Michael Sefton, Ph.D., Director of Psychology and Neuropsychology at Whittier Rehabilitation Hospital Westborough, has treated a lot of winter sports traumatic brain injuries during his career.
Here he shares some thoughts on the causes, treatments, and prevention of these frequently devastating injuries.
Winter Sports are something to worry about. Because we don’t ski or ice skate on the ponds all year long, our skills can be rusty and put us at risk for injury and concussion. Skiing is a high-speed sport which can lead to fall injuries resulting in a dislocated shoulder, elbow injuries, fractures, or the ‘skateboarders’ injury: double fracture of navicular bones in both wrists along with skiers thumb. Indeed, any sport can result in concussion – winter or summer.
Many well-known people have been killed or seriously injured while skiing. Actress Natasha Richardson, the wife of actor Liam Neeson, was killed in Quebec in 2009. Singer Sonny Bono died in 1998 after hitting a tree in Lake Tahoe, CA. ABC reporter John McWethy died after missing a turn and striking a tree in 2008. Michael Kennedy, son of Senator Robert Kennedy and grandson of President John F. Kennedy, died in 1997 while skiing and playing catch with a football on the slopes. In December 2013, Formula 1 driver Michael Schumaker sustained a severe traumatic brain injury while skiing with his son in Switzerland. Now, eight years on, he remains in a minimally conscious state.
More tragically, in 2021, Boston University Ice Hockey Player Travis Roy died from complications from a spinal cord injury he sustained in 1995 while playing for the Terriers. Travis was left paralyzed from the neck down after playing for 11 seconds in his first game. On January 6, 2022, a high school hockey player in Connecticut died after sustaining a massive, “unimaginable” injury from a skate blade during a varsity game.
In Massachusetts, a Milton Academy 18-year-old boy was paralyzed and sustained a traumatic brain hemorrhage during a tournament game in September 2021. This year, his was the second spinal cord injury involving a Massachusetts high school ice hockey player. In January 2021, a Bishop Feehan HS athlete sustained a spinal cord injury in Springfield, MA. Ice hockey for both men’s and women’s teams has moderate concussion rates.
More serious traumatic brain injuries are seen in outdoor sports and are often associated with athletes pushing themselves beyond their capabilities, resulting in crashes. There is also a measure of risk when skiers use alcohol or drugs before hitting the slopes. In recent years, injury prevention campaigns have espoused the benefits of wearing helmets, skiing under control, and keeping to the marked slopes.
Here are a few common injuries treated here at Whittier Rehabilitation Hospital-Westborough.
Skiing injuries result from a collision, usually where two trails converge and one skier – or both – is not paying attention to the traffic. More skiers than ever before are wearing helmets while hitting the slopes, but traumatic brain injuries can still happen. Excessive speed results in skier collisions, which can occur when skiers are out of bounds and off marked trails, and hit trees or rocks.
Ice hockey is a high-speed sport, and with body checking starting at age 12, children and adults alike are at risk for acceleration/deceleration injuries and focal wounds (traumatic injury to the scalp, skull, or head surface) from stick and puck strikes. Diffuse injuries occur when the head strikes a hard object, such as the ice of the boards. Meanwhile, the brain within the skull keeps moving and slams up against the irregular interior of the skull. This can cause hemorrhagic injuries to both the frontal lobe and contre coup injuries to the rear occipital region of the brain. The full range of injuries can also be expected such as lacerations, fractures, and contusions.
A player does not need to be knocked unconscious to be diagnosed with a concussion. Women’s hockey is third highest in reported concussions and body checking is not permitted in women’s hockey. Rugby (#1) and American Football (#2) are fall sports. Men’s ice hockey is fourth in the incidence of concussion. In youth sports, Rugby (played in the fall) and Ice Hockey have the most concussions, while wrestling (a winter sport) is #6 overall for mild traumatic brain injuries.
Sports, across the lifespan, are fun and generally safe. Sports are an essential part of youth and adult development, helping kids learn teamwork and important lessons about winning and losing. Physical training and appropriate equipment are essential in all interscholastic sports. Athletes risk injury whenever they are playing or skiing/boarding when out of control. Athletes should be mindful of other players on the ice and on the slopes, which may risk less speedy or aggressive players.
At Whittier Rehabilitation Hospital-Westborough, Dr. Sefton does some biofeedback and neurofeedback for TBI cases and post-concussion syndrome. Whittier uses the neurofeedback protocol espoused in the literature that helps shape a patient’s beta waves so that they are more in tune with the environment. These services are available on an outpatient basis.
In the photo: Dr. Sefton shows a screen that is utilized for patients who have concussions. Some folks that have residual deficits from concussions have too much slow-wave activity in their brains, making their efficiency of cognitive functioning somewhat off their baseline. Whittier uses the neurofeedback protocol espoused in the literature that helps shape a patient’s beta waves to be so that they are more in tune with the environment. It also plays an essential role in lowering the autonomic fight-flight activity that patients experience due to abnormal recovery from concussion and more serious traumatic brain injuries. In time the transition to a higher beta activity (power) makes them a little more attentive to the environment and perhaps a little more efficient with their cognition, attention, and ultimately, learning and higher-order executive functioning.