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How Can We Help Athletes Who Aren't Self-Reporting Concussions?

University of the Fraser Valley/

This year, Indiana became the first state to require concussion awareness training for coaches at the youth and high school level, although other states have passed similar measures. To learn more about what the training will entail and what we still don't know about concussions, we spoke with Dr. Tom McAllister, a brain injury expert at the IU School of Medicine.

Barbara Lewis: Can you tell us exactly what happens to the brain during a concussion? 

Dr. Tom McAllister: Sure, I can tell you what we think happens. Believe it or not, there's still a lot that we don't understand. But basically, a concussion is caused by some sort of force acting on the head. And then that, in turns, sets up a dynamic in which the brain moves, and it moves out of phase with its casing. That ends up twisting and stretching some of the nerve cells in the brain. And then, in turn, results in what we clinically define as a concussion. Which means they have an alteration in their level of consciousness, which means they make  act confused; they may be disoriented. They may not fully understand the situation that they are in. And they may have incomplete memory for what just happened. 

Barbara Lewis: This is really dependent on self report though, too, isn't it? 

Dr. McAllister: It is. Concussion exists really across the spectrum. It's really another term for mild brain injury. And that can range from a loss of consciousness (which doesn't so much rely on self reports -- if someone is laying on the field, for example, and they don't answer your questions and so forth) to really a fairly subtle clinical manifestation in which (for example in a sports context, they may go and line up on the wrong side of the ball because they are confused as to which team they are playing on or which direction their team is headed in). So even short of that, people need to report that they aren't feeling right; that they are confused. But to a confused person, they are not even sure they are confused sometimes. 

Lewis: For the last few years, we've been hearing a lot about concussions and especially in football. High school sports are competitive. College sports obviously extremely competitive. How's the reporting going? Are the athletes still pretty reluctant to be taken out of the game? 

Dr. McAllister: Absolutely. That point is really what has driven an enormous interest  on the part of defense and the NIH to come up with some type of marker or identifier of concussions. It's often called a biomarker or some sort of imaging test or some sort of blood test that we can use. Because short of that, we're pretty confident that we're missing a lot of concussions. And number two, there's an enormous motivation on athletes to not say that they have a concussion. Paradoxically, the emphasis on concussion has resulted in people wanting to think twice or three times before they report, because it means, "I might miss more time before I can get back in the game. Or, if I have too many of these concussions, will it jeopardize my standing as a player?" So, it's a problem. And part of what we need to do is help people understand the significance of brain injury and repetitive injuries like this, and that really the culture around reporting needs to change over time.