Forget it: players can’t continue after head hit
IT IS not just a head knock - it's brain damage.
The simple message from Southern Cross University psychology researcher Dr Jim Donnelly should have the Clarence Valley's sport players, especially its footballers, reanalysing the way they play their chosen game.
"You have to get out there and say you have suffered brain damage," Dr Donnelly said.
"If you had a fractured leg you can't play, but because it (concussion) is inside the skull and you can't see the damage, it's easier to ignore, or use words that make it feel like it's no big deal."
State of play
Rugby league, union and Aussie rules are three of the top sports associated with concussion, but it is a condition that can strike during any kind of activity. In fact, falling from a horse is the most common cause for head injuries in girls, in a study being conducted by Dr Donnelly.
Concussion is not so much about impact than it is the movement of the brain inside the skull after a blow to the head.
"One of the myths out there is you have to be knocked unconscious to suffer a concussion, and that's definitely not the case," Dr Donnelly said.
As rugby star Connor Vest mentions in the story at the bottom of the opposite page, players tend not to voice their concern and opt to continue playing through pain.
Concussion symptoms should be easy to see, but it is the only major injury that players successfully hide by "faking good".
"In many cases the player is the wrong person to be making that decision," Dr Donnelly said.
"By putting their hand up that would require clear thinking or insight into the risks at a time when they just may have suffered a brain injury.
"I wouldn't rely on the player to put their hand up."
Dr Donnelly's solution is clear-cut.
"If a player looks like they have suffered a concussion due to a blow to the head and they've had a momentary alteration in their level of consciousness, they should be off the field and stay off the field for that game until they are properly assessed," he said.
"It's a tough call as that team spirit and wanting to be mentally tough and physically tough is an important part of the game.
"But when it comes to concussion management you can't let that enthusiasm and not wanting to let your mates down override the health of a player.
"Once a person has had that first concussion on the field there is a significantly increased risk of getting another head injury that may be more severe."
Dr Donnelly points to a group of concussed adults known as the "miserable minority" as a prime example of why concussion needs to be taken more seriously.
The miserable minority is a group of adults who have not recovered from concussion as they should have and still suffer problems a year later.
"Those who had more than one concussion seemed particularly vulnerable," Dr Donnelly said.
"We just want to be able to find out the truth for the person we're working with and give them support.
"(Detecting) 'faking good' is one of the key things when assessing adults and young people who are motivated to get back on the field or back to normal play activities.
"We have to have some objective tests that allow you to measure whether their brains are back to where to they were before."
Dr Donnelly and his colleagues are working with two private schools - The Armidale School
and John Paul College - to set a baseline for individuals that will inform the management of any concussion.
Every child at both schools has a personal computer so the research team can easily use internet-based testing programs (Head minder or Cog Sport/Axon Sport) to make the acquisition of such data more efficient.
Dr Donnelly said he had data on about 1000 private school students and was keen to move his testing into the public school system.
"We'd like to be able to do the same thing in public schools, but that hasn't happened yet," he said. "We've had some interest from the Department of Education and they're looking at how things go at the private schools before making that decision."
Dr Andrew Gardner and his colleagues at Newcastle have been assessing ex-professional league players who have suffered concussion. Dr Gardener has been getting brain scans of former Newcastle Knights and doing neuropsychological testing to determine if there are problems with thinking or emotions.
He has also published a paper on the effects of repeated concussions and how it affects their thinking, attention and (long and short-term) memory.
Internationally, there are many publicly available reports and journal articles about the effects of concussion on sport stars.
Former professional footballer and wrestler turned concussion activist Dr Chris Nowinski is the co-founder of the Sports Legacy Institute and has published numerous pieces about chronic traumatic encephalopathy, a neurodegenerative disease that could be a later consequence of concussion.
What is it?
Concussion is the term used to describe what happens in the brain after a blow to the head or the face, and it usually includes the brain moving inside the skull as the skull has stopped moving.
It includes things such as stretching or shearing of connections between brain regions.
How much force is required?
Knowing that is a challenge, but it really doesn't need a lot. You can get a concussion without even being knocked out.
What terms are used to grade concussion?
Mild, moderate or severe. It is important to get all head injuries checked out regardless of grading.