Traumatic Brain Injuries in Equestrian Sport
Dan Han, PsyD, chief of the University of Kentucky (UK) Neuropsychology Service’s Clinical Section and associate professor of neurology, neurosurgery, and physical medicine and rehabilitation at the UK College of Medicine, spoke about traumatic brain injuries (TBI) and rehabilitation following TBI at the inaugural Horse Industry Safety Summit, held April 23 at UK’s Spindletop Hall, in Lexington.

Starting off, he reiterated a common thread among the day’s speakers: Equestrians are athletes, and athletes suffer injuries. He stated that, among sports-related TBIs, the highest incidence among adults occurred in equestrians.

“Riding requires a lot of athleticism,” Han said. “Riding a horse is tougher than mixed martial arts and kickboxing. It requires a high level of athleticism and neural engagement to ride. It’s also very complicated—riding marries a horse and person into synchrony. Other sports pale in comparison to high-level equestrian sports.”

Han is used to receiving questions about head injury across the range of sports. One question he gets asked is why there is such variability in recovery.

“I’m often asked why someone is able to bounce back from a comatose state and be Olympic-ready and why some recoveries are much slower,” he said. “For example, William Fox-Pitt (who competed for Great Britain in the Olympic three-day eventing competition 10 months after a serious head injury) and Jonty Evans (an Irish Olympic eventer who was in a coma for six weeks following a head trauma and had to learn to walk and talk again) had very different recovery times. I have to explain that the injury mechanisms are very different.”

He explained what actually happens during head trauma.

“One side gets hit, and the brain squishes into the other side,” Han said. “Microscopic tears occur during the injury. The analogy I use is worn fiber. For instance, imagine you see someone wearing a suit. The suit could look fine from a distance, but if the fiber is worn or even torn, you would only see that wear, which is really injury, when you are close up. The integrity of the fiber is affected. That’s brain injury.

“There are 1.7 million documented TBIs each year, and TBI is a contributing factor in 30% if all injury-related deaths in U.S.,” he continued. “Health professionals have not always helped athletes understand TBI. It is estimated that up to three million TBIs go undocumented each year. Doctors have to correctly recognize the injury and treat it appropriately.”

Age when a TBI occurs is a significant variable, he said: “TBI affects kids very differently than adults. With kids, injury occurs during development and interrupts the development. Also, females have higher odds of poor outcomes than males.”

Han described some of the difficulties associated with TBI.

“Most concussions resolve in 24 or 48 hours, although they can last for two weeks for kids,” he said. “Post-concussive disorder can last weeks, months, even years. TBI can affect memory and attention deficits. It can affect day-to-day function. Headaches are common; smell and taste loss can occur. The neurologic gauge in the brain for mood and emotional state can get out of whack after the trauma of concussion. TBI is related to quality of life and depression rates, because it interferes with enjoying experiences in life. There is a cumulative psychological toll associated with TBI.

“The good news,” Han continued, “is that recovery can still happen over three years post-injury. There is a ‘Goldilocks’ zone between rest and keeping brain from atrophying. Not doing anything is detrimental to recovery. Using physical therapy, occupational therapy, and speech therapy can help with functional recovery. Other parts of the brain take up the slack, but if you are still symptomatic at one year, that might be your new baseline.”

Karin Pekarchik, senior extension associate for distance learning within UK’s Biosystems and Agricultural Engineering Department, served on the planning committee for the Horse Industry Safety Summit.

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