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Concussion in Sport: The Unheeded Evidence

Published online by Cambridge University Press:  10 September 2018

Abstract:

Patients with repeated minor head injury are a challenge to our clinical skills of neurodiagnosis because the relevant evidence objectively demonstrating their impairment was collected in New Zealand (although published in the BMJ and Lancet) and, at the time, was mired in controversy. The effects of repeated closed diffuse head injury are increasingly recognized worldwide, but now suffer from the relentless advance of imaging technology as the dominant form of neurodiagnosis and the considerable financial interests that underpin the refusal to recognize that acute accelerational injury is the most subtle and insidiously damaging (especially when seen in the light of biopsychosocial medicine), and potentially one of the most financially momentous (given the large incomes impacted and needing compensation) phenomena in modern sports medicine. The vested interests in downplaying this phenomenon are considerable and concentrated in North America where diffuse head injury is a widespread feature of the dominant winter sports code: Gridiron or American Rules football. The relationship of this to shattered lives among the brightest and best of young men and the relatively dated objective evidence are a toxic mix in terms of ethical analysis and, therefore, there is a malignant confluence of social forces that tends toward minimizing the injury.

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Articles
Copyright
Copyright © Cambridge University Press 2018 

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References

Notes

1. Gronwall, D, Wrightson, P. Delayed recovery of intellectual function after minor head injury. The Lancet 1974;304(7881):605–9.CrossRefGoogle Scholar

2. Gronwall, D, Wrightson, P. Cumulative effect of concussion. The Lancet 1975;306(7943):995–7.CrossRefGoogle Scholar

3. O’Jile, JR, Ryan, LM, Betz, B, Parks-Levy, J, Hilsabeck, RC, Rhudy, JL, et al. Information processing following mild head injury. Archives of Clinical Neuropsychology 2006;21(4):293–6.CrossRefGoogle ScholarPubMed

4. See note 3, O’Jile et al. 2006, at 295–6.

5. Gaetz, M, Goodman, D, Weinberg, H. Electrophysiological evidence for the cumulative effects of concussion. Brain Injury 2000;14(12):1077–88.Google ScholarPubMed

6. Mendez, CV, Hurley, RA, Lassonde, M, Zhang, L, Taber, KH. Mild traumatic brain injury: Neuroimaging of sports-related concussion. Journal of Neuropsychiatry and Clinical Neurosciences 2005;17(3):297303.CrossRefGoogle ScholarPubMed

7. See note 5, Gaetz et al. 2000.

8. See note 6, Mendez et al., at 230.

9. Lewine, JD, Davis, JT, Sloan, JH, Kodituwakku, PW, Orrison, WW Jr. Neuromagnetic assessment of pathophysiologic brain activity induced by minor head trauma. American Journal of Neuroradiology 1999;20(5):857–66.Google ScholarPubMed

10. Strich S. Shearing of nerve fibres as a cause of brain damage due to head injury: A pathological study of twenty cases. The Lancet 1961;278(7200):443–8.

11. Oppenheimer, DR. Microscopic lesions in the brain following head injury. Journal of Neurology, Neurosurgery, and Psychiatry 1968;31(4), at 299.Google ScholarPubMed

12. See note 10, Oppenheimer 1968, at 301

13. Stern, RA, Riley, DO, Daneshvar, DH, Nowinski, CJ, Cantu, RC, McKee, AC. Long-term consequences of repetitive brain trauma: Chronic traumatic encephalopathy. P M & R 2011;3(10):S460–7.CrossRefGoogle ScholarPubMed

14. Baugh, CM, Stamm, JM, Riley, DO, Gavett, BE, Shenton, ME, Lin, A, et al. Chronic traumatic encephalopathy: Neurodegeneration following repetitive concussive and subconcussive brain trauma. Brain Imaging and Behavior 2012;6(2):244–54.CrossRefGoogle ScholarPubMed

15. McCrory, P, Meeuwisse, W, Dvorak, J, Aubry, M, Bailes, J, Broglio, S, et al. Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016. British Journal of Sports Medicine 2017;51:838–47.Google Scholar

16. See note 1, Gronwell, Wrightson 1974.

17. Evans, AS. Causation and disease: The Henle-Koch postulates revisited. The Yale Journal of Biology and Medicine 1976;49(2):175.Google ScholarPubMed

18. McNamee, MJ, Partridge, B, Anderson, L. Concussion ethics and sports medicine. 2016;35(2):257–67.Google Scholar

19. Anderson, L, Jackson, S. Competing loyalties in sports medicine: Threats to medical professionalism in elite, commercial sport. International Review for the Sociology of Sport 2013;48(2):238–56.CrossRefGoogle Scholar

20. Gillett, G. Bioethics in the Clinic: Hippocratic Reflections. Baltimore: Johns Hopkins University Press; 2004.Google Scholar