Concussions' effect on employment (7/18/19 newsletter)

Hanna Rytter Mála Rytter, Department of Psychology at the University of Copenhagen. Photo: Joachim Rode

Hanna Rytter Mála Rytter, Department of Psychology at the University of Copenhagen. Photo: Joachim Rode

We are pleased to have students from Carleton College interning with Concussion Alliance. Intern contributors this week:

Editor: Galen Moller
Contributors: Hannah Kennicott, and Julian Szieff.

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UCalgary news has an in-depth article about the university’s recent successful online course “Concussion: prevention, detection, management.” Concussion Alliance co-founder Malayka Gormally was one of 8,500 people from around the world to take the MOOC, or Massive Open Online Course. Course modules were taught by leaders in the field from numerous countries; the MOOC was led by Dr. Pierre Fremont, Laval Universite School of Medicine, and Kathryn Schneider PT, PhD, Sport Injury Prevention Research Centre at the Faculty of Kinesiology, University of Calgary. The next MOOC will likely be in the fall of 2019.


A new survey of athletic trainers in NCAA college programs across the country found considerable pressure on trainers. More than a third of athletic trainers surveyed by the National Athletic Trainer’s Association reported that coaches had an influence in their hiring or firing. Additionally, while only 20% of trainers (500 trainers) responded to this question, 58% of respondents stated that they had been “pressured … to make a decision that was not in the best interest of a student athlete’s health.” While it is important to note that these results may be skewed due to survey design or by the limited number of respondents, this pressure both in terms of health decisions and employment is very concerning. Early return to play can impact students sports and academic performance and lead to lifelong injury and issues.


An abstract entitled “Traumatic Brain Injury and Cannabis Use: A Primer for Clinicians” was accepted from the International Brain Injury Association’s 13th World Congress on Brain Injury, (Toronto in March 2019) and published (abstract #0071) in Brain Injury. The paper, by Shree Bhalerao et al., provides clinicians with an overview of the evidence relating to cannabis use for post-TBI symptoms: “neurosensory (pain and headaches), neurocognitive (overwhelmed while multitasking) and neuropsychiatric (anxiety, sleep and to avoid opioid addiction).” The authors intend the paper to help clinicians answer their patients’ questions concerning cannabis after a TBI. They also note that current evidence on cannabis use by TBI patients is sparse, and they hope their paper encourages further studies which “explore the impact of Cannabis after its legalization.”


Examining the neuro-structural effects of age on concussions came into focus in a recent survey by Sebastien Tremblay with the Montreal Neurological Institute. Using an MRI machine, they evaluated two groups of fully-recovered older adult concussion patients: one in which the patients had recovered from their concussion at an advanced age (average age: 61 y/o), and one in which they had recovered in early adulthood (average age: 24 y/o). Their findings show that while advanced-age concussions are dangerous, the interaction of concussion symptoms and the aging process creates more structural disruption. This is a novel finding: that the interactions of the aging process with post-concussion neurological changes can precipitate structural changes in the brain, even in asymptomatic patients. The study by Sebastien Tremblay et al. was published in NueruoImage: Clinical.


A study conducted by Dr. Lianne Tomfohr-Madsen et al. found that a six-week cognitive-behavioral therapy intervention for insomnia is effective in treating adolescents with post-concussion symptoms and poor sleep. The authors acknowledge that a larger study is needed to confirm these results. The paper was published in the Journal of Head Trauma Rehabilitation.


A North Carolina Health News article by Emily Davis reports that a Senate Health Care Committee gave the go-ahead for The North Carolina Veterans TBI and PTSD Treatment and Recovery Act. The bill, if passed, would allow North Carolina veterans diagnosed with TBI or PTSD access to hyperbaric oxygen therapy. The chambers are designed to improve blood flow and improve tissue repair by increasing the atmospheric pressure, but there is still conflict in the current research regarding the therapy’s efficacy.

Mental Health

The abstract “Associations of Traumatic Brain Injury, Depression, and Childhood Adverse Experience in Disadvantaged Canadians” addresses the experience of a cohort of Canadians who have experienced homelessness or are adolescents in foster care. Within the Disadvantaged cohort, those with a history of TBI had significantly higher scores on the Adverse Childhood Experiences (ACE) questionnaire than the control group. The researchers found that a history of TBI was “associated with sexual abuse and mental illness in the family.” For the disadvantaged adolescents, “TBI was also associated with criminal offense in the family.” The abstract, by authors Daniel Zhang et al., was accepted from the International Brain Injury Association’s 13th World Congress on Brain Injury, (Toronto in March 2019) and published (abstract #0098) in Brain Injury.


Researchers at the University of Copenhagen conducted a large scale (19,000 concussion patients) Danish national registry survey on concussions’ effect on employment. Comparing these patients to a controlled sample population without concussions, the researchers found that patients age 20-40 and patients with high education were much less likely to be employed full time five years later.

Hana Malá Rytter, the lead researcher on this survey and Head of the Danish Concussion Center, hypothesizes that "people with higher education often hold positions, where they are required to multi-task, engage in teamwork and shift focus between different tasks while making decisions and taking responsibility. Skills that are often challenged, when long-term symptoms after concussion impair the ability to concentrate." All of these factors add stress and mental load, which are impaired functions in concussion recovery. Although the University of Copenhagen research did not mention concussion management regarding patients in the study, the Eureka Alert article states that “Patients with concussion rarely receive actual treatment as the brain primarily needs time and rest in order to heal.”

Concussion Alliance would like to stress that if symptoms last longer than two weeks, the 5th International Consensus on Concussion in Sport currently recommends management of concussion patients through “interventions including psychological, cervical, and vestibular rehabilitation.” There is “insufficient evidence that prescribing rest [beyond 48 hours]...may promote recovery.” See our page on Guidelines for Recovery for more advice on recovery.

Women's Health

A study looked at female veterans who experienced a TBI from intimate partner violence and their future psychosocial health risks. The researchers compared a subgroup who reported persistent symptoms at the start of the study, to a subgroup without persistent symptoms at the start of the study. The study concluded that women who experience a TBI from intimate partner violence, and who initially report persistent symptoms, are “at higher risk for worse psychosocial health outcomes 18 months later.” The authors KM Iverson et al. recommend screening to tailor “psychosocial interventions” to reduce the risk for this population. The study was published in Comprehensive Psychiatry.


The new documentary Headstrong follows pro wrestler Rob Van Dam through the experience of discovering that he has a concussion. The documentary was originally going to be about Van Dam’s comedy tour, but when the wrestler started showing symptoms from a concussion he obtained two to three days before the tour, the course of the film changed dramatically. In an interview on The Two Man Power Trip Of Wrestling Podcast, Van Dam reflects on how he used to think about head impact: “I thought I am showing how tough I am and I’m showing what a chair shot I can take to my head, and I’ll recover from it.” But when he watched through the documentary, he says, he realized that he “did everything wrong.” The film is available on iTunes, Amazon, and Google Play.

CTE and Neurodegeneration

Brain Pathology recently published the work of Dr. Kevin F. Bieniek et al., which examined the occurrence of chronic traumatic encephalopathy in several populations. As reported by Sabine Galvis for the Science website, the researchers found evidence of CTE in 5% of athletes in general and 7.9% of football players. Interestingly, they also identified that the rate of CTE in nonathletes is around 1.3%.

Additional contributor 

Concussion Alliance co-founder Malayka Gormally