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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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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Sleep and Emotional Health

Sleep can have a large impact on a person's emotional health and vice versa.

The relationship between disordered sleep and emotional health is an intricate one, as each can influence the other for better and worse. Stress and worry, as well as mental illnesses such as depression and anxiety can interfere with sleep. And an abundance of research indicates that people who experience disrupted sleep, including obstructive sleep apnea and insomnia, are at dramatically elevated risk for depression and other psychiatric disorders. Insomnia is an important risk factor for depression, and has also been linked to a sharply increased risk of suicide among people who suffer from depression. Despite all that we know about this complicated relationship, scientists are still working to understand the underlying mechanics and root causes of sleep disorders and mood disorders when both are present.

A new study provides some important new information about how disrupted, insufficient sleep may contribute to the onset of emotional difficulties as well as the development of depression and other psychiatric problems. Researchers at the University of Pittsburgh School of Medicine investigated emotional responses in the brains of people with insomnia and found dysfunctional activity in an area of the brain that regulates and processes emotions. Their findings may provide an explanation for the mechanism by which disrupted sleep influences depression and other psychiatric conditions.

Researchers included 44 adults in their study. Of these, 14 had chronic insomnia, and no other primary psychiatric disorders. The remaining 30 participants were people who had no insomnia and who slept well. All of the study subjects participated in the same exercise, a task involving voluntary emotional regulation. First, participants were shown a series of images containing both negative and neutral emotional content. They were asked to view the series of images passively, without trying to control or influence their emotional responses. When they were shown the images a second time, participants were asked to decrease their emotional response using a voluntary emotional regulation technique called cognitive reappraisal. Cognitive reappraisal involves the deliberate attempt to change your emotional response to a stimulus. In this case, participants were asked to intentionally decrease their negative emotional responses to the images shown to them. Researchers’ analysis showed:

• A distinct difference in the brain activity of those with insomnia compared to those with normal sleep patterns. Specifically, researchers found a dramatic difference in the activity of the amygdala, a cluster of neurons within the temporal lobe that plays a critical role in processing and regulating emotion.
• Amygdala activity was significantly greater for those with insomnia during the period when they were asked to decrease their negative responses to images using cognitive reappraisal, compared to those without the sleep disorder.
• There was no significant difference between insomnia and non-insomnia participants during their passive viewing of the images.

Previous research has shown that cognitive reappraisal decreases amygdala activity.These results, which show the opposite, suggest that insomnia may impair the brain’s ability to successfully process negative emotions, a finding that could help to explain the mechanics of how sleep contributes to depression and other psychiatric disorders.

Other recent research has demonstrated evidence of neural changes and emotional regulation difficulties among people with disordered, insufficient sleep:

• The ability to accurately judge emotion in human faces is compromised by sleep deprivation, according to research conducted at the University of California, Berkeley. Researchers measured the ability to read emotions in faces by people who were sleep deprived in a laboratory setting, and found significant impairment to their assessment of certain emotions, including anger and sadness. The impairment was particularly significant among women. The decrease in this ability was alleviated after a night of recovery sleep.
• Researchers in the United Kingdom examined how sleep deprivation affects inhibition and impulse control. They found a night of sleep deprivation lowered inhibition and increased impulsivity to negative stimuli.
• In responding to a series of images categorized as pleasant, neutral, or unpleasant, people who were sleep deprived perceived the neutral images more negatively than those who were not sleep deprived. Those who were sleep deprived also demonstrated more negative moods.
• Sleep deprived patients were more highly reactive to both negative and positive stimuli, showing greater levels of activity in the limbic regions of the brain, where much of the work of emotional regulation and processing occurs.

The latest research findings add to the growing body of scientific knowledge indicating that sleep problems cause dysfunction in the brain that may contribute to emotional difficulties and psychiatric conditions. This is an exciting and important area of research, as scientists continue to explore the biological roots of both sleep disorders and psychiatric disorders.

All of us who’ve experienced insufficient, disrupted sleep know first-hand how being sleep deprived can negatively affect our emotional equilibrium. When we’re tired, we’re more likely to be short-tempered, impatient, and moody. Research such as this brings us closer to understanding the mechanics that may underlie a broad range of emotional disturbance and dysfunction.

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