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
A LITTLE HISTORY….
“No evidence” of
concussions’ impact
Funding for research,
major rule changes,
new committee
1990s
2009
New commissioner
and increasing
pressure
2006
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"
Chronic
Traumatic
Encephelopathy
1984
(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
ELITE
OLYMPIC
• NCAA
• Multiple Concussions
• Second Impact Syndrome
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
SLEEP DISTURBANCE
PSYCHOLOGICAL/EMOTIONAL
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 shortterm emotional
distress following
concussion reveal
transient
depression, feelings
of fatigue and
reduced energy
levels, confusion,
and overall mood
disturbance.
Depression
Perceived
Fatigue
Confusion
Anxiety
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