As children continue to enter contact sports, concussions will undoubtedly go up — but so does the chance of CTE.

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Traumatic brain injuries are everywhere, from the workplace to sports. It is estimated that there are nearly 500 TBIs per 100,000 individuals annually in Canada; to narrow that down, one person in Canada would suffer a TBI every three minutes.

A TBI occurs due to shaking of the brain caused by blows to the head. It is the most apparent cause of death among young adults. TBI can range from being either mild, moderate or severe, depending on the results retrieved from neurological assessments. A concussion is often referred to in clinical settings as mild TBI.

Concussions can typically resolve spontaneously after 7-10 days with close monitoring of symptoms but can lead to immediate impairment of neurologic function with subsequent head injuries. Common symptoms present in the diagnosis of a concussion include headaches, dizziness, nausea, lack of concentration, memory impairment and tiredness.

It is estimated that 200,000 concussions occur per year in Canada alone, and of that, children under the age of five were the most prevalent demographic to experience a concussion.

Now, when looking at sports-related concussions, football is the most common sport in which concussions are diagnosed, where a study showed it accounted for more than half of all 2561 concussions reported.

In the NFL, the position played is an important factor for predictions on concussions and brain injuries, where offensive and defensive linemen are more prone to concussions than any other position. However, these concussions may be caused by low impact hits due to the short distance between the hitting and receiving players, whereas a quarterback would receive stronger hits at a lower frequency.

Though as players become sidelined for injuries, the media has a tendency to blow up injury stories and depending on fan support, the player may be ridiculed for not playing, as opposed to receiving empathy. Thus, many players who may indeed have a concussion go undiagnosed to ensure they are not portrayed as “weak” in their own perspective, in addition to the media’s and fans’ perspectives.

Now as players become injured with concussions repeatedly, long-term neurodegenerative effects may result and more specifically, chronic traumatic encephalopathy. Impulsivity, aggression, and suicidal behaviour encompass the clinical presentation for CTE, alongside the loss of memory and muscle spasms. However, a key limitation with the diagnosis of CTE is the requirement for it to be post-mortem.

CTE has gained recent attention from a study in 2017, where the CTE centre in Boston University concluded that CTE was diagnosed in 110 of 111 former deceased NFL players. More specifically, there was global attention on the specific case of Aaron Hernandez.

Hernandez was on route to becoming one of the greatest tight ends at the time. However, his life turned upside down when he was convicted guilty in 2015 and sentenced to life imprisonment without parole for the first-degree murder of Odin Lloyd in 2013.

Just two years after his conviction, Hernandez committed suicide in April 2017. But after further studies by the Boston University CTE centre, it was found that Aaron Hernandez suffered the most extreme case of CTE ever found in anyone of his age.

Ann McKee, director of the BU CTE centre, was shocked to find Aaron being diagnosed with Stage III CTE at only 27 years old, exclaiming that his problem-solving, judgement and impulse control behaviours may have been compromised.

“This would be the first case we’ve ever seen of that kind of damage in such a young individual,” said McKee at the time.

“This would be the first case we’ve ever seen of that kind of damage in such a young individual.”

Ann McKee

When looking at concussion rehabilitation programs, it is never that simple, especially for children and youth; but at McMaster University, the CanChild research centre has a specific attention to youth and children with disabilities, and in this case, concussion education and rehabilitation.

More specifically, the centre developed evidence-based protocols for Return to Activity and Return to School for children and youth, led by Professor Carol DeMatteo. It was found that roughly 50 per cent of children and youth adhered to the protocols, and it is primarily dependent on education and awareness of concussion protocols.

To help with adherence, DeMatteo and her team developed the Back2Play app, where concussion symptoms are regularly monitored with an apple watch and real-time activity data is recorded. With that being said, return to school has happened quicker than return to activity.

As children consistently enter themselves into contact sports leagues, it will be no surprise that the prevalence of concussions will rise. However, with greater emphasis on the education of brain injuries, further concussions can be avoided and prevent the unfortunate cases of CTE.