Concussive injuries to the head and brain are relatively common in the National Football League. This is not news, since the issue has been covered in many articles in the popular press and many news specials on television. As an NFL offensive lineman for 13 years, I suffered a huge number of hits to the head — an estimated 215,000 at least. Nevertheless, I have fared better than many of the players of my era: many suffered from chronic traumatic encephalopathy. (...) For example, some of my fellow Hall of Fame players from that era, Mike Webster, Jim Ringo, John Mackey, and Joe Perry, all suffered from CTE and all are now deceased. I count myself lucky that the main malady affecting me after those many blows to the head is a 60% hearing loss in my left ear — probably due to undiagnosed concussions and particularly to thousands of head slaps by defensive players, whose first hit after the snap was often a right-handed blow to the helmet's open hole over my left ear. (shrink)

Concussion is a common, serious injury in youth ice hockey, affecting up to 25% of players per season by one estimate. • Bodychecking is a major cause of injury and concussion in hockey, yet some Canadian provinces allow players as young as nine years to engage in bodychecking. • Reducing rates of concussion requires eliminating bodychecking for all except elite hockey players aged 16 years and older, as per the recommendations of the Canadian Academy of Sports and (...) Exercise Medicine. (shrink)

Chronic traumatic encephalopathy resulting from head hits and concussions is an unfortunate illness that has affected numerous football players, especially in the National Football League. Many of my fellow players suffer from this problem, and many have died prematurely because of it. I make some suggestions for improving the situation for retired and current players.

Concussion and Mild Traumatic Brain Injury affect millions of people worldwide. mTBI has been called the “signature injury” of the recent conflicts in Iraq and Afghanistan, affecting thousands of active duty service men and women, and veterans. Sport-related concussion represents a significant public health problem, with elite and professional athletes, and millions of youth and amateur athletes worldwide suffering concussions annually. These brain injuries have received scant attention from neuroethicists, and the focus of this special issue is on (...) defining the ethical considerations and developing and elucidating the neuroethical contributions to the discussion about concussion and mTBI. (shrink)

Concussions in professional sports have received increased attention, which is partly attributable to evidence that found concussion incidence rates were much higher than previously thought. Further to this, professional hockey players articulated how their concussion symptoms affected their professional careers, interpersonal relationships, and qualities of life. Researchers are beginning to associate multiple/repeated concussions with Chronic Traumatic Encephalopathy, a structural brain injury that is characterized by tau protein deposits in distinct areas of the brain. Taken together, concussions impact many (...) people in the sporting community from current and former professional athletes and their families to medical and health professionals and researchers. In light of the growing awareness and sensitivity towards concussions, the purpose of this paper is to provide recommendations that are designed to improve player safety in professional hockey and address the ethical issues surrounding these suggestions. (shrink)

Abstract:Patients with repeated minor head injury are a challenge to our clinical skills of neurodiagnosis because the relevant evidence objectively demonstrating their impairment was collected in New Zealand (although published in theBMJandLancet) and, at the time, was mired in controversy. The effects of repeated closed diffuse head injury are increasingly recognized worldwide, but now suffer from the relentless advance of imaging technology as the dominant form of neurodiagnosis and the considerable financial interests that underpin the refusal to recognize that acute (...) accelerational injury is the most subtle and insidiously damaging (especially when seen in the light of biopsychosocial medicine), and potentially one of the most financially momentous (given the large incomes impacted and needing compensation) phenomena in modern sports medicine. The vested interests in downplaying this phenomenon are considerable and concentrated in North America where diffuse head injury is a widespread feature of the dominant winter sports code: Gridiron or American Rules football. The relationship of this to shattered lives among the brightest and best of young men and the relatively dated objective evidence are a toxic mix in terms of ethical analysis and, therefore, there is a malignant confluence of social forces that tends toward minimizing the injury. (shrink)

IntroductionConcussion is a growing public health concern. No uniformly established therapy exists; neurofeedback studies report treatment value. We use infralow frequency neuromodulation to remediate disabling neurological symptoms caused by traumatic brain injury and noted improved outcomes with a novel concussion protocol. Postconcussion symptoms and persistent postconcussion symptoms are designated timelines for protracted neurological complaints following TBI. We performed a retrospective study to explore effectiveness of ILF in PCS/PPCS and investigated the value of using this concussion protocol.MethodPatients with PCS/PPCS (...) seen for their first neurology office visit or received their first neurofeedback session between 1 August 2018 and 31 January 2021 were entered. Outcomes were compared following treatment as usual vs. TAU with ILF neurotherapy. The study cohort was limited to PPCS patients; the TAU+ILF group was restricted further to PPCS patients receiving at least 10 neurotherapy sessions. Within the TAU+ILF group, comparisons were made between those who trained at least 10 sessions using concussion protocol and those who trained for at least 10 sessions of ILF regardless of protocol.ResultsAmong our resultant PPCS cohort leading persistent neurological complaints were headache, memory impairment, and brain fog. PPCS patients in TAU+ILF+CP demonstrated greater net and percent improvement of symptoms compared to PPCS subjects in TAU. PPCS patients in TAU+ILF-CP trended toward significant symptom improvements compared to TAU, and TAU+ILF+CP trended toward greater efficacy than TAU+ILF-CP.ConclusionPPCS patients who received TAU+ILF+CP demonstrated significantly greater improvement as a group when compared to TAU. When used as an integrative modality to treatment as usual in managing patients with PPCS, ILF neuromodulation with use of concussion protocol provided significant symptom improvements. (shrink)

This study examined the extent to which concussion management plans at National Collegiate Athletic Association member schools were in line with NCAA Concussion Policy and best practice recommendations in absence of any process to ensure compliance. Most schools' concussion management plans were in compliance with 3 or 4 of the NCAA's 4 required components. Annual athlete education and acknowledgement was the requirement least often included, representing an area for improvement. Further, schools tended to more often include best (...) practices that were more medically-oriented, compared to best practices that were less medical in nature. (shrink)

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes (...) and products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes. (shrink)

Background:Reducing the incidence and negative consequences of concussion among youth athletes is a public health priority. In 2010, Massachusetts passed legislation aimed at addressing the issue of concussions in school athletics. We sought to understand local-level implementation decisions of the Massachusetts concussion law.Methods:A qualitative multiple-case study approach was utilized. Semi-structured interviews with school-employed actors associated with the law's implementation were used for analysis. Interview data were subjected to a conventional content analysis.Results:A total of 19 participants from 5 schools (...) were interviewed. Schools were purposefully selected from communities varying in socioeconomic status and population. Participants included 5 athletic directors, 5 coaches, 4 athletic trainers, 4 school nurses, and 1 health and wellness coordinator. Eight themes emerged regarding specific ways schools have implemented the law. Six themes emerged regarding factors influencing implementation.Conclusions:All cases employ neurocognitive testing as a means to assess concussions, place decision-making authority in athletic trainers' hands, and use a 30-minute online video to disseminate concussion education. Employing athletic trainers could pose challenges to school districts with limited financial capacity, as financial assistance from the state is not provided under the law. The validity of neurocognitive testing and the effectiveness of online concussion training need further study. Cooperation from student athletes, their parents, and physicians is necessary for full implementation of the law. (shrink)

Drawing on the recent concussion litigation from the United States’ National Football League, the paper examines the emergence of neuroscience knowledge as part of a defining rationale for the justification and rationalization of the lawsuit. The paper argues that neuroscience knowledge is best understood as a regulatory discourse that is attached to larger social, political, and economic realities that bring it into being as a legitimate type of knowledge. This larger socio-political governance logic is one that scholars call ‘biopolitical’ (...) which emphasizes the protection of individual life over and above other ways of being. Risk discourses that frame risk-taking practices as immoral thus emerge within this biopolitical regime of governance that frame morality in terms of public health that individual citizens ought to pursue. With this in mind neuroscience knowledge plays an important role in concussion litigation. It emerges as a technology of biopolitical governance in that it is used to justify legal decisions on concussion. This is despite the fact that neuroscience knowledge remains nascent and even scientifically uncertain. Because of this, the paper argues that scholars ought to not only consider neuroscience research skeptically, but also ought to be aware of the dangers of neuroscience’s emergence as an ‘anticipatory discourse’ that has the potential to reduce human behavior to matters of the brain that thus transforms our very ontology of ourselves and the practices we perceive as ‘good’. (shrink)

Postmortem evidence of chronic traumatic encephalopathy (CTE) in the brains of American National Football League players who suffered concussions while playing have intensified concerns about the risks of concussion in sport.1 Concussions are frequently sustained by amateur and professional players of Australia’s three most popular football codes (Australian football, rugby league, and rugby union) and, to a lesser extent, other contact sports such as soccer. This raises major concerns about possible long-term neurological damage, cognitive impairment and mental health problems (...) in players of these sports. (shrink)

Concussion is a form of traumatic brain injury that has been defined as a “trauma-induced alteration in mental status that may or may not involve loss of consciousness.” Terms such as getting a “ding” or getting your “bell rung” are sometimes used as colloquialisms for concussion, but inappropriately downplay the seriousness of the injury. It is estimated that between 1.6 and 3.8 million concussions occur annually in the United States as a result of participation in sports or recreational (...) activities. To date, there are no objective, biological markers for concussion; rather, the current diagnosis of concussion is dependent upon symptom reporting by the athlete. In the acute phase, concussions can result in a broad spectrum of symptoms that can be transient or last for days, weeks, or even months. Symptom prolongation is generally referred to as post-concussion syndrome. (shrink)

Current discussions about concussion in sport are based on a crucial epistemological question: whether or not we should believe that repetitive mild Traumatic Brain Injury causes Chronic Traumatic Encephalopathy. This epistemological question is essential to understanding the ethics at stake in treating these cases: indeed, certain moral obligations turn on whether or not we believe that mTBI causes CTE. After discussing the main schools of thought, namely the CTE-sceptic position and the CTE-orthodox position, this article examines the concussion (...) debate in sport and asks if its current articulation helps to answer whether or not we should call for responsive, ethical action. (shrink)

The principle of informed consent is so firmly established in bioethics and biomedicine that the term was soon bowdlerized in common practice, such that engaging in the informed decision-making process with patients or research subjects is now often called “consenting” them. This evolution, from the original concept to the rather questionable coinage that makes consent a verb, reveals not only a loss of rhetorical precision but also a fundamental shift in the potential meaning, value, and implementation of the informed consent (...) process. Too often, the sharing of information has been replaced by the mere acquisition of agreement with the authority ostensibly offering a choice.Scholars of informed consent agree that its salience and its legitimacy derive from a fiduciary duty to inform, in order to respect, protect, and promote autonomous decision making by those to whom the duty is owed. (shrink)

This paper examines college athletes’ perceived support for concussion reporting from coaches and teammates and its variation by year-in-school, finding significant differences in perceived coach support. It also examines the effects of perceived coach support on concussion reporting behaviors, finding that greater perceived coach support is associated with fewer undiagnosed concussions and returning to play while symptomatic less frequently in the two weeks preceding the survey. Coaches play a critical role in athlete concussion reporting.

Neuroscience research has improved our understanding of the long term consequences of sports-related concussion, but ethical issues related to the prevention and management of concussion are an underdeveloped area of inquiry. This article exposes several examples of conflicts of interest that have arisen and been tolerated in the management of concussion in sport (particularly professional football codes) regarding the use of computerized neuropsychological (NP) tests for diagnosing concussion. Part 1 outlines how the recommendations of a series (...) of global protocols for dealing with sports-related concussions (the 1st, 2nd and 3rd Consensus Statements on Concussion in Sport) have endorsed the use of NP testing. The development of these protocols has involved experts who have links with companies that sell computerised NP tests for concussion management. Part 2 describes how some professional football leagues—in particular the National Football League (NFL), the Australian Football League (AFL) and the National Rugby League (NRL)—have mandated specific NP testing products. They have done so on the basis of these international guidelines and by engaging experts who have conflicts of interest with NP testing companies. These decisions have also been taken despite evidence that casts doubt on the reliability and validity of NP tests when used in these ways. (shrink)

Concussions are a significant public health problem worldwide. This brain injury is problematic in the paediatric population for a variety of reasons; however, the enquiry into these problems has been mainly through the biomedical perspective. This approach has impacted nursing knowledge and practice of children and youth with a concussion, primarily since other perspectives are viewed as not being objective. In this manuscript, I draw on Thomas Kuhn's view of objectivity to evaluate the biomedical perspective of concussion. I (...) utilize current research and clinical examples to illustrate the advantages and drawbacks of this perspective for nursing. From this discussion, I propose an alternative perspective to capture the complexity of paediatric concussions for nursing, a systems perspective. Although I argue for an alternative perspective to approach paediatric concussions for nursing, I maintain that the biomedical perspective can be incorporated as one part of nursing knowledge and practice for paediatric concussion. (shrink)

State concussion laws and sport-league policies are important tools for protecting public health, but also present implementation challenges. Both state laws and league policies often require athletes provide written acknowledgement of having received concussion-related information and/or of their responsibility to report concussion-related symptoms. This paper examines these requirements in two ways: an analysis of the variation in state laws and sport-league policies and a study of their effects in a cohort of collegiate football players.

Professional sports with high rates of concussion have become increasingly concerned about the long-term effects of multiple head injuries. In this context, return-to-play decisions about concussion generate considerable ethical tensions for sports physicians. Team doctors clearly have an obligation to the welfare of their patient (the injured athlete) but they also have an obligation to their employer (the team), whose primary interest is typically success through winning. At times, a team’s interest in winning may not accord with the (...) welfare of an injured player, particularly when it comes to decisions about returning to play after injury. Australia’s two most popular professional football codes—rugby league and Australian Rules football—have adopted guidelines that prohibit concussed players from continuing to play on the same day. I suggest that conflicts of interest between doctors, patients, and teams may present a substantial obstacle to the proper adherence of concussion guidelines. Concussion management guidelines implemented by a sport’s governing body do not necessarily remove or resolve conflicts of interest in the doctor–patient–team triad. The instigation of a concussion exclusion rule appears to add a fourth party to this triad (the National Rugby League or the Australian Football League). In some instances, when conflicts of interest among stakeholders are ignored or insufficiently managed, they may facilitate attempts at circumventing concussion management guidelines to the detriment of player welfare. (shrink)

Concussion in professional football is a topic that has generated a significant amount of interest for many years, partly due in recent times to the filing of the class-action litigation and the uncapped compensation injury fund and settlement involving 4,500 retired professional players and the National Football League. The proceedings claimed that the NFL, as the governing body of American football, failed in its duty to protect players’ health during their professional playing careers by exposing players to risks of (...) repetitive concussions and actively concealing links to potential long-term consequences. The NFL litigation sharpened the focus on the fundamental regulatory, governance and ethical considerations for football governing bodies, as self-regulated organisations, when governing the delicate balance between the dynamics of contact and collision sports, entertainment and player-health considerations. It also raised questions about public accountability and responsibilities to all levels of the sport through a framework of public health ethics. The NFL litigation and Congressional hearings have led to changes within the NFL and its regulatory and governance responses. A case study of the NFL responses to concussion in the sport of American football can provide insight into concussion regulation. Australian football governing bodies can align their regulatory and governance responses to concussion within their sports with the aim to avoid similar accusations, and circumvent a more coercive form of intervention. (shrink)

The idea of human-like robots with artificial intelligence (AI) engaging in sports has been considered in the light of robotics, technology and culture. However, robots with AI can also be used to clarify ethical questions in sports such as boxing with its inherent risks of brain injury and even death.This article develops an innovative way to assess the ethical issues in boxing by using a thought experiment, responding to recent medical data and overall concerns about harms and risks to boxers. (...) The thought experiment imagines a fight between a human and a robot. Critical issues about head trauma and brain injuries are then discussed. These can be summed up in two ethical questions: ‘why is it acceptable for a boxer to deliver concussive and recurrent subconcussive punches to a human head (skull and brain), powerful enough to achieve a knockout, or score more points, or to potentially inflict an injury immediately or eventually resulting in death?’, with the reciprocal question, ‘why is it acceptable to allow oneself to be injured in a like manner, possibly fatally, by an opponent?’The two questions are explored using the thought experiment in two matching perspectives: where the human boxer is attacking and the robot boxer is defending; and conversely, where the human boxer is on the receiving end of punches delivered by the robot. Each perspective opens with some general remarks, followed by an analysis of the boxing contest and eliciting some implications for future opportunities for the sport. (shrink)

Postmortem research on the brains of American tackle football players has revealed the presence of chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by repeated head trauma. Repeated concussion is a risk factor for CTE, raising ethical concerns about the long-term effects of concussion on athletes at risk for football-related concussion. Of equal concern is that youth athletes are at increased risk for lasting neurocognitive and developmental deficits that can result in behavioral disturbances and diminished academic (...) performance. In this article, we consider evidence of the effects of concussion in youth athletes, and discuss ethical duties to youth athletes and how these duties might be satisfied, given the intrinsic risks of football. Finally, we evaluate potential strategies for reducing concussions in junior football, and recommend the optimal strategy for reducing brain injury to an acceptable level while still making available the benefits of football participation for youth athletes. (shrink)

Head injuries are an inherent risk of participating in the major collision sports played in Australia. Protocols introduced by the governing bodies of these sports are ostensibly designed to improve player safety but do not prevent players suffering from repeated concussions. There is evidence that repeated traumatic brain injuries increase the risk of developing a number of long term problems but scientific and popular debates have largely focused on whether there is a causal link between concussion and chronic traumatic (...) encephalopathy. We argue that the governing bodies of collision sports played in Australia have used uncertainty about CTE to justify a “wait and see” approach instead of attempting to prevent repeated head injuries. This stance is difficult to defend when these governing bodies claim to give a high priority to protecting player welfare. (shrink)

Concussion in sports is a topic that is receiving increasing amounts of publicity and attention. Increasing recognition of concussion as well as improving understanding of the short- and long-term physiologic effects of concussion have resulted in widespread legislation governing the recognition and treatment of sports concussion. The increasing amount of medical research in the field and oftentimes subjective symptoms of concussion leave many ethical questions to be answered.

While provisions of youth sports concussion laws are very similar, little is known as to how they are being implemented, factors that promote or impede implementation, or the level of compliance in each jurisdiction. We aimed to describe state experiences with implementation in order to inform ongoing efforts to reduce the harm of sports-related traumatic brain injury and to guide future evaluations of the laws’ impacts and the development of future public health laws. We conducted key-informant interviews in 35 (...) states with recently enacted concussion legislation. States varied considerably in their readiness and capacity for implementation. Factors facilitating implementation included existing partnerships, procedures, and resources; centralized implementation authority; prior related efforts; and involvement in the policymaking process by those now charged with implementation. Inhibitors included ambiguous statutory language, unclear delegation of authority, and compliance difficulties. Ongoing challenges persist, including primary prevention; determining which providers are qualified to make return-to-play assessments and contents of those assessments; compliance difficulties in rural and under-served areas; and unclear responsibility for enforcement. Despite the similarity of youth sports concussion laws, early evidence suggests there is considerable variation in their implementation. These findings are critical for ongoing empirical investigations to accurately evaluate the laws’ provisions and to identify successful legal approaches to protecting young athletes. (shrink)

Over the past decade, a flurry of media stories devoted to sports-related concussions have drawn attention to the previously “silent epidemic” of traumatic brain injury in athletes. From 2001 to 2009, the annual number of sports-related TBI emergency department visits in individuals age 19 and under climbed from 153,375 to 248,414, an increase of increase of 62 percent. Multiple head injuries place youth athletes at risk for serious health conditions, including cerebral swelling, brain herniation, and even death — postconcussive conditions (...) that have collectively been referred to as “second impact syndrome.” Studies have shown that children and teens — and girls, in particular — are more likely to sustain a concussion and have a longer recovery time than adults. Recent research also suggests that even subconcussive hits in children and adolescents may result in longer-term health effects such as decreased cognitive functioning, increased rates of depression, memory problems, and mild cognitive impairment. (shrink)

Concussion is a form of mild traumatic brain injury that can occur as a result of contact to the head or other parts of the body that causes a rapid acceleration-deceleration force to the brain that may cause a functional disturbance in an individual’s ability to concentrate or learn new information. Contrary to popular belief, it is not a bruise to the brain, and there is usually nothing detectable on standard imaging such as a computed tomography or magnetic resonance (...) imaging. Symptoms and signs are therefore important to detect and include decreased levels of consciousness, headache, nausea, difficulty concentrating, memory loss, and poor coordination. These signs and symptoms usually occur within minutes after the injury but may also appear several hours or even days later. (shrink)

Magnetic resonance imaging (MRI) can provide a number of measurements relevant to sport-related concussion (SRC) symptoms; however, most studies to date have used a single MRI modality and whole-brain exploratory analyses in attempts to localize concussion injury. This has resulted in highly variable findings across studies due to wide ranging symptomology, severity and nature of injury within studies. A multimodal MRI, symptom-guided region-of-interest (ROI) approach is likely to yield more consistent results. The functions of the cerebellum and basal (...) ganglia transcend many common concussion symptoms, and thus these regions, plus the white matter tracts that connect or project from them, constitute plausible ROIs for MRI analysis. We performed diffusion tensor imaging (DTI), resting-state functional MRI, quantitative susceptibility mapping (QSM), and cerebral blood flow (CBF) imaging using arterial spin labeling (ASL), in youth aged 12-18 years following SRC, with a focus on the cerebellum, basal ganglia and white matter tracts. Compared to controls similar in age, sex and sport (N = 20), recent SRC youth (N = 29; MRI at 8 ± 3 days post injury) exhibited increased susceptibility in the cerebellum (p = 0.032), decreased functional connectivity between the caudate and each of the pallidum (p = 0.035) and thalamus (p = 0.021), and decreased diffusivity in the mid-posterior corpus callosum (p < 0.038); no changes were observed in recovered asymptomatic youth (N = 16; 41 ± 16 days post injury). For recent symptomatic-only SRC youth (N = 24), symptom severity was associated with increased susceptibility in the superior cerebellar peduncles (p = 0.011) and reduced activity in the cerebellum (p = 0.013). Fewer days between injury and MRI were associated with reduced cerebellar-parietal functional connectivity (p < 0.014), reduced activity of the pallidum (p = 0.002), increased CBF in the caudate (p = 0.005), and reduced diffusivity in the central corpus callosum (p < 0.05). Youth SRC is associated with acute cerebellar inflammation accompanied by reduced cerebellar activity and cerebellar-parietal connectivity, as well as structural changes of the middle regions of the corpus callosum accompanied by functional changes of the caudate, all of which resolve with recovery. Early MRI post-injury is important to establish objective MRI-based indicators for concussion diagnosis, recovery assessment and prediction of outcome. (shrink)

In the United States, approximately 2.53 million people sustain a concussion each year. Relative to adults, youth show greater cognitive deficits following concussion and a longer recovery. An accurate and reliable imaging method is needed to determine injury severity and symptom resolution. The primary objective of this study was to characterize concussions with diffusion tensor imaging. This was performed through a normative Z-scoring analysis of DTI metrics, fractional anisotropy, axial diffusivity, and radial diffusivity, to quantify patient-specific injuries and (...) identify commonly damaged brain regions in paediatric concussion patients relative to healthy controls. It was hypothesized that personalizing the detection analysis through normative Z-scoring would provide an understanding of trauma-induced microstructural damage. Concussion patients were volunteers recruited from the Emergency Department of the McMaster Children’s Hospital with a recent concussion, 9 males and 17 females, mean age 14.22 ± 2.64, while healthy paediatric brain DTI datasets were obtained from an MRI data repository. Significant abnormalities were commonly found in the longitudinal fasciculus, fronto-occipital fasciculus, and corticospinal tract, while unique abnormalities were localized in a number of other areas reflecting the individuality of each child’s injury. Total injury burden, determined by the number of regions containing outliers per DTI metric per patient, was used as the metric to quantify the overall injury severity of each patient. The primary outcome of this analysis found that younger patients experienced a significantly greater injury burden when measured using fractional anisotropy. These results show that DTI was able to detect microstructural changes caused by concussion, on a per-person basis, and has the potential to be a useful tool for improving diagnostic accuracy and prognosis of a concussion. (shrink)

The Consensus Statement of the Third International Congress on Concussion in Sport in November 2008 defined concussion as a “complex pathophysiologic process affecting the brain, induced by traumatic biochemical forces.” Definitions of concussion vary slightly between various professional organizations of neurosurgeons, neurologists, and orthopedic surgeons, but all share the common characteristics of trauma affecting the head or body resulting in transient neurologic deficits or symptoms. Underlying the symptoms of concussion is a complex pathophysiologic process at the (...) cellular level. While concussion is typically thought of as resulting from a direct impact to the head, a concussion can also be sustained as a result of an impact to the body causing the force of the impact to be transmitted to and absorbed by the brain. (shrink)

Currently, all 50 states and the District of Columbia have youth concussion laws based on the core principals of the 2009 Lystedt Law of Washington State. On April 23, 2013, the state of Georgia signed into law House Bill 284, “The Return to Play Act of 2013” and became one of the last states to pass youth concussion legislation. This Act became effective on January 1, 2014. The purpose of this report is to highlight the legislative process of (...) enacting Georgia House Bill 284 and compare it to the legislation of other states. (shrink)

In this article, the authors examine post-concussion syndrome (PCS) from an existential-phenomenological perspective, specifically as a Heideggerian analysis of Dasein (or Daseinsanalysis; Condrau, 1988). As a medical syndrome, PCS was once defined in terms of its pathophysiology. However, in the absence of reliable evidence of pathophysiology, PCS has been removed from the DSM-5. We have suspended the natural attitude, in this case the biomedical model, and have taken seriously the symptoms of PCS as indications that meaningful changes have occurred (...) within the structure of the patient’s existence. Following the medical theories of Goldstein (1995) and Gadamer (1996), the authors describe the significance of PCS as it is lived by Tyrese, an NCAA Division II football player whose series of concussions left him permanently sidelined. Careful consideration is paid to the existential dimensions of the syndrome, specifically the backgrounds of temporality, sociality, and attunement. In conclusion, a new approach to rehabilitation is explored. (shrink)

This study investigated the relationship between concussions and medication adherence among 247 adults experiencing homelessness in Oklahoma City, Oklahoma, who were prescribed medication for a psychiatric disorder. Participants were asked whether they had “ever experienced a blow to the head that caused a concussion,” and medication adherence was measured by asking participants whether they had taken their psychiatric medication yesterday. The data were analyzed using univariate and multivariable logistic regressions. Results showed that more than half of the sample had (...) a concussion history, and homeless adults with a concussion history had higher odds of non-adherence to psychiatric medications compared with those who reported no concussion history [OR = 2.13 ]. Findings suggest that medication non-adherence is associated with incurred concussions. Raising awareness among service providers of the relationship between traumatic brain injury and medication adherence may increase efforts to improve adherence in this underserved population. (shrink)

Objectives: The N2b is an event-related potential component thought to index higher-order executive function. While the impact of concussion on executive functioning is frequently discussed in the literature, limited research has been done on the role of N2b in evaluating executive functioning in patients with concussion. The aims of this review are to consolidate an understanding of the cognitive functions reflected by the N2b and to account for discrepancies in literature findings regarding the N2b and concussion.Methods: A (...) scoping review was conducted on studies that used the N2b to measure cognitive functioning in healthy control populations, as well as in people with concussions.Results: Sixty-six articles that met inclusion criteria demonstrated that the N2b effectively represents stimulus-response conflict management, response selection, and response inhibition. However, the 19 included articles investigating head injury found widely varied results: some studies found the amplitude of the N2b to be increased in the concussion group, while others found it to be decreased or unchanged.Conclusion: Based on the available evidence, differences in the amplitude of the N2b have been linked to response selection, conflict, and inhibition deficits in concussion. However, due to large variations in methodology across studies, findings about the directionality of this effect remain inconclusive. The results of this review suggest that future research should be conducted with greater standardization and consistency. (shrink)

In 1845, Robert Graham’s death created a vacancy for the traditionally dual appointment to the University of Edinburgh’s chair of botany and the Regius Keepership of the Edinburgh Royal Botanic Garden. John Hutton Balfour and Joseph Hooker emerged as the leading candidates. The contest quickly became embroiled in long running controversies over the nature and control of Scottish university education at a time of particular social and political tension after a recent schism in Church of Scotland. The politics of the (...) appointment were complicated by the fact that the Edinburgh Town Council chose the chair while the keepership was under the patronage of the Westminster government . Balfour eventually emerged triumphant after a bitter campaign marked on all sides by intense politicking. The struggle to replace Graham provides a case study in how Victorian men of science adapted their aspirations to the practical realities of life in industrial, reforming, imperial, multinational Britain. (shrink)