Concussion was defined by a  panel of medical and neurological experts, the “Zurich Group”, at the 4th International Conference on Concussion in Sport in 2012 as “a complex pathophysiological process affecting the brain, induced by biomechanical forces”1.


Traumatic brain injury (TBI) is a major public health issue exacting a substantial personal and economic burden globally.

(TBI) is now recognized as a major health issue that affects more than 3.5 million persons each year.2 The impact of TBI on the public includes the personal burden endured by survivors and their families and a substantial economic toll.3 Further, TBI may also be a risk factor for the later development of neurodegenerative disorders, including Alzheimer's disease.4-10 Despite this huge encumbrance on society, no treatment has been shown to be efficacious despite multiple phase III clinical trials.11-13


Annual hospital presentations for sport related concussions between the ages of 0-19 in the US are reported to be 175,000.15 Of these, up to 15% could continue to be asymptomatic resulting in performance decline for a prolonged period of time (2 years) following their last concussion. 

We argue that the use of biomarkers is a useful and important approach to comprehensively assess brain function following concussion.16

​Amongst children and youth aged 0 to 14 years in the U.S. each year TBI results in an estimated;

             - 3,000 deaths
             - 29,000 hospitalisations
             - 400,000 emergency department visits


TBI is reported to be the leading cause of disability in young people in the U.S. Most studies of the outcomes of TBI in children and youth are based on case series from selected hospitals or rehabilitation facilities, small regional samples or anecdotal reports.17

Furthermore, evidence suggests that TBI may be a risk factor for the later development of neurodegenerative disorders, including Alzheimer's disease.18-24

TBI can be a concern for children even more so than for professional adult athletes. Unlike other injuries where the young body seems to heal more rapidly than the adult one, brain related trauma can heal more slowly and be longer lasting.25

The impact of TBI is significant, and includes the personal burden endured by survivors and their families, as well as the substantial economic toll on society.26 Struggling to deal with those challenges can have a significant impact on the psychological wellbeing of the partner, and on the quality and stability of the relationship. Compared with the general population, partners generally report higher levels of anxiety, stress and depression; and lower levels of positive well-being, quality of life and life satisfaction.


A consistent research finding is that partners are particularly upset by some of the personality and behavioral changes that may result from TBI, in the form of either the appearance of undesirable behaviors such as aggression and social disinhibition, or the loss of beneficial attributes such as motivation.27


Updated 2014 guidelines for the management of sports-related concussion in Australian general practice summarised the associated complications of concussion into 5 points.28

1. Impaired performance and increased risk of injury on return to play (RTP):

Slowed reaction times and cognitive deficits may lead to increased risk of further injury.
2. Acute, progressive diffuse cerebral oedema:
Also known as ‘second impact syndrome’ where the brain can fatally swell following repeated trauma when the initial insult was not noted.
3. Prolonged symptoms:
There is level 2 evidence that 5-10% of concussed athletes take >10 days to recover and approximately 1% take >3 months.
4. Depression and other mental health issues:
Evidence exists for a 2-3x increase in relative risk of clinical depression in retired footballers.
5. Cumulative cognitive deficits i.e. Chronic traumatic encephalopathy (CTE): Recurrent head trauma has been associated with progressive deterioration in brain function.



References

1. Consensus Statement on Concussion in Sport-the 4th International Conference on Concussion in Sport Held in Zurich, November 2012. Clinical Journal of Sport Medicine. 2013;23(2):89-117.​ Paul McCrory et al. 2. V.G. Coronado, L.C. McGuire, K. Sarmiento, J. Bell, M.R. Lionbarger, C.D. Jones, A.I. Geller, N. Khoury, and L. Xu (2012). Trends in traumatic brain injury in the U.S. and the public health response: 1995–2009. J Safety Res43, 299–307. 3. P. Corso, E. Finkelstein, T. Miller, I. Fiebelkorn, and E. Zaloshnja (2006). Incidence and lifetime costs of injuries in the United States. Inj. Prev. 12, 212–218.​ 4. C.A. Molgaard, E.P. Stanford, D.J. Morton, L.A. Ryden, K.R. Schubert, and A.L. Golbeck (1990). Epidemiology of head trauma and neurocognitive impairment in a multi-ethnic population. Neuroepidemiology 9, 233–242. 5. J.A. Mortimer, L.R. French, J.T. Hutton, and L.M. Schuman (1985). Head injury as a risk factor for Alzheimer's disease. Neurology 35, 264–267. 6. J.A. Mortimer, C.M. van Duijn, V. Chandra, L. Fratiglioni, A.B. Graves, A. Heyman, A.F. Jorm, E. Kokmen, K. Kondo, W.A. Rocca, and et al. (1991). Head trauma as a risk factor for Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group. Int. J. Epidemiol. 20, Suppl 2, S28–S35. 7. E.S. O'Meara, W.A. Kukull, L. Sheppard, J.D. Bowen, W.C. McCormick, L. Teri, M. Pfanschmidt, J.D. Thompson, G.D. Schellenberg, and E.B. Larson (1997). Head injury and risk of Alzheimer's disease by apolipoprotein E genotype. Am. J. Epidemiol. 146, 373–384. 8. Z. Guo, L.A. Cupples, A. Kurz, S.H. Auerbach, L. Volicer, H. Chui, R.C. Green, A.D. Sadovnick, R. Duara, C. DeCarli, K. Johnson, R.C. Go, J.H. Growdon, J.L. Haines, W.A. Kukull, and L.A. Farrer (2000). Head injury and the risk of AD in the MIRAGE study. Neurology 54, 1316–1323. 9. B.L. Plassman, R.J. Havlik, D.C. Steffens, M.J. Helms, T.N. Newman, D. Drosdick, C. Phillips, B.A. Gau, K.A. Welsh-Bohmer, J.R. Burke, J.M. Guralnik, and J.C. Breitner (2000). Documented head injury in early adulthood and risk of Alzheimer's disease and other dementias. Neurology 55, 1158–1166. 10. V.E. Johnson, W. Stewart, and D.H. Smith (2012). Widespread tau and amyloid‐beta pathology many years after a single traumatic brain injury in humans. Brain Pathol. 22, 142–149.​ 11. D.K. Menon (2009). Unique challenges in clinical trials in traumatic brain injury. Crit. Care Med. 37, Suppl 1, S129–S135. 12. K.W. McConeghy, J. Hatton, L. Hughes, and A.M. Cook (2012). A review of neuroprotection pharmacology and therapies in patients with acute traumatic brain injury. CNS Drugs 26, 613–636. 13. J. Lu, K.W. Gary, J.P. Neimeier, J. Ward, and K.L. Lapane (2012). Randomized controlled trials in adult traumatic brain injury. Brain Inj. 26, 1523–1548.  

14. V.G. Coronado, L.C. McGuire, K. Sarmiento, J. Bell, M.R. Lionbarger, C.D. Jones, A.I. Geller, N. Khoury, and L. Xu (2012). Trends in traumatic brain injury in the U.S. and the public health response: 1995–2009. J Safety Res.

15. Faul M, Xu L, Wald MM, Coronado VG. Centers for Disease Control and Prevention. Traumatic brain injury in the United States. GA, USA. 16. Marc Dalecki, et al. Concussion May 12, 2016.  

17. http://www.cdc.gov/traumaticbraininjury/assessing_outcomes_in_children.html                            

18. C.A. Molgaard, E.P. Stanford, D.J. Morton, L.A. Ryden, K.R. Schubert, and A.L. Golbeck (1990). Epidemiology of head trauma and neurocognitive impairment in a multi-ethnic population. Neuroepidemiology 9, 233–242.      

19. J.A. Mortimer, L.R. French, J.T. Hutton, and L.M. Schuman (1985). Head injury as a risk factor for Alzheimer's disease. Neurology 35, 264–267.
 

20. J.A. Mortimer, C.M. van Duijn, V. Chandra, L. Fratiglioni, A.B. Graves, A. Heyman, A.F. Jorm, E. Kokmen, K. Kondo, W.A. Rocca, and et al. (1991). Head trauma as a risk factor for Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group. Int. J. Epidemiol. 20, Suppl 2, S28–S35.
                    

21. E.S. O'Meara, W.A. Kukull, L. Sheppard, J.D. Bowen, W.C. McCormick, L. Teri, M. Pfanschmidt, J.D. Thompson, G.D. Schellenberg, and E.B. Larson (1997). Head injury and risk of Alzheimer's disease by apolipoprotein E genotype. Am. J. Epidemiol. 146, 373–384.
                       

22. Z. Guo, L.A. Cupples, A. Kurz, S.H. Auerbach, L. Volicer, H. Chui, R.C. Green, A.D. Sadovnick, R. Duara, C. DeCarli, K. Johnson, R.C. Go, J.H. Growdon, J.L. Haines, W.A. Kukull, and L.A. Farrer (2000). Head injury and the risk of AD in the MIRAGE study. Neurology 54, 1316–1323. 23. B.L. Plassman, R.J. Havlik, D.C. Steffens, M.J. Helms, T.N. Newman, D. Drosdick, C. Phillips, B.A. Gau, K.A. Welsh-Bohmer, J.R. Burke, J.M. Guralnik, and J.C. Breitner (2000). Documented head injury in early adulthood and risk of Alzheimer's disease and other dementias. Neurology 55, 1158–1166.
24. V.E. Johnson, W. Stewart, and D.H. Smith (2012). Widespread tau and amyloid‐beta pathology many years after a single traumatic brain injury in humans. Brain Pathol. 22, 142–149.   

25. Bond Chapman, S. (2006). Neurocognitive Stall: A paradox in long term recovery from pediatric brain injury. Brain Injury/professional 3(4), 10-13.  

26. P. Corso, E. Finkelstein, T. Miller, I. Fiebelkorn, and E. Zaloshnja (2006). Incidence and lifetime costs of injuries in the United States. Inj. Prev. 12, 212–218.     

27. Gerard A Riley. The partner’s experience of traumatic brain injury and its recovery. Concussion July 28, 2016.                                                       

28. Updated guidelines for the management of sports-related concussion in general practice. Volume 43, No.3, March 2014 Pages 94-99. M. Makdissi, et al.