“I hate Friday Night Tykes,” states Michele Monaco, DSc, ATC, associate professor of Human Movement Sciences and clinical coordinator at Immaculata, referring to the popular cable TV reality show that takes an inside look at the wild world of Texas youth football. “Go get ’em” is what the coaches tell the young players, perpetuating the idea that a concussion is just ‘getting your bell rung.’”
It’s a very simple question: how many concussions are too many? However, Monaco needs to explain how truly fragile the brain is to help answer this question. The brain is the most complex organ in the body and also the most delicate. Monaco describes the brain as a gelatinous form that is soft and squishy and is protected by a film of water that surrounds it.
Getting a blow to the head isn’t the only cause of concussions—violently whipping your head back and forth (like during a whiplash incident) can cause the same effects. Sudden, rapid movement can cause cells to spin, shear, and rip off the brain. “Getting hit in the chest, which still rocks the head and neck, can also cause a concussion,” Monaco explains.
Concussion symptoms may include brief loss of consciousness, impaired long-term memory, reduced problem-solving ability, lower social inhibition, and problems with attention and perception. Damage from deteriorating brain cells can continue for days. Monaco stresses the fact that a person doesn’t need to be diagnosed with all of the above symptoms; even one can indicate a concussion.
Invited by former colleagues (Linda Mazzoli and Robert Franks, D.O., director and co-medical director of the Jefferson Comprehensive Concussion Center) to learn from and contribute to a research group sponsored by Thomas Jefferson University and the Rothman Institute, Monaco has spent two years collecting and analyzing data from over 4,000 concussion patients, all of whom are athletes. She acknowledges that a majority of concussions result from car accidents, but sports seem to garner the most attention. This fall, she and her colleagues plan to submit their research findings. Monaco will also submit her research that examines the potential benefits of vitamins on concussion recovery.
Because experts from various disciplines often join in the research discussions, Monaco has been exposed to disparate thinking that moves her own knowledge forward in unexpected ways. “Why I love doing this is that there may be another component of science that might not be my forte. So I am constantly learning and reading and going, ‘OK, that is really important, and I never really thought of it.’”
In addition to the research, Monaco and her colleagues from the Jefferson/Rothman group educate parents about concussions and also conduct baseline tests for local sports teams. Part of the job of athletic trainers is to administer baseline tests to athletes before the season begins so that if players are injured, taking the same test again will determine if they are concussed. Trainers can then assess where the deficits are and how the athletes are recovering.
Monaco explains that there are three baseline tests that serve as the industry standards: the impact test, the sway balance test, and the King-Devick test. All three tests were administered to the 4,000 research subjects. However, Monaco was discouraged to discover that athletes understand how the baseline tests impact their future playing opportunities and often “throw” the tests—deliberately scoring lower than their potential so that later, if they do sustain a concussion, their baseline tests may not differ as much from their post-concussion status.
While athletes sometimes muddy the waters of reliable testing, marketers have jumped on the concussion bandwagon by targeting well-meaning parents with advertisements that make false claims: “Buy this headband that protects against concussions!” Monaco shakes her head and notes that no headband—not even a helmet—can prevent a concussion. She is frustrated that parents are misinformed and that this faulty information is coming from the sporting equipment industry.
However, if marketing can be used for unscrupulous goals, it can also be used to move the concussion agenda forward. Monaco explains that a traumatic brain injury and a concussion are essentially the same thing. There is a movement among national experts to officially change the name. “Traumatic brain injury” has more emotional shock value and negative connotations than the less worrisome word “concussion.”
Immaculata students majoring in athletic training are well-prepared to recognize and handle traumatic brain injuries. Monaco explains that the topic of concussions is threaded throughout the entire program. In the Anatomy of the Brain course, students learn how to recognize a concussion, and in later classes, they learn how to evaluate, document, and rehabilitate concussed patients. With many states mandating that at least one athletic trainer be on site during sporting events, the demand for athletic trainers will only increase. Monaco and the rest of the faculty in Human Movement Sciences make sure students are ready for the myriad duties required of athletic trainers.
How will the future of football—or any other competitive sport—be changed by increased knowledge about traumatic brain injury? Monaco is optimistic about the fact that parents are paying more attention and asking good questions regarding the welfare of their children. She insists that the public’s concern about concussions and the media attention focused on this issue must change the game of football, the dominant sport in our society, which has the ability to capture the attention of its audience and beyond.
As a parent of three girls, Monaco would eventually like to delve deeper into research regarding the correlation between concussions in middle school girls and suicide rates. Today, younger kids are involved in much more strenuous sports than they were years ago. Monaco also found that a large proportion of girls soccer players were underreporting concussion symptoms.
On the bright side, children are now being educated at a younger age on the risks of playing, and parents seem more willing to challenge decisions by a coach and/or athletic trainer.
Knowing what she knows, Monaco acknowledges that she worries about her daughters playing basketball and soccer. “If I had a boy, I wouldn’t let him play football,” she says definitively.