Review of sports-related concussion: Potential for application in military settings
| Autor: | Darryl Thomander, Kelvin T. L. Chew, Henry L. Lew, Joseph Bleiberg |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
medicine.medical_specialty
Warfare Neurology Traumatic brain injury media_common.quotation_subject Comorbidity Severity of Illness Index Neuroimaging Concussion medicine Humans Psychiatry Military Medicine Brain Concussion media_common Neurologic Examination Psychological Tests biology Athletes Rehabilitation Head injury Cognition Recovery of Function medicine.disease biology.organism_classification United States Causality Military Personnel Athletic Injuries Practice Guidelines as Topic Consciousness Psychology |
| Zdroj: | Journal of rehabilitation research and development. 44(7) |
| ISSN: | 1938-1352 |
| Popis: | INTRODUCTION Recognizing and managing the effects of cerebral concussion are vitally important to those involved in the healthcare of athletes. "Cerebral concussion" and "mild traumatic brain injury" (MTBI) are overlapping terms. Given that approximately 80 percent of nonfatal traumatic brain injuries (TBIs) from all causes are classified as "mild" [1], an estimated 1 million or more Americans sustain a concussion each year [2]. The annual number of concussions due to sports in the United States is estimated at 300,000 [3]. The U.S. military maintains an extensive sports program that serves to help maintain and enhance the physical conditioning and quality of life of service men and women [4]. The number of military service members who participate annually in sports programs and sustain sports-related concussions is currently unavailable, but we expect the incidence rate to be similar to that of civilian athletes. Because of the current high use of improvised explosive devices (IEDs) in war, awareness of and concern regarding combat-related concussions sustained in the U.S. military have increased. Much of what has been learned about concussion in the past decade has been acquired through the systematic study of concussions sustained in sports. DEFINITION OF CONCUSSION The word "concussion" originates from the Latin word concutere, which means "to shake violently." In 1966, the Committee on Head Injury Nomenclature of the Congress of Neurological Surgeons produced the following consensus definition of cerebral concussion: "A clinical syndrome characterized by the immediate and transient posttraumatic impairment of neural function such as alteration of consciousness, disturbance of vision or equilibrium, etc. due to brain stem involvement" [5]. In 1997, the American Academy of Neurology (AAN) defined concussion as "any trauma-induced alteration in mental status that may or may not include loss of consciousness" [6]. In November 2001, clinicians and researchers gathered in Vienna, Austria, for the First International Symposium on Concussion in Sport [7]. This group of experts met to improve the understanding of concussive injury. The group defined concussion as "a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces." They described several common features that incorporate clinical, pathological, and biomechanical injury constructs and that can be used to define the nature of a concussive head injury: 1. Concussion may be caused by a direct blow to the head, face, or neck or by a blow elsewhere on the body that transmits an "impulsive" force to the head. 2. Concussion typically causes the rapid onset of short-lived neurological impairment that resolves spontaneously. 3. Concussion may cause neuropathological changes, but its acute clinical symptoms largely reflect functional disturbance rather than structural injury. 4. Concussion causes a graded set of clinical syndromes that may or may not involve loss of consciousness (LOC). The clinical and cognitive symptoms typically resolve sequentially. 5. Concussion is typically associated with grossly normal structural neuroimaging studies. Current definitions and explanations of cerebral concussion will, no doubt, be modified as research in this field continues. The causes of concussion include the shock waves of explosive blasts, which are currently being studied in the numerous U.S. service personnel with blast-related MTBI [8]. Most fatalities and brain injuries among U.S. soldiers in Afghanistan and Iraq are caused by IEDs (http://www.dvbic.org/pdfs/DVBIC-Facts-2007.pdf). In one review of cases, 59 percent of those exposed to explosive blasts were diagnosed with TBI and 44 percent of these TBI cases were considered mild [9]. The changes responsible for the temporary neurological and cognitive impairments associated with concussion have been attributed to a highly complex neurometabolic cascade [10], which cannot be seen with structural neuroimaging. … |
| Databáze: | OpenAIRE |
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