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Concussions: A heads-up for parents to keep kids safe

A concussion is a mild traumatic brain injury (mTBI). Yes, a brain injury. It is not just a “ding.” The Centers for Disease Control estimates between 1.8 and 3.6 million sports- and recreation-related concussions annually among kids ages 5-18.

 

Direct impact to the head or a force to the body which moves the head violently can cause concussion/mTBI. The brain floats inside the hard protective skull. During violent head movement the brain moves, stretches and strikes the inside of the skull injuring nerve cells (neurons). Blood flow to the affected area is decreased. This leaves athletes stumbling, dazed and confused. There is no brain bleeding or bruising, so CT scans are normal.

Prevention of concussion/mTBI is extremely difficult, but rules changes and enforcement can decrease injury rates. Helmets with newer technology are not yet proven to prevent or decrease the risk of concussion/mTBI. The Kansas State High School Activities Association (www.KSHSAA.org) and Missouri State High School Activities Association (www.MSHSAA.org) have both adopted rules requiring an athlete with any signs, symptoms or behaviors of concussion/mTBI (Table 1) to be immediately removed from the game or practice and not return that same day. The athlete must be cleared by an MD or DO physician before returning to play. Legislatures in Kansas and Missouri are considering laws with similar language. The goal is to identify every athlete with concussion/mTBI and have them return to play only when safe.

 

Unfortunately, the greatest threat to the health and well-being of an athlete with concussion/mTBI is not the initial injury but rather the failure of athletes, coaches, athletic trainers, parents or physicians to recognize the injury and understand criteria for safe return to play. More than 50 percent of injured athletes report headaches, feeling slowed down, difficulty concentrating, dizziness, fogginess or fatigue. Memory problems, difficulty focusing, having to read items several times and still not remembering are also commonly reported problems. School work often worsens symptoms, leading to decline in academic performance.

 

Physical and brain rest is key to recovery. Brain rest, including limiting school and computer work, texting, reading and video games, is key to healing. About 80 percent of injured kids recover within 3 weeks, but those who do not rest their brains risk several weeks or months of symptoms. Occasionally, medication, therapy for balance and dizziness and neuropsychologic assessment are prescribed.

 

The developing adolescent brain is more vulnerable to injury than the adult brain, which is why high school athletes generally take longer to recover than older collegiate or professional athletes. But even though they are more vulnerable, young athletes are often asked to “tough it out, because it’s only a concussion.” This is a reckless and dangerous message. Returning to play before a complete recovery risks rare but catastrophic brain injury, which can lead to permanent impairment or death.

 

All athletes must meet three criteria for safe return to sport (Table 2). They must be symptom free at rest, have a normal examination—which ideally includes neurocognitive testing—and be symptom free with exertion. Not until all criteria are met should an athlete be released to play. No exceptions.

 

Parents are the best advocates for kids, and knowledge is power. Brain Injury of Kansas and Greater Kansas City, www.BIAKS.com, provides education programs and advocacy. The Centers for Disease Control and Prevention offers Heads Up for Youth Sports, http://www.CDC.gov/Concussion/HeadsUp/youth.html. The National Federation of High Schools www.NFHS.com offers information and a quiz to test your knowledge. We only have one brain. Let’s change the discussion about concussion/mTBI in Kansas City.

Signs, Symptoms and Behaviors Associated with Concussion/mTBI (adapted from CDC)

Return To Play Criteria

Lori A. Boyajian-O'Neill, D.O. is co-director of The Center forConcussion Management at Midwest Sports Medicine Physicians. She is aUSA Volleyball Team Physician, a Board Member for the Brain InjuryAssociation of Kansas and Greater Kansas City and active in efforts toprovide community-based education programs on sports concussion.

Lori A. Boyajian-O'Neill, D.O.

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