Traumatic Brain Injury in Professional Athletes

Traumatic brain injury (TBI) is damage to the brain caused by an external mechanical force. Severity is classified by loss of consciousness, memory loss around the event and level of responsiveness.

Concussion is a mild TBI. More severe injuries can involve bleeding, contusion or diffuse axonal injury visible on imaging.

In professional sport the overwhelming majority of head injuries are mild, but the functional consequences of repeated mild injuries can be significant.

• High-velocity collisions in football and impacts from a pitched or batted ball in baseball can generate forces well above ordinary daily life.
• Falls onto artificial turf, dirt and outfield walls add another mechanism beyond player-to-player contact.
• Protective equipment reduces skull fracture risk but does not eliminate the rotational forces associated with brain injury.

A single severe event is typically pled as a specific injury on a date.

Where the history includes both a significant event and years of routine exposure, both theories may be evaluated together.

More on how repetitive-exposure claims work: Cumulative trauma explained.

• Persistent cognitive difficulty, especially with memory and attention
• Personality and behavioral change reported by family
• Headache, dizziness and fatigue
• Sensory changes including smell, taste and vision
• Seizure activity in a small number of cases

• Neurological examination and imaging appropriate to severity
• Neuropsychological testing with functional assessment
• Review of acute records from the time of injury, including emergency care if any
• Assessment of activities of daily living and work capacity

• Emergency department, hospital and ambulance records from the date of injury
• Acute imaging and follow-up scans
• Team injury reports, athletic training room logs and daily treatment notes
• Team physician and consulting specialist records, including imaging reports
• Surgical operative reports and post-operative rehabilitation notes
• Contracts, transaction history and roster or practice-squad records showing dates of employment
• Post-career medical records from primary care doctors, orthopedists and other specialists

A head injury occurring in a game, practice or team activity may be treated as an industrial injury.

Where impairment is significant, evaluation may address future medical care as well as permanent disability.

Coordination with league disability programs is common where both may apply, and offset rules can affect the net result.

Rules differ by state and by sport. Eligibility factors and types of compensation cover the general framework.

• Neurology and rehabilitation medicine
• Cognitive and occupational rehabilitation
• Speech and language therapy where communication is affected
• Long-term medication management

• Higher-severity injuries can involve permanent limits on work capacity and, in some cases, need for assistance at home.
• Impairment rating for brain injury draws on both objective testing and documented functional limitation.
• Vocational evidence is often central where an athlete cannot return to comparable post-career work.