TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological PerspectiveKendra 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

1990s

New commissioner and increasing

pressure2006

Funding for research, major rule changes,

new committee2009

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"

1984

Chronic Traumatic

Encephelopathy(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

• NCAA

• Multiple Concussions

• Second Impact Syndrome

ELITE

OLYMPIC

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 PSYCHOLOGICAL/EMOTIONAL

SLEEP DISTURBANCE

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 short-term emotional distress following concussion reveal transient depression, feelings of fatigue and reduced energy levels, confusion, and overall mood disturbance.

Depression Perceived Fatigue

AnxietyConfusion

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 PerspectiveKendra Ogletree Cusaac, Ph.D.

Licensed Clinical Psychologist

Sport Psychologist

University of South Carolina

Email: ogletree@mailbox.sc.edu