Welcome to Health queries the podcast where your health questions are answered by faculty and experts in the query College of Health and Human Services at Missouri State University. I'm your host, Lauren Stockham, and March is brain injury Awareness Month. So this month, I sat down with Dr. David Carr, an athletic training professor in the public health and Sports Medicine Department. He also specializes in concussion rehabilitation.
So my name is David Carr. I'm a faculty member in sports medicine, athletic training, and an athletic trainer for almost 30 years now. did my undergraduate at San Diego State, I did a master's degree at the University of Michigan, and I did my doctorate at Southern Miss have been here at Missouri State for about seven years now. My research interests are kind of eclectic all over the place. But I've had a focus in the last several years on concussion rehabilitation. I met a physical therapist that specializes in treating concussion patients and we have started collaborating on all sorts of projects.
So what constitutes a traumatic brain injury? And what are you know, some common ones that we see in sports and in everyday life, I know concussions is one.
Well, a concussion is a physiological response to trauma to the brain. Whereas you can have traumatic brain injuries that have a physical response, where there's bleeding going on intracranial inter cerebral bleeding, the vast majority of what we see as athletic trainers are the physiological changes of concussion that typically resolves within 24 hours. So what happens actually in the brain when, let's say, when somebody gets a concussion, so a lot of things happen all at once there's a cascade of events. Again, it's a physiological response. There's alterations in blood flow, there's alterations and different chemicals that circulate through the blood. Those occur over the course of anywhere from seven to 10 days till they come back to normal pre injury levels. But it the misconception is, is that it's some sort of alteration of the brain's anatomy. Again, it's not most in most cases, it's not a physical alteration of the brain. It's just a physiological alteration.
Can you explain what you mean by physiological alteration rather than physical?
Sure, well think physical, I mean, it's actually moving pieces and disrupting the space, whereas physiological, it's just the way it functions. It's not its actual physical self doesn't change. It's just the way chemicals are being transmitted around between the nerves the way blood is circulating around that kind of thing.
Let's kind of zero in on concussions here, since that's where your researches what are some symptoms after you get a concussion think a mild concussion to a severe concussion. What happens?
Sure, some of the most common are dizziness, headache. Some patients will experience nausea, they'll be tired or lethargic. In some cases, there will be a loss of consciousness. In most cases, there is not real, more severe cases that persist longer. They'll develop what we call post concussion syndrome, where they'll have trouble with concentration, trouble with their memory. Those kinds of things are really can impact the student athlete quite a bit down the line.
You mentioned student athletes, what sports are more at risk for concussions?
Your high impact collision sports are going to have more incidents of concussions, football, hockey, lacrosse, soccer, where people are running into each other on a regular basis.
So if somebody has repeated concussions or a very severe concussion, is there any sort of long term damage or long term consequences to that? I know that they talk a lot about in football, you know, people get hit constantly and have gotten multiple concussions. So what are the impacts of that?
So I mean, if you've seen the movie concussion with Will Smith or you followed the NFL in the last 10 years, it's become a fairly widespread pop culture, if you will, about concussions. You get NFL players that play a career of sustaining head injuries, and then they develop what's called CTE chronic traumatic encephalopathy. It's theory that this is happening. One of the biggest problems is the studies that they conduct to determine the prevalence of CTE are limited to patients where they suspect that there's a history of concussions. So they're looking at a very narrow slice of the population. Whereas if they truly want to say yes, this is what's causing it, they need to start studying the brains of people that don't have a long history of repeated concussions. It's expensive. It's not an easy process to get people to donate their brains. So there are limitations, practical limitations to be able to being able to expand that population. But the going theory is that repeated concussions can cause that buildup of proteins that alters their brain function.
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In athletic training, how do you guys kind of rehabilitate or treat maintain people with let's say, severe concussions or severe brain injury?
Well, it takes a multimodal assessment, meaning you have to use multiple methods to determine where their problems are, where they lie, you need to use a team approach of specialists, no one person can do it all. No one professional has that kind of base of knowledge to treat them, then you try to narrow down where their problems are coming from. Is it because of their eyes? Is it because of their ears? Is it because of their neck? What's driving their symptoms? And then you have to address those, they call them clinical trajectories of what's driving the symptoms. If they have trouble with neck issues, we'll we're going to do a lot of Orthopedic soft tissue treatment of the neck. If they're having trouble with eye tracking, we'll we're going to work on eye tracking, wherever they have the problem. That's where we're going to try to focus our rehabilitative efforts.
When it comes to preventing sports related head injuries, what are sports organizations doing wrong? And then what are they doing right?
I think some are working on preventative strategies by amending their rules to avoid situations that are going to cause problems I've seen youth soccer associations change the rules to prohibit heading of the ball to reduce the concussive forces hitting those kids heads. I know some sports prohibit full body checks in lacrosse in women's lacrosse, you can't full body check, because that's going to introduce increase the chances of a head injury. What are they doing wrong? I would say soccer probably needs to get their act together with regards to dealing with concussions, the nature of their substitution process of not stopping the clock during the game of limiting the number of substitutions that a team can have makes it really hard for the medical staff to do a comprehensive assessment of a player that has just come off the field and determining whether or not they can return to play. You've watched World Cup FIFA in you'll see guys that clearly got their bell rung in there a little wobbly coming off, they've got balance issues, but the team is forced to play a man down while they're assessed. That's a that's not a good thing when you're trailing or even trying to win the game. And then they're kind of rushing through the evaluation process to determine whether or not they can go back. So I think soccer needs to consider changing some of their rules to give teams a little more flexibility, a little more time to make their assessment and ability to substitute a player if necessary. I remember the last World Cup, I can't remember the team but a guy was clearly concussed from his behavior on the field and coming off the field. And he went right back on you look at the consensus statements coming from international experts. Once you've been assessed to have a concussion, you should not return to play that day. That's just blanket across the board yet, because of the pressures of the game in the rules, that guy went right back on the field.
That's definitely an issue. So turning just a bit. What are some common misconceptions in your work?
I don't know about misconceptions, but I know the big thing that I've been looking at lately is return to learn. It's kind of overlooked. Every state in the country now has concussion legislation that most of them only impact K through 12 because that's what the state really has control over. And the return to learn aspect is really overlooked. It's all about return to play. And we've done a really good job of educating athletes and coaches and parents about how if you're injured from a concussion, you're going to follow a six day return to play protocol where we progressively get you more and more active. But what isn't covered is the return to learn aspect is returning about students, they happen to also be athletes. And that return to learn is supposed to happen before they return to play. If you can't handle a full day of classes without symptoms, how are you going to get out there on the field and be able to perform? I think a misconception is that return to learn is taken for granted, and is not properly addressed at all levels. In my opinion. The study we did last year, looking at what was publicly available information on the internet, there was only about 60 to 70% of institutions had a return to learn policy, in addition to the return to play, so approximately 30% aren't addressing it, at least in policy. Now, the next step is to look at what is actually happening on the ground. And that's going to be a harder study to do to look at individual institutions. Are they addressing return to learn? As for legislation, I'm not sure that's the way to go. legislation is such a hard process to get through the literal act of Congress of speak. Whereas I think school districts should be more mindful of it to push it within their district more at the local level. I think states certainly can have a role in that. The State High School activity associations should definitely have a role in that of stressing return to learn before return to play.
So where can the public go to learn more about these injuries and the steps to recovery?
I think the Missouri Brain Injury Association is a great start. They have put together a lot of materials over the years for public education. And they partnered recently with my state organization, the Missouri athletic trainers Association, to expand their offerings to to the schools, to teachers, administrators to help them better understand traumatic brain injuries and how they can be treated, what kind of policies they need in place to help people with the traumatic brain injuries.
Great. Do you have any final thoughts?
March is also national athletic training month. So plug in there for us.
What do you love about athletic training?
Well, I got a good athletic training to help athletes get back on the field got a real kick out of not necessarily seeing the injury happen, though I don't shy away from the blood and gore. But I do enjoy seeing that progression from injury to rehab to return to play. And that really motivated me, I now I'm in an academic role, so I don't have that direct patient care. Now I get a kick out of seeing a student come in that really doesn't know much of anything. And then watching them learn and grow and progress over the course their degree and then enter the field and become successful.
That's amazing. athletic trainers are definitely essential. And the tag for this month is they're essential to health care, so that's perfect. Well, thank you for sitting down with me.
No problem.
Join us back here next month as we take another dive into your health questions and interests. For more information on the McQueary College of Health and Human Services, visit MissouriState.edu/MCHHS and follow us on Twitter, Instagram and Facebook @MSUMCHHS.
