Young Athletes and Concussions

This article discusses concussions and the impact concussions have on young athletes, what is being done about concussions, and what should be done in the future.

Young athletes are the focus of new efforts to improve the care of concussions in children and teens, who are more vulnerable than adults to long-term physical, cognitive and emotional problems as a result of the brain injury.

Medical centers including Dartmouth-Hitchcock Medical Center in Lebanon, N.H., Children’s Hospital of Philadelphia and the University of Pittsburgh Medical Center are offering new programs to better educate school nurses, coaches, athletic directors, parents and pediatricians about steps to take to avoid repeat trauma and complications.

CONCUSSION MYTHS AND FACTS

• Myth: Only contact sports put athletes at risk of concussion.
• Fact: Concussions can occur in any sport or recreational activity—even ballet—if there is a violent movement or blow to the head or body that causes the brain to move rapidly inside the skull.
• Myth: You must lose consciousness or black out to have a concussion.
• Fact: Only a small number of concussions involve loss of consciousness.
• Myth: Concussions affect everyone the same way.
• Fact: Genetic differences may account for susceptibility. A history of migraines and weak neck muscles are associated with injury, and girls are more vulnerable than boys.
• Myth: Helmets in football and other activities can protect players.
• Fact: Helmets protect against skull fractures, but don’t always protect against the forces that cause the brain to traumatically move within the skull.
• Myth: You need to repeatedly wake up someone who has had a concussion.
• Fact: Rest is important. Check on concussion victims, but allow them to rest.
• Myth: The effects of a concussion are short-lived.
• Fact:  Concussions can cause cumulative damage to neurons and structural damage to the brain.

Source: Dartmouth-Hitchcock Medical Center, University of Pittsburgh Medical Center, CDC

New research is also leading to a better understanding of concussion, which occurs when a sudden movement or direct force to the head sets brain tissue in motion within the skull. Studies show, for example, that each patient may experience concussion differently, and some patients are more genetically predisposed to sustaining a concussion. Tests are helping identify those patients who may have protracted recovery periods.

“Concussion is a very common injury, and the good news is that most people get better by themselves,” says Michael Lipton, associate director of the Gruss Magnetic Resonance Research Center at Albert Einstein College of Medicine in Bronx, N.Y. “But
there is a group who won’t do as well.”

‘WHO NEEDS TO BE WATCHED’

Dr. Lipton and others have used a special imaging technique to detect a biomarker that may provide a clearer long-term prognosis after a concussion. The advance could help health professionals identify “who needs to be watched more carefully,” he said.

Most states now require students who have had concussions to be kept out of sports until they are cleared by a medical professional. But experts warn that physicians may not be aware of the latest approaches to managing concussions or adhere to protocols for assessing patients and gradually returning them to school and play.

Estimates of the frequency of sports-related concussions in the U.S. run as high as 3.8 million a year. Among children and adolescents, according to the Centers for Disease Control and Prevention, ER visits for sports- and recreation-related brain injuries rose by 60% over the last decade.

Last summer, the CDC established a working group to create a set of guidelines for use in doctors’ offices and emergency departments within the next two years.

In a survey of 145 emergency and primary-care doctors published recently in the journal Pediatrics, researchers at Children’s Hospital of Philadelphia found that doctors didn’t consistently follow assessment guidelines or prescribe proper discharge instructions to concussion patients. These instructions outline such steps as rest; refraining from activity and stimuli such as TV and videogames; and gradual return to schoolwork and play.

Last year, Children’s Hospital trained more than 100 providers in its network in concussion management and assessment. “We have to be very careful and rigorous in the way we evaluate and manage pediatric patients,” says Mark Zonfrillo, lead author of the study.

COUCH POTATO

The University of Pittsburgh Medical Center, which works with physicians and athletic trainers to identify and manage sports-related concussions, offers physical therapy to restore visual function, stamina and balance. Experts there helped develop a computerized test called Impact—for Immediate Post-Concussion Assessment and Cognitive Testing—which measures verbal and visual memory, reaction time and impulse control. More schools now offer such tests to athletes in contact sports before they start play. Cognitive function then can be compared with tests administered after a concussion.

Michael Collins, director of the UPMC sports medicine concussion program, says that if Impact scores fall below a certain level following an injury, there is an 85% chance recovery will take longer. “Those kids have to be managed very carefully,” says Dr. Collins, who is part of  the CDC group working on the new guidelines. One risk is post-concussion syndrome, which includes chronic difficulties such as mood changes, nausea and problems with sleep, thinking, memory and attention.

A second injury sustained during recovery from concussion can result in second-impact syndrome, which can cause brain swelling, bleeding and permanent disability or death, warns Susanna Gadsby, the nurse-coordinator who oversees Dartmouth-Hitchcock’s sports concussion program and its workshops. “Our aim is to help kids get back to play safely, and often just pulling a kid from the field and making them a couch potato for a while is the answer,” she says.

At Hanover High School near Dartmouth last fall, there were six concussions diagnosed in a two-week period during football, soccer and field-hockey season, says athletic director Michael Jackson.

Hanover is one of several high schools and colleges participating in a study at Dartmouth Medical School measuring the impact of blows to the head in athletes. Using sensors implanted in helmets, they hope to better understand, among other things, what kinds of impacts cause concussions and “what it is about a particular impact that gives one person a concussion, while the other bounces up as if nothing happened,” says lead researcher Thomas McAllister.

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