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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Neck injuries versus concussions

Concussions and neck injuries have similar symptoms, so diagnosing and differentiating these conditions is often difficult.

Athletes and others reporting cognitive difficulties after a head injury are usually diagnosed as having had a concussion. But is it really a concussion? A new study published by University at Buffalo medical faculty finds that many of the same symptoms are common to concussions and to injuries to the neck and/or balance system, known collectively as cervical/vestibular injuries.

The research was based on responses about symptoms from 128 patients -- some of whom were professional athletes -- who were being treated at UB's Concussion Management Clinic in the School of Medicine and Biomedical Sciences.

It was published online ahead of print last week in the Clinical Journal of Sport Medicine.

The purpose of the study was to determine how to distinguish between concussion injury and neck injury, based on symptoms.

"Based on our research, we conclude that some patients who have been told they've suffered a concussion, and whose symptoms persist for several months may actually have suffered a neck injury, rather than a concussion, or in addition to a concussion," says John J. Leddy, MD, clinical professor in the UB Department of Orthopaedics and senior author.

He embarked on the study based on his experience as director of the UB Concussion Management Clinic.

"I'd seen enough patients in our clinic, some previously diagnosed with post-concussion syndrome, who continued to experience symptoms even after passing our treadmill test, which indicates full recovery from concussion," says Leddy, who sees patients through UBMD, the physician practice plan of the UB medical school.

"The symptoms for both conditions are so nonspecific that it's really hard to make a diagnosis based on them," Leddy continues, "so we had to find another way to discriminate between them."

To determine which of the respondents had probably sustained a concussion and which more likely had a neck injury, the UB researchers used the graded treadmill test developed by Leddy and co-author Barry Willer, PhD, UB professor of psychiatry.

"The treadmill test helps us make a first delineation between what I call physiologic concussion and other possible causes of cognitive symptoms," says Leddy.

"Because a concussion is a brain injury, we thought that cognitive symptoms would be more likely associated with concussions," he says. "Surprisingly, that didn't turn out to be the case. People who have had neck injuries can also have problems with concentration and with memory. They feel like they're in a fog, which is exactly what people report after concussion."

Symptoms reported by both groups were headache, dizziness, blurred vision, poor concentration and memory deficits.

Patients in both groups filled out a detailed questionnaire concerning their symptoms. These responses were then correlated to their treadmill test results. "Then we did some sophisticated statistical analysis," says Leddy. "Even when we looked at the data in multiple ways, there was really no way to separate out the two groups based on their symptom patterns alone."

Determining which condition a patient has experienced is critical, Leddy explains, because courses of treatment are very different.

"The treatment for a neck injury is actually to be more active, to do physical and vestibular therapy, to have a more active intervention, whereas after a concussion, exercise must begin slowly and incrementally after a period of rest," he says.

Leddy notes that more research should be done on larger samples concerning concussion and neck injury.

In the meantime, he says, patients who think they've had a concussion and whose symptoms have not diminished after several months, should instead be examined for neck and vestibular injury by a sports medicine physician, a neurologist or a physiatrist, a specialist in rehabilitation medicine.

"I think a lot of practitioners listen to the symptoms and just chalk it up to concussion," he adds, "but if they also examined the neck in these people, they might discover that a neck injury is involved and that's a treatable problem."

Physical symptoms that may indicate a neck injury include tenderness, muscle spasm, reduced motion and/or reduced cervical proprioception, Leddy explains.

Co-authors with Leddy and Willer are John G. Baker, PhD, UB Department of Nuclear Medicine; Asim Merchant, MD and Jason Matuszak, MD, of the UB Department of Family Medicine; John Picano, an MD candidate at UB and Daniel Gaile, PhD, of the UB Department of Biostatistics.

The UB Concussion Management Clinic is a joint effort between the Department of Orthopaedics and the Department of Psychiatry.

The research was supported by the Robert Rich Family Foundation, the Buffalo Sabres Foundation, the Program for Understanding Childhood Concussion and Stroke, the Ralph C. Wilson Foundation and the National Football League Charities.

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CDC's Heads Up app helps to spot symptoms of concussions in children

Summer concussions are from falls and accidents. I see many water sport induced brain injuries.

 If your child is not right, trust your instincts. Trust your child if they feel they are not right. See a physician! - JR

An app created by the CDC helps to spot symptoms of concussions in children.

Need a primer on how to spot the signs of a concussion for your child? The Centers For Disease Control and Prevention's Heads Up app will help you learn how to recognize the signs and symptoms, and what to do if you think a child has a concussion or other serious brain injury.

This is crucial information that you can find easily in the app to act quickly if needed. Children and teen athletes are more susceptible to concussion than older athletes, and they have an increased risk compared to adults for traumatic brain injury with greater severity and prolonged recovery due to their developing brains.

The app says that signs and symptoms generally appear soon after an injury, but the seriousness of the injury and some symptoms may not appear for hours or days. In rare cases of a hematoma (a collection of blood in the brain), you would need to take your child immediately to the emergency room. If a child does suffer from a concussion, there is information on recovery, such as when to return to school and sports.

This app can also help you pick the right helmet for your child's activity, including what to look for and what to avoid. For example, you can choose hockey to find out about the correct size and fit, tips for finding a good helmet, and how long it should last.

Besides sports, there are safety tips to prevent brain injuries at home, playground, cars, homes, and bikes.

Lastly, the CDC encourages to share information on concussions with others. In May, President Obama at the Healthy Kids and Safe Sports Concussion Summit called for the end of the culture in youth sports where kids are encouraged to “suck it up” after sustaining head injuries.

“We have to change a culture that says you suck it up,” said President. “Identifying a concussion and being able to self-diagnose that this is something that I need to take care of doesn’t make you weak - it means you’re strong.”

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Children's concussion symptoms stay after injury

A study shows that the symptoms of concussions in children stay long after the injury occurrence.

Kids who suffer a concussion can have lingering effects long after the physical symptoms fade away, U.S. researchers report.

In a study from the emergency medicine division at Boston Children's Hospital, doctors found that, while headache, dizziness and blurry vision can appear right after a concussion, emotional and mental symptoms, such as irritability and frustration, show up much later and stay longer.

"Patients and their families should expect the physical symptoms that they experience after a head injury to get better over the next few weeks, but that emotional symptoms may come on later, even as the physical symptoms subside," said lead researcher Dr. Matthew Eisenberg.

"Only by knowing what symptoms can be expected after a concussion can we help reassure patients and families that what they experience is normal, know when to seek additional help, and make sure that children are taking appropriate precautions in regard to school and sports to achieve a full recovery," Eisenberg added.

For the study, published online May 12 and in the June print issue of Pediatrics, Eisenberg's team used questionnaires to keep track of 235 children and young adults, aged 11 to 22, who suffered a concussion and went to a pediatric emergency department.

The patients were followed for three months after their injury, or until all their symptoms were gone. During that time they were asked about symptoms, sports activity, and school and athletic performance.

The most common physical symptoms were headache, dizziness and fatigue, which tended to start right after the injury and got better over time. Most also had mental symptoms, such as difficulty concentrating and taking longer to think, the researchers found.

While most children recovered within two weeks after the injury, 25 percent still had headache a month after their injury, the investigators found.

In addition, more than 20 percent suffered from fatigue, and nearly 20 percent reported taking longer to think for a month after their concussion.

For many, emotional symptoms -- such as frustration and irritability -- were not as common right after the injury, but developed later, the study authors noted.

Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children's Hospital, said, "It takes longer than people think to fully recover from a concussion. My experience is that kids who still have symptoms two weeks after a concussion are going to have a very hard time, and it's going to be a struggle to get them to the point where they have no symptoms."

In addition to physical and mental rest, Kuluz believes in treating the symptoms. He prescribes ibuprofen and other medications to relieve headache, and melatonin and other drugs to help patients sleep.

Kuluz also recommends physical therapy to help children recover. Therapy includes working on balance and helping with any vision problems. "Therapy also helps you find your threshold for exertion. Many of my kids find that very helpful," he said.

He also recommends keeping children out of school for a couple of days after the injury and then gradually letting them get back to a normal routine.

"Keeping a child out of school for too long will have a negative effect on their mental health. They will become anxious, they'll become irritable, because they worry about falling behind," he said. "But if they go back too soon without teachers being aware of their condition, they can fail, and it happens a lot."

Kuluz tries to get kids back to school for half a day or as much as they can tolerate until they get better. Children should not start sports again until all symptoms have disappeared and then only gradually, he added.

If a child still has symptoms two or three days after a concussion, Kuluz recommends seeing a doctor who is experienced in dealing with concussions or going to a concussion clinic.

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Study: Bicycle helmets don't protect kids from concussions

A study shows that bicycle helmets do not offer protection from concussions.

Helmets won't protect your kids from concussions, according to a study by the Institute of Medicine and the National Research Council.

"I've personally been in several accidents and I've suffered a concussion with a helmet on," said cyclist Kara Tate.

It may not have prevented a concussion, but Tate feels her helmet saved her. "I know it would have been much, much, worse had I not had that protection."

And as a mother, she never lets her kids go without them whenever they're biking, roller-blading, or skating.

Because of lack of evidence, the study found that helmets don't reduce the risk of concussions.

Anthony Quintile hopes the study doesn't give parents the wrong idea. He's part of the Flagstaff Biking Organization, a local advocacy group that had a hand in getting legislation passed in 2010, requiring children to wears helmet while riding bikes in Flagstaff.

"We always have concerns that people are going to read some piece of a piece of a study shared on some sort of social media and think that means, 'Oh, I don't need to wear a helmet when I'm riding a bicycle or doing any other activity that you might sustain a head injury,'" Quintile said.

He says the research doesn't reflect all of the other injuries helmets still protect against.

"Just on face value, bumping your head on concrete with a helmet versus without, you're not going to sustain that simple injury, let alone maybe something significantly more substantial," Quintile said.

The study challenges companies to create and design safer helmets to help reduce rotation of the brain after a crash, called rotational acceleration. Experts say rotation of the brain may cause damage to nerve fibers, leading to concussion symptoms.

While helmet manufacturers continue to make improvements to try to protect the brain, Tate says it's still a no-brainer to wear a helmet. She says they provide her kids with so many more benefits she can see.

"You know they have these bright-colored helmets on and they were reflective, so it was better for their safety in terms of just sharing the road with motorists," she noted.

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Girls suffer worse concussions than boys do

A study looked into how gender affects concussion and showed that girls suffer worse concussions than boys do.

Girls who suffer a concussion may have more severe symptoms that last longer compared to boys, according to new research that builds on other studies finding gender differences.

"There have been several studies suggesting there are differences between boys and girls as far as [concussion] symptom reporting and the duration of symptoms," said Dr. Shayne Fehr, a pediatric sports medicine specialist at Children's Hospital of Wisconsin.

In his new study, Fehr also found those differences. He tracked 549 patients, including 235 girls, who sought treatment at a pediatric concussion clinic.

Compared to the boys, the girls reported more severe symptoms and took nearly 22 more days to recover, said Fehr, also an assistant professor of pediatric orthopedics at the Medical College of Wisconsin.

He was due to present the findings this week at the annual meeting of the American Medical Society for Sports Medicine, held in New Orleans. Studies presented at medical meetings are typically viewed as preliminary until published in a peer-reviewed journal.

A concussion is any brain injury that disturbs normal functioning. Concussions are typically caused by a jolt or blow to the head, often in collision sports such as hockey or football, according to the American Academy of Pediatrics (AAP).

In recent years, experts have advised coaches, players and parents that athletes should not return to play until they are seen by a doctor if a concussion is suspected.

In the new study, Fehr tracked patients aged 10 to 18, all treated between early 2010 and mid-2012. Each patient reported on their symptoms, how severe they were and how long it took from the time of the injury until they were symptom-free.

In addition to reporting more severe symptoms, girls took an average of 56 days to be symptom-free. In comparison, the boys took 34 days. Overall, the time to recovery was 44 days when boys and girls were pooled.

That duration of symptoms, Fehr said, is much longer than what people commonly think. "Commonly you hear that seven to 10 days [for recovery] is average," he said.

Fehr did not find age to be linked with severity of symptoms. Most of the injuries -- 76 percent -- were sports-related, with football accounting for 22 percent of the concussions.

The top five reported symptoms were headache, trouble concentrating, sensitivity to light, sensitivity to sound and dizziness. Boys and girls, in general, reported the same types of symptoms, Fehr said, but the girls reported more severity and for a longer time period.

"This confirms what has been reported before," said Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children's Hospital, who reviewed the findings.

While he said the 44-day recovery seems lengthy, he added that it probably reflects the boys and girls studied. They all went to a concussion clinic, so their injuries may have been more severe.

What's not known, Fehr said, is why the differences exist and whether they are related to more reporting of symptoms right after the injury by girls or if girls are truly more significantly affected.

"I wouldn't treat girls any differently than boys,'' he said.

For both genders, it's important to be seen by a doctor and not return to play prematurely, which can be dangerous or even fatal, according to the AAP. Anyone with a history of concussion is at higher risk for another injury.

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In rats, brain damage occurs with no signs of concussion

Brain damage is seen in rats after repeated "subconcussive" brain trauma, or a head injury that shows no concussion symptoms.

A standard experimental model of concussion in rats causes substantial brain damage -- but no behavioral changes comparable to those seen in patients with concussion, reports a study in the April issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The results highlight the "disconnect" between preclinical and clinical studies of concussion, according to the report by Dr. Charles L. Rosen of West Virginia University, Morgantown, and colleagues. The study also adds to concerns over the possible long-term effects of repeated, "subconcussive" brain trauma -- causing no concussion symptoms -- in humans.

Despite Diffuse Brain Damage, No Signs of 'Concussion' in Rats

Concussions are thought to be a form of "mild traumatic brain injury." However, there is no definitive diagnostic test to determine when a concussion has occurred. Instead, concussion is diagnosed on the basis of symptoms such as headache, nausea, dizziness, and confusion.

In contrast, animal studies of concussion have focused on directly observed injury to brain tissues, with little attention to the possible behavioral and functional consequences of the brain trauma. Thus there is a "clear disconnect" between experimental and clinical studies of concussion, according to Dr. Rosen and colleagues.

To address this discrepancy, they used a standard technique, called the "impact-acceleration model," to induce brain injury in rats. As reported by previous studies, this technique caused "diffuse axonal injury" to the brain, with visible evidence of damage on the cellular level.

The researchers also compared injured and uninjured animals on a wide range of functional and behavioral tests. The tests were chosen to reflect symptoms and functions similar to those used to diagnose concussion in humans -- for example, locomotor activity, coordination/balance, cognitive function, and anxiety- and depression-like behaviors.

But despite a rather extensive pattern of brain injury, the rats had no significant abnormalities on any of the tests. That was so on the day after brain injury as well as up to one week afterward. "The lack of functional deficits is in sharp contrast to neuropathological findings indicating neural degeneration, astrocyte reactivity, and microglial activation." Dr. Rosen and colleagues write.

Findings Support Concerns about 'Subconcussive Injury'

The new study comes at a time when new researchers are finding evidence of long-term neurodegenerative changes in the brains of people who have never been diagnosed with a concussion. One key study in high school football players found changes in neurological function and health in athletes who never had concussion symptoms, but had sustained "repetitive subconcussive blows."

Traditionally, concussion has been regarded as a temporary problem that resolves with no long-term effects. But that view has changed in recent years, with studies in athletes and others showing chronic traumatic encephalopathy linked to repetitive head injury -- both the concussive and subconcussive types.

The new experiments support the concept that significant brain damage may be present in individuals who have completely normal results on symptom-based assessments currently used to diagnose concussions. Dr. Rosen and coauthors write, "It appears that even subconcussive injury, or injury below the current clinical threshold for detection using standard measures, may have lasting neurological effects."

The researchers emphasize that their short-term study in rats provides no direct evidence of long-term changes caused by "mild" traumatic brain injury in humans. They discuss the need for further research to clarify the effects of traumatic brain injury over time, and to develop new models for understanding the long-term impact of repeated head trauma.

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A blood test may help diagnose concussions

This article discusses research that claims that a blood test could be a non-subjective way to diagnose a concussion.

A report Monday in the journal Pediatrics says kids who suffer concussions should lay off reading, homework and video games. By giving their brains a rest, most can recover in 20 to 50 days, about twice as fast as those who keep doing those activities.

We also have news regarding how concussions are diagnosed. Researchers are developing a test that could be a game changer.

Quarterback Taylor Kelly of the Arizona State Sun Devils understands the mindset of college football players when it comes to injuries: They are going to want to keep playing.

"Guys just want to go out and play it, you know?  They don't care if their heads are a little banged up," Kelly said.

Neurologist Dr. Javier Cardenas specializes in brain injury. He says overcoming the reluctance of athletes to admit symptoms is only one of the problems in diagnosing concussions.

"Right now when we identify a concussion it is purely subjective. We look at symptoms. Do they have headaches? Do they have dizziness? There is no objective information. Having something objective is the holy grail of concussion," said Cardenas.

This season, Kelly and his teammates took part in a study trying to find a better way to detect concussion. Riddell, the athletic equipment company, supplied the team with helmets that measure all head impacts during practices and games. Then, after every game, the players gave samples of their blood, saliva and urine.

These are now being analyzed at the Translational Genomics Research Institute in Phoenix to see whether evidence of head trauma shows up in body fluids as a so-called biomarker.

Brain cells contain generic material call microRNA. Normally, tiny spheres containing that material break off and make their way into the spinal fluid, then the bloodstream. During a concussion, the bran actually bounces against the skull, and researchers believe the impact can cause changes in the microRNA, changes they hope can be detected in blood tests.

TGen scientists are comparing the RNA in each player's body fluids with the impact data from his helmet to see if they match up.

"It might be that we can actually protect players. So identify players who are at risk but have them take it easy, sit out more, based how their biomarkers are rising over time," said Kendall Van Keuren-Jenses, a member of the research team.

The scientists have data illustrating how the technology might have helped one of the players in the study.

The graphic shows the head impacts recorded in his helmet over several weeks. One hit was the equivalent of four times the punch b a heavyweight boxer – the hardest impact received by any player in the study. He continued to play, and was diagnosed with a concussion 10 days later.

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ImPact Test-Retest Reliability: Reliably Unreliable?

This study is an observational study of the reliability of follow up tests. In my personal opinion, ANY patient who is SYMPTOMATIC but has a normal test AND any ASYMPTOMATIC patient with an abnormal test should have an expert evaluation .

Do experts review all these baseline tests and provide an interpretation?

Do parents get results and an option to evaluate their child?
Are schools  putting students with abnormal tests in the game?

hmmm...

 JR

ImPact Test-Retest Reliability: Reliably Unreliable?

Jacob Resch , PhD, ATC*; Aoife Driscoll , BSc†; Noel McCaffrey , MD†; Cathleen Brown , PhD, ATC‡; Michael S. Ferrara , PhD, ATC, FNATA‡; Stephen Macciocchi , PhD, ABPP§; Ted Baumgartner , PhD‡; Kimberly Walpert , MD‖

*University of Texas at Arlington;

†Dublin City University, Ireland;

‡University of Georgia, Athens;

§Shepherd Center, Atlanta, GA;

‖Georgia Neurological Surgery, Athens

Context: Computerized neuropsychological testing is commonly used in the assessment and management of sport-related concussion. Even though computerized testing is widespread, psychometric evidence for test-retest reliability is somewhat limited. Additional evidence for test-retest reliability is needed to optimize clinical decision making after concussion.

Objective: To document test-retest reliability for a commercially available computerized neuropsychological test battery (ImPACT) using 2 different clinically relevant time intervals.

Design: Cross-sectional study.

Setting: Two research laboratories.

Patients or Other Participants: Group 1 (n = 46) consisted of 25 men and 21 women (age = 22.4 ± 1.89 years). Group 2 (n = 45) consisted of 17 men and 28 women (age = 20.9 ± 1.72 years).

Intervention(s): Both groups completed ImPACT forms 1, 2, and 3, which were delivered sequentially either at 1-week intervals (group 1) or at baseline, day 45, and day 50 (group 2). Group 2 also completed the Green Word Memory Test (WMT) as a measure of effort.

Main Outcome Measures: Intraclass correlation coefficients (ICCs) were calculated for the composite scores of ImPACT between time points. Repeated-measures analysis of variance was used to evaluate changes in ImPACT and WMT results over time.

Results: The ICC values for group 1 ranged from 0.26 to 0.88 for the 4 ImPACT composite scores. The ICC values for group 2 ranged from 0.37 to 0.76. In group 1, ImPACT classified 37.0% and 46.0% of healthy participants as impaired at time points 2 and 3, respectively. In group 2, ImPACT classified 22.2% and 28.9% of healthy participants as impaired at time points 2 and 3, respectively.

Conclusions: We found variable test-retest reliability for ImPACT metrics. Visual motor speed and reaction time demonstrated greater reliability than verbal and visual memory. Our current data support a multifaceted approach to concussion assessment using clinical examinations, symptom reports, cognitive testing, and balance assessment.

Key Words:  intraclass correlation, concussions, mild traumatic brain injuries, neuropsychological 
testing, athletes

FULL study here

Address correspondence to Jacob Resch, PhD, ATC, University of Texas at Arlington, Box 19259, 113 Maverick Activities Center, Arlington, TX 76102. Address e-mail to resch@uta.edu.

Study: Brain damage from concussion stays after symptoms subside

A study shows that after symptoms from a concussion go away, the brain damage from the concussion persists.

Months after concussion symptoms such as dizziness, headaches and memory loss fade, the brain continues to show signs of injury, a new study suggests.

Comparing 50 concussion patients with the same number of healthy people, researchers found that the brains of those suffering concussions showed abnormalities four months later. This happened despite the fact that their symptoms had already eased to some degree.

The findings may sway conventional thinking about when it's safe to resume physical activities that could produce another concussion, the study authors said.

"This is a very different population than professional athletes going out and having concussions on a fairly [frequent] basis, as well as jostling their brain around their skull on a regular basis in practice," said study author Andrew Mayer, an associate professor of translational neuroscience at the Mind Research Network in Albuquerque, N.M. It's hard to predict an outcome based on these findings, he said, "but just because you feel you're healed doesn't mean you are."

The study, which was funded by the U.S. National Institutes of Health, is published in the Nov. 20 online edition of the journal Neurology.

Considered a mild traumatic brain injury that occurs from a sudden blow to the head or body, a concussion has symptoms that range from headache and blurry vision to difficulties in sleeping or thinking clearly. Most occur without losing consciousness, according to the U.S. Centers for Disease Control and Prevention.

Mayer and his team matched 50 patients with mild concussions to 50 healthy people of similar age and education levels. They tested all participants in memory and thinking skills, as well as other symptoms such as anxiety and depression.

Special brain scans using technology that is not available in standard brain scans were also given. All tests and scans were repeated two weeks after the concussion, and again four months later.

While concussion symptoms were reduced by up to 27 percent four months after injury, brain scans of those with concussions showed abnormalities in the frontal cortex area of both sides of the brain. These abnormalities may have resulted from changes in location of fluid around brain cells or changes in the shape of certain brain cells in response to damage, Mayer explained.

The findings, he noted, suggest that the recommendation that athletes suffering concussions should refrain from play for one to two weeks may not be sufficient.

"In one or two weeks, most people typically report feeling better," he said. "But when we start talking about it in an analogy of a burn or knee injury, it becomes a little more clear when the doctor says we need to wait a bit longer [to return to prior activities]. It makes sense that the brain would be similar to those tissue types," added Mayer.

Kenneth Podell, co-director of the Houston Methodist Concussion Center, said the study strengthens the understanding that physical changes within the brain after concussion are separate from mental symptoms. But Podell, who was not involved in the research, added that the study couldn't offer implications for potential long-term concussion effects such as depression or dementia.

"Everyone seen at four months should be followed in another four, six or eight months and then re-scanned," he said. "One of the biggest problems we have looking at concussions is we try to predict long-term effects from short-term findings. This injury is very difficult to commit the type of resources needed to do that kind of very expensive and time-consuming study."

Read more here

Children May Need Gradual Transition Back to Academics After Concussion

The American Academy of Pediatrics claims that once a child has a concussion, he or she may need a gradual transition back to school and academic classes.

This article is helpful in that it details accommodations.

I have some trouble with the assertions about rest. JR

A concussion should not only take a student athlete off the playing field -- it may also require a break from the classroom, according to a new clinical report from the American Academy of Pediatrics (AAP).

In the clinical report, "Returning to Learning Following a Concussion," released Sunday, Oct. 27 at the AAP National Conference & Exhibition in Orlando, the AAP offers guidance to pediatricians caring for children and adolescents after suffering a concussion.

"Students appear physically normal after a concussion, so it may be difficult for teachers and administrators to understand the extent of the child's injuries and recognize the potential need for academic adjustments," said Mark Halstead, MD, FAAP, a lead author of the clinical report. "But we know that children who've had a concussion may have trouble learning new material and remembering what they've learned, and returning to academics may worsen concussion symptoms."

Research has shown that a school-aged student usually recovers from a concussion within three weeks. If symptoms are severe, some students may need to stay home from school after a concussion. If symptoms or mild or tolerable, the parent may consider returning him or her to school, perhaps with some adjustments. Students with severe or prolonged symptoms lasting more than 3 weeks may require more formalized academic accommodations.

The AAP recommends a collaborative team approach to help a student recovering from a concussion. This team should consist of the child or adolescent's pediatrician, family members and individuals at the child's school responsible for both the student's academic schedule and physical activity. Detailed guidance on returning to sports and physical activities is contained in the 2010 AAP clinical report, "Sport-Related Concussion in Children and Adolescents."

A symptom checklist can help evaluate what symptoms the student is experiencing, and how severe they are.

"Every concussion is unique and symptoms will vary from student to student, so managing a student's return to the classroom will require an individualized approach," said Dr. Halstead. "The goal is to minimize disruptions to the student's life and return the student to school as soon as possible, and as symptoms improve, to increase the student's social, mental and physical activities."

Because relatively little research has been conducted on how concussion affects students' learning, the AAP based its report primarily on expert opinion and adapted it from a concussion management program developed at the Rocky Mountain Hospital for Children, Center for Concussion in Denver, Colo. The AAP calls for further research on the effects and role of cognitive rest after concussion to improve understanding of the best ways to help a student recovering from a concussion.

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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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There's no such thing as a concussion-proof helmet

This article explains why parents should be weary of helmets claiming to be "concussion-proof"and what to do about concussions in their children.

Football season is upon us and many parents of young players may be swayed by helmets claiming to be "concussion-proof." There is no such thing, experts warn.

Some manufacturers are promoting aftermarket add-ons for football helmets – such as liners, bumpers, pads and electronic devices – that promise to reduce the risk of concussion. However, there is little research evaluating the effect of physical impact on young athletes, and risk-reduction claims about helmets designed for adult players may not be relevant to younger players, New York Attorney General Eric Scheiderman warned. 

“It’s important to remember that no helmet can fully prevent a concussion,” Schneiderman said, as he cautioned manufacturers against making claims they can't back up. “Ensuring that manufacturers don’t mislead the public and endanger young New Yorkers is a key concern for my office."

Head injuries, including concussions, can happen at any time on the field of play, regardless of the type of helmet being worn. False claims may give players and parents a false sense of security. Instead, parents, coaches and young football players should rely on a number of tips and strategies to help reduce the risk of head injury, including: learning and recognizing symptoms of a concussion; minimizing head-to-head hits on the field, and enforcing stronger and stricter penalties against such behavior.

What to do

Although the age, condition, type and fit of the helmet are important factors, reducing the risk of concussion is not “all about the helmet.” Schneiderman issued these tips to reduce the risk of concussion and head injury in youth football:

• Players, parents and coaches must be trained on the symptoms and risks of concussion.
   
• Recognizing the signs of concussion and removing a player immediately is extremely important.
   
• New York State law requires that players be removed from play until they are asymptomatic for a minimum of 24 hours and have written approval from their physician to return to play. Many other states have similar laws.
   
• The number of concussions can be significantly reduced with modifications to practice format and an emphasis on penalty enforcement.
   
• Reducing the number of hits is instrumental to reducing the risk of concussion because of the cumulative risk from repeated hits. Limit the amount of contact in practice and forbid drills that involve full-speed, head-on blocking and tackling that begins with players lined up more than three yards apart.
   
• Players need to be trained to focus on techniques that minimize head-to-head hits. Coaches and referees must strictly enforce penalties against such behavior.

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Youth concussions in sports

This article discusses the basics of youth concussions, discusses the signs and symptoms, and provides resources for more information.

Athletes sometimes joke about “getting your bell rung” or feeling a “stinger” after taking a hit to the head during sports. However, adolescent concussions are common and can have serious consequences.

WHAT IS A CONCUSSION?

A concussion is a type of brain injury. The brain is made of soft tissue and is surrounded by a cushion of spinal fluid. The skull surrounds the brain and protects it. A person can injure their brain by getting hit on the head, or even the body, resulting in the brain moving around in the skull. This can lead to bruising of the brain, damage to blood vessels, and injury to nerves. People can get a concussion from a fall, a car crash, or a sports injury.

CONCUSSIONS AND SPORTS

One of the most common ways children and adolescents get concussions is through sports injuries. A recent review estimated that up to 3.8 million recreation- and sports-related concussions occur each year in the United States. The sport with the highest risk of concussion in high school is football. In girls' sports, the rate of concussion is highest in soccer and basketball. Girls have a higher rate of concussion than boys when they are in similar sports. Young athletes' brains are still developing, thus they may be at higher risk for the effects of a concussion. The way in which the injury happens may be very important in predicting how serious the injury will be. This was described in a study in this month's Archives.

SIGNS AND SYMPTOMS

The signs and symptoms of concussion fall into 4 categories:

• Physical: Headache is the most frequently reported symptom of a concussion. Nausea and vomiting can also occur. Problems with balance, vision, and fatigue are also common.
• Cognitive: A feeling of mental “fogginess” or feeling “slowed down” are also common. Loss of memory is a symptom that suggests a more serious injury.
• Emotional: Symptoms may include irritability, sadness, or nervousness.
• Sleep: Symptoms may include feeling drowsy and sleeping more than usual. However, some patients sleep less than usual and have difficulty falling asleep.

CONCUSSION: TRUE OR FALSE

• If my child is in a soccer game and hits his head, the concussion should be “toughed out” until the end of the game.
  False. Children or adolescents who have a concussion, or parents or coaches suspect they have one, should always be evaluated by a qualified health care provider before returning to play.
• You do not have a concussion if you did not lose consciousness.
  False. A concussion often does not result in loss of consciousness; brain injury occurs even without this.
• My child had a concussion and her pediatrician said she should take a break from playing basketball and from playing video games.
  True. After a concussion, all athletes should be restricted from physical activity until they have no symptoms both with rest and with exercise. Physical and cognitive exertion should be avoided. Activities such as doing homework, playing video games, using a computer, or watching television may worsen symptoms. A return to full activities should only occur under the guidance of a qualified health care provider and should stop if symptoms return with activities.
• A concussion can take weeks or even months to fully recover from.
  True. Symptoms of a concussion usually resolve in 7 to 10 days, but some athletes may take weeks or months to fully recover.

FOR MORE INFORMATION

American Academy of Pediatricians
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;126/3/597

INFORM YOURSELF

To find this and other Advice for Parents articles, go to the Advice for Parents link on the Archives of Pediatrics & Adolescent Medicine website at http://archpedi.ama-assn.org/.

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