Concussion specialists warn time period used to explain head impacts—’subconcussion’—is deceptive and harmful

An editorial revealed within the British Journal of Sports Medicine by specialists from Spaulding Rehabilitation, Boston College, Mayo Clinic, and the Concussion Legacy Basis, argues that the time period “subconcussion” is a harmful misnomer that needs to be retired. The authors are interesting to the medical group and media to substitute the time period with extra particular phrases so the general public can higher perceive the dangers of mind accidents and advance efficient efforts to forestall continual traumatic encephalopathy (CTE).

“The general public has been led to consider via media coverage and films that concussions alone trigger CTE,” stated senior creator Dan Daneshvar, MD, Ph.D., chief of Mind Harm Rehabilitation at Spaulding Rehabilitation, a member of the Mass Basic Brigham well being care system, and assistant professor, Harvard Medical College.

“However the analysis is evident: concussions don’t predict CTE standing, and the hits that trigger concussions are sometimes not the toughest ones, making ‘subconcussive’ deceptive when describing impacts.”

The authors consider a part of the confusion outcomes from the truth that head impacts that do not trigger concussion are known as “subconcussive impacts,” implying they’re lower than concussions. Scientists usually say that CTE is attributable to “small, repetitive impacts,” which leaves out the impact of any “giant repetitive impacts.”.

Ross Zafonte, DO, president of Spaulding Rehabilitation and chair of the Harvard Medical College Division of Bodily Drugs and Rehabilitation, served as a co-author.

Earlier research report a excessive incidence of enormous repetitive impacts throughout soccer. Revealed helmet sensor research present that round 10% of head impacts skilled by football players are more durable than the common concussion. That implies that if a soccer participant will get one concussion throughout a 1,000 head impacts season, round 100 hits had been more durable than that one concussion. One examine confirmed that for each concussion a school soccer participant experiences, they expertise 340 head impacts of better drive.

The authors of the editorial advocate changing “subconcussive” with “nonconcussive” to raised describe head impacts that do not lead to a concussion.

“We have all the time recognized CTE is attributable to head impacts, however till we did this evaluation, I did not understand I absorbed lots of of maximum head impacts for each concussion once I performed soccer,” stated Chris Nowinski, Ph.D., lead creator, co-founder and CEO of the Concussion Legacy Basis, and former Harvard soccer participant.

“Utilizing the time period subconcussive naturally led me to think about smaller hits, however now I believe these frequent bigger hits are taking part in a extra vital position in inflicting CTE than we beforehand believed.”

The editorial additionally highlights how the time period subconcussive has not solely confused the dialogue round head impacts, but in addition round traumatic mind accidents. Research constantly present that athletes uncovered to lots of of repetitive head impacts, within the absence of a concussion, nonetheless have modifications to mind operate, blood biomarkers of brain injury, and structural modifications on imaging that look just like modifications in athletes with identified concussions. The idea of subconcussive harm has been shoehorned into the dialog to clarify this “lacking hyperlink.”

The authors recommend we cease utilizing subconcussive harm, noting the lacking hyperlink is best described as subclinical traumatic brain injury (TBI). Subclinical TBI occurs when there are modifications in mind operate, biomarkers, or imaging with out TBI indicators or signs.

“The human mind has greater than 80 billion neurons, and we may be assured an athlete can’t really feel it when just one is injured,” stated neurosurgeon Robert Cantu, MD, medical professor of neurology, Boston College College of Drugs, and diagnostics and therapeutics chief, Boston College ARDC-CTE Heart.

“Athletes, military veterans, and members of the group incessantly endure subclinical traumatic mind accidents, and we advise retiring subconcussion, a poorly outlined time period, when referring to mind accidents.”

By altering this nomenclature, the authors hope to make clear why concussions don’t predict who has CTE, whereas the quantity and power of repeated head impacts does. They implore the medical community and media to correctly title the impacts and accidents that may’t be seen, which may advance the dialog to speed up CTE prevention efforts, such because the CTE Prevention Protocol.