Mild Traumatic Brain Injury in equestrian sports

It's long been known that head injuries can be one of the most pervasive and most dangerous types of injuries associated with our participation in equestrian activities. The Department of Sports Medicine at the University of Pittsburgh is currently studying the way in which brain injuries are diagnosed and treated, and their work is expanding our understanding of how brain injuries affect function, and how quickly those with injuries may return to their normal activities. Most importantly, the University of Pittsburgh program is the ...It's long been known that head injuries can be one of the most pervasive and most dangerous types of injuries associated with our participation in equestrian activities. The Department of Sports Medicine at the University of Pittsburgh is currently studying the way in which brain injuries are diagnosed and treated, and their work is expanding our understanding of how brain injuries affect function, and how quickly those with injuries may return to their normal activities. Most importantly, the University of Pittsburgh program is the ...

Story originally posted by: Heather Bailey

Bad falls from horseback can happen during any mounted activity, not just jumping. All riders should be knowledgeable about the effects of and how to prevent head injuries. (Horse and rider walked away from this accident unharmed).

It’s long been known that head injuries can be one of the most pervasive and most dangerous types of injuries associated with our participation in equestrian activities. The Department of Sports Medicine at the University of Pittsburgh is currently studying the way in which brain injuries are diagnosed and treated, and their work is expanding our understanding of how brain injuries affect function, and how quickly those with injuries may return to their normal activities. Most importantly, the University of Pittsburgh program is the first to start examining equine related head injuries specifically, and to adapt their diagnostic programs to the equestrian participant.

Dr. Mary Pelham Psy., project coordinator of the program says the system arose out of the concerns of high school and college football teams for their players. "45% of high school football players will expect o have a concussion at some point in their career," she said. "Liability issues created a need to offered the best diagnosis and treatment for concussion and brain injury."

However, Pelham became interested in studying equine related injury because it turns out our percentage of MTBI (mild traumatic brain injury) is even higher than in high school and college football. And she suspects that the percentage is even higher than the numbers would indicate. "Only people who go to the emergency room show up on our radar," she said. "People who don’t seek medical attention, or those who wait and go see their family physician, won’t make these statistics.."

In 2001, 79,745 equine participants were admitted to the emergency room with injuries. Approximately 20% of those had injury to their head or neck, including MTBI. The reason why risk is so high among riders, is because of the additional height, speed, and size of the horse. Although the fact that some participants wear protective headgear can increase their chances of emerging unscathed from an accident, the fact that many riders have a previous history of head injury can increase their chances of receiving another head injury-concussions are cumulative, and are considered a risk factor is receiving another one. Also prevalent in equine related injuries is the so-called "second impact syndrome" where the rider will be injured by their impact with the ground, but then may be injured more severely by the horse then falling on them or trampling them.

One of the primary things these studies have demonstrated is that the previously "best" method of determining injury, lack of consciousness, is really not a good indicator of injury, nor is it a good predictor of recovery. "The problem with too much emphasis on loss of consciousness, is that it doesn’t take in to account delayed on set of symptoms," said Pelham. She feels this can be especially important in equine competitive activities, where the participants often attempt to scramble back in to the saddle and finish their event without being medically evaluated.

The department has developed a program call ImPact, which is a tool to create a database for studying symptoms and recovery rates. Ideally, a subject comes in before they suffer an injury, and gets a "baseline" test. The series of neuro-cognitive tests examine memory (verbal and visual) as well as reaction time, and other things. After an injury is suffered, the tests are re-administered at two days post injury, and 10 days post injury (longer if the injury is bad enough to suggest that). If the subject does not have a set of baseline results on file, their post-injury results are compared with a set of averages for their age and sex. Subjects are also interviewed extensively about their memories of the accident, as well as how they are currently feeling.

These interviews have yielded some interesting results, namely how frequently people are willing to lie in order to get back to the playing field. In this way, says Pelham, football players and equestrians are very similar. "If there is a football game or a horse show the weekend after an injury, then all we hear is, "I’m fine," laughed Pelham.

By comparing the baseline or averages, with how quickly they return to "normal" function, safe rates of "return to play" can be determined. There are three levels of concussion, and on average they have found it takes subjects 8 days to return to near-normal function following the least severe grade of injury. They have also discovered that the single best predictor of a patient’s outcome is degree of amnesia following an accident. "More than loss of consciousness, more than disorientation, amnesia can let us know what someone’s outcome will be," said Pelham.

They have also learned that exertion can exacerbate symptoms of MTBI. A patient who appears on initial testing to have returned to normal function levels, will be re-tested after exerting themselves (often 20 minutes or so on a treadmill), and those tests will often reveal the results are not as favorable and close to normal, as those pre-exertion.

The issues that are still under study through this database are overall long-term affects of MTBI, how academic function may or may not be affected, and at what point the number of injuries is so cumulative that a given athlete should retire. Also under study is the degree to which protective equipment and helmets can reduce or eliminate MTBI. "We know they help," said Pelham. "But we don’t have the hard data about the differences for different athletes."