Concussions:
When in Doubt, Sit ‘em Out!
by Suzanne Koup-Larsen
Concussions happen more than we think they do,” says Rebecca King, school nurse at Brandywine Springs Elementary School in Wilmington, DE. Most people believe that concussions occur when someone receives a blow to the head that causes them to lose consciousness. “Just because a person doesn’t black out doesn’t mean that he hasn’t sustained a concussion,” says John Laird, athletic trainer at Cherry Hill High School West in Cherry Hill, NJ. Sports concussions don’t just occur in high school football. They’re also common in activities such as bicycling, horseback riding and sledding.
Of the estimated four million U.S. concussions each year, doctors treat only one million. According to Alexis Chiang Colvin, MD, a fellow at the University of Pittsburgh who researches childhood concussions, as many as 90 percent of concussions go unreported.
Often coaches, parents, and students don’t recognize the symptoms when kids have a concussion, assuming they merely “had their bell rung,” or just “got some cobwebs knocked loose.” Not treating a concussion seriously is dangerous because if a second head injury occurs before the cocussion has healed, it can be more severe with longer-term consequences.
Sports concussions
Concussions account for 6 percent of all sports-related injuries among kids aged 5-18. For boys, the organized sport in which the most concussions occur is football. For girls, it is soccer. The leading sports and activities for concussions in ages 5- 18 are:
• Bicycling
• Football
• Basketball
• Playground activities
• Soccer
What is a concussion?
A concussion is a mild traumatic brain injury caused by a blow to the head that makes the brain move within the skull. Concussions are not defined by level of consciousness or brain swelling. They cannot be diagnosed or detected by MRI or CAT Scan. Rather, they are injuries that change how the brain normally works at a cellular level.
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Symptoms Unconsciousness or reduced consciousness “is one of many symptoms,” says local athletic trainer Julie Knowles. Symptoms include:
Symptoms typically appear immediately after the injury, but sometimes they can be delayed in appearing, especially vomiting or severe fatigue. Symptoms can last for weeks beyond the original injury. |
When can I play again?
Concussion “isn’t an injury you should play through,” says James M. Callahan, MD, medical education director at the Children’s Hospital of Philadelphia Emergency Department. “Rest is probably the thing that’s going to get them better the fastest.” It is imperative to give the brain time to heal from a concussion before returning to previous activity levels.
Medical experts suggest the following recovery schedule, assuming that no symptoms return:
• Day 1: Rest
• Day 2: Low aerobic activity, such as walking around or stationary bicycling
• Day 3: More aerobic activity, such as running
• Day 4: Some (non contact) sports drills may be incorporated
• Day 5: Return to practice
• Day 6: Okay for game play
If symptoms recur on any of these days, the child must remain at that level until symptom-free. Get clearance from a health professional before
returning to sports play. Some concussions may take weeks to heal fully. According to Dr. Callahan, most kids recover from concussions in 7-14 days, but it’s unpredictable. “You have to wait to see how the symptoms evolve,” he says.
Due to problems with memory and concentration, some children may require a reduction in academic assignments until their brain fully recovers. According to Dr. Colvin, an attempt to concentrate on schoolwork can exacerbate concussion symptoms.
Dangers grow after first concussion
In the short term, concussions can lead to problems with memory and concentration, which can cause academic difficulties. In addition, personality and mood changes can result, resulting in irritability or behavioral problems.
“With appropriate care, there are no long term effects from a single concussion,” says Dr. Callahan. However, a second concussion before the first has healed can lead to Second Impact Syndrome. This brain injury can be more significant, even if the blow to the head is not as forceful. “It doesn’t take much impact to get the same or greater symptoms after you’ve already had concussions,” says athletic trainer Julie Knowles.
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What's Being Done? Heads Up, a program of The U.S. Centers for Disease Control and Prevention in partnership with the Children’s Hospital of Philadephia, promotes awareness of concussions among coaches, student athletes and parents with a campaign called Heads Up. Fact sheets about concussion symptoms and management are available at the Heads Up website, www.cdc.gov/concussioninyouthsports ImPACT, a computerized test used widely in the National Football League, provides a tool for coaches and trainers to help diagnose concussions on the playing field. This test uses memory and reaction time tests administered on a laptop computer to see if athletes are demonstrating deficiencies. The results are compared to a baseline that has previously been established for that athlete. A deficit can signal that a player needs to sit out and seek further medical attention. www.impacttest.com Other resources: Brain Injury Association of America, www.biausa.org, has Delaware, New Jersey and Pennsylvania chapters. Brain Injury Association of NJ offers an information website, www.sportsconcussion.com. |
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