Concussions in Children
Nathan Rendler, MD
Valle Verde Pediatrics
An increasing concern seen in our office is the growing number of concussions in sports. By definition, the concussion is considered a type of mild traumatic brain injury caused by a bump, blow or jolt to the head that may or may not be associated with a loss of consciousness. At times, the concussion may also occur from a body blow that causes the head to move rapidly back and forth. The athlete often presents with headaches, dizziness, light sensitivity, weakness, lethargy and abnormal mental function, including difficulty with concentration. Unfortunately, even what appears to be a mild injury may be serious, and needs careful evaluation and follow-up. Oftentimes, since the athlete wants to return to competition as soon as possible, he/she minimize the symptoms so that the history may be unreliable, and may not provide enough of a guide as to when it safe to return to play.
Over 300,000 sports-related concussions occur each year at the high school level or below, with 60% of these injuries involving high school football players. Recently, nearly 3,000 former players and players’ family members are in the news for suing the National Football League, claiming the league knew about the dangers of head trauma and concussions and failed to disclose the risks and appropriately manage the consequences. A diagnostic challenge is that concussions are not specifically seen on x-ray, MRI or CT scan, and these tests are used primarily to rule out skull fracture or an intracranial bleed. Therefore, it is recommended that any concerning signs and symptoms be evaluated promptly by a physician.
In our office, the physician first performs a careful neurological exam to assess the extent of the injury. Complete rest for at least 48 hours after the injury is usually very helpful and may help with an overall quicker recovery. We also work closely with our clinical psychologist, Dr. Jeff Daly, who uses the most-widely accepted concussion evaluation system, called ImPACT testing. It is a standard test that has been used by many professional sport leagues, as well as amateur organizations in college, high school and even elementary schools.
ImPACT testing takes about 30 minutes to complete and measures multiple aspects of cognitive function in the athlete. It is a scientifically validated computerized evaluation system that looks at attention span, working memory, sustained and selective attention time, response variability, non-verbal problem solving and reaction time. It is most helpful when it is administered as a baseline before the concussion occurs, but it remains helpful if the results are abnormal since it may be re-administered at a later time to help determine the extent of injury and the steps needs for recovery. This helps us to improve our ability to manage the recovery process and provide a better assessment for the athlete, parents and coaches as to when it is safe to return to play.
We look forward to helping our patients recover from concussions and focus on their safety and their long term well-being. As always, prevention is the best medicine. Some helpful tips are to teach and practice safe playing techniques, and to encourage athletes to follow the rules of play and to practice good sportsmanship and avoid unnecessary harmful contact. Properly fitting protective equipment is essential and should be well maintained, fit properly and be worn consistently and correctly.
We encourage parents, coaches and athletes to work together as a team to help increase concussion awareness, leading to prompt treatment and improved safe recovery. Please contact us with any concerns you may have. We will schedule an appointment for you quickly and look forward to helping you.