Concussion: What we're doing to better diagnose brain injuries

2013-12-17 13:57:38 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.

Reebok Checklight Reebok Checklight

As we continue the discussion on concussion, I want to offer readers an update on what we as an industry are doing to better recognize or diagnose concussions.

According to a recent study from the University of North Carolina, only about 40 percent of them are picked up initially.

Today, I had the chance to speak with WAKR host Ray Horner about this topic.

One of the things we’re focusing on is the reliability of these new sensors being placed on helmets to measure the g-forces or impact of a hit. We want to make sure there are no false negatives before we recommend widespread use.

Below is an audio file and transcript of our discussion.



HORNER: Let’s bring in our good friend, Dr. Joe Congeni from Sports Medicine Center at Akron Children’s Hospital. Joe, what do you have for us this morning?

DR. CONGENI: Hey, Ray. You know, one of the really fun parts of my job is that I get a chance to not only just see patients in my office in sports medicine, but we get a chance to talk with a lot of different groups about advocating and preventing sports injuries for kids.

This Sunday, I’ll be giving a talk to the athletic directors statewide down in Columbus. That’s a group that’s gonna be really important to us.

Dr. Joe Congeni Dr. Joe Congeni

We’re going to be talking about prevention of injuries and particularly prevention of concussion and brain injury. They’re gonna want an update of how we’re doing and what new tools are out there.

You know, in the last week since I spoke to you last, there’s been a little bit more news with a guy that grew up in your and my era, Tony Dorsett. chronic traumatic encephalopathy.

You hear those stories. You know, it’s not everybody from that day in age of football, but it is concerning.

We’re trying to do everything on the front end we can, Ray. I know for the A-Ds (athletic directors), it’s really important to them to try to prevent these things from getting to a point like with Tony Dorsett.

Tony Dorsett was inducted into the Football Hall of Fame in 1994. Tony Dorsett was inducted into the Football Hall of Fame in 1994.

Probably the biggest decision points, Ray, when it comes to brain injury is No. 1, recognizing that it is a concussion and seeking help, and the other part is then knowing when the brain returns to normal and when somebody can play again. Those are the two things we’re trying to .

I want to talk just briefly today about that first end of how we recognize or diagnose or tell someone about it.

Fifteen years ago we did a study at the University of Akron and we found that over 80 percent of people that have initial symptoms of concussion don’t report symptoms to anybody. Instead, they continue to play with those symptoms until they have a more significant brain injury.

A recent study was done at the University of North Carolina that showed that percentage now to be closer to 60 percent. Still, with all the discussion about brain injury and the long-term effects and other things, 60 percent of young athletes who have these continue to play. They don’t mention ‘em to anybody.

So, only about 40 percent of them are picked up initially. It is these people that are really putting themselves at risk if they continue to play.

A lot of the research recently has what can we do up-front to recognize these better.

One of the hot topics that came out in the last year is these sensors or add-ons to the helmet. I think you and I touched on them briefly, but I’m going to give a little update about it down in Columbus this weekend.

You know, Riddell has one. It’s called Insite. Reebok has one. It’s called CheckLight. Then there’s one built in to the chin strap called Shockbox that actually measures the impact or the g-forces or the energy — you know, the acceleration or deceleration — of the forces that are on the brain, so that we can pick up who has had a significant impact.

Riddell's Insite Liner Riddell's Insite Liner

They are not widely used yet, but we’re going to check into the research here after another year of use and see if they can be helpful to us. There’s a lot of debate because a lot of people are saying, “Get ‘em on everybody. Everybody should be using these.” (Of course the manufacturers are saying get ‘em on everybody.)

But until there’s a lot of research to know is this really going to be helpful to us, . Of course we want to help on the front end and say we’d like if this could be a tool that helps us be more sensitive and pick up people that have brain injury.

These have kind of a green light, yellow light, red light. The people that have a red light from a hard impact need to be checked clinically. But on the negative end, what are the cons of these things?

What we’re most concerned about in the science side of it is are there going to be a lot of false negatives, Ray?

Shockbox Shockbox

What I mean by that, people who have a significant impact that really would be considered a concussion-type impact, but because it’s a rotational mechanism, you know, the whiplash mechanism or a cumulative effect mechanism, where this builds over time, it may not show up as a red light. It may show up as a green light the person’s fine.

Could this person actually fly under the radar screen and have a false negative by the sensors in the impact data?

So, as we look at this information this year, we’re starting to gather this data and see whether these tools can be helpful to us in that up-front area. We’re totally open to those, but we just have to see if it’s gonna be one more thing that’s gonna be beneficial in helping us pick these kids up early.

HORNER: Alright, good information, Joe. And you can see a lot of work going into this, the health of these kids. Thanks, Joe, appreciate it.

DR. CONGENI: Okay, Ray. Have a great week.

HORNER: You too. Dr. Joe Congeni, Sports Medicine Center at Akron Children’s Hospital, joining us this morning.

 

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