Gray 1

Research Paper

Chase Gray

English 1101

Jamie Dunham

3/25/2021

Why are brain injuries so traumatic?

Recently, there has been a lot of research around the brain and how it develops. It

has always been interesting for me because the brain is so complex and functions faster than any

product created ever before. However, there are a lot of injuries and diseases associated with the

brain that slow down the rest of the body. When there are injuries introduced to the brain during

sports, like concussions, there are negative impacts to the brain, the rest of the body, and mental

health.

A big reason I chose this topic is because of the big impact it has on somebody’s life.

One of my best friends in highschool had so many concussions to the point that he was not

allowed to play any contact sports the rest of his life. Since the sport that we played together was

soccer, he lost a big part of his life. Personally, he never really opened up about how it affected

him mentally, but I could tell that there was something up. I didn’t really see or talk to him until

he found a loophole in the doctor’s orders. He was able to play a sport that didn’t really have any

contact. He said:

There were a lot of things that happened that year and the next. These were my last two

years in highschool, so a lot of my focus shifted to college. Within the span of two

seasons, I had multiple concussions that forced me to limit a lot of the things I did before.

Some sports were restricted and I missed a decent amount of school recovering from the
 Gray 2

concussions. The time it took to get caught back up and not being able to play put me in a

really bad space. (Max)

This is why the topic matters to me so much. People’s lives are affected negatively and

even could be ruined, in the case of a professional career. Too many head injuries could result in

the end of someone’s professional career and possibly leading to a lack of memory or

coordination. In the case of severe concussions, this could permanently damage portions of the

brain.

There are a lot of effects brain injuries have on the brain and the rest of the body. The

most common are concussions. A concussion, or mild traumatic brain injury, is defined as a

temporary unconsciousness or confusion caused by a blow to the head that could lead to

temporary cognitive symptoms. This is a very slimmed down definition because the symptoms of

concussions are extensive depending on the area of the brain that is affected. A severe

concussion is classified as a concussion where you lose consciousness for five minutes.

Studies about concussions are extensive in research and have been going on for a long

time as we try to unlock the capabilities of the brain. In a study done in Ireland, doctors used

traumatic brain injuries to understand the neurological components in the brain. In the research

done by Philip J. O’Halloran and his acquaintances:

Traumatic Brain Injury (TBI) is a major cause of morbidity and mortality with

approximately 1.4 million patients attending hospital with a TBI/year in the United

Kingdom. In the 30 month period, there were 463 incidences of overall traumatic brain

injury referred to our adult service, of which 35% were related to sports and exercise

activities. About 120 male injuries and 44 female injuries were recorded. (Philip J.

O’Halloran et. all, pg 1-2)

This research shows that, over a thirty month period, about one hundred and 64 patients

were treated for a brain injury from a sport or exercise injury. The rate at which the hospital

admits patients with a TBI is surprisingly high considering there are not many sports or exercise

related injuries. In 2017, traumatic brain injuries accounted for 18% of all major trauma injuries

in Ireland. Based around my findings, sports and exercise are a common cause of TBIs and may

be associated with morbidity and mortality. In another study done to research brain injuries and

its effects on the rest of the body, done by Thomas W. Mcallister:

Traumatic brain injury (TBI) is a worldwide public health problem typically caused by

contact and inertial forces acting on the brain. Recent attention has also focused on the

mechanisms of injury associated with exposure to blast events or explosions. Advances in

the understanding of the neuropathophysiology of TBI suggest that these forces initiate

an elaborate and complex array of cellular and subcellular events related to alterations in

Ca++ homeostasis and signaling. Furthermore, there is a fairly predictable profile of brain

regions that are impacted by neurotrauma and the related events. This profile of brain

damage accurately predicts the acute and chronic sequelae that TBI survivors suffer from,

although there is enough variation to suggest that individual differences such as genetic

polymorphisms and factors governing resiliency play a role in modulating outcome. This

paper reviews our current understanding of the neuropathophysiology of TBI and how

this relates to the common clinical presentation of neurobehavioral difficulties seen after

an injury.

There is also a wide range of effects brain injuries have on the cells inside the brain. In another

study done to research brain injuries and its effects on the rest of the body, done by Thomas W.

Mcallister:
 Gray 4

Traumatic brain injury (TBI) is a worldwide public health problem typically caused by

contact and inertial forces acting on the brain. Recent attention has also focused on the

mechanisms of injury associated with exposure to blast events or explosions. Advances in

the understanding of the neuropathophysiology of TBI suggest that these forces initiate

an elaborate and complex array of cellular and subcellular events related to alterations in

Ca++ homeostasis and signaling. Furthermore, there is a fairly predictable profile of brain

regions that are impacted by neurotrauma and the related events. This profile of brain

damage accurately predicts the acute and chronic sequelae that TBI survivors suffer from,

although there is enough variation to suggest that individual differences such as genetic

polymorphisms and factors governing resiliency play a role in modulating outcome. This

paper reviews our current understanding of the neuropathophysiology of TBI and how

this relates to the common clinical presentation of neurobehavioral difficulties seen after

an injury.

In the statement made by Thomas W. Mcallisters, he makes it clear that brain injuries are a large

issue ranging from neurotrauma and other implications. In his trial, he concluded that there are

relatively the same effects on everyone when introduced to a common head injury, but later saw

that there is a possibility that these head injuries can activate or change genetic sequencing in

your body. He uses the word “polymorphism” which basically means the presence of genetic

variation within a population, upon which natural selection can operate. This means that though

the same thing was introduced into the population, there are a wide array of outcomes that occur

to the different people in the population. I think this is a good thing to think about because

everyones’ body reacts differently to different stimuli, so there is a lot to learn about different

people’s gene structure as well as reactions that can be dove into when studying the brain. He
 Gray 5

also brings up calcium homeostasis and signaling when talking about this study. He also states

later in his study:

Of particular importance is the release of glutamate and other excitatory amino acids

with a resultant influx of extracellular Ca++ into the cell. This in turn releases additional

Ca++ from intracellular stores, thus producing sufficient quantities of free intracellular

Ca++ to initiate a host of intracellular reactions that can result in cytotoxic injury and

eventually cell death.

-A simplified graph summarizing TBI related cellular injury cascades

In this quote he explains the significance of the calcium rotation in an injured part of the brain. In

the explanation, he talks about how calcium is needed to help the brain recover in the

extracellular space (area outside of the brain cells) of the brain. This causes calcium to be pulled

into the extracellular space from the cells. In doing this, the brain gets all the calcium it needs to

recover, but in the process it ends up killing the cells because of the lack of calcium the cells

need. Even though this is helpful in the moment, the killing off of those cells causes the bad

diseases and effects we see today like contusions and strokes.

There is a connection between traumatic brain injuries and cognitive development in any

age. From research done, cognitive abilities are significantly affected when an injury to the head

is introduced. According to the Model Systems Knowledge Translation center, many cognitive

functions associated with understanding others, thinking of how to respond, and reaction time

slow dramatically. Some problems with cognitive skills after a brain injury include:

Rambling or getting off topic easily, difficulty expressing thoughts, misunderstanding

jokes or sarcasm, or some diseases like Aphasia, which is a disorder that can affect your

speech or ability to understand language properly. As you can see, there are a lot of

problems that can be caused from a brain injury. (MKTC)

This quote shows all of the effects of injuries to the brain, all of them being negative. From the

research on the website, there are actually a lot of things that are affected in the brain in all the

different areas and functions. With this information, there are ways listed to improve all of the

things that could happen with injuries. Things like relying on others to help you through

problems and taking a minute to think about making decisions before you do. Also therapists and

neurologists could be brought in to help with cognitive abilities.

The rest of the body is affected the most from an injury to the head or brain. Even with

the brain being the main organ being affected, the rest of the body ends up being hurt as well as

the parts of the brain. Parts of the brain like the Hypothalamus, which controls the autonomic

nervous system, initiates physical response, and regulates body temperature, intake, and sleep.

Seeing as this part of the brain controls these functions of the body, including part of the nervous

system, it would be very detrimental to the rest of the body if the hypothalamus is injured. In the

article written by Toufic R. Jildeh:

189 concussions were documented in 153 athletes. Of these, 140 cases were the first

recorded instance of concussion in players with publicly available data. Thirty-six

(25.7%) athletes sustained a LE injury within 90 days of concussion; 26 (20.2%) were

non–season-ending and included in RTP analysis. The odds of sustaining an acute LE

musculoskeletal injury within the 90-day period after concussion was 4.69 times greater

in concussed players compared with controls (95% confidence interval 1.96-11.23, P < .

001). There was no significant difference in games (4.2 ± 5.0 vs 4.7 ± 4.7 games, P = .

566) or days (18.5 ± 39.1 days vs 10.9 ± 10.6 days, P = .912) missed between concussed

players with LE injury and non concussed controls. The most common LE injuries in

concussed athletes were ligament sprains/tears (65%).

-LE: Lower Extremity, All cases recorded with NBA players

In this group of information, it states all the statistics and percentages of recorded connections

between concussions and lower extremities. Lower extremities is any injury that occurs waist

level or lower. According to the information in this study, there is a large correlation between

musculoskeletal and brain injuries in the NBA It i even stated that, in the study, you are about 5

times more likely to sustain a musculoskeletal lower extremity injury within a month and a half

of receiving some sort of concussion or brain injury. This study is a very good one to look at

because it talks about the direct relevance and correlation between the two different types of

injuries. Another concern with brain injuries is the development of spinal cord/brain diseases

later on in life. Diseases like Parkingsons disease and dementia are seen to be very common later

on in life for victims of brain injury. In a study performed by the University of California San

Francisco, there was a large scale study of over 300,000 participants, among those 300,000 were

military veterans that received some sort of brain injury including ones obtained in everyday
 Gray 8

civil life. Now that there has been research linking the two, the focus shifted from short term to

in between the two stages, being short term and long term effects. Nina Bai writes in her

collaboration with the University of California San Francisco:

Researchers suggest several possible mechanisms that could link concussion and mental

decline. Perhaps the concussion triggers a cascade that increases abnormal protein

buildup in the brain, a common hallmark of neurodegenerative diseases. The concussion

might cause inflammation or vascular changes. Another theory is that the injury could

make the brain more vulnerable overall, what the researchers call a loss of brain reserve.

This quote talks about all of the things that researchers believe could link the time between the

short term brain injuries and long term neurological degenerative diseases that come with it later.

In Nina Bai’s statement about what links the two, she briefly talks about how each link and long

term outcome depends on the person being studied. Basically, she means that everyone has

different reactions, so it is near impossible to figure out one, main area that could link the two.

There are two theories that she has come up with, one being a degenerative effect from the

concussion to later years, and the other being that the brain just becomes more susceptible to

diseases and injuries.

An interesting part of the research article from the University of California San Francisco

is the different perspective of how to diagnose a concussion. Screening for a concussion isn’t as

simple as those for a virus or bacteria. Right now, CT scans are used to look for protein

biomarkers, but they aren’t always sensitive enough to pick up a concussion. Daniel Lim and

Geoffrey Manley are among the scientists trying to create another way to detect concussions,

using blood instead of a scan. Nina Bai explains their plan:

The two are focused on using long noncoding RNAs (lncRNAs) – molecules that are

remarkably tissue-specific and can leak out of a cell when it is injured. Distinctive

lncRNAs found in the blood can be traced to broken bones, torn muscles, or injury to

organs like the heart and kidney. Likewise, brain-specific lncRNAs in the blood would

indicate a brain injury.

In this plan that the two researchers have created, they are trying to find a reliable way to

diagnose a concussion because they do not like the unreliability of the CT scans. They plan to

use the specific RNA from organs to determine if an organ is injured. This is possible because

when the cells get injured, the specific RNA for the organ that is injured can leak out into the

bloodstream. Scientists will be able to see these RNA strands in blood flow shortly after the

injury, so they hope they can develop a portable test for childrens sport events. Even though it

sounds possible, manly states that about 30% of those that receive medical assistance for a

concussion do not schedule a follow up appointment, so there is not enough data. He states,

“Many of those who aren’t being seen are suffering and need medical attention. It’s a major gap

in care that represents an important public health issue in this country.” He shows that brain

injuries are really important in health in the United States. However, there is some hope for

researchers creating this new form of testing. In a different study, they used mice with mild

concussions to see if there was any way to treat a concussion months after it happens. To their

surprise, it worked. Rosi, who directs neurocognitive research at the Brain and Spinal Injury

Center, said, “Despite what trauma does to the brain, it seems there are reserves, at least in the rodent

brain, that we can use to make the brain function again.” He is explaining how the information obtained

from the rat experiment gives the researchers hope about the future of medical treatments for brain

injuries.
 Gray 10

Almost 10% of all athletes will receive a concussion or brain injury in their lifetime. The brain,

being one of the most complicated and fastest computers known to man, sparks an interest in many

scientists and researchers. Even though the brain is this fantasizing, there are really bad downsides when

the brain stops working like it's supposed to. IIf there is an injury introduced to the brain there could be

many negative effects to the brain like bad mental health, areas of the brain, and the rest of the body.
 Gray 11

Citations:

Jildeh, Toufic R., et al. “Concussion Is Associated With Increased Odds of Acute Lower-

Extremity Musculoskeletal Injury Among National Basketball Association Players.” Arthroscopy, Sports

Medicine, and Rehabilitation, vol. 3, no. 1, Feb. 2021, pp. e219–e225. EBSCOhost,

doi:10.1016/j.asmr.2020.09.014.

O’Halloran, Philip J., et al. “Sports & Exercise Related Traumatic Brain Injury in the Republic of

Ireland – The Neurosurgical Perspective.” Journal of Clinical Neuroscience, vol. 81, Nov. 2020, pp. 416–

420. EBSCOhost, doi:10.1016/j.jocn.2020.10.015.

Mcallister, Thomas W. “Neurobiological consequences of traumatic brain injury.” The National

Center for Biotechnology Information, U.S. National Library of Medicine/National Institutes of health, 13

09 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182015/. Accessed 26 03 2021.

Model Systems Knowledge Translation Systems Center. “Traumatic Brain Injury.” Cognitive

Problems after Traumatic Brain Injury, 13 September 2020, https://msktc.org/tbi/factsheets/Cognitive-

Problems-After-Traumatic-Brain-Injury#:~:text=After%20a%20TBI%2C%20a%20person's,understand

%20what%20others%20are%20saying. Accessed 24 April 2021.

Nina Bai. “With Dangers of Everyday Concussions Revealed, Scientists Race to Find Solutions.”

uscf.edu, University Of California San Francisco, 17 October 2018,

https://www.ucsf.edu/news/2018/10/412006/dangers-everyday-concussions-revealed-scientists-race-find-

solutions. Accessed 28 March 2021.

Tremblay, Sara, et al. “A Review of the Effects of Physical Activity and Sports Concussion on

Brain Function and Anatomy.” International Journal of Psychophysiology, vol. 132, no. Part A, Oct.

2018, pp. 167–175. EBSCOhost, doi:10.1016/j.ijpsycho.2017.09.005.

Tunthanathip, Thara, et al. “Clinical Nomogram Predicting Intracranial Injury in Pediatric

Traumatic Brain Injury.” Journal of Pediatric Neurosciences, vol. 15, no. 4, Oct. 2020, pp. 409–415.

EBSCOhost, doi:10.4103/JPN.JPN_11_20.
 Gray 12

Veliz, Philip, et al. “Head, Neck, and Traumatic Brain Injury Among Children Involved in

Sports: Results From the Adolescent Brain Cognitive Development Study.” Journal of Adolescent Health,

vol. 68, no. 2, Feb. 2021, pp. 414–418. EBSCOhost, doi:10.1016/j.jadohealth.2020.06.004.