Tackling concussions on the front line
A few decades ago, when a football player got his “bell rung” with a hard hit to the head, he would shake it off, take smelling salts and return to the game.
Times have changed.
Dr. Christopher Giza
The University of Michigan faced outrage last year for allowing a quarterback to return to a game after a violent helmet-to-helmet hit. In March, a top NFL rookie retired because of concerns about long-term effects of brain injuries. Concussions have even caught the attention of Hollywood, with Will Smith starring in a film that opens Dec. 25 about the life and work of the UC Davis pathologist who first discovered chronic traumatic brain injuries in professional football players.
It’s not just football. With fall sports in full swing, concerns are mounting about concussions in youth and adult sports, from soccer to water polo.
“When I was growing up, people had to get knocked out to have a concussion,” said Dr. Christopher Giza, a professor of neurosurgery and pediatric neurology who directs the UCLA Steve Tisch BrainSPORT Program. “We’re certainly much more aware now. We have a better understanding of what a concussion is.”
From expanding awareness in youth sports to conducting groundbreaking studies of collegiate athletes and military personnel, experts at UCLA and other UC campuses are on the front lines of advancing knowledge about traumatic brain injury and improving care. Their efforts are helping to shed light on ways to diagnose, treat and prevent concussions.
What is a concussion?
A concussion is a brain movement injury that results from the brain being hit or moved too quickly.
“Your brain is made kind of like Jell-O — it floats in fluid inside the skull, and when the skull moves quickly, the brain can jostle around. It can wiggle, shake,” Giza explained. “When that happens, you can develop neurological symptoms.”
Signs of a concussion include headache, dizziness, nausea, vomiting, looking “out of it,” being slow to talk, confusion, disorientation, slurred speech, loss of coordination, memory loss or any period of unconsciousness. But you don’t have to be knocked out to suffer a concussion: Less than 10 percent of concussions involve loss of consciousness.
An estimated 1.6 million to 3.8 million sports- and recreation-related concussions occur in the U.S. each year, according to the Centers for Disease Control and Prevention. The vast majority of people who suffer a concussion get better within a few weeks.
"Most concussions are recoverable,” Giza said. But concussions can be difficult to identify, and some people suffer more serious symptoms, particularly after multiple concussions.
Lab studies have shown a “window of vulnerability” after a first concussion, Giza said. Concussed athletes are three to six times more likely to get another concussion. If they rush back to play, their reflexes, reaction time and thinking may be slower, putting them at risk of a second concussion and longer recovery period.
The key is to get proper medical care and follow guidelines on returning to play.
“When in doubt, sit them out,” Giza said. “There’s no single test to diagnose a concussion. It’s best to have multiple tests.”
UCLA medical experts have performed baseline assessments on more than 1,000 athletes, testing kids as young as 6 years old for learning and memory, attention and concentration, problem-solving abilities, reaction time and balance.
A week after Giza did a baseline assessment this spring of junior high boys who play lacrosse, one of them suffered a concussion and showed up at a UCLA clinic with his frightened parents. Giza, who treated the boy, remembered from his baseline assessment that he had signs in his history that showed he might be at risk for a longer recovery from a head injury.
“He had a concussion,” Giza said. “Right away I knew things that would affect his treatment. When his balance wasn’t right, it was easy to show him. The treatment plan was tailored to his risk factors.”
Grand Alliance initiative
Last year, the NCAA and Department of Defense launched the most comprehensive study of concussion and head impact exposure ever conducted. UCLA is participating in the three-year study, a $30 million effort that aims to enroll 37,000 student-athletes. Participants will receive a comprehensive preseason evaluation for concussion and be monitored through the season. So far, there have been more than 7,000 baseline assessments and 250 reported concussions.
“In one year, this is already the largest prospective study of concussions ever,” Giza said. “This can really be a defining moment in our understanding of concussions in humans.”
The team doctor
Dr. John DiFiori, UCLA Athletics head team physician, professor of family medicine and chief of the Division of Sports Medicine at UCLA, is collaborating with Giza on the NCAA-DoD study.
Dr. John DiFiori
“One of the most difficult decisions with a concussion is determining safe return to play,” DiFiori said. “Through the study, we’ll have a better idea to know when the brain is fully recovered. That’s what I call the Holy Grail of concussion management: to know when it’s safe to return to play.”
UCLA’s coaches and student-athletes have been very supportive of the study, said DiFiori, team physician for the Bruins’ football and men’s basketball programs.
“As team physicians, we are on the sidelines diagnosing concussion, removing the athlete from play and monitoring their condition. Any athlete diagnosed with a concussion is removed from that contest. We then perform daily evaluations over the ensuing days to weeks to gauge when it is appropriate [for that athlete] to return to play,” DiFiori said. “It’s most important that the decision on when to return to the field is one that minimizes their risk of another concussion. It’s better to miss one game than to miss a whole season.”
UCLA has been at the forefront of care for concussions — its multidisciplinary expertise made it one of four sites participating in both the clinical study and advanced research cores of the NCAA-DoD study, DiFiori said.
The study could help provide objective measures for determining when it’s safe to play again, he said. For the study, UCLA football players are wearing sensors in their helmets, and those who have concussions will receive blood tests for brain biomarkers and multimodal MRI exams.
“The research is very exciting,” DiFiori said. “There is clearly a need for more research to provide evidence that will help guide safe return to play.”
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