, and is a common consequence of sport participation. An estimated 1.6 to 3.8 million sports-related concussions occur in the United States each year.
Also, by the nature of the varied mechanisms of injury and situations that can lead to brain injuries (sports injuries, auto wrecks, falls, etc.), it is important for the patient to realize that in the initial event setting, or the Emergency Room situation, serious symptoms and signs of other conditions suffered in the injury event (such as fractures, abdominal injuries, spine injuries, etc.) may cause for the Concussion to go unrecognized (even in the ER ) – especially when the patient appears to be neurologically normal by the time of arrival to the ER. Though this situation was common a decade ago, the recognition of potential TBIs in the ER has become less common due to the recent focus on training of Emergency staff to recognizing the potential of such injuries despite a superficially normal neurological appearance of the patient. For example, though symptoms may be minimal and transient at first, and the injured person seem to “come around” to normal within a few seconds or minutes, following the actual injury event, this does not mean that the brain was not significantly injured, or that a delayed transient or permanent injury of the brain has taken place.
Recent developments in the understanding of the pathophysiology of a mechanical brain injury, have shown that some neurological deficits of a TBI may take several days to present themselves clinically. For this reason, it is important that any suspected concussion (or other TBI) be evaluated by a physician well trained and studied in the area of brain injury. That said, there is no single medical specialty that trains “concussion specialist.” The science of TBIs crosses several traditional medical specialties. No specialty actually focused into this area until very recently. Yet, after the NFL and Federal Government starting putting significant research funding into the research of concussions, several specialty boards wanted in on the money and so developed subspecialty training programs in TBI medicine. Accordingly, in any particular geographic area, the local “expert” may be a particular neurologist, a sports medicine or PMR doctor, or even a local DC. The key is in finding a doctor who has taken on the additional self-directed training to know how to work-up a TBI case, and is experienced in developing an appropriate and comprehensive treatment plan. To this point, there are also several DC (Chiropractors) who understand this area of science and medicine to a very high degree and are able to provide very good care to the Concussed patient. One should not simply look to the reported specialty of a doctor, but should look to find a doctor (of whatever specialty) who has the proper experience. Indeed, some DCs were early-in on the study of TBIs before many MDs, and have worked extensively to help patients recover from such injuries. (See: https://carrickinstitute.com/programs/traumatic-brain-injury/)
Dr. Lowry (an MD with extensive clinical and basic science research experience in treating concussions) has learned from many world leaders in this field of traumatic brain injury. He has been involved with research in the area of concussions/TBI, and he has significant experience in treating over a thousand TBI cases in his career. He has been a leader in bringing up-to-date medical understanding of concussions to the San Antonio area.
Dr. Lowry was an early-comer to TBI treatment in the San Antonio area.
Dr. Lowry earned an advanced degree in neurophysiology. Prior to entering Medical School at George Washington University, Dr. Lowry had been involved in researching the activity of various neurotransmitters in the brain, and his post-graduate work includes a surgery residency, which emphasized trauma. He has been involved as a ringside physician for USA boxing and the professional ranks for over twenty years, and he has a special interest in the sleep and visual pathway changes caused by Traumatic Brain Injuries. He has studied boxers (a sport with significantly more concussions than football even – on a per player basis) using advanced EEG technology and found that sleep (specifically slow wave sleep) is significantly altered a large portion of TBI cases. His wife (Lynnell), being an ophthalmologist, helped peak his interest in the how the visual system is commonly injured in TBIs – and yet often times doctors, and even the patients, are unaware of the damage – thinking their post-TBI headaches and slowed cognitive capabilities are just part of the injury that will recover on its own if just left alone long enough.
Studying advanced neurophysiology and clinical lectures from the Carrick Institute, he has brought attention to other physicians around the South Texas Region and professional boxing circles, that taking a detailed examination of the visual system in suspected concussed patients is a key in examining the concussed patient. Dr. Lowry has worked to bring together other specialists in the San Antonio area to work as a loose-knit team of specialists to all help in the treatment of his concussed patients.
“No one specialist; no one person can treat a true concussed patient alone – it requires a team effort.” – Robert Lowry, MD
While the majority of concussion injuries are self-limited and will near fully-resolve within a couple months, up to 30% may be associated with long-term or even permanent cognitive losses catastrophic injuries such as spinal cord injury and skull fracture. Additionally, long-term effects of repetitive head impact exposures without associated clinical manifestations of concussion are unknown. A history of prior concussion is associated with an increased risk for recurrent concussions.
The effect of concussion on developing brains is of particular concern. Children with concussion, particularly multiple concussions, are at risk for developing chronic or recurring headaches and suffering from impaired memory, cognitive dysfunction, attention deficit disorders, and other behavioral changes. Symptoms of neurologic and neuro-behavioral disorders such as depression, post-traumatic stress disorder, anxiety, sleep disorder, vestibular dysfunction, cervicalgia and oculomotor dysfunction may also be experienced up to six months following a concussion. Unfortunately, an estimated 283,000 children visit emergency departments each year to seek care for sports- and recreation-related TBIs, including concussions. Among high school students, 15.1 percent report having at least one concussion related to sports or physical activity.
All fifty states and the District of Columbia have enacted legislation aimed at protecting our nation’s youth from potential serious negative outcomes related to sport-related concussion. Most legislation requires education about concussion, removal from play for at least 24 hours in the event of a suspected concussion, and return to play only after evaluation by a qualified healthcare provider and a described return-to-play protocol.
The AAN (American Academy of Neurology) strongly encourages state and local policymakers to update relevant policies and regulations to ensure youth with sports-related concussions receive appropriate care.