Ethically we can no longer sit on the fence - a neuropsychological perspective on the cerebrally hazardous contact sports

Background and objective. The number of male and female contact sport participants is increasing worldwide. The aim of the review is to discuss the potential for deleterious sequelae of sports concussion (mild traumatic brain injury (MTBI)), and management thereof. Discussion. Incidence of concussion in the field contact sports is high, not only for boxing, but also for soccer, football and especially rugby. An overview of studies investigating persistent deleterious cognitive and symptomatic outcome following cumulative sports MTBI suggests that individuals may be at risk for permanent neurological damage following participation in a contact sport. Established sequelae of traumatic brain injury (TBI) typically involving frontal systems include cognitive decline, behavioural changes such as diminished self-regulation and aggression, and increased risk for Alzheimer's disease. The presence of such consequences hidden within the context of the widely popularised contact sports, has societal implications that should be acknowledged. Compromised scholastic abilities and enhanced aggressive tendencies in association with sports MTBI are in need of further longitudinal research. Conclusion. A comprehensive preventive approach to the management of MTBI in sport is advocated that includes professionally applied neuropsychological assessment as a crucial component. Future policy considerations are the introduction of mandatory informed consent for participation in a high-risk contact sport such as rugby, particularly at youth level, and financial provision for concussion management amongst economically disadvantaged populations. South African Journal of Sports Medicine Vol. 19 (2) 2007: pp. 32-3

Ethically we can no longer sit on the fence - a neuropsychological perspective on the cerebrally hazardous contact sports

Background and objective. The number of male and female contact sport participants is increasing worldwide. The aim of the review is to discuss the potential for deleterious sequelae of sports concussion (mild traumatic brain injury (MTBI)), and management thereof. Discussion. Incidence of concussion in the field contact sports is high, not only for boxing, but also for soccer, football and especially rugby. An overview of studies investigating persistent deleterious cognitive and symptomatic outcome following cumulative sports MTBI suggests that individuals may be at risk for permanent neurological damage following participation in a contact sport. Established sequelae of traumatic brain injury (TBI) typically involving frontal systems include cognitive decline, behavioural changes such as diminished self-regulation and aggression, and increased risk for Alzheimer's disease. The presence of such consequences hidden within the context of the widely popularised contact sports, has societal implications that should be acknowledged. Compromised scholastic abilities and enhanced aggressive tendencies in association with sports MTBI are in need of further longitudinal research. Conclusion. A comprehensive preventive approach to the management of MTBI in sport is advocated that includes professionally applied neuropsychological assessment as a crucial component. Future policy considerations are the introduction of mandatory informed consent for participation in a high-risk contact sport such as rugby, particularly at youth level, and financial provision for concussion management amongst economically disadvantaged populations. South African Journal of Sports Medicine Vol. 19 (2) 2007: pp. 32-3

Cerebral damage in diving: Taking the cue from sports concussion medicine

Within the compressed gas diving arena there is a risk of cerebral damage with deleterious neuropsychological sequelae in association with decompression illness (DCI), hypoxia, gas toxicity, as well as the cumulative subclinical effect of ‘silent’ paradoxical gas embolisms, the last being an area of growing concern. However, within diving medicine there is little evidence of the regular use of neuropsychological evaluation to monitor brain-related sequelae of frequent diving activity. In contrast, in recent years there has been an explosion of interest in the management of sports concussive injury, including emphasis on the pivotal role ofneuropsychological evaluation within that context. Taking the cue from sports concussion medicine, it is proposed that there is an urgent need to incorporate neurocognitive baseline and follow-up screening as a core component in the medical management of those involved in intensive commercial and recreational compressed air diving activities. The objective would be to facilitate (i) accurate neurodiagnostic follow-up of frank DCI or an identifiable hypoxic or toxic incident; (ii) timeous identification of cumulative deleterious effects of repetitive subclinical hypoxic/toxic incidents and/or ‘silent’ paradoxical gas embolisms that might affect them in later life; and (iii) disability assessment following any such eventsor the combination thereof for rehabilitation and compensation purposes