I recently attended a conference which discussed “The Brain & Law” which I found very interesting and thought provoking, from both legal and medical perspectives. The session discussed the advances in medical research in relation to brain trauma, particularly concussion and how ‘microglia’ reacts in trauma, which will impact on personal injury law and also on patients/clients who suffer head injuries, including concussion.
I recently watched a movie titled “Concussion“, which recounted events, albeit with creative license, and showed Dr Omalu, a forensic neuropathologist, being stonewalled by the American NFL as he tried to ring alarm bells on the effects of repeated head trauma on NFL players’ health. What are the long-term health risks and legal position for the various sporting bodies in Australia in respect to a players ‘head trauma‘, including what could be considered a light knock that may cause concussion?
More and more sportspeople are speaking up about their head injury experiences. Athletes such as James McManus (rugby league), Casey Dellacqua (tennis), Chris Rogers (cricket) and Justin Clark (rugby league) have had to take time out or forced to cut their athletic careers short due to concussion. The ‘one punch’ attack has drawn much attention, which has caused almost 100 deaths since 2000.
Its not major head trauma that is of most concern or the short term consequences of head impacts, rather the long term neurological damage that can be as a result of repeated, apparently minor knocks to the head.
What is Concussion?
The brain floats inside the skull, suspended within a protective cushion of CSF (cerebrospinal fluid). A direct blow to the face, neck or head or from an impact somewhere else in the body may create such a force, that the brain is shaken and if strong enough the brain can strike the skull or twist upon itself. When this occurs, concussion is the outcome, with far reaching effects.
When concussion occurs in sports, players mostly remain conscious and therefore the condition goes undiagnosed.
Concussion In Football
Australian football codes could be associated with an even greater concussion risk than the American game as a result of differences in protective equipment worn and the speeds of the game. They also worry that rule changes introduced to make games faster and more enjoyable for fans, as well as the increased prevalence of bigger, stronger and faster athletes, are adding to the risks.
Concussions are frequently sustained by amateur and professional players of Australia’s three most popular football codes (AFL, rugby league, and rugby union) and, to a lesser extent, other contact sports such as soccer. This raises major concerns about possible long-term neurological damage, cognitive impairment and mental health problems in players of these sport.
Those looking closely at the head injuries young Australians are receiving on the nation’s sports fields also suspect that many more are receiving potentially devastating blows than the official figures suggest.
In the American NFL, there have been 39 rules changes to promote player health and safety in the past five years; the institution of concussion protocols, unaffiliated neurotrauma consultants and injury spotters at games; and an investment of tens of millions of NFL dollars into research and technology devoted to brain injuries.
AFL adopted a return-to-play guideline at the beginning of the 2011 season that excludes concussed players from continuing to play in the same match. The enactment of this rule highlighted the lack of similar policies to reduce concussion and secondary head trauma in professional rugby league and rugby union in Australia, although the International Rugby Board has since adopted the recommendations of the Zurich consensus statement. The National Rugby League has not made this a priority. If concussion rules are to succeed, they must be enforceable and consistently applied in ways that are resistant to manipulation.
There is an urgent need to investigate the cumulative effects of head traumas over longer periods using methods that track an athlete’s playing history and record head injuries in standardised ways to allow valid comparisons across cohorts.
What Protocols To Best Manage and Diagnose Concussion?
- What tests are most useful? – SCAT2 or MRI or other tests, which demonstrate microglial phenomenon as these tests become readily available?
- Who are most qualified to diagnose and manage concussed players? (GP’s, neurologists, neuropsychologists)
- Who is going to manage conflict of interests and coercive pressure between coaches, players and doctors when a player is apparently concussed?
- What about under-reporting of concussion so as not to have to ‘sit out’ of 1> games
- What rules need to change to further protect players brain health?
- What systems and protocols are in place or need to be implemented and enforced for players, to further protect players brain health?
The implementation of research in Australia would require the cooperation of sporting bodies to obtain sufficient numbers of athletes to provide meaningful results about the sequelae of head injuries, which may raise uncomfortable questions about how brain trauma is currently managed in sports
What is CTE?
The cumulative effects of chronic and subtle brain injuries resulting in CTE can currently only be observed postmortem. CTE produces symptoms similar to those of early-onset dementia, along with behavioural and cognitive impairment.
The “Concussion’ Movie
It is fact, the NFL agreed to pay $765 million to settle the lawsuit brought by 4,500 players alleging that the NFL concealed the dangers of head trauma.
Sports in Australia
Sports in Australia, particularly contact sports, need to attend to the cumulative effects of years of chronic or subtle brain injuries among their players at the elite and amateur levels. There is a medical and ethical imperative for all sports to minimise the risks of head injuries and concussion among players, otherwise, the risk of litigation by past and present players, will be significant.
In the future, sportspersons (and other persons who suffer concussion i.e. domestic violence victims, military personnel exposed to explosions) will be able undergo a medical test which will demonstrate ‘microglial’ changes in the traumatised or concussed brain. This will provide further evidence of the ‘concussed brain‘ in a short time frame after the incident, which will assist in managing head trauma. Currently MRI and CTs do not demonstrate these changes.
Australian sports could be at major risk of litigation being initiated by players and/or ex players, if systems and protocols are not in place, strictly adhered to and/or the risks of head trauma are concealed, much like in the USA.
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