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Concussions are considered synonymous with mild traumatic brain injury (TBI). Even thought there is some debate in the literature about how to properly diagnosis concussion and TBI (Bernhardt, 2009), there are clear symptoms from individuals who have suffered from a traumatic brain event. Symptoms such as amnesia, nausea, disorientation, confusion, headache, visual disturbance, fatigue and slurred speech have been described (Moser, 2007). Importantly for diagnosis in sports-related activity, loss of consciousness does not always occur when a person has suffered a concussion. The pathology of a concussion occurs when the brain is rapidly accelerated or decelerated and shearing forces cause direct neuronal cellular damage. This is often referred to as diffuse axonal injury, or DAI. A recent study in mice has shown that there was a significant increase in damaged neurons in the brain even after a mild TBI compared to controls (Tashlykov et al., 2009). It is becoming increasingly clear that the effects of concussions and TBI are more severe than they were once believed to be.
Traumatic brain injury is an injury that has many facets, meaning effects on single neurons, but arguably more important, effects on the neuronal network resulting in potential cognitive deficits. In fact, repeated concussions of the brain can have much more severe effects on function, simply because the brain has already experienced one concussion. Research has shown one-third of people with mild TBI experience depression within the next year. In fact, as many as three-fourths of people who have experienced mild TBI will develop anxiety and one-half will develop new-onset aggression (Fann et al., 1995). Furthermore, repeated blows to the head resulting in mild to moderate TBI may lead over years to depression, an inability to concentrate, and possibly several forms of dementia, including Alzheimer’s.
In athletics, the decision to return to play has largely been subjective and has relied on the accounts of the players to the team physician. There are several assessment techniques including the Sport Concussion Assessment Tool (SCAT) as well as the system developed by McCrea et al have been created and can be used on the field. However, having a player return too quickly to play even after one to two weeks off could have serious cognitive consequences later in life (Johnston et al., 2001). An important, objective tool for assessing a player’s recovery from concussion could be the use of brain imaging technologies.
Specifically, SPECT imaging has been shown to be highly effective at showing functional deficits in brain activity due to TBI. In fact, studies have shown that SPECT can visualize brain injuries much better than MRI and CT scans (Abu-Judeh, et al., 2000). Diminished blood flow can reflect damage to the brain; thus, it is important to be able to detect diminished blood flow to prevent further damage in the case of sports-related concussions. Given limitations of the other techniques, SPECT could be a valuable tool to find regions of the brain that are not functioning well and thus might be at risk for permanent damage. Indeed, one study has shown that if a patient has a normal SPECT brain scan after a head injury, then there is an excellent chance that the patient will have a complete recovery (Jacobs et al., 1996).
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