How can Chronic Traumatic Encephalopathy (CTE) be prevented?
For a disease to be preventable in some way, shape or form, a definitive means to detect and diagnose a condition is generally necessary. A clear understanding of the causes and risk factors (including those which may be modifiable or non-modifiable) also impact the potential ways and means a medical condition can be prevented.
How much of a role do major or sub-concussive impacts play in disease development? How much impact will likely cause symptom onset? What genetic or other condition predisposition factors (like those of mood disorders perhaps) may influence symptom onset? Could injurious impact trigger a cascade of damaging effects? Does adequate recovery from injury make a difference? Does the use of specific substances have a primary role in the development of CTE? In which case, preventative strategies may apply in this respect too… There are many, many questions that scientists are yet to be able to answer.
The nature of risk factors is just one of several areas where defined clarity through research could shed light on what else there is to consider about CTE development, and in turn help identify the best prevention guidelines or strategies, wherever possible. All of these components – causes, risk, disease detection ability and diagnosis - significantly impact one another when it comes to the clear interpretation of a disease or condition, and how to either manage or eradicate it.
For the time being, CTE is mostly associated with repetitive head / brain injury and multiple sub-concussive impact events. As such, the primary area of prevention relates to avoidance of activity that is considered high risk for head injury. This is something that any person can keep in mind when it comes to preventing unnecessary risk for head injury. For now, avoidance of activity that poses any degree of injurious impact risk is something of a blanket rule, until such time as further research either proves concurring results or demonstrates otherwise (or even both).
Thus, contact sports are high on the list of probable risk activities where head injuries frequently occur, as is military service. Until such time as research is able to prove other definite risk factors, contact sportsmen and those enrolled in military service remain high-risk populations where prevention is currently most applicable.
For now, contact sportsmen, for instance, may be able to look at ways their sport can be made safer so as to try and reduce the number of sub-concussive impact events (or more serious injuries) that can occur, many of which take place during practice sessions. Practice structures could potentially be re-looked at to identify ways unnecessary impact events can possibly be avoided altogether. Some contact is a necessary part of the game with its purpose being to teach players protective tactics that can help to avoid (general) serious injury (to the players or those of opposing sides). In this instance, limited practice repetitions may help to reduce possible sub-concussive or more serious impact events.
Some contact sports, like American football, hockey, soccer and rugby have already adopted rule changes within the game structure to help make them safer for players. Another potential rule which can be implemented relates to the number of concussions experienced during a career and whether this should be used as a benchmark for when to retire from professional play. Alternatively, even one concussion incident with residual symptoms may be considered a benchmark for play retirement.
Continuous medical care can have a helping hand in this regard, whereby players are sufficiently checked and evaluated for any signs of incurred or even residual damage from impact events (such as with the use of imaging studies). Any rule changes to a game are only really effective when properly implemented, however. Unless enforced successfully and committed to by players, safety risk can only then be maintained at an acceptable level.
Sportsmen with longer careers may be more at risk of eventual CTE development, accruing more damage to the brain than those with shorter careers and less impact exposure. This is perhaps one aspect professional sporting divisions could factor into consideration when signing up young athletes.
Another factor to consider is that although many contact sports come with plenty of protective equipment, none can be expected to be able to 100% prevent a concussion. Equipment can include that of specially designed helmets, padded headgear and even mouth guards, all of which may help to reduce some degree of injury / impact effect, but this is not entirely avoidable. Many contact sports helmets are designed to reduce the risk of skull fractures but have not shown complete effectiveness in preventing injury from all variations of impact. Incidences of impact may be reduced with design improvements committed to absorbing some impact force, but such safety advancements may also not necessarily deter dangerous play entirely. Players can still adopt aggressive play techniques. (9)
If more serious injury occurs, like concussion, a person should ensure that they get adequate rest (physically and mentally) and abide by all of ‘the doctor’s orders’ before returning to any normal activity. No sportsman should be allowed back to play until such time as they are asymptomatic and given the all clear from medical professionals. Adequate recovery is key for the prevention or reduced risk of complications and long-term consequences, like neurological challenges. Ensuring proper healing is the best way to reduce potentially related problems down the line, which may or may not include the development of CTE (further research may better clarify this).
9. U.S. National Library of Medicine - National Institutes of Health. September 2014. Counseling Athletes on the Risk of Chronic Traumatic Encephalopathy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137675/ [Accessed 10.05.2018]