What parents should know about concussions

This article reviews the signs and symptoms of concussions that parents of athletes should be aware of. - JR

Parents of young athletes know that along with the many benefits of participating in sports, there comes a certain amount of injury risk. And while most would agree that the benefits of being active and involved in athletics outweigh those risks, it’s important to make sure your child gets proper treatment if an injury occurs. As more evidence surfaces about long-term health challenges related to concussions, it’s especially crucial that parents bring themselves up to speed on the proper procedures for caring for an athlete who experiences a concussion.

The most important thing parents need to know about concussions is that if an athlete exhibits any signs or experiences any symptoms of a concussion, he or she should be immediately removed from play. While this recommendation is nothing new, the American Academy of Neurology (AAN) is again emphasizing its importance with the release of its updated 2013 sports concussion evidence-based guidelines.

“Among the most important recommendations the academy is making is that any athlete suspected of experiencing a concussion should immediately be removed from play,” says Christopher C. Giza, MD, co-author of the AAN guidelines. “We’ve moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually. There is no set timeline for safe return to play.”

For parents unfamiliar with concussion signs and symptoms, they include:

* Headache and sensitivity to light or sound

* Changes to balance, coordination and reaction time

* Changes in memory, judgment, speech and sleep

* Loss of consciousness or a “blackout” (happens in less than 10 percent of cases)

Removal from play is just the first step in properly treating a concussion. After a player who is exhibiting concussion signs or having concussion symptoms is removed, it’s equally important that the player be examined by a licensed health care professional trained in diagnosing and managing concussions. “Being seen by a trained professional is extremely important after a concussion,” says Jeffrey S. Kutcher, MD, co-author of the AAN guidelines. “If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor.”

If your athlete is diagnosed with a concussion, it’s extremely important to follow the recommendations of the health care professional, and the athlete should not be permitted to resume any sports-related activities until he or she is cleared by a licensed health care professional to do so. Parents, coaches and officials should all work together to see that the health care professional’s recommendations are followed, ensuring the best possible short- and long-term outcome for the athlete.

Parents, coaches and officials should familiarize themselves with concussion protocols before they ever get to the field or court, but the AAN also offers a smartphone app should you need to review them. The Concussion Quick Check app can be downloaded free of charge and provides a handy guide to making sure your athlete gets the proper care.

In addition to emphasizing proper care for athletes exhibiting concussion symptoms, the new AAN guidelines include the following concussion-related findings:

* Among the sports in the studies evaluated, risk of concussion is greatest in football and rugby, followed by hockey and soccer. The risk of concussion for young women and girls is greatest in soccer and basketball.

* An athlete who has a history of one or more concussions is at greater risk for being diagnosed with another concussion.

* The first 10 days after a concussion appears to be the period of greatest risk for being diagnosed with another concussion.

* There is no clear evidence that one type of football helmet can better protect against concussion over another kind of helmet. Helmets should fit properly and be well maintained.

* Licensed health professionals trained in diagnosing and managing concussion should look for ongoing symptoms (especially headache and fogginess), history of concussions, and younger age in the athlete. Each of these factors has been linked to a longer recovery after a concussion.

* Risk factors linked to chronic neurobehavioral impairment in professional athletes include prior concussion, longer exposure to the sport and having the ApoE4 gene.

* Concussion is a clinical diagnosis. Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis.

To view the entire AAN concussion report and find more concussion resources, visit www.aan.com/concussion.

Read more here

ACSM on Sports Concussions - Two Steps Forward, One Step Back

The American College of Sports Medicine (ACSM) released the following information on sports concussions. I appreciate them raising awareness of brian injury. With all due respect to my colleagues, their advice on "brain rest" is neither biologically possible nor data based. 


They write "

Like any other injured body 

part, the concussed brain should be 

rested in order to recover. D

uring recovery, athletes should have no physical exertion that will raise the heart rate, and they should also perform no mental work, such as school or other tasks, that require concentration. Doctors commonly prescribe periods of reduced schoolwork and tests after a concussion, but they may need to start with complete brain rest, including no thinking, texting or video games." 

If you or your child get a prescription for total "brain rest", you should ask why. 

I still recommend that people with a brain injury should seek a BRAIN specialist.  JR


WHAT IS A CONCUSSION?
A concussion is an injury to the brain caused by a sudden acceleration or deceleration force, and concussions occur in many different sports. While an athlete does not need to hit his or her head to suffer a concussion, hits to the head— against another person, a ball, or the ground—are a common cause. The brain moves inside the skull, and the sudden movement can cause the brain to swell. Helmets protect against more serious head injuries, but they do not necessarily prevent concussions. It may not be obvious to parents, coaches, trainers and athletes immediately how bad the head injury is, so if a concussion is at all suspected, the athlete needs to stop with the practice or the game.

SYMPTOMS OF CONCUSSION

The most serious concussion symptoms could be associated with a more severe head injury, such as bleeding into the brain. People with the following “red flag” symptoms need emergency care:
• Increasing confusion or headaches;
• Vomiting, double vision or unequal pupils;
• Irritability or behavior change; and
• Drowsiness or fading in and out of consciousness.

Other concussion symptoms are less obvious and are split among four categories:

• Physical symptoms—headache; nausea; dizziness; vision or balance problems; sensitivity to light or noise.
• Cognitive symptoms—feeling mentally slow or foggy; trouble concentrating; trouble remembering.
• Emotional symptoms—irritability; sadness; nervousness; feeling more emotional than usual.
• Sleep-related symptoms—sleeping more or less than usual; drowsiness; trouble falling asleep.

CONCUSSION DIAGNOSIS

Assuming the injured athlete does not have any of the most serious symptoms, he or she will not need a head CT scan or MRI. There is currently no imaging test that can diagnose a concussion. The doctor will ask about symptoms, complete a neurological physical exam and possibly balance testing, and may opt to perform mental agility testing known as neuropsychological testing. These tests are best if there is a pre-injury baseline for comparison, and this may be a service offered by your local school, club or hospital.

CONCUSSION TREATMENT

Unfortunately, people with a concussion usually look and act normally, so it is difficult for them and their family, teachers and coaches to tell they’ve suffered a concussion. Like any other injured body part, the concussed brain should be rested in order to recover. During recovery, athletes should have no physical exertion that will raise the heart rate, and theyshould also perform no mental work, such
as school or other tasks, that require concentration.

Doctors commonly prescribe periods of reduced schoolwork and tests after a concussion, but they may need to start with complete brain rest, including no thinking, texting or video games. As the brain recovers, cognitive activity can be gradually returned. Only when the brain is working normally at rest, with no recurrence of the symptoms listed above, is the athlete ready to return to play.

Most people with concussions recover in 7-14 days. Some individuals require significantly longer times, and some are never quite back to normal. Repeated concussions can be associated with more
severe injury and longer recovery. A repeated concussion before the brain is fully recovered can be fatal, causing rapid brain swelling and second impact syndrome.

RETURNING TO PLAY

A progression of return-to-play after a concussion begins only after all symptoms have cleared at rest and with mental exertion. Then an athlete can begin a five-day gradual return, stopping and waiting
at any point when exertion causes symptoms to return.

• Day 1: Low-level activity, such as walking or slow jogging.
• Day 2: Increased intensity of jogging, running or biking.
• Day 3: Heavy non-contact activity, including sprinting.
• Day 4: Contact activity in controlled practice situation.
• Day 5: Full participation.

Read more here

Cognitive rest for concussion management lacks data

Cognitive rest for concussion management lacks data

Good debate on concussion treatment data! I suspect that the ER docs and pediatric neurologists are talking about different clinical scenarios. Who would argue with avoiding vigorous athletics or contact injury just after leaving the ER?

But, let's consider a sample of typical school recommendations following a concussion:

Treatment/ Rehabilitation    

"XX ISD athletes who sustain a head injury will be instructed to rest, both 
physically and cognitively.  This means that the athlete will be restricted from athletic 
participation, and should be restricted from recreational exercise, video games/television 
viewing, computer usage, including text messaging"

This can go on for months in some students.

Some schools recommend that students avoid spicy foods. Really?

Where is the pediatric data?

- JR

Cognitive rest for concussion management lacks data

• Infectious Diseases in Children, October 2012
  Joshua Rotenberg, MD; Marc P DiFazio, MD, FAAN; Michael W Kirkwood, PhD

Raising awareness among pediatricians about how to best manage concussions in children and adolescents is important and more information is beginning to appear in various media. However, reports that encourage “cognitive rest” as the cornerstone of concussion treatment are not yet validated.

See Also

• Few pediatricians provide written instructions for cognitive rest ...
• New guidelines established for diagnosis, management of ...
• Cognitive developmental differences nonsignificant for infants ...

Unfortunately, although sports-related concussion is common in childhood, there is a paucity of empirical literature to support rest — cognitive or otherwise — as a management approach. Adding to the confusion, media reports implicate concussion in debilitating neurologic conditions and long-term neurodegenerative conditions; although to date, the evidence here remains speculative based on single case studies or survey data rather than controlled studies.

‘Second-impact syndrome’

There are reasons to briefly interrupt a child’s participation in contact sports after concussion. Patients may be at greater risk for injury, in general, if balance is affected and it allows time for adequate assessment of the injury. However, management during the past decade has emphasized removal from sports participation to lessen the risk for so-called “second-impact syndrome.”

Marc P. DiFazio

This condition reportedly puts the individual at risk for fatal brain edema after a second concussion while still symptomatic from the first. However, critical analysis of the purported syndrome emphasizes the nebulous nature of this condition and even questions its existence. Catastrophic outcomes from sports-related concussion are much more likely to stem from acute intracranial bleeding after single concussions than diffuse edema or back-to-back concussions. Regardless of the exact pathology, death from sports-related head trauma in youth, although tragic in every case, is also several times less likely than death from sports-related cardiovascular events — and even less likely than death from lightning strikes.

Although physical exercise itself has never been implicated in worsening recovery from concussion, complete physical rest is commonly recommended. Additionally, many practitioners now recommend “cognitive rest” to supposedly hasten recovery. Cognitive rest remains ill-defined and usually entails a removal from school and cognitively stressful activities. A return of symptoms (pain, dizziness) upon reintroduction of activity, physical or otherwise, is considered causative of more injury, and further rest is prescribed. Patients are often told to rest until asymptomatic, often resulting in weeks missed from school, sports or extracurricular activities.

Michael W. Kirkwood

Currently, there is no evidence that the brain can be “put to rest” by refraining from such activity, and the increase in symptoms that may be associated with cognitive stress does not imply a worsening of the underlying concussive injury. That is, head pain and other nonspecific symptoms have not been shown to be definitive markers of ongoing cerebral injury. Although cognitive rest certainly sounds logical, brain activity is continuous and is generally uncontrolled by conscious means, and even during sleep intense brain remodeling and activity is evident.

Additionally, there is no good evidence in humans that rest results in brain healing or improved outcomes, and some data actually suggest that activity relatively soon after injury or while symptomatic has no effect on outcomes. Clearly, a standard-of-care guide regarding rest after sports-related concussion does not yet exist.

Negative effects of cognitive rest

Joshua Rotenberg

Some might wonder whether there is really a downside to recommending cognitive rest. The implicit idea in the recommendation for rest is that if this is not followed, problems can be expected. In fact, prospective controlled studies demonstrate that most athletes recover well and relatively quickly with or without rest. More generally, psychoeducation and early reassurance after injury appears to reduce the chance of persistent symptoms after mild traumatic brain injury. This appears to support the clinical impression that patient or parental anxiety after a concussion can exacerbate symptoms and delay a return to typical functioning.

Adolescent obesity leads to midlife morbidity, and correspondingly, middle-aged adults who are obese have increased cardiovascular and neurologic health risks. Additionally, involvement in youth sports has long demonstrated physical and psychological benefits.

Individual approach to assessment

Given the lack of evidence supporting rest or even a symptom-free waiting period subsequent to a concussion, we approach our children and adolescents in a positive and reassuring fashion, avoiding rigid adherence to any particular management strategy. We recommend a return to exercise in a staged fashion, with an allowance for a self-determined escalation in activity, as tolerated. Regarding cognitive stress, we encourage a child’s return to school, albeit with temporary accommodations for headache and any cognitive difficulties that may occur. Frequent breaks and forgiveness for time and work missed are strongly recommended to avoid placing more stress on the student.

Children who experience concussion with recalcitrant symptoms or a previous history of neuropsychiatric difficulties are offered early psychological or medical intervention targeting anxiety, depression, fatigue, sleep difficulties or attentional challenges. Children are seen frequently and are encouraged and reassured that most who experience a mild traumatic brain injury have complete resolution within several weeks. We employ a number of indicators to craft an individual approach to assessment, including physical examination, symptom report, balance assessment, neurocognitive screenings, neuropsychological evaluation and screening for previous neuropsychiatric challenges. This approach is typically welcomed by parents, who are often relieved and reassured by the individualized care.

We hope that professional discourse among pediatric specialists will result in a data-driven approach to management of this common neurologic problem. Allowing anecdotes, popular beliefs or the media to dictate how we address this very frequent and long-standing sports-related complication is imprudent. Recommendations to avoid sports participation or exercise are potentially dangerous — given that more than 20% of children are obese — and as such are at greater risk for neurologic and cardiovascular complications during the lifespan, according to a 2012 study by Dattilo and colleagues.

Pediatricians should encourage exercise and sports participation while offering prudent counseling regarding concussion and brain protection throughout the life span.

• Marc P. DiFazio, MD, FAAN, is the Medical Director of the Regional Outpatient Center and Assistant Professor of Neurology at Children’s National Medical Center in Washington, D.C. He is also Assistant Professor at the Uniformed Services University of the Health Sciences in Bethesda, Md. DiFazio can be reached at: marcdifazio@gmail.com.
  Michael W. Kirkwood, PhD, is from the Department of Physical Medicine & Rehabilitation at University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colo. Kirkwood can be reached at: Michael.Kirkwood@childrenscolorado.org.
  Joshua Rotenberg, MD, is Board Certified in Child and Adolescent Neurology and works with the Texas Medical & Sleep Specialists in Houston. Rotenberg can be reached at: pedzzz@gmail.com.
• Disclosure: DiFazio, Kirkwood and Rotenberg report no relevant financial disclosures.

PERSPECTIVE

• We thank Dr. DiFazio and colleagues for their editorial about cognitive rest as a treatment following concussion. Approximately 75% to 80% of traumatic brain injuries are mild and there is robust evidence that these seemingly minor injuries result in poor neurocognitive outcomes in an important proportion of pediatric patients.
  We agree with Dr. DiFazio’s group that there is equivocal evidence supporting, and significant controversy surrounding, ‘second-impact syndrome,’ and that this potential risk of death is extremely rare. However, we do not identify fatality risks due to second-impact syndrome as the driving force behind the recommendation for cognitive and physical rest following concussion. Instead, our focus is on the far more common morbidity and short-term disability following concussion due to metabolic mismatch and associated symptoms in the acute phase immediately following the injury.
  In this early phase, activities that place demands on brain metabolism (ie, physical exercise, learning or recreational activities such as school, video games and texting) divert metabolic resources away from the healing process. Research on pediatric concussion has demonstrated increased energy demand with decreased cerebral blood flow immediately following these injuries. Due to the time course of this physiologic process, treatment in the acute phase differs from management in the chronic stages of concussion. Patients with acute injury are more likely to seek emergency medicine and general pediatric care prior to referral to a subspecialist for more persisting symptoms from concussion. It is during the early initial acute phase post-injury when cognitive rest may be helpful in light of our current understanding of the pathophysiology of concussion.
  While we agree that the evidence surrounding the effectiveness of this treatment is still emerging, there are data supporting cognitive and physical rest immediately following concussion. Animal studies of exercise following traumatic brain injury demonstrate worse outcomes with early exercise, and better outcomes with later exercise. Other research on children with concussion shows increased symptoms and poorer cognitive testing performance with cognitive and physical disability in the early phase following injury, and improved performance with reduced symptoms following cognitive rest.
  Rather than being prescriptive about the absolute duration and of cognitive rest, we emphasize that it is variable, personalized to each specific child and directed by the elicitation of symptoms. We follow a gradual approach to “return to learn” with subsequent “return to play,” whereby patients and their families can continue a self-paced approach to recovery. Patients can progress to the next step in their recovery if symptoms resolve, and revert to a prior step if symptoms are elicited. Our steps, modeled after the Zurich Return to Play guidelines, include a graded re-entry into cognitive activity.
  Rest can vary from a day to a week or more, and is highly individualized. However, after the acute phase a few weeks following injury, cognitive rest has not been demonstrated to be helpful, and may actually be counterproductive. Rather, patients in this stage benefit from active rehabilitation including directed vestibular therapy as well as a graded aerobic therapy program. Of note, as our recommendation for cognitive rest is not synonymous with bed rest, includes a graded return to cognitive activity and is not meant to last indefinitely, we do not think a reasonable period of rest following injury would at all contribute to the emerging obesity epidemic as the authors suggest. Our aim in sports medicine is to return patients back to full participation in sports and other activities as safely and expeditiously as possible given our current understanding of pediatric and adolescent concussion.
  We believe prescribing a combination of appropriate initial rest with a progressive increase in activity in the acute phase, followed by active rehabilitation would in fact minimize the duration of symptomatology, while facilitating a timely return to both cognitive and physical activity.
  We agree with the authors that there is a great amount of needed research on this topic, including identifying the optimal time of rest and risk factors for poor outcomes. We fully support ongoing biomolecular and animal research focused on pathophysiology, biomechanical study of injury mechanisms, epidemiologic analysis of existing patient data, and clinical trials of various treatments in order to further the field of mild traumatic brain injury management. We would encourage that, while further data emerges, recommendations should focus on a “moderate” standpoint, whereby neither strict cognitive and physical rest for a pre-determined time, nor immediate resumption of physical or cognitive activities are recommended following injury. Instead, providers should first ‘do no harm’, and allow, during the acute phase of injury, the brains of acutely concussed children to rest for a reasonable duration that is primarily driven by individual symptomatology, with appropriate rehabilitation for children with chronic, prolonged symptoms.
  Kristy B. Arbogast, PhD
  Matthew F. Grady, MD
  Christina L. Master, MD
  Roni L. Robinson, RN, MSN, CRNP
  Douglas J. Wiebe, PhD
  Douglas J. Wiebe, PhD
  Mark R. Zonfrillo, MD, MSCE,
• Kristy B. Arbogast, PhD, is from the Center for Injury Research and Prevention and the Division of Emergency Medicine at the Children’s Hospital of Philadelphia. Arbogast can be reached at arbogast@email.chop.edu.
  
  Matthew F. Grady, MD, is from the Sports Medicine and Performance Center at the Children's Hospital of Philadelphia. Grady can be reached at gradym@email.chop.edu.
  
  Christina L. Master, MD, is from the Sports Medicine and Performance Center at the Children's Hospital of Philadelphia. Master can be reached at masterc@email.chop.edu.
  
  Roni L. Robinson, RN, MSN, CRNP, is from the Sports Medicine and Performance Center at the Children's Hospital of Philadelphia. Robinson can be reached at robinsonr@email.chop.edu.
  
  Douglas J. Wiebe, PhD, is from the Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine, University of Pennsylvania. Wiebe can be reached at dwiebe@exchange.upenn.edu.
  
  Mark R. Zonfrillo, MD, MSCE, is from the Center for Injury Research and Prevention and the Division of Emergency Medicine at the Children’s Hospital of Philadelphia. Zonfrillo can be reached at zonfrillo@email.chop.edu.

full article here

An expert argues that the rules in youth's sports need to change in order to prevent concussions. He believes this will better reduce concussions than helmets can.

Imagine ice hockey without body checking and football with less hitting. What might sound blasphemous to hockey and football fans and players could protect youngsters from potentially deadly concussions.

L. Syd Johnson, an assistant professor at Michigan Technological University who has studied the disastrous effects of concussions in professional sports, argues that the time has come for major changes in hockey and football.

"Helmets don't really help," Johnson says. "A concussion occurs when your skull goes one way and your brain the other. Helmets help with skull fractures, but they don't help for concussions, though players still think they do."

Johnson favors banning fighting in hockey, which is accepted in the NHL and North American junior leagues but illegal in European and Olympic hockey. The Canadian Academy of Sports and Exercise has called for a ban on body checking in all levels of minor hockey, she points out.

Johnson acknowledges that 100 percent of hits can never be taken out of football, but they can be can be lessened, she says.

"I'm most interested in changes in the way hockey and football are played for the recreational and junior players who won't make professional leagues," Johnson says. "Youth are a neglected population of players when it comes to studying the effects of concussions. Nobody really knows the long-term consequences, nobody has studied them."

Johnson's research also taps into the culture of sports, she says. Fighting in hockey, for example, is celebrated in venues like Don Cherry's twenty-volume video series, "Rock 'Em, Sock 'Em Hockey," that focuses on fisticuffs and body checking.

"As adults, we need to protect kids from injury," she says. "Sports are valuable. They help fight obesity, for example. But there are ethical implications. What's important in sports? What are we teaching kids?"

Johnson says that players in sports need to be respected as humans, not merely replaceable beings for our entertainment.

Read more here

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

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 (http://www.txmss.com), 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 http://www.pedzzz.blogspot.com.

http://www.chron.com/business/press-releases//business/press-releases/article/Five-Ways-to-Prevent-a-Concussion-in-Your-Teenage-3769750.php

I am happy to see changes to football practice policies based on data of childhood head impacts. JR

Amidst Concern About Head Injuries, Youth Football League Issues New Practice Rules

see article by 

June 14, 2012, 4:13 pm ET by Gretchen Gavett

Football has never been more popular. But is it worth the risks? Watch FRONTLINE’sFootball High for more on head injuries, heatstroke and other issues facing young athletes.

Starting in August, Pop Warner youth football league practices will likely look a bit different.

The league announced yesterday that it’s revamping its practice rules in response toincreased concern about head injuries in football. The rules include:

• A ban on full speed head-on blocking or tackling drills when players line up more than 3 yards away from one another. Intentional helmet-to-helmet hits are not allowed.
• A limit on hits during practice. Only one-third of practice time per week can be devoted to drills that use contact, which breaks down to about 40 minutes per practice.

In a press release about the revamp, Pop Warner also reiterated that certain blocking and tackling techniques, including face tacking and spearing, remain prohibited. The league is in the process of updating its website to include easily accessible information about concussions and safety.

Full article here

Virginia Tech researchers placed helmets with sensors on 7- and 8-year-old football players and collected data on more than 750 hits to the head over a season. The findings are the first quantitative study of the acceleration and risk that young brains face in youth football. Special correspondent Stone Phillips reports.

Initial report here