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Concussion & Depression

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Concussion is a traumatic, 'closed head' injury resulting in temporary & varying degrees of impariment to neurological functioning. It is a change in mental status accompanied by confusion, loss of memory and sometimes unconsciousness.

Medical & Para-medical personnel use 'grading systems' for the diagnosis & treatment of concussion. One of the accepted & commonly used grading systems is as follows:

Grade 1: Brief confusion and other associated symptoms that resolve within 15 minutes of concussion and during which time there is no loss of consciousness.

Grade 2: As above, though the episode and symptomatology resolves in a period longer that 15 minutes. Again, there is no loss of consciousness.

Grade 3: Loss of consciousness for any period of time

Motor vehicle accidents & sports injuries are the major causes of concussion with an extremely high risk indicated in Rugby League or similar 'body contact' sports.

Whilst there may be no 'long term' effects from concussion, a 'post-concussion syndrome' may last for weeks or months. The more concussions one receives, the higher the risk for the next episode and ultimately the greater propensity for the development of permanent injury. These may entail psychiatric disorders such as clinical depression later in life, loss of long term memory and 'dementia related illnesses' such as Alzheimer's Disease.

Studies have revealed a 'three-fold' greater chance of mid life depression in footballers who have received three or more bouts of concussion, as compared to those who have never been concussed. In relation to Alzheimer's Disease, the risk is 'five-fold'.

Concussion is somewhat of an unfortunate ‘fact of life’ for the Rugby League player. It is generally anticipated that a player will receive a ‘head knock’ sufficient to result in concussion at some stage during their playing life. It is regrettably part & parcel of a body contact sport.

Recent research in theUSA has indicated that repeated concussions during a player’s career (3 or more) can result in the development of ‘middle age’ depression, well after a player has retired. Dementia, memory loss & other disorders of the brain are also greater in those who have experienced bouts of concussion.

The research also clearly indicated that the majority of concussions go unreported and therefore untreated. The reasons for this are the misconceptions relating to concussion & what it is. We have all generally believed it to be when someone is ‘knocked out’ or loses consciousness.

Concussion is basically a‘bruise to the brain’.A mild concussion is a blow that causes confusion and short term memory loss. The so called ‘classic’ concussion entails a loss of consciousness (LOC) with the resultant after-effects far worse. The chance of receiving a 2^nd concussion is 4 times greater than receiving the 1^st.

concussion brain

On the left, figure A inidcates brain trauma from concussion in the first 24 hours. Figure B indicates areas of noted trauma two (2) days after the initial incident resulting in the concussion.

The U.S. study found that those retired players who reported three (3) or more previous concussions were three (3) times more likely to be diagnosed with depression than those without a history of concussion.

The controversy regarding concussion and its long term consequences appears to be the determination of what it is and what it entails. Historically it has been a clinical diagnosis, though this is not that simple when determining factors such as ‘how many concussions are too many?’ & ‘what is the true incidence of mild cognitive impairment & concussion?’ The research study conducted indicated that concussions are underreported by a factor of 5 to 10 times, particularly in body contact sports such as ‘football’.

Whilst this study was based on American Football, one needs to acknowledge the physically protective efforts made for the players. As opposed toRugby League, American Football players spend less time on the field and have a large array of protective padding and attire such as helmets in order to reduce injury. Rugby League players do not.

One of the saddest aspects to the reality of frequent concussion is the oft used comment by players regarding their sport. They quite rightly say their experiences playing in front of large crowds, with their mates and playing the game they love and excel at‘provides memories that will last a lifetime’. It is regrettable for some that their‘capacity for memory recall is likely to not last a lifetime’.

This is written not to deter people from participating in the sport or reduce the intensity at which they play the game, it is information provided in order that those involved take the issue of concussion more seriously and take steps to ensure the long term well being of the player.

Suggested symptoms if concussion is suspected:

Loss of consciousness

Confusion

Vacant stare

Slurred speech

Excessive drowsiness

Headache

Fatigue

Dizziness

Nausea/vomiting

Irritability

There are, however, many misconceptions & misunderstandings regarding concussion treatment & management. These are:

Loss of consciousness is rarely present in sport concussion & does not correlate to the severity of the injury.

The type, severity & duration of the symptoms are the most beneficial factors in determining the severity of the concussion.

Assessment & management of the concussed player must be individualised.

Factors such as age & previous history of concussion (including time span between bouts of concussion & severity of the concussion) must be taken into account.

Players exhibiting continuing symptoms should not be allowed to return to play.

Neuropsychological testing may assist in evaluating cognitive functioning when determining the appropriate time to return to the game.

Physical & mental rest is essential to recovery.

Younger players should be treated more conservatively.

Returning to the game should be gradual & progressive.

Concussion

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Should you have concerns regarding any issue relating to your 'mental or physical well-being', 'Kick off' strongly recommend you seek professional assistance. This may entail contacting your GP or similar clinician (Psychologist, Psychiatrist, Counsellor etc.). You may also contact the appropriate agency or service that might assist you. Irrespective of your choice, ensure you see someone who might help.

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