orcutt JC, Rizzo JF, Bower KS, Schuchard RA. Nov 2009. Eye and visual function in traumatic brain injury. JRRD. 46: 811-818.
Gunton KB, Brown A. 2012. Prism use in adult diplopia. Current Opinion in Ophthalmology. 23(5): 400-404. Retrieved from: http://www.medscape.com/viewarticle/771807
Gutierrez S. Nov 2012. TBI linked to range of vision problems. US Army. Retrieved from http://www.army.mil/article/91942/TBI_linked_to_range_of_vision_problems/