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New Insights into Concussions
Barbara Kapetanakes, PsyD.

A recent study of the brains of deceased NFL players found that 96% of those in the study had signs of chronic traumatic encephalopathy (CTE), a brain condition that can cause cognitive problems, dementia, and depression.  In 2010, Owen Thomas, a UPenn football captain was found dead of apparent suicide and autopsy results revealed that he had the beginnings of CTE.  Reports indicate that Thomas had no history of depression, and that, even though he had never been diagnosed with a traumatic brain injury, he may have had hundreds of smaller hits that started to cause damage little by little.  The issue of brain injury has been in the news a lot over the past couple of years, with specific focus on professional football players and student athletes.  The CDC estimates that there are between 1.6 and 3.8 million concussions a year.  The number is not clear because many concussions go unreported or misdiagnosed, particularly when they are mild.

Doctors have known for years that repeated blows to the head can cause long-lasting damage, what used to be called “Dementia Pugilistica” referring to the memory loss, confusion, and other symptoms often suffered by professional boxers (“pugilists”).  Most casual, amateur athletes didn’t worry much about head injuries nor did parents worry about children playing school or town sports or falling on the playground.  However, parents and athletes have a new awareness of the risk for head injury and are now looking at how to prevent injury, deal with it if it occurs, and develop a more uniform course of action.

Here in Westchester County, Robert Astorino, County Executive, has formed a new task force to study the effects of concussions on youngsters playing sports. This group will be working with coaches, parents, and medical professionals, to make sports safer and deal with head injuries should they occur (full disclosure: I have been appointed to this task force).  More children are playing sports throughout their school careers, and this obviously leads to more possible injuries.  Most injuries are minor and don’t require any intervention, even when the head is involved, but in some cases, even a small bump can cause a mild concussion.

The Physics of a Concussion

The NFL study is timely, as we are hearing more and more about football players who retire earlier than planned and/or have suffered from cognitive damage due to repeated blows to the head.  Helmets can protect somewhat, but can’t protect from everything.  A concussion is not caused by something as simple as getting hit in a certain area of the head.  The brain is somewhat loose in the skull, surrounded by cerebrospinal fluid that acts as a shock absorber.  If you hit your head or get a whiplash-type injury, there is the potential that your brain will move within that space and that the fluid around it will be unable to absorb the shock adequately.  You can then suffer an injury to the brain in a different area than where the skull was struck, for example, you are hit on the left side of the head, but there is damage to the right side of your brain because your brain shifted within your skull and hit the opposite side.  This is called a contracoup injury.  In a whiplash situation, the neurons can suffer tearing or shearing due to the quick motion.  A football helmet cannot prevent these contracoup or whiplash injuries.  

Helmets are not indestructible and should probably be replaced more often than they are to prevent breakdown of the shock absorbent material inside.  In addition, many head injuries happen in soccer, where the players don’t wear helmets.  Typically this is a head to head collision between players or a head colliding with another part of the body.  It is not unheard of that a player’s head collides with another player’s arm or leg causing an injury, and the player with the injured limb is given medical intervention while the child whose head did the damage is assumed to be fine.  Somehow we assume the skull is more indestructible than a tibia, but this is not an accurate assumption.  In addition, because injury can occur due to a shifting of the brain, as stated, a player can have no external signs of injury, or barely a bruise or bump, but his brain has suffered bruising or swelling that can’t be seen.  

We’re Only Scratching the Surface

When I talk to people about the brain, such as when I test a young child who is having learning difficulties, I often say that even though we know a lot about the workings of the brain, it’s still only a tiny fraction of what there is to know. It’s a small organ—only about three or four pounds—but there are billions of neurons (nerve cells).  The neurons communicate both chemically and electrically and through both neurotransmitters and hormones.  Disorders such as schizophrenia, bipolar disorder, and Alzheimer’s Disease appear to have strong genetic links from which scientists have been able to learn about specific areas of brain function.  For all we do know, there is still a lot that we don’t understand, for example, what a small head injury may do to a person, or why one person reacts differently to a concussion than another.  We do believe that pre-existing medical and psychiatric problems may have an impact on how a person reacts to and recovers from a head injury, but we are still learning.  

Playing Safe

We don’t want to discourage children from playing sports—there are more health risks to having children be sedentary and not participate in physical activity than there are to playing them in the first place.  And accidents can’t be prevented regardless of how your child spends his free time--my worst accidents as a child were not team-sports related, and they usually happened with a parent no more than 15 feet away.  Accidents happen, and we do have to allow children to play, get hurt, skin their knees, work through any fears, push themselves to improve, and recover from injuries. What we want to do is minimize the risk and treat an injury properly if it occurs, rather than panic and ban all sports.   I’m an amateur equestrian, and in the ring we start with proper equipment and attire—we don’t ride horses in flip flops or use saddles that are falling apart.  We wear helmets so that if we do fall, we have some protection.  At some of the more dangerous levels of jumping and riding, such as cross country, many riders wear protective vests to minimize the risk of broken ribs and internal injury.  We don’t “overmount,” meaning we don’t ride horses that are above our ability to control or perform stunts we are not prepared for.  Beginners ride “bomb-proof” horses who are unlikely to act up or get scared, and will hang tight when the beginner makes mistakes and gives conflicting messages.  But even bomb-proof horses can trip, get spooked by something, or get riled up by another horse.  Despite these strategies, and despite that I am not a daredevil when it comes to bodily harm, I have fallen and escaped serious injury most likely due to helmets, proper apparel, the right horse, and good footing in the ring.  We can’t ever eliminate the risk, but we can try to minimize it.  We should do that in all sports, especially with children who have developing brains.  Solid helmets, good turf, proper instruction in sportsmanship and safety, and the like can help minimize risk in all sports.  While we don’t need to bundle children up in bubble wrap before they step onto their scooters, we should at least try to protect what parts we can in an attempt to minimize risk.  

What to Do if Your Child is in an Accident

As more research is done into this issue, there will surely be more products, more regulations, and more questions about best practices.  For now, if your child gets a bump on his head, ask if he’s feeling any of the following symptoms: trouble concentrating or remembering, headache or sensitivity to light or noise, irritability, or changes in sleep.  Keep asking.  Ask right after the injury, a few hours later, and a few hours after that.  Ask the next day and the day after.  If your child has these symptoms call a doctor and insist on being seen.  Most likely no intervention will be required, but you should ask the pediatrician for a note excusing him from gym class and sports again until the symptoms have subsided.  Most concussions resolve themselves within a few weeks, even if left untreated, but you don’t want there to be risk of another injury if the child falls in gym class.  There is a lot of evidence that shows that repeated injury, especially during the time of healing, can cause more damage.  

With every study we learn more and more about the brain, and therefore can do more to protect it from harm.  We want children to run and play and engage in sports, even if there is risk of injury, because physical activity is healthy on so many levels, but we also need to be smart about prevention and treatment, especially in sports with a high risk for collisions or falls.  

Dr. Kapetanakes is a psychologist in private practice in Sleepy Hollow, NY.  She provides therapy, evaluations, and divorce mediation.  


Disclaimer: Although Dr. Kapetanakes is a board member of the Westchester County Psychological Association (WCPA), the views in this article are hers and not the views of WCPA.

Statements contained  in the authored articles on the Westchester County Psychological Association (WCPA) website are the personal views of the authors and do not constitute WCPA policy unless so indicated. The information in the articles on the WCPA website is for educational purposes only. The information contained in the articles is not intended for diagnosis, psychological advice or medical advice.  It is not intended to be treatment and is not a replacement for psychotherapy. If you are in need of psychological treatment, you can utilize our clinician database which can be accessed by clicking on the link, "Find a Psychologist." WCPA and its directors and employees are not liable for any damages resulting from the utilization of information contained in articles posted on the WCPA website.



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