TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist University of South Carolina
OBJECTIVES • To understand the context of sport, TBI, and its importance in sport • To understand the psychological, emotional, and cognitive consequences of TBI on athletes and sport environment
• To understand the role of the clinical sport psychologist and other sport medicine personnel
NFL TO SPEND $765M TO SETTLE CONCUSSION LAWSUITS
A LITTLE HISTORY…. “No evidence” of concussions’ impact
Funding for research, major rule changes, new committee
1990s
2009
New commissioner and increasing pressure 2006
SPORT CULTURE PERSPECTIVE • Expectations of athletes • How concussions are perceived • Which sports are most at risk?
• Developmental issues
PREVALENCE • The Centers for Disease Control and Prevention reported that 200,000 sports-related head injuries are treated in emergency departments annually within the United States and that sports related concussions accounts for approximately 20% of all TBIs per year.
BOXING #1 SPORT FOR MTBI INCIDENCE
"Punch drunk" syndrome 1928
"dementia pugilistica"
Chronic Traumatic Encephelopathy
1984
(CTE)
2000s
PREVALENCE • A history of concussion among athletes varies by sport (from highest upper estimates to lowest): • Equestrian (3%-91%) • Boxing (1%-70%)
• Rugby (2%-25%) • Soccer (4%-22%)
• American football (2%-20%)
DEVELOPMENTAL ISSUES • TBI: Athletes vs. Nonathletes • Concussions occur at all levels of play • Young athletes (under 18 years old) vs. older athletes (over 18 years old) • Male athletes vs. female athletes
ELITE OLYMPIC
• NCAA
• Multiple Concussions • Second Impact Syndrome
NATIONAL COLLEGIATE SCHOLASTIC
ENTRANCE
KROLL’S PERSONALITY PERFORMANCE PYRAMID
MULTIPLE CONCUSSIONS • Athletes who have previously sustained a concussion are more than two times likely to sustain a second concussion and may be more likely to experience a greater number and perceived severity of post concussive symptoms.
EFFECTS OF TBI • http://nortonsafe.search.ask.com/videos?geo=US&q=JIM+MCMAHON&prt= 360&locale=en_US&o=15527&chn=retail&ver=20&tpr=10
SIGNS OF TBI Signs are behaviors/events that are observable by others: • Loss of consciousness • A dazed or vacant look • Motor incoordination/balance problems • On-field confusion/disorientation
SYMPTOMS OF TBI
SOMATIC
COGNITIVE
SLEEP DISTURBANCE
PSYCHOLOGICAL/EMOTIONAL
SOMATIC SYMPTOMS OF TBI • Headache • Nausea/vomiting • Balance problems • Dizziness • Fuzzy/blurry vision • Low energy/fatigue • Light/noise sensitivity
COGNITIVE SYMPTOMS OF TBI • Memory Dysfunction • Attention Problems • Mental “fogginess” • Cognitive slowing • Fatigue
PSYCHOLOGICAL/EMOTIONAL SYMPTOMS OF TBI • More emotional • Sadness • Anxiety • Irritability • Negative/pessimistic attitude • Personality changes
SLEEP AND OTHER DISTURBANCES • Difficulty falling asleep • Sleeping more/less than usual • Sexual disorders and problems • Loss of interest in sex • Relationship difficulties • Substance use and abuse
ATHLETES VS. NONATHLETES AND TBI
• Motivation
• Return to play pressures and desires • Underreporting of symptoms/symptom minimization
ASSESSMENT AND MANAGEMENT OF TBI • Acute evaluation on the field • Sideline or locker room evaluation • Formal postacute neurocognitive assessment • Graded progression of physical exertion • Unrestricted return to play
EMOTIONAL SEQUELAE OF TBI IN ATHLETES • The research reports on shortterm emotional distress following concussion reveal transient depression, feelings of fatigue and reduced energy levels, confusion, and overall mood disturbance.
Depression
Perceived Fatigue
Confusion
Anxiety
PSYCHOLOGISTS’ RESPONSIBILITIES • To educate athletes, their families, coaches, physicians, athletic trainers, and policy makers to recognize and appropriately manage this complex injury. In doing so, we will more effectively enhance player safety and prevent disabling symptoms.
PREVENTION • Equipment • New prototype helmets • Rule changes • Penalties and fines • On the field evaluation • Return to play • Successive head trauma • Education: Athletes, Coaches, Parents
QUESTIONS???
TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist University of South Carolina Email:
[email protected]
