Big Impact

How HSU Researchers Are Changing our Understanding of Concussions

Arianne Aryanpur and Desiree Perez

Researchers at Humboldt State are adding to a growing body of scientific knowledge about the nature of concussions. Are mild traumatic brain injuries something athletes can shake off or is there something more to them?

FOR MANY ATHLETES, it can seem nothing is worse than a career-ending injury. Bone fractures or torn ligaments can hamper a promising athletic career, but what about injuries that aren’t immediately manifest when they occur? With the case of concussions, many athletes are able to walk away and even try to play the next day. But what about the long-term effects on their brain’s ability to think and process information?

There is a growing concern in athletics at all levels about concussions. Athletes, coaches and parents are all trying to better understand the short- and long-term effects, and the North Coast Concussion Program and a faculty member in the Department of Kinesiology are adding to a growing body of research.

studying results of soccer header impact

Beth Larson throws a soccer ball to former HSU soccer player Tamlyn Tsubota.

So what exactly is a concussion? Scientists define it as a mild traumatic brain injury caused by a blow or bump to the head or body and, according to the federal Centers for Disease Control and Prevention, they’re not exactly uncommon. Some 3.8 million sports- and recreation-related concussions are reported each year.

With recent high-profile suicides in the NFL potentially stemming from the long-term effects, athletic officials and universities are bringing a new focus to understanding these injuries. Just this June, the NCAA announced it is joining forces with schools in the Ivy League and the Big 10 to try to understand how concussions are affecting student-athletes.

The North Coast Concussion Program is located in a small lab tucked in the Kinesiology & Athletics Building. The program welcomes student-athletes and community members to take part in a 20-minute test to determine their baseline cognitive state. Since 2008, more than 3,000 athletes have participated. The program stems from alumna Beth Larson’s (’10, M.S. Kinesiology) graduate research and builds on the research of HSU faculty member, Justus Ortega.

Larson, who is also a lecturer in the Kinesiology department, gives all HSU student-athletes an immediate post-concussion assessment and cognitive test (or ImPACT test) during the pre-season. The computerized test is a standard from middle school to professional sports. It is used to evaluate thinking and reasoning ability, including attention span, reaction time and memory.

These baseline data are used to determine how an athlete functions normally and compare that to post-concussion performance. Students, faculty, staff and community members are also invited to use the program’s services if they suffer a concussion.

After a head injury, an athlete is sent to the concussion program for a follow-up evaluation. The ImPACT test is administered again, and the results are compared to the baseline.

The test helped Katelyn Smith (’13, Kinesiology) determine when to return to the rugby field after sustaining a mild concussion last year. Although rugby is a contact sport, players aren’t required to wear helmets.

How else are you going to know how bad a concussion is> I don't want an untreated head injury to affect my daughter for the rest of her life. - Dannielle Peterson, Community Member HSU player headers a soccer ball

After a hard tackle, Smith began experiencing confusion and sensitivity to light. She took the ImPACT test and it indicated a mild brain injury. She wasn’t cleared to jog at first, but then slowly, she was able to return to play.

Students who resume activity too soon run the risk of permanent damage. Second-impact syndrome (SIS) is a deadly condition in which an athlete suffers a second, often mild hit before symptoms of her first concussion have subsided. The subsequent trauma leads to rapid brain swelling and in most cases death, Larson says.

SIS cases helped pass AB 25 last year, a youth concussion law in California mandating that student-athletes suspected of suffering from a concussion be removed from play and receive a health care evaluation before returning to play, Larson says.

This year, Larson and her team began offering ImPACT testing to students in the Humboldt Del Norte High School Sport League, which includes 11 area campuses.

A recent session at Ferndale High School, not far from Arcata, attracted about a dozen athletes and their parents. Dannielle Petersen, who brought her daughter Abbigail—a soccer player—said she was grateful for the service.

“How else are you going to know how bad a concussion is? I don’t want an untreated head injury to affect my daughter for the rest of her life,” she said.

Part of Larson’s work involves educating parents about just that. The idea is to inform family members about the preventative benefits of baseline testing. “It’s kind of like wearing a seat belt,” Larson says. “Why wouldn’t you do it?”

Of course, educating parents and working with athletes who obviously had a concussive event are one thing. Larson’s graduate research also probed the effects of mild head impacts, or sub concussive events—like the kind of bumps the noggin takes when heading a soccer ball.

Larson found that players who self-reported as headers scored significantly worse on cognitive tests given pre-and post-season, while those who self-reported as non-headers scored as well, if not slightly better than, their initial test. Headers were also found to score significantly worse in the area of visual memory. While no definitive links between sub-concussive blows and long-term cognitive impairment have been made, establishing a strong baseline dataset is essential to pushing the research forward.

What Larson really wants to know is what a pre-and post-concussed brain looks like in a range of people, from hardcore athlete to regular Joe. Her work also adds to the studies of another HSU researcher, Kinesiology Professor Justus Ortega.

In 2010 Ortega and former HSU Professor Anthony Kontos co-wrote a chapter in “The Handbook of Sports Neuropathology.” Their collaboration covered the effects of concussion on mental function and balance while a person is standing or walking.

During his research, Ortega noticed that he had seen similar behavior from impaired people taking police field sobriety tests, which include standing on one leg, walking a line and turning around, and checking for erratic eye movement. Essentially, the police are looking at a person’s ability to perform a physical task that requires balance, while also doing a mental task. “A drunk person basically can’t multitask,” Ortega says.

The impairments that he noticed are called lateral instabilities, and they—along with cognitive performance—are what Ortega has dubbed the “HSU Johnny Cash test.” In the test, a person suspected to have a concussion has to “walk the line.” At the same time, he or she is given neurocognitive tests, such as counting down in increments of three and memory tasks. Each time a subject falters from the line, he or she gets an error added to the score. The hypothesis is that a person suffering from a concussion will register many more errors walking the line than he or she would if uninjured.

Currently, Ortega is working with the Department of Defense on a grant proposal to expand his research. As a researcher who has worked with the National Institutes of Health to probe the effects of aging on walking performance, Ortega’s work could have broad and wide-ranging impacts.

Ferndale students taking cognitive test

At Ferndale High School, student-athletes conduct a computer-based cognitive test, which measures factors like attention span, reaction time and memory.

What are the signs of a concussion

While no two athletes respond to a concussion in the same way, it’s important to know the common signs of a traumatic brain injury.

OBSERVED SYMPTOMS
  • Dazed or stunned
  • Unsure of game, score, or opponent
  • Moving clumsily
  • Answering questions slowly
  • Losing consciousness (even temporarily)
  • Behavior or personality change
  • Forgetting events prior to the incident
  • Forgetting events after incident
REPORTED SYMPTOMS
  • Headache
  • Nausea, vomiting
  • Balance problems, dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish or groggy
  • Concentration or memory problems
  • Confusion

According to Humboldt State researcher Beth Larson (‘10, Kinesiology), athletes should not resume activity until their symptoms have cleared, their results from the immediate post-concussion assessment and cognitive test (or ImPACT test) have been returned and they’ve been cleared by a health care professional.

SAMPLE COGNITIVE TEST

First, a screen with about 30 Xs and Os appears. Three random letters are yellow and the rest are black.

Then, a speed test, in which the “Q” button is hit as quickly as possible when a red circle appears and a “P” button when a blue square appears.

Lastly, the original Xs and Os reappear and the test taker has to recall which ones were yellow by clicking on them.