Thursday, August 09, 2012

Five Ways to Prevent a Concussion in Your Teenage Athlete - Pediatric Neurologists Share Tips to Help Reduce Concussions in Children and Teenagers

Houston Chronicle

Five Ways to Prevent a Concussion in Your Teenage Athlete

 - Pediatric Neurologists Share Tips to Help Reduce Brain Injuries in Children & Teenagers

Houston, TX August 07, 2012
Your son leaves for his football game. Your daughter is off for soccer practice. Two hours later, the team trainer calls home to report that your teenager is in the ER, having suffered a concussion.
What can a parent do today to prevent a concussion in a child or teenager? Here is advice from four child neurologists, experts in the management of traumatic brain injury.
Dr. Joshua Rotenberg, a pediatric neurologist in Houston and San Antonio (, advises parents, “Before letting your child or teen take the field, review your own game-plan for concussion prevention.”
Here are 5 Pre-Season Action Items for parents of athletes:
#5 Increase Subject Matter Knowledge - The presentation of concussion can be subtle and a child may not recognize it in themselves. With knowledge, one can prevent concussion or at least prevent complications.
Dr. Kevin Joseph of Valley Medical Center/University of Washington Medicine advises families and athletes to learn about the symptoms of concussion.
Concussion symptoms can take the form of almost any disturbance of brain function. These can include any combination of physical (headache, dizziness, ringing in ears, nausea/vomiting, blurry vision, weakness), emotional (depression, anxiety), cognitive (memory problems, focus problems) and sleep disturbances (insomnia, excessive sleepiness).
Concussion can be caused by a direct head trauma or indirectly by a sudden impulse of energy. That is, a concussion is not necessarily caused by a recognizable head-to-head impact.
Concussion does not only happen to male football players! Current estimates are that up to 20% of high school football players will sustain a concussion in a season. But, women’s soccer is the second most likely school sport to cause a concussion.
Other activities more likely to cause traumatic brain injury in teens are bicycling, basketball, volleyball and cheer. Even non-athletes are susceptible to falls and accidents.
Among athletes, who is at high risk? Concussion risk factors include prior concussion and neuropsychological problems such as Attention Deficit Hyperactivity Disorder (ADHD).
One study indicated that 26% of children with ADHD had sustained a head injury. Ensure that ADHD treatment is adequate to prevent impulsive or distracted performance.
Children who have sustained a previous concussion are up to 6 times more likely to have a subsequent concussion. For children and teens who have suffered multiple concussions, ensure that they have seen a specialist and they are cleared for full contact activity.
#4 Check Protective Equipment - Ensure that athletes have a current and highly rated helmet that also has an appropriate fit.
Dr. Marc Difazio, a child neurologist at Children’s National Medical Center, Washington DC, notes, “Safe helmet systems go far to prevent concussion. Football, lacrosse and hockey players can obtain effective helmets that greatly decrease the force of the impact of a blow.”
There are helmet systems for soccer players that do not interfere with the ability to head the ball (not a major cause of concussion by the way!). These systems can certainly be used in other contact sports (such as field hockey), which do not require a helmet.
Mouth guards are important for preventing oral trauma, but have not been shown to reduce concussion.
Consult a certified athletic trainer to ensure your equipment has an optimal fit.
#3 Ensure Adequate Training - Young athletes require general athletic training and sport specific technique
Dr. Marc Difazio observes, “Unrestricted head movement is one component of concussion physics. Strength training for head, neck and shoulders of young athletes helps to deliver more precise control of their bodies, possibly lessening the movements associated with impact, and potentially decreasing concussion risk.”
Proper training in football and rugby tackling is crucial. Tackling technique in football must be taught from the start, and dangerous head-on methods discouraged immediately.
Heading the ball appropriately in soccer has not been shown to cause concussion if done correctly. However, Dr. Difazio has observed that “novice players may not perform the technique appropriately, leading to excessive head movement and a resultant risk of concussion. Teaching correct heading techniques is therefore as important as kicking, dribbling and game strategy."
#2 Heighten Parental Vigilance - You are entrusting your child’s brain to coaches and trainers. Most are excellent stewards of this trust. But, even with the best trainer and coach, you are the expert on your child.
Be present and vigilant about your child’s participation. Ask about style and contact of practices and games. Valid questions include: Are freshmen scrimmaging with seniors? Who cares for the equipment? How do they fit?
Dr. Joseph advises, “Know who is responsible for responding to head injuries at the game....Know what the school or organization policy is regarding head injuries (what happens on game day and when can the child return to play).”
Youth sports can be less regulated than interscholastic school sports. Do youth football players have more aggressive collision in practice than in games? Perhaps! One recent study indicated that concussive head injury in youth football may be more common in practice than in the game. If you note atypical practice or game activities, discuss these with the coach and trainers.
Most importantly, you know your child best. You may detect cognitive, behavior or performance abnormalities before anyone else does. Keep a low threshold to suspect concussion. Parental observation and symptom identification are key to diagnosis.
In many states, there are concussion laws describing how school athletes must be removed from play or practice if concussion is suspected. Note that this is a low threshold.
If you suspect a head injury, for whatever reason, have your child evaluated and let the physicians sort it out. Missing one game or practice is better than missing weeks of participation.
# 1 Form an action plan in case of concussion!
Reassuringly, concussions most often resolve quickly and completely within a couple of weeks. The majority of children and teens suffer no long term implications.
At the same time, keep in mind what you would do following a severe injury or a deteriorating situation. An emergency evaluation may be necessary in severe or deteriorating head injury cases. Following a head injury, if the little voice inside you is telling you to go to the emergency room, listen to that voice.
Children with concussion should see a physician. Make sure to visit your primary care physician. The doctor who knows your child might also be able to detect differences that a parent missed.
To meet the need for rapid access to pediatric brain specialists, these neurologists offer expedited evaluations.
Dr. Rotenberg advises seeking the highest possible level of expertise in the identification and management of brain injury for children “The symptoms and signs of concussion are physical, neurologic and neuropsychological. It is important to seek a child and adolescent neurologist’s advice since a specialist can identify serious head injury, diagnose concussion and treat its complications”.
Remember, a computerized test alone can not establish a diagnosis of concussion. “You can purchase an online test or go to a retail store. But is it valid or useful?” asks Rotenberg. Variables such as the setting, motivation and the specifics of the test must be considered with the whole person
Finally, Dr. Rotenberg advises all parents, “Ensure that all children have an adequate pre-season physical examination by a physician who knows your child.”
Drs. Rotenberg, Joseph and DiFazio serve on a pediatric working group for sports neurology. Texas Medical & Sleep Specialists serves the Houston and San Antonio areas with pediatric neurology and specialty care. Contact Dr. Rotenberg at 713-464-4107 or read more at his blog

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