Viewpoints: Ending the concussion epidemic

• Did you know that concussions change nerve cells and blood flow, and that women are more susceptible to serious effects?
• Biomarkers will eventually tell us whether an individual has suffered a concussion, what the extent of the injury is, and how long it will last
• These scientific developments will have important legal, policy and ethical implications

Our country faces a concussion epidemic.

Athletes, soldiers, accident victims, domestic violence victims and so many more suffer from debilitating concussion injuries. Once thought to be just temporary aberrations, concussions are now known to have long-term detrimental effects on brain function in at least some patients.

At the same time that science is revealing the serious risks of concussion injuries, it is also providing new tools to help deal with this problem. New blood-testing and brain-scanning technologies may provide much better information for detecting, monitoring and ensuring effective treatment of brain injuries.

The results of these developments may inspire societal changes ranging from when we permit football players to re-enter the field to how we treat victims of domestic violence.

Concussions change how our brains work

Concussions involve shocks to the brain that change nerve cells and brain blood flow. Because we can’t see it, our understanding of the injury remains limited. Yet these injuries can cause persistent headaches, memory loss, confusion, moodiness and even dementia. Some effects last weeks, others last years. Research shows that females, as well as people who have previously suffered a concussion, are at greater risk for more serious effects.

America is slowly coming to grips with the epidemic of traumatic brain injury, but the effort is in its infancy. Football at the professional, college and youth levels is only beginning to recognize the frequency and effects of concussions. But football is not going away anytime soon — and neither are hockey, soccer, and other sports with concussion risks.

Nor will exposure to concussive injury risk in combat be abated in the near future. Soldiers will continue to return from war with cognitive problems, PTSD (post-traumatic stress disorder), depression and behavioral problems linked to traumatic brain injury. In addition, the incidence of car accidents, workplace accidents and domestic violence involving concussive injury is, unfortunately, unlikely to shrink significantly within the foreseeable future.

Treatment will change a lot (and soon)

While the epidemic may not abate any time soon, our ability to identify and treat concussions is on the verge of major transformation. Science is racing to combat these problems. Significant research in this area is occurring here in the Valley at TGen, Mayo Clinic, Barrow Neurological Institute, Banner Health and Phoenix Children’s Hospital.

In particular, scientists are working to develop objective measures of concussive injury. They are finding “biomarkers” of concussive injury by identifying certain proteins in different body serums, like blood, urine and saliva, as well as identifying unique brain-scan patterns, eye-tracking movements and genes associated with concussive injury.

These biomarkers will eventually tell us whether an individual has suffered a concussion, what the extent of the injury is, and how long it will last. The availability of biomarkers may also tell us who is more likely to be susceptible to concussive injury and whether in the long term an individual is likely to suffer cognitive and behavioral problems.

Biomarkers come with big policy questions

These scientific developments will have important legal, policy and ethical implications. They will shift responsibility for concussive management.

For example, most states, including Arizona, have legislation that requires concussion education for coaches, athletic trainers and players; removal of players from play with suspected head injuries; and medical clearance before returning to play. But these laws can only go so far.

They don’t require the use of objective data (which we don’t yet have) to determine injury. They don’t address the long-term danger of repetitive, sub-concussive trauma. They don’t generate data to quantify how many hits are too many hits. And they don’t require the generation of baseline data on athletes.

All of that will change with these new scientific developments.

My Turn: In war vs. concussions, Arizona is winning

Biomarkers may verify claims of brain injury in other contexts that we currently have difficulty recognizing, whether from domestic violence or from car accidents. The link between concussion and long-term injury will become stronger.

In fact, identifying biomarkers may expand our conception of injury in these settings and require long-term monitoring of effects. Employers may begin to screen for certain job applicants who may be considered at increased risk of concussive injury and perhaps deny them employment.

If they are hired, they may require special accommodations. In contrast, privacy interests in the information regarding susceptibility and previous effects may become stronger.

Betsy Grey is a professor of law andfaculty fellow at the Center for Law, Science & Innovation at the Sandra Day O’Connor College of Law at Arizona State University.Her recent scholarly work has focused onthe impact of advancements in neuroscience on tort law.

Gary Marchant is a Regents' Professor of Law and faculty director at the Center for Law, Science & Innovation at ASU Law.

On Nov. 13, ASU Lawsponsored a conference, “ Safeguarding Brains: The Law, Science & Ethics of the Concussive Injury Epidemic,” which exploredthe concussion epidemic and the legal and ethical implications of advancements in neuroscience.