traumatic brain injury and athletes: a clinical sport psychological perspective kendra ogletree...

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TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist University of South Carolina

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Page 1: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological PerspectiveKendra Ogletree Cusaac, Ph.D.

Licensed Clinical Psychologist

Sport Psychologist

University of South Carolina

Page 2: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

OBJECTIVES

• To understand the context of sport, TBI, and its importance in sport

• To understand the psychological, emotional, and cognitive consequences of TBI on athletes and sport environment

• To understand the role of the clinical sport psychologist and other sport medicine personnel

Page 3: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

NFL TO SPEND $765M TO SETTLE CONCUSSION LAWSUITS

Page 4: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

A LITTLE HISTORY….

“No evidence” of concussions’ impact

1990s

New commissioner and increasing

pressure2006

Funding for research, major rule changes,

new committee2009

Page 5: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

SPORT CULTURE PERSPECTIVE

• Expectations of athletes

•How concussions are perceived

•Which sports are most at risk?

•Developmental issues

Page 6: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

PREVALENCE

•The Centers for Disease Control and Prevention reported that 200,000 sports-

related head injuries are treated in emergency departments annually within the

United States and that sports related concussions accounts for approximately 20%

of all TBIs per year.

Page 7: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

BOXING #1 SPORT FOR MTBI INCIDENCE

"Punch drunk" syndrome 1928

"dementia pugilistica"

1984

Chronic Traumatic

Encephelopathy(CTE)2000s

Page 8: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

PREVALENCE

• A history of concussion among athletes varies by sport (from highest upper estimates to lowest):

• Equestrian (3%-91%)

• Boxing (1%-70%)

• Rugby (2%-25%)

• Soccer (4%-22%)

• American football (2%-20%)

Page 9: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

DEVELOPMENTAL ISSUES

• TBI: Athletes vs. Nonathletes

• Concussions occur at all levels of play

• Young athletes (under 18 years old) vs. older athletes (over 18 years old)

• Male athletes vs. female athletes

• NCAA

• Multiple Concussions

• Second Impact Syndrome

ELITE

OLYMPIC

NATIONAL

COLLEGIATE

SCHOLASTIC

ENTRANCE

KROLL’S PERSONALITY PERFORMANCE PYRAMID

Page 10: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

MULTIPLE CONCUSSIONS

• Athletes who have previously sustained a concussion are more than two times likely to sustain a second concussion and may be more likely to experience a greater number and perceived severity of post concussive symptoms.

Page 12: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

SIGNS OF TBI

Signs are behaviors/events that are observable by others:

• Loss of consciousness

• A dazed or vacant look

• Motor incoordination/balance problems

• On-field confusion/disorientation

Page 13: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

SYMPTOMS OF TBI

SOMATIC COGNITIVE PSYCHOLOGICAL/EMOTIONAL

SLEEP DISTURBANCE

Page 14: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

SOMATIC SYMPTOMS OF TBI

•Headache•Nausea/vomiting• Balance problems•Dizziness• Fuzzy/blurry vision• Low energy/fatigue• Light/noise sensitivity

Page 15: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

COGNITIVE SYMPTOMS OF TBI

•Memory Dysfunction• Attention Problems•Mental “fogginess”• Cognitive slowing• Fatigue

Page 16: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

PSYCHOLOGICAL/EMOTIONAL SYMPTOMS OF TBI

• More emotional• Sadness• Anxiety• Irritability• Negative/pessimistic attitude• Personality changes

Page 17: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

SLEEP AND OTHER DISTURBANCES

•Difficulty falling asleep• Sleeping more/less than usual• Sexual disorders and problems• Loss of interest in sex• Relationship difficulties• Substance use and abuse

Page 18: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

ATHLETES VS. NONATHLETES AND TBI

•Motivation

• Return to play pressures and desires

•Underreporting of symptoms/symptom minimization

Page 19: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

ASSESSMENT AND MANAGEMENT OF TBI

• Acute evaluation on the field• Sideline or locker room evaluation• Formal postacute neurocognitive assessment•Graded progression of physical exertion •Unrestricted return to play

Page 20: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

EMOTIONAL SEQUELAE OF TBI IN ATHLETES

• The research reports on short-term emotional distress following concussion reveal transient depression, feelings of fatigue and reduced energy levels, confusion, and overall mood disturbance.

Depression Perceived Fatigue

AnxietyConfusion

Page 21: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

PSYCHOLOGISTS’ RESPONSIBILITIES

• To educate athletes, their families, coaches, physicians, athletic trainers, and policy makers to recognize and appropriately manage this complex

injury. In doing so, we will more effectively enhance player safety and prevent disabling

symptoms.

Page 22: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

PREVENTION• Equipment• New prototype helmets

• Rule changes• Penalties and fines• On the field evaluation• Return to play• Successive head trauma

• Education: Athletes, Coaches, Parents

Page 23: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

QUESTIONS???

Page 24: TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological Perspective Kendra Ogletree Cusaac, Ph.D. Licensed Clinical Psychologist Sport Psychologist

TRAUMATIC BRAIN INJURY AND ATHLETES: A Clinical Sport Psychological PerspectiveKendra Ogletree Cusaac, Ph.D.

Licensed Clinical Psychologist

Sport Psychologist

University of South Carolina

Email: [email protected]