What You Should Know About TBIs
21 Sep 2009
What would I worry about if my children were playing hockey and football? In two words, brain injury. Earlier, this year actress Natasha Richardson fell and struck her head while skiing on a beginners slope at Mont Tremblant in Quebec. She walked away apparently without injury. But what shocked the world was the headline news 24 hours later. She had died following this accident.
What had happened? Our brains arn’t firmly attached by screws inside the head. So a sudden hit to the head throws the brain against the skull. But Richardson’s death shows that, if we have an unlucky day, this impact may cause rupture of blood vessels that surround the brain. When bleeding begins, continues and is not diagnosed, the increased pressure of the blood causes injury to the brain, and death can occur unless surgery is done to stop the hemorrhage.
Symptoms of traumatic brain injury (TBI) depend on the extent of the brain damage. After a mild TBI the person may feel dizzy, confused, stunned or disorientated. If the extent of the injury is more severe they may have seizures, headache, vomiting and become unconscious. Also a TBI is suspected if the patients complains of double vision, speech difficulties, weakness on one side of the body and loss of balance when trying to walk.
Mild TBIs do not always need treatment. But even if the symptoms are mild, it’s prudent to go to the hospital emergency for evaluation. This is particularly crucial if patients are taking a blood thinner such as Coumadin that increases the risk of bleeding.
Today the number of TBIs is likely to increase and, unlike Natasha Richardson’s, they will not make headline news. So as the NHL hockey season begins we will again hear about the "big hits" in our national sport that have become violent.
Ken Dryden, the former goal tender for the Montreal Canadians, says we all forget how much the game has changed. Today, players are 27 pounds heavier, taller and shifts have decreased from two minutes (Henri Richard routinely had a three minute shift!) to 40 seconds. The result is that players go out on the ice to give it their all for 40 seconds. And when two 225 pound bodies collide during a big hit, both heads are vulnerable to concussion.
Since teenagers aspire to be in the NHL they also try to mimic their heroes. But this comes with a price. A study showed that 86 percent of all hockey injuries among players 9 to 15 years of age are due to body checking.
New modern equipment such as helmets with visors has prevented the loss of eyes. But helmets make young players believe head injuries cannot occur. A sudden violent hit to the head, helmeted or not, can have the same effect as Natasha Richardson’s. But the more common head injury in hockey is concussion.
Concussion causes a variety of symptoms such as headache, double vision and a feeling of "having my bell rung". Players lose coordination and are unable to answer simple questions, such as "what is the score?" And they do not need to be unconscious to have suffered concussion.
The major problem for doctors is that bruised brains are hard to diagnose. A torn muscle is easy to locate. But there’s no way to physically assess brain damage from concussion. Dr. Karen Williams, a neurosurgeon at McGill University, says that if there’s any doubt about concussion the player must be removed from the game.
The $64.00 question is when players should be allowed to return to hockey. Teenage players invariably downplay their symptoms, want to act tough, and are afraid someone will take their place. But it’s prudent to allow more time rather than less if players show signs of concussion. Moreover, there’s good reason to suspect that concussion is under-reported in young players.
Hockey is a contact sport, as is football, and will never be 100 percent safe. But brain concussion is a terrible price to pay for a sport that’s supposed to be fun for young players. It could be safer, if sports commentators would stop gleefully reporting the number of ‘big hits" in the game. Hell will feeze over before that happens.
