As students head back to school, fall sports are getting into full swing. This is the time for parents to become educated about concussions. Concussions occur most commonly in football and girls’ soccer, but they can occur in any sport or even during normal daily activities.
Experts define concussion as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Stated more simply, it is a force that causes injury to the brain that leads to a disruption of the normal function of brain cells. The effects on the brain cannot be seen on x-ray, MRI or CT scan. Because of this, there is not a single test that can be done to tell if an athlete has had a concussion. Physicians have to rely on symptoms and evaluation of how different parts of the brain are working and thinking to make a diagnosis. That is why it is important for athletes, parents, coaches and trainers to be able to recognize the symptoms of a concussion.
Symptoms can be dramatic, such as passing out or disorientation. However, often they are less obvious. Headaches, sensitivity to light or noise, blurry vision, trouble concentrating or sleeping, or irritability can all be signs that an athlete has a concussion. Dizziness, neck pain, nausea, problems with balance, fatigue, irritability, anxiety or moodiness are also reported by concussed athletes.
If there is a concern that an athlete has sustained a concussion, Florida law mandates that he or she be removed from activity until evaluated by a medical professional. This often makes athletes reluctant to report their symptoms because they do not want to come out of a game or practice. It is important for parents and coaches to remind athletes of the symptoms of concussion and encourage them to report them immediately. The sooner they start the recovery process, the sooner they will be back to playing at 100 percent.
It is important that children and adolescents suspected of having a concussion be evaluated by a medical professional who has experience in concussion management. During the evaluation, the doctor will ask your child about the symptoms he or she is having. The physician will usually also evaluate things such as memory, concentration and balance. Other computerized tests, such as the ImPACT, can aid in the evaluation of things such as reaction time, attention span and problem solving.
Although pediatricians sometimes use medications to help with concussion symptoms that involve headache or sleep, the best treatment we have for concussion at this time is rest. Patients need to rest the brain to give it a chance to heal. This includes physical rest and cognitive rest.
Physical rest is easy to understand. Athletes should not participate in any sport activities and should limit physical activity to only what they need to do to get around the house or school while they are recovering. Cognitive rest can be harder to achieve. Students can attend school if they are able and their pediatricians say it is safe. But accommodations such as allowing concussed kids to go to the nurse and rest if they do not feel well, reducing homework or allowing them to make up projects and tests after they have recovered can be helpful. Parents should discuss with their doctor which accommodations would be appropriate and then advise teachers of the doctor’s recommendations.
Athletes also need to limit screen time, including computers, TVs, video games and phones. This includes reading from print if it makes their symptoms worse.
With appropriate rest, most athletes are symptom free in about seven to 10 days. However, this is quite variable, and younger children tend to take longer to recover. Once an athlete has had the appropriate amount of rest and is symptom free, they can be cleared to begin a progressive return to play. He or she will advance from light activity back to full participation over a minimum of five days or longer based on many factors, including an athlete’s age, symptoms or previous concussion history.
A lot of research is being done to find ways to prevent concussions and to look at the long-term effects of concussions. Right now, there is no evidence that any special helmets or headbands can prevent a concussion. The best way to keep athletes safe is to know the signs of a concussion, remove athletes from play if they have sustained a concussion and ensure that their recovery and return to play are managed by someone who is knowledgeable about concussions.
Carolyn Kienstra, M.D., is a pediatrician at UHealth –University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.