9/12/2013 Traumatic brain injury and athletes: A Clinical Sport Psychological Perspective Kendra 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 9/12/2013 NFL to spend $765M to settle concussion lawsuits

A little history…. “No evidence” of concussions’ impact 1990s 9/12/2013 A little history…. “No evidence” of concussions’ impact 1990s New commissioner and increasing pressure 2006 Funding for research, major rule changes, new committee 2009

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 KROLL’S PERSONALITY PERFORMANCE PYRAMID ELITE OLYMPIC NATIONAL COLLEGIATE SCHOLASTIC ENTRANCE

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.

9/12/2013 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 Jim McMahon 10 minutes

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

PSYCHOLOGICAL/EMOTIONAL 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 Anxiety Confusion

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 Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist University of South Carolina Email: ogletree@mailbox.sc.edu