Hard Knocks

Studies conducted in the College of Health and Human Sciences on the subject of concussions are providing insight into concussion education, the acute effects of concussions on athletes, and the cumulative effects of brain injuries that individuals have incurred over a period of years.

News reports in recent months have detailed permanent brain injuries in former NFL players who suffered multiple concussions resulting in a condition called chronic traumatic encephalopathy that has led to early memory loss and dementia. Studies have shown that players as young as their 30s or 40s have brains that resemble that of an 80-year-old with dementia.

Tom Buckley and Barry Munkasy, professors in the Department of Health and Kinesiology, and their research team of graduate students have studied more than 25 athletes during the past two years in hopes of identifying concussion recovery patterns.

Researchers are investigating post-concussion changes in individuals’ ability to maintain their balance using both a standard exam called the Balance Error Scoring System (BESS) and more sophisticated biomechanical measurements during transitional body movements.

“The BESS is an inexpensive test that is easy to do,” said Buckley, “but it may be underestimating how long a person is actually impaired.” The BESS is a challenging test in which researchers measure a series of stances for an individual by asking them to stand in various positions with their eyes closed, both on a firm and foam surface.

According to Buckley, the BESS test only successfully identifies an athlete’s impairments for the first three to four days following a concussion. “By using the BESS test, athletes may be released to return to athletics too soon. Our findings, in agreement with other research, suggest that the effects of concussions persist longer than previously thought,” he said.

Also, once an individual suffers an initial concussion, they are at risk for second impact syndrome if they suffer another head injury while still symptomatic from the previous concussion. “If second impact syndrome occurs, there’s about a 50 percent death rate,” Buckley noted. These and other recent findings have resulted in athletic trainers and the rest of the sports medicine community becoming more conservative in their treatment of concussions.

“In addition to balance problems, a person with a concussion typically presents with cognitive processing problems,” he said. So, in addition to basic balancing tasks, concussed individuals are also asked to perform cognitive tasks while moving. The basis of these tasks is to examine one’s ability to think and move at the same time. Some of the exercises include solving math problems or reciting the months of the year backward while walking.

Buckley and his team have recently completed a research project funded by the Army Research Office where they partnered with other researchers from the University of Florida and PMB InTelliGence, a West Lafayette, Ind., corporation, to study approximate entropy, which examines the effect brain injuries have on the amount of time it takes a person to regain their balance, and how balance patterns compare between healthy individuals, and those suffering a brain injury.

“In this study, we looked at a person’s movements following a concussion. For example, a healthy person will have a very consistent movement pattern, and a person who has suffered from a concussion will have a very inconsistent pattern of movement. We tracked this over a long period of time to see how these changes occur,” he said. In fact, the Army Research Office has requested that the team pursue a follow-up study to this initial research, and Buckley said that the next phase of this study will begin this fall.

Concussions are of substantial interest to the armed services as a recent study found that 15 percent of soldiers surveyed have experienced head trauma while serving in Iraq.

Buckley is optimistic that the results of this research will promote further training of coaches and athletes on the appropriate ways to recognize a concussion and the importance of reporting the symptoms to their athletic trainer. “The big push now is to educate coaches and athletes on the serious risks associated with frequent concussions,” he said. According to Buckley, Georgia Southern’s coaching education students have a very thorough understanding of concussion symptoms, based on a study conducted by one of his graduate students who found that the students had significantly more concussion knowledge than previous investigations of active coaches.

“There are a lot of myths about concussions,” Buckley said. “For example, you do not have to be knocked unconscious or be completely disoriented to have a concussion. National data has shown that there are upwards of 60,000 concussions reported each year in high school football players, however a lot of athletes think that you have to be knocked unconscious, so approximately 50 percent of concussions that occur don’t get reported.”
Even with all of the breakthrough data that has surfaced on this topic, there is, however, one drawback. “It’s hard to get subjects,” said Buckley.

“It’s one of the challenges of this research, so we’re a little bit limited in what we are able to do.” However, Buckley is confident that new, more advanced diagnostic testing methods are on the horizon. For example, “there are ongoing studies using the gaming system Wii and a WiiFit board to measure balance,” he noted, “and also using a special carpet that can literally be rolled out on any hard surface, anywhere for testing.”

–Mary Beth Spence