Aynsley Smith, PhD, RN, explains why everyone should embrace life and “respect the brain”

As a sports scientist at the Mayo Clinic Sports Medicine Center and mother of athletes, Dr. Aynsley Smith has studied and seen first-hand the lasting effects of head impacts on the brain. Recently, Dr. Smith focused her sights on the study of concussion in hockey players to help health care providers better understand head trauma in sports. A founding member of the International Concussion Society’s Scientific Advisory Board, Dr. Smith is passionate about her work and research on concussions, which affects millions of North Americans, including athletes and military personnel, every year. Below, she discusses the importance of educating everyone on the importance of preventing head trauma while encouraging people to live fully and “respect the brain.”

What does the word concussion mean to you?
I relate the word concussion to a vivid mental picture of neurons in children and athletes who participate in contact sports and military personnel after head impacts, rendering affected neurons dysfunctional. I also imagine the post-head trauma oxidative energy crisis that results in profound fatigue, a manifestation of concussion. That alarming mental picture drives me to take action on prevention, to promptly diagnose concussion, to quantify the severity of the injury and, ultimately, to treat it quickly to save the brain cells. Prevention and prompt appropriate treatment will protect the brain from permanent damage.

How have concussions impacted your life or career?
For years, I conducted research in hockey and other sports on performance enhancement, the psychology of injury, and the physiologic and psychologic zones of optimal functioning. We studied health care providers, musicians, hockey goalies and yips-affected golfers. I taught performance enhancement to hockey teams, and I became aware of the frequency, causation and devastating consequences of concussions—particularly in the fast, hard-hitting game of hockey. When I retired, I focused solely on concussions in hockey. I knew if we studied and monitored all aspects of concussions in hockey, in modern, enclosed ice arenas, the information we learned would generalize to other sports and concussions in the military.

I critique my decisions as a parent of three children who participated in sports that placed them at high risk for concussions. Most worrisome was the head trauma exposure our daughters sustained participating in equestrian events. Several crashes into jumps occurred when a horse fell or the rider was thrown. One daughter has persistent post-traumatic headache; however, one daughter who sustained fewer head hits is symptom-free, and our son, who played hockey and ski-raced, is fortunately without head trauma.

Have your experiences changed your perception of concussion? In what way?
I am aware of the brain’s immediate oxidative energy crisis response to head trauma and the potential for lasting brain damage conditions such as CTE. As such, I work almost full time on all aspects of concussions in hockey, focusing on prevention, objective diagnosis, determining severity quantification, identifying promising treatments for study and providing education. I recognized our need to move beyond the subjective concussion diagnoses that relied on questions such as “are you dizzy” that players could deny or exaggerate. We identified components of an objective diagnosis and published a paper to alert the sports medicine community on the need to objectify their concussion diagnosis.

Between concussed athletes and concussive trauma in the military, millions of North Americans have sustained significant head trauma and are in dire need of meaningful treatment and prevention.

If you could share one piece of information about concussion, what would it be?
Embrace life fully, be adventurous and be a risk-taker. At the same time, “respect the brain” by protecting yourself and those around you from head hits in sport, military and life. I believe effective treatment is on the horizon.

---

Aynsley Smith, PhD, RN, is on the Scientific Advisory Board for the International Concussion Society. The International Concussion Society sponsored website Concussion.Org is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class Scientific Advisory Board, Concussion.org aims to be the most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury. If you would like to be interviewed for an influencer profile, please fill out this form.

Thomas Bottiglieri, DO, aims to fight concussion so current and future athletes can keep playing the sports they love, safely

Dr. Thomas Bottiglieri found his passion for treating concussion through his own personal experiences. During his high school and college career as a linebacker, he suffered from concussion symptoms, but did not have the resources needed to adequately return to play. “In the days that I played football,” Dr. Bottiglieri said, “almost nothing was known, or at least said out loud, about the dangers of brain injury in sport.” Due to the lack of knowledge surrounding concussions, he chose to retire from his sport to focus on his recovery. This experience led to his decision to specialize in sports medicine and concussion. Today, he is Associate Professor of Sports Medicine at New York-Presbyterian/Columbia University Medical Center, where he works to better understand the disease in order to best evaluate, treat and protect patients. As a member of the International Concussion Society’s Scientific Advisory Board, Dr. Bottiglieri elaborates on the future of the field.

What does the word concussion mean to you?
A concussion is a syndrome including a constellation of injuries impacting brain function after trauma. My interested has always revolved around sport related concussions. When specifically working with athletes, there is a unique character of the pathology involved, given the known signs and symptoms as well as the more opaque sub concussive blows in collision sports.

How have concussions impacted your life or career?
Having participated in high school and collegiate football, as a linebacker, I am personally familiar with the nature of concussion. I have a love-hate relationship with football given the character-building nature of the sport. However, there is obviously a detrimental impact, which I have experienced both personally and professionally.

Due to my experiences, I hope that furthering the science to better understand the pathophysiology, biomarkers, and appropriate treatment for brain injury in sport will help to both protect athletes and save the game.

Have you ever experienced a concussion personally?
There are several stories I could tell of times when my brain was injured during sports participation. The most important, though, is my last concussion. It was one that occurred after never having reported a single injury, despite many. When in college, after several weeks of ignoring concussion symptoms, and multiple undiagnosed concussions, a final hit caused me to lose consciousness while participating in an Oklahoma drill, during practice. This was followed by subsequent post-concussion syndrome that lasted years.

It is my belief, that had I known the impact of each injury and had appropriate medical treatment, I might have been able to recover and have success with college football.

In your opinion, why is it so important to educate your field about concussions?
The term concussion is still an ill-defined entity and overall lacks research. There is a need for further studies to better characterize the various subtypes of concussion and understand the pathophysiologic mechanisms involved. For the athletic population, it is important that they are educated on the implications of each injury in the short and long term, appropriate time for return to play, and the time at which they are no longer safe to participate.

There are many studies happening. However, it is important to be able to apply the science for clinical practice, while pushing the field to undertake studies needed to fill gaps of current clinical knowledge.

If you could share one piece of information about concussion, what would it be?
The most important marker of injury is honest symptom reporting, which makes building trust with your athletes vital in their care. Athletes, organizations, physicians, and athletic trainers need to have a mutual understanding that the ultimate outcome of the game is the health of an athlete.

---

Thomas Bottiglieri, DO, is a member of the Scientific Advisory Board of the International Concussion Society. The International Concussion Society sponsored website Concussion.org is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class Scientific Advisory Board, Concussion.org aims to be most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury.

Jennifer Wethe, PhD, ABPP-CN, takes a balanced approach to concussion awareness, treatment and management

Concussion is not just an organized sports problem, says Dr. Jennifer Wethe, Co-Director of the Sports Neurology and Concussion Program at Mayo Clinic Arizona and founding member of the International Concussion Society’s Scientific Advisory Board. As a mother to a son who has experienced concussions in his day-to-day life, unrelated to organized sports, Dr. Wethe wants to change the perception of mild traumatic brain injury and educate people about treatment and prevention options. She recently spoke with us about her personal experience with concussion. Read on.

How did you become interested in studying concussion?
I’ve worked with individuals with acquired brain injury throughout my career. Earlier in my career, most of my time was spent with individuals who had sustained a moderate or severe brain injury. In addition to assessing injury-related changes in functioning, I worked closely with the individuals and their families to help them understand the injury, the course of recovery, and what they could do to improve functioning and enhance daily performance.

Over time, I developed a growing recognition of the need to provide related services tailored to individuals with milder forms of traumatic brain injury. Even though these individuals do not require lengthy hospitalizations, they still require a timely evaluation of injury-related changes in functioning, appropriate concussion education, guidance on managing symptoms and returning to normal activities, and interventions for their symptoms. Eventually, the Mayo Clinic hired me specifically to help develop their concussion program.

Have you or anyone you’re close to experienced concussion?
My children have. Oddly enough, I was specializing in concussion before they came along. My son, in particular, has had a few concussions. His have occurred not through organized sports, but by virtue of being an active kid. One happened when he was out sledding. Another happened during recess. He was knocked into a playground structure then hit the ground and likely had a brief loss of consciousness. He was only in second grade at the time and neither he nor the school recognized or reported the injury. In both cases, I did not know about the injury until later in the day when I recognized that something was off and then got the full story.

Have your son’s experiences changed your perception of concussion or the way you go about treating it?
My son’s experiences really highlight that concussion is not just an organized sports problem. All of my son’s injuries happened over the course of his day-to-day life. Most of them probably wouldn’t have been recognized if he didn’t have a concussion specialist for a mom. I want to build awareness that concussion is not just a sports issue. It can happen almost anywhere, anytime. Appropriate concussion education, identification and management, as well as prevention of repeat injury are crucial. At the same time, it is important to take a balanced approach. Concussion is not the end of the world. Most individuals experience a full recovery from concussion, especially if it is promptly identified and appropriately managed. Physical activity, sports and opportunities for kids to be kids are very important. We certainly don’t want to take that away.

Why do you believe that it’s important to educate your field about concussion?
Concussion is often missed or misdiagnosed. I’ve seen cases in which a student has taken a hard hit to the head and experienced enough symptoms that they went to the school nurse, but they were told that there was no concussion or need for further evaluation because there was no visible bump on the head and the student’s eyes looked normal. At the same time, I have seen new symptoms misattributed to a prior concussion, months after the concussion had fully resolved. Both situations are problematic. Our approach to concussion identification and management has changed dramatically in the last decade. There is a lot of misinformation and misunderstanding out there. Concussion should not be ignored, but it should not be disproportionately feared either. It is important to recognize it when it does occur.  We need current, accurate concussion education provided to health care professionals as well as the public so that concussion is recognized as an injury to be taken seriously, but also an injury that can be treated.

What do you believe fuels the misinformation about concussion?
It’s hard to say. I think some of it is the old-school belief that there is no concussion unless there is a loss of consciousness. In reality, less than 10 percent of concussions are associated with a loss of consciousness. We also have to change the “tough guy” mentality of ignoring symptoms of a real injury. On the other side, I think the risks of concussion have been sensationalized by the media.  We always hear the news reports about the big, bad, scary cases, so it makes it hard for folks to maintain a balanced, accurate perception of what is typical.

---

Jennifer Wethe, PhD, ABPP-CN, is a Board Member of the International Concussion Society. The International Concussion Society sponsored website Concussion.Org is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class scientific advisory board, Concussion.org aims to be the most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury. If you would like to be interviewed for an influencer profile, please fill out this form.

Willie Stewart, PhD, MBChB, stresses the importance of educating medical professionals about TBI

“Simply, concussion is a traumatic brain injury,” says Dr. Willie Stewart. As a Clinical Associate Professor at the University of Glasgow and Consultant Neuropathologist at NHS Greater Glasgow and Clyde, Dr. Stewart is dedicated to researching traumatic brain injury (TBI) and its outcomes. If mismanaged, he says, this type of TBI could have catastrophic effects on an individual. But even as a leading concussion researcher, and a founding member of the Scientific Advisory Board of the International Concussion Society, Dr. Stewart waited 36 hours for his concussion to be recognized after a bike accident two years ago. Below, he discusses the importance of educating medical professionals about TBI and shares the current state of concussion research.

How have concussions impacted your life or career?
The University of Glasgow has been at the forefront of researching traumatic brain injury and its outcomes for many decades, supported by the Glasgow TBI Archive. Our work used to focus largely on outcomes from single moderate or severe TBI and its link to dementia in particular. At the time, the risks of exposure to repetitive mild TBI were thought to be almost exclusively for former boxers.

In the last decade, there is a growing awareness of what we now recognize as chronic traumatic encephalopathy (CTE), which has brought a realization that late neurodegenerative outcomes of TBI aren’t restricted to car accidents or boxing but are also a concern in other sports like rugby and football. This has transformed research in our field.

Have you ever experienced a concussion personally? Tell us about that time.
Besides multiple occasions as a youth rugby player, I was hit by a car in 2016 on my regular cycle commute to work. Multiple broken bones were identified within hours, but it took 36 hours for mild TBI to be recognized, despite my having no recall of the accident.

In your opinion, why is it so important to educate your field about concussions?
Some estimates suggest that TBI is a contributing factor to between 5 and 10% of dementia. However, CTE remains a remarkably rare diagnosis in all but specialist research centers like my lab in Glasgow. To make any significant progress in understanding the effects and outcomes of concussion and wider TBI, we need to increase awareness of CTE and its diagnosis.

If you could share one piece of information about concussion, what would it be?
Concussion is a form of traumatic brain injury with immediate and late effects that we know little about as of now. There are no objective strategies for its diagnosis, but we do know mismanaged concussion can have catastrophic outcomes. As such, “if in doubt, sit them out.”

---

Willie Stewart, PhD, MBChB, is a member of the Scientific Advisory Board of the International Concussion Society. The International Concussion Society sponsored website Concussion.Org  is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class scientific advisory board, Concussion.org aims to be the most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury. If you would like to be interviewed for an influencer profile, please fill out this form.

William Levine, MD, believes in teamwork — both for the athletes he treats and to answer big questions about concussion

“Traumatic brain injury. Period. End of story.” That’s how Dr. William Levine describes “concussion” to the student-athletes he treats as Head Team Physician at Columbia University, in order to help them understand the gravity of the situation. And as one of the first members of the Scientific Advisory Board of the International Concussion Society, Dr. Levine is working to bring the potential long-term impact and real-life effects of concussions on athletes into focus. Below, he discusses how he has seen the conversation shift since he started at Columbia 20 years ago, and what questions remain.

How have your experiences changed your perception of concussion?
We have about 700 student-athletes at Columbia, and I have personally treated every athlete with a concussion during my tenure. It is safe to say that much was unknown regarding the impact of repetitive brain trauma when I began my career at Columbia. Now, concussion protocols, unbiased neurological consultants, medical retirement due to concussion, and the fear of chronic traumatic encephalopathy (CTE) are all prevalent factors of any sports medicine program and team.

In your opinion, why is it so important to educate your field about concussions?
The more information and research the better to treat athletes and educate our society about the significant impact of concussions. Part of the problem is that there is so much more information today than ever before, but there remain as many — if not more — unanswered questions as there are answers. What is the true pathway to development of CTE? Is there a specific phenotype that makes an athlete more susceptible to concussions? Do we have a clear understanding of the best return-to-play criteria in counseling athletes as they prepare to return to the playing field?

Continuing to change the culture has been what I would consider the first phase in the war on concussion: getting athletes, parents, and coaches aware and involved. My observation is that this has definitely occurred and there has been a paradigm shift over the past decade, for sure. Whereas underreporting used to be the norm, now, we see young athletes coming in reporting every single event. And CTE is not talked about just in the medical circles — all of a sudden, you see sportscasters on ESPN talking about CTE.

The second phase is much trickier: What can we do to decrease the incidence and prevalence? Are there biomarkers that can help us identify at-risk athletes for recurrent concussion? For CTE? What can we do better to rehabilitate athletes to minimize the likelihood of recurrent concussion?

If you could share one piece of information about concussion, what would it be?
Concussion is a serious problem that requires thoughtful, non-sensationalized investigation to comprehend the diagnosis, the symptoms, the consequences, the treatment and the ultimate outcomes more fully. Knee-jerk reaction, anecdotal evidence and sensationalized reports will not help us get any closer to answering these critically important questions. We need all constituents — neurologists, orthopedic surgeons, neurosurgeons, sports medicine physicians, athletic trainers, physical therapists, neurodiagnostic experts and vestibular rehabilitation experts — to engage fully in this problem to understand traumatic brain injury better and ultimately treat and hopefully prevent lifelong debilitating consequences.

---

William Levine, MD, is a member of the Scientific Advisory Board of the International Concussion Society. The International Concussion Society sponsored website Concussion.org is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class Scientific Advisory Board, Concussion.org aims to be the most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury.

ICS President John Leddy, MD, FACSM, FACP, speaks on his goals for the future of the Society and what every health care provider should know about concussion

Dr. John Leddy, Medical Director of the University at Buffalo Concussion Management Clinic, recently assumed the role of President of the International Concussion Society, bringing his 30 years of experience as a sports medicine doctor and team physician to the Society.

Until recently, the recommendation for people with concussion was to rest until symptoms resolved. “I started noticing that some of the athletes who were advised on that approach were not getting better; in fact, they seemed to be getting worse,” Dr. Leddy says. He began working with Barry Willer, PhD, to help athletes feel better mentally and recover faster. Together, they developed the Buffalo Concussion Treadmill Test, which assesses athletes’ symptoms and level of recovery “to try to help them get back to their normal lives.”

Now at the helm of the International Concussion Society, Dr. Leddy wants to establish the Society as the leading expert source for concussion-related topics: “We want to ensure that people are getting the best information out there from centers that are leading innovators in concussion investigation and management,” he says. “Our goal is that a doctor in a community that does not have a concussion center can go to Concussion.Org and access resources that would help him or her effectively treat patients.”

Below, Dr. Leddy expands on his personal history with concussion, and why it is imperative that health care providers better educate themselves on its symptoms and lasting effects to better treat those affected by it.

What does the word concussion mean to you?
From a medical standpoint, it means something I am interested in helping people get through to the best of my ability. I want to help individuals recover and give them information on how to avoid any long-term problems or repeat injuries. From a research standpoint, I am interested in studying the physiology of concussion in a systematic way. I want to help clinicians effectively diagnose concussion and help patients recover faster. If we investigate why concussions affect our bodies the way they do, we can develop effective treatments to potentially reduce prolonged symptoms and avoid potential long-term consequences.

How has your perception of concussion changed?
In the 1990s and early 2000s, concussion was thought of as a brain injury that primarily affected your thinking, and that is true, it does. But what the sports medicine approach to concussion has taught me over the years is that it is much more than that. The brain affects every organ system and physiological process in the body. It affects your mood, vision and balance. Additionally, it affects the amount of blood flowing to your brain during exercise and your autonomic nervous system, which impacts the heart, blood pressure, pulse and breathing.

Essentially, I moved from an appreciation of concussion being an isolated brain injury to being a brain injury with widespread physiological effects on the body.

Have you experienced a concussion personally?
Playing basketball in high school, I had my legs taken out from under me and came down on my head. I wasn’t knocked out, but I was clearly disoriented and confused. My mother took me to the doctor, and I remember him shining a light in my eyes and asking me questions. I didn’t have long-lasting effects. Luckily, I got over it, but I’ll never forget it. It was pretty scary, and it affected me for a week or so.

Why is it so important to educate health care providers about concussions?
If health care providers don’t fully understand concussions, they might return someone to a sport or work before the patient is fully recovered. We know that if you do that, and the individual does too much physically or is hit again before full recovery, it makes things worse. There is excellent research in both animals and humans to show that the concussed brain is very vulnerable to repeat injury or to excess physiological stress. That is why it is important for health care providers to recognize and diagnose concussion and to try to establish when somebody is fully recovered.

The purpose of that is not to return someone to their sport as soon as possible. It is to make sure that with practical clinical tools, the doctor can make an informed opinion that the individual is indeed recovered and it is now safe for him or her to return to the former level of activity, whether that is work for an adult or a sport for a scholastic athlete.

I look forward to leading the International Concussion Society and promoting access to the latest evidence-based treatment recommendations for concussions, to inform health care providers and anyone who is impacted by this injury. The field needs an evidence-based resource for people anywhere in the world to easily access online, and that’s what we will provide.

---

John Leddy, MD, FACSM, FACP, is President of the International Concussion Society and a Scientific Advisory Board Member. The International Concussion Society sponsored website Concussion.org is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class Scientific Advisory Board, Concussion.org aims to be the most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury.

International Concussion Society Co-Founder Ken Shubin Stein shares why concussions are worth fighting for

For Dr. Ken Shubin Stein, Co-Founder of the International Concussion Society Board of Directors, concussions are a personal matter. As a result, he has pledged to dedicate the next phase of his professional career to advocating for concussion treatment and research. His commitment to the cause and passion for making an impact led him to become one of the founding members of the International Concussion Society, the nonprofit group building awareness around concussions through the Concussion.Org website. And we were lucky enough to get a closer look as to what drives him to make a difference. Take a look.

How have concussions impacted your life or career?

I am directly impacted by concussion in a few ways, but I would say most substantially because of my mother, who sustained a concussion 20 years ago that continues to affect her. She experiences post-concussion syndrome, which causes her intense headaches and has made working very difficult for her. The experience touched my life in many ways, and sparked a lifelong interest in concussion research and treatment.

Have your experiences affected your involvement in the field?

My personal experiences combined with the surprising lack of existing resources for doctors, scientists, teachers, and coaches became the impetus to start the International Concussion Society. Once I began looking into the resources that are currently available, I found a startling number of information gaps. The issue is that as the field gets more attention, the more disparate and disconnected the information becomes. It’s very hard for a layperson, as well as some doctors, to get an up-to-date understanding on the best thinking across different specialties.

In your opinion, why is it so important to educate your field about concussions?

The current estimate is that in the United States, the likelihood of having a concussion is 20-25%. That means one in every four or five Americans will experience a concussion at some point in their life. Concussions are likely to affect every family in America and currently, we have so few trained concussion experts. We don’t even have agreed upon protocols and understandings. It’s important to begin educating all stakeholders to spread awareness because we really only understand just the tip of the iceberg about what is largely considered the most common form of traumatic brain injury.

How are you hoping the International Concussion Society will help change that?

The International Concussion Society will provide a trusted resource and information hub for all of concussion’s stakeholders. That means physicians, scientists, patients, families, coaches, athletes and other people involved in patient care will be able to go to Concussion.Org to get connected to the best information and resources available. That includes everything from tools to help people locate a trained concussion doctor near them to links to the best and most recent findings on the topic.

If you could share one piece of information about concussion, what would it be?

If you or somebody you care about thinks that they might have a concussion, they should radically rest until they are cleared by a specialist. This is something that I don’t think is stressed nearly enough when discussing concussion recovery. Radical rest means no TV, no emotional excitement or stimulation, no reading, no work, no going to school; just rest. It’s extremely important in the immediate post-concussion period, even if you’re not sure if you have actually had a concussion. That window is believed to be extremely important in a patient’s healing and prognosis.

Ken Shubin Stein, MD, MPH, CPH, CFA, is a Board Member of the International Concussion Society. The International Concussion Society sponsored website Concussion.Org  is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class scientific advisory board, Concussion.org aims to be most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury. If you would like to be interviewed for an influencer profile, please fill out this form.