Faculty of Medicine researchers have shown that concussion-related processes and changes in brain microstructure persist well beyond the initial trauma — leaving open the possibility that adolescent athletes could be returning to sports before their brain injury has fully healed.
Using a clinical assessment tool and brain imaging, the researchers examined brain function and white matter structures in a dozen adolescents aged 14- to 17-years-old who had experienced at least one sports-related concussion in the past two months, compared with 10 otherwise healthy, non-concussed adolescent athletes.
The tool, called the Sports Concussion Assessment Tool 2, is often used at the playing field and in clinical settings to determine the level of brain injury based on 22 symptoms, including balance, orientation and memory. Diffusion Tensor Imaging, a type of magnetic resonance imaging, images the movement of water through the brain, which can be affected by brain structure changes from even the mildest of concussions.
“The imaging results showed that the integrity of white matter in the brain was significantly different between the concussed and non-concussed teenagers,” says Naznin Virji-Babul, an Assistant Professor in the Department of Physical Therapy and a scientist in the Brain Research Centre and the Child & Family Research Institute.
Coaches and trainers sometimes dismiss or downplay negative results from the concussion assessment tool, Dr. Virji-Babul says. But results from that assessement “were strongly associated” with the changes revealed through Diffusion Tensor Imaging.
“Our research has immediate impact on return-to-play decisions made by physicians and medical personnel, coaches, parents, and the athletes themselves,” says co-author Lara Boyd, a Canada Research Chair in the Neurobiology of Motor Learning and also a member of the Brain Research Centre. “Age-specific diagnostic guidelines that are applied consistently across the disciplines of neurology, physical medicine, rehabilitation, and sports medicine are needed.”
The results were published in the January edition of the journal Pediatric Neurology.
Nearly one in four people who experienced a concussion between 2009 and 2010 were adolescents, though that number may be higher because the injuries may not have be reported or were treated outside a hospital emergency room. Concussions are especially concerning in children and adolescents because their brains are still developing and may be more susceptible to damage or take longer to fully recover.
The researchers are planning future studies to assess the impact of brain injury on function, in order to understand the risks of returning to play and sustaining additional concussions, as well as developing improved clinical practice guidelines in physicians’ management of sport concussion, including return-to-play decisions.
This study was supported by the Martha Piper Research Fund, the Brain Research Centre, and UBC. Analysis of the brain scan images was completed by Michael Borich, a postdoctoral fellow with Dr. Boyd.