Risks From Concussion Injury In Sports Underestimated

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(MSNBC News Services,  Two or more significant blows to the head while playing sports can harm teen-agers,thinking abilities for years to come, according to studies that suggest such injuries are more common and more serious than some coaches and parents might think.

THREE SEPARATE sports injury studies highlighting the risks from concussions were published in Wednesday's issue of the Journal of the American Medical Association. This is a major public health issue that has been given short shrift, said Michael W. Collins, a neuropsychologist at Henry Ford Health System in Detroit and a leader of one of the studies. And this is information parents should know.

A concussion is any alteration in mental function after a blow to the head, said Collins. Signs or symptoms may be subtle, a headache, dizziness, difficulty with balance or memory, confusion or a personality change.

HIGH SCHOOL ATHLETES

One of the studies, conducted by researchers at Med Sports Systems in Iowa City, Iowa, did not explore the effects of concussions but only how often they occurred in football, wrestling, soccer, basketball, softball, baseball, field hockey and volleyball at 235 high schools nationwide from 1995-96 through 1997-98.

There were 1,219 concussions, 63 percent of them in football, and 99 students suffered two or more, said researchers led by John W. Powell, a professor of kinesiology and an athletic trainer at Michigan State University. The researchers estimated that more than 62,800 concussions occur among high school students nationwide annually in the sports they studied. Researchers also reported that sideline tests for concussion may miss many cases of mild brain injury in high school and college athletes, with possible long-term effects on their mental functioning.

While many athletic trainers spot and appropriately manage head injuries on the field, according to Collins, some schools, particularly in rural areas, may rely on the judgment of coaches who are unaware of the more subtle signs of concussion, such as headache, dizziness or confusion. Many people believe concussion means the loss of consciousness, he said. So when athletes aren't knocked out, they're put back in the game.

FOOTBALL PLAYERS

Collins led a study of 393 college football players from four universities that looked at the risk factors for poor recovery from a mild brain injury. His team found that about one in three had suffered a concussion at some time in the past and one in five had suffered two or more.

Those who had suffered two or more were significantly more likely to report continuing problems with headaches, sleep and concentration, and they scored significantly worse on paper-and-pencil tests of the ability to learn words, to think quickly and to handle complex tasks.

Further, players who had learning disorders, 13.5 percent of the sample, fared even worse if they had two or more concussions, suggesting that the disorders make the brain especially vulnerable to jarring injuries. About 12 percent of all collegians have learning disorders, research has shown. "If they have a learning disability, if they have one concussion, you should be a lot more cautious in returning them to game conditions and practices after their first concussion, said an expert not involved in the studies, Jeffrey T. Barth, chief of medical psychology and neuropsychology at the University of Virginia.

He said the research on the prevalence of concussions among high school students confirms previous work but is by far the largest study, and it highlights a problem that, has been kind of ignored over the years. Most emphasis on managing concussion has been at college and pro levels, he said.

Animal research suggests that the youthful brain remains vulnerable after a first concussion for a longer time than a mature brain does, so a high school athlete may need a much longer recovery time from a concussion before returning to play than a college player or a pro, Barth said.

REPEATED BLOWS IN SOCCER

A third article in the journal reported that amateur soccer players scored lower on tests of memory and planning than other amateur athletes did, and that repeated blows to the head may be the culprit. Dutch researchers at the St. Anna Hospital in Geldrop compared the results of brain functioning tests of 33 amateur soccer players with those from 27 middle-distance runners and swimmers. Thirty-nine percent of the soccer players showed impaired performance on tests that measured planning abilities compared to 13 percent in the other group of athletes. On memory tests, 27 percent of the soccer players showed impairment compared to 7 percent of the swimmers and runners. Of the soccer players studied 27 percent had suffered one concussion during their playing career and 23 percent reported a history of two to five concussions. The median number of balls, headed, in a match was 8.5 among those studied.

While some research has implicated, heading, the ball, Barth and other experts believe the more likely explanation is the frequent collisions between players and players, heads hitting the ground or a goalpost.

According to a study published earlier this year in the same journal, Americans suffer about one million traumatic brain injuries each year, resulting in more than 50,000 deaths and about 80,000 long-term disabilities. About 30 percent of these are sports-related.

The Associated Press, Reuters and the Medical Tribune News Service contributed to this report.