PSYCHIATRIC ASPECTS OF TBI IN SPORTS David Baron, MSEd, DO University of Southern California Acknowledgement Steven Baron, PhD Associate Professor of Psychology, Montgomery College

DAVID BARON, MSEd, DO

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!!Speakers Bureau: None

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Disclosures

LEARNING OBJECTIVE Identify current and emerging developments that will shape the management of sports-related traumatic brain injury (TBI) in athletes

WHERE WE’VE BEEN

!!Lack of appreciation of impact on long-term effects (especially psychiatric)1

!!Treated like an ankle sprain !!Called it a brain bruise !!Administered smelling salts !!“Get back in the game”

!!Virtually no research on effects of chronic, multiple head trauma2

1. Mayers L. Arch Neurol 2008;65:1158-1161. 2. McCrory P, et al. Phys Sportsmed 2009;37:141-159.

WHERE WE’VE BEEN (CONT.)

!!Culture of collision/contact sports !!Macho image

!!Very limited hard data !!Similar to steroid issue

30 years ago

WHERE WE ARE

!!Increasing awareness of neuropsychiatric consequences !!Increased suicide in pro football !!Andre Waters story

WHERE WE ARE (CONT.)

!!Working on consensus guidelines !!NFL locker room poster

changed July 20101

!!“Return-to-play” guidelines2

1. New York Times. NFL Asserts Greater Risks of Head Injury. July 26, 2010. http://www.nytimes.com/2010/07/27/sports/football/27concussion.html. 2. Herring SA, et al. Med Sci Sports Exercise 2005;37:2012-2016.

WHERE WE ARE (CONT.)

!!Emerging technology !!Susceptibility-weighted imaging (SWI)1

!!Wilton logic screen2

!!Hot topic in lay/sports press !!Time Magazine article in January 20103

!!Global interest

1. Giza CC. Curr Sports Med Rep 2010;91:35-39. 2. http://www.wiltonlogic.com/news-info/index.html. 3. http://www.time.com/time/nation/article/0,8599,1957046,00.html.

WHERE WE ARE GOING (HOPEFULLY)

!!Evidence-based consensus guidelines !!Evaluation !!RTC !!Strictly enforced rules

!!Baseline screening with regular follow-up to detect early subtle changes !!Change in our culture and attitude about

head/neck trauma

WHERE WE ARE GOING (HOPEFULLY)

!!Better baseline measurement and documentation !!Early intervention post-trauma !!Better education !!Atlas and Athena program

!!Improved equipment for better protection !!Retrospective evaluation of athletes

with former subclinical concussions

WHAT’S NEEDED

!!Coordinated collaboration and cooperation !!Sports federations !!Youth sports !!NCAA !!Professional sports !!Trainers/coaches/med staff !!Sports psychiatrists/psychologists !!Neuroimagers

!!Funding !!Media portrayal of head trauma changed !! Improved equipment/testing of effectiveness