How teens experience concussions

This article explains how teens experience concussions, and the relationship between physical and emotional symptoms that results from them.

With multiple concussions between the two of them, Dan Han and Lisa Koehl's latest research interest isn't surprising.

"I played competitive soccer through high school and continue to play recreationally," says Koehl, a doctoral candidate in the University of Kentucky's Department of Psychology, "so I have firsthand experience with the dynamics that come into play when a teen suffers a concussion."

As a former high school assistant principal in the Chicago public school system, Han was responsible for overseeing student-athletes' return to school after a concussion. Han left educational administration to pursue his doctorate in neuropsychology. Now director of the Multidisciplinary Concussion Program at the UK HealthCare, Han has a reputation for top-notch clinical work and research on concussion.

"There aren't many places in Kentucky where you find a true multidisciplinary concussion program," Han says. "UK HealthCare's Multidisciplinary Concussion Program embraces an interdepartmental group effort -- from Neurology, from Neurosurgery, Sports Medicine, Physical Medicine and Rehabilitation, from the Trauma team -- we all work together to look at how brain injury affects the cognitive, physical and emotional state of our patients."

This group effort puts the athlete's safety first. For that reason, UK HealthCare's concussion program is the go-to for the athletics programs at Fayette County Public Schools, the University of Kentucky, Eastern Kentucky University, and Kentucky State University, who all rely on the UK Multidisciplinary Concussion Program's clinical expertise in sports concussion for state-of-the-art input to help make decisions affecting an athlete's return to play.

Add to Han's clinical skills a lifelong love of full contact martial arts (Han practices kickboxing and Brazilian jujitsu), and it's easy to see how Han and Koehl are well-suited to study the symptoms of sports concussions.

Drawing from a large UK database of patients with brain injury, Koehl and Han used a subset of 37 athletes aged 12 to 17 to explore post-concussion changes in physical, emotional, and cognitive symptoms over time.

According to Koehl, 22 of the 37 study participants demonstrated post-concussive emotional symptoms. Of those, 23 percent were sensitive to light while 14 percent were sensitive to noise. In comparison, of the 15 teens without emotional symptoms, 13 percent were sensitive to light and no teens were sensitive to noise.

There were no differences between the two groups in factors such as what percentage experienced loss of consciousness, amnesia, nausea and/or headaches, indicating that the groups were likely comparable in the level of severity of concussion.

"We discovered a bidirectional relationship between both emotional symptoms developing in conjunction with physical symptoms, and also emotional symptoms developing because of the physical symptoms," said Koehl.

In other words, said Koehl, "This research gives us a better understanding of the interaction between physical and emotional symptoms in concussion and will allow us to explore ways to help adolescents recover in a more timely fashion."

According to Han, teens in the study who reported anxiety were 55 percent more likely to experience attention difficulties than those without anxiety, while teens with irritability/aggression were 35 percent more likely to self-report problems with attention than teens without irritability.

"While these findings are preliminary and require a larger sample size to predict outcomes with more confidence, we are intrigued by the potential these data offer in terms of providing teens with a better treatment plan based on their unique cognitive, physical and emotional response to concussion," Han said.

"Identifying factors that affect a teen's experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school during recovery."

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Teenagers with emotional problems after concussion

This article discusses which symptoms after a concussion, such as sensitivity to light or noise, that may indicate a teen is more likely to have emotional problems.

After a concussion, teens who are sensitive to light or noise may be more likely to also have emotional symptoms such as anxiety, according to a study released today that will be presented at The Sports Concussion Conference in Chicago, July 11 to 13, 2014, hosted by the American Academy of Neurology.

The symptoms after a concussion can vary widely from person to person. Symptoms can include physical, emotional and cognitive difficulties.

"While most people recover from a concussion within a week, a number of factors affect people's recovery, and studies have shown that teenage athletes may take up to seven to 10 days longer to recover than older athletes," said study author Lisa M. Koehl, MS, and Dong (Dan) Y. Han, PsyD, of the University of Kentucky in Lexington.

The study involved 37 athletes age 12 to 17 who had persisting symptoms for an average of 37 days following a concussion. Participants were excluded if they had a previous history of psychological issues. One group of 22 teens had emotional symptoms such as irritability, aggression, anxiety, depression, apathy, frequent mood changes or excessive emotional reactions after the concussion. The second group of 15 teens did not have emotional symptoms. There were no differences between the two groups in factors such as what percentage experienced loss of consciousness or amnesia, indicating that the groups were likely comparable in the level of severity of concussion.

The study found that of the 22 teens who had emotional symptoms, five teens (23 percent) were sensitive to light while three teens (14 percent) were sensitive to noise. In comparison, of the 15 teens without emotional symptoms only two teens (13 percent) were sensitive to light and no teens were sensitive to noise.

The number of concussions experienced and whether teens also had headaches or nausea were not related to whether they also had emotional symptoms. Researchers also found that having a family history of psychiatric problems did not make teens any more or less likely to have emotional symptoms after a concussion.

Teens who had anxiety were 55 percent more likely to self-report attention difficulties than those without anxiety, while teens with irritability/aggression were 35 percent more likely to self-report problems with attention than teens without irritability. The authors noted that the findings are preliminary with small samples and stressed the importance of replicating this study with a larger sample size.

"Identifying factors such as these that may exacerbate issues teens experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school for these athletes," Koehl and Han said.

The study was supported by the American College of Sports Medicine Research Foundation.

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Depression risk in teens increased by concussions, study claims

A new study claims that concussions in teens makes them three times more likely to suffer from depression.

Teens with a history of concussions are more than three times as likely to suffer from depression as teens who have never had a concussion, finds a new study in the Journal of Adolescent Health.

"What this study suggests is that teens who have had a concussion should be screened for depression," said lead study author Sara Chrisman, M.D., a pediatrician at Seattle Children's Hospital.

Concussion, considered a mild traumatic brain injury, can also have serious psychological effects. Most prior research on these psychological effects has focused on adults. However, many teens experience concussions through sports injuries or accidents, and less is known about long-term complications in adolescents.

The study used data from the 2007-2008 National Survey of Children's Health and included health information from over 36,000 adolescents ages 12 to 17. 2.7 percent of the sample had had a concussion and 3.4 percent had a current depression diagnosis.

Teens who were 15 years or older, lived in poverty or who had a parent with mental health problems were more likely to be depressed than other teens, said Chrisman, "but what was surprising was when we took those factors into consideration, it didn't take away from the association between depression and a history of concussion."

Chrisman also cautioned that it's not known what exactly might account for higher rates of depression in teens with a history of concussion. It could be the brain injury itself, diagnostic bias due to repeated medical visits for concussion, doctors mistaking symptoms of a concussion for depression, or from the social isolation that they may experience while recovering.

Jeffrey Max, M.D., a psychiatrist who specializes in psychiatric outcomes of traumatic brain injury in children and adolescents at the University of California, San Diego noted, "In our research, we've found that about 10 percent of the kids had a full depressive disorder or subclinical depressive disorder 6 months after a concussion." Children who have a history of concussion are more likely to develop attention-deficit/hyperactivity disorder (ADHD) and have difficulties controlling their moods, especially anger, rather than experience depression, Max added.

Unlike Chrisman, however, Max observed that the actual brain injury associated with concussions is probably a major cause of depression in the first few months after injury. "In the clinic, we've certainly seen cases where within hours [of sustaining a concussion], a kid who's never had depression before is suddenly depressed and suicidal. One of our studies found that the brain images in children with traumatic brain injury and depression were actually quite similar to those seen in adults who develop depression as a result of traumatic brain injury."

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Less concussions occur at higher altitudes in high school sports

An interesting study claims that the likelihood of a concussion in high school sports is lower at higher altitudes.

According to a recent study done by doctors at Cincinnati Children's Hospital Medical Center, high school athletes who play collision sports at higher altitudes are less likely to suffer from concussions than those who play at lower altitudes.

The doctors who were involved in the study recognized that prior research indicated that the volume and/or pressure of intracranial fluid, which acts as a cushion to protect the brain inside of the skull, is affected by one's altitude and that it may be associated with the likelihood and/or severity of a concussion. They hypothesized that when adjusting to higher altitudes, physiological responses increase intracranial fluid volume and these responses would provide a "tightened fit" which should help protect the brain from concussions like bubble wrap.

Data on concussions and more than 20 million athlete exposures were gathered between 2005 -2012 from nearly 500 high schools across the US. The data focused on concussion occurrence in a variety of sports including but not limited to boys' and girls' soccer, volleyball, basketball, cheerleading and boys' football and ice hockey. The altitude of the participating schools ranged from 7 to 6903 ft.

When concussion rates were examined relative to altitude, sequential elevations in altitude above sea level were associated with a reduction in concussion rates overall. Specifically, high school sports played at higher altitudes demonstrated a 31 percent reduction in the incidence of total reported concussions. Further analysis showed that concussion rates at increased altitude for football players were reduced by 30 percent for overall exposures, 27 percent for competition exposures and 28 percent for practice exposures.

Dr. Greg Myer, Director of Research, Sports Medicine, Cincinnati Children's Hospital Medical Center, says that "this research shows us that the physiological responses to altitude may be associated with a reduction in sports-related concussion rates, especially in collision sports."

He goes on to say that future research that focuses on other techniques that can optimize intracranial fluid volume (via jugular compression) will play an important role in the determination of the most effective approaches to prevent sport related concussion in athletes.

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Concussion symptoms the same for teens and adults

A study claims that concussions symptoms are at the same level of severity for teenagers and young adults.

Whether injured athletes are teens or young adults does not affect the severity of their concussion symptoms, according to a new study. However, differences may still exist in the concussion's aftermath, the researchers say.

Some previous research has raised concerns that high school-age athletes may suffer more severe symptoms after a concussion than college-age athletes, but this study found no evidence of that.

Related symptoms include headache, dizziness, nausea, fatigue, irritability, sleeping difficulties and problems with memory and concentration.

Vanderbilt University School of Medicine researchers compared concussion symptoms in 92 athletes aged 13 to 16 with those of 92 athletes aged 18 to 22. Both groups had 56 percent females and 44 percent males.

No significant differences occurred between the two groups in the number, duration or severity of concussion symptoms, according to the study published online Sept. 24 in the Journal of Neurosurgery: Pediatrics.

Some age-related differences may occur after sports-related concussion, the researchers said. They noted that previous research from the Vanderbilt Sports Concussion Center concluded that age-related differences exist in neurocognitive testing after sports-related concussion.

In evaluating sports-related concussion, it's important to separate different ways of assessing outcomes, study co-author Dr. Scott Zuckerman said in a journal news release. These methods include assessing symptoms, neurocognitive testing, balance problems, school performance and others.

"It appears that symptoms may not be a prominent driver when assessing outcomes of younger versus older athletes. We hope that our study can add insight into the evaluation of youth athletes after sports-related concussion," Zuckerman said in the news release.

The author of an accompanying editorial, Dr. Ann-Christine Duhaime, noted that definitions of concussion are not uniform, its diagnosis is not standardized and it's extremely difficult to match all variable factors in a study of sports-related concussion in different age groups.

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One fifth of 7th-12th graders claim to have had traumatic brain injury

An interesting study shows that one out of five 7th through 12th graders said they have had traumatic brain injury during their lives.

One in five adolescents surveyed in Ontario said they have suffered a traumatic brain injury that left them unconscious for five minutes or required them to be hospitalized overnight, a statistic researchers in Toronto say is much higher than previously thought.

Sports such as ice hockey and soccer accounted for more than half the injuries, said Dr. Gabriela Ilie, lead author of the study and a post-doctoral fellow at St. Michael's Hospital.

Traumatic brain injuries, such as concussions, were reported more often by males than females, by those with lower school grades and by those who used alcohol or cannabis in the previous 12 months, she said.

The study was to be published Wednesday (June 26) in theJournal of the American Medical Association.

Dr. Ilie said this is one of the first studies of traumatic brain injury to focus only on adolescents and to include all of their self-reported TBIs. Most previous studies based their reporting only on hospital records. Concussion is the most common form of traumatic brain injury.

The data used in the study were from the 2011 Ontario Student Drug Use and Health Survey (OSDUHS) developed by the Centre for Addiction and Mental Health. The survey, one of the longest ongoing school surveys in the world, contains responses from almost 9,000 students from Grades 7-12 in publicly funded schools across Ontario. The OSDUHS began as a drug use survey, but is now a broader study of adolescent health and well-being. For the first time in 2011, questions about traumatic brain injury were added to the survey.

"The questions about TBI were added to the OSDUHS because there were no current data on prevalence in the adolescent population," said Dr. Robert Mann, a senior scientist at CAMH and director of the OSDUHS. "Early research has indicated that there may be links between TBIs and mental health and substance use during adolescence -- we plan to study this in the near future."

The survey found that 20 per cent of adolescents in Ontario said they had had a traumatic brain injury in their lifetime. It found that 5.6 per cent of them had had such an injury in the past 12 months.

Dr. Ilie said this suggests the prevalence of TBI among young people is much higher than previously known, because many head injuries remain uncounted when they are not being reported to parents, teachers, sports coaches or health care workers. In Canada, 50 per cent of all injuries that kill and disable youth involve a TBI.

This new research found that 46.9 per cent of the TBIs reported by adolescent females occurred during sports (e.g., hockey, skate boarding); the figure was 63.5 per cent for males.

Students who reported drinking alcohol occasionally/frequently and those who reported using cannabis 10 or more times over the past 12 months had more than five times and more than three the odds, respectively, of acquiring a traumatic brain injury in the past 12 months than students who reported abstinence. The survey also showed that students who reported overall poor grades at school (below 60 per cent) had almost four times the odds of a lifetime acquired brain injury than students who reported grades at or above 90 per cent.

"Traumatic brain injury is preventable," said Dr. Ilie. "If we know who is more vulnerable, when and how these injuries are occurring, we can talk to students, coaches, and parents about it. We can take preventive action and find viable solutions to reduce their occurrence and long-term effects."

Brain injuries among adolescents are particularly concerning because their brains are still developing. There is growing evidence that people who have had one or more concussions are at greater risk of future concussions, and evidence that multiple brain injuries can result in lasting cognitive impairment, substance use, mental health and physical health harms.

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