Proper evaluation and treatment of head injuries is crucial for kids’ well-being.
By Wendy Thomas
What parent has not rushed their child to the doctor's office after they hit their head? Most of the time the large bump that appears requires not much more treatment than a cold compress and a lot of TLC, but sometimes those blows can result in more significant and worrisome damage.
Studies are finding that trauma to the brain, especially in children, if not recognized and managed properly, can result in significant and sometimes permanent damage. Although the majority of children who experience a concussion are likely to recover, an as yet unknown number of these individuals may experience chronic cognitive and neurobehavioral difficulties as a result of recurrent injury.
With advancements in medicine and science, the days of clearing someone after a blow to the head if they can tell you what day of the week and who the president is are gone.
Kids are more active in the summer and the opportunity for brain trauma increases with each skateboard, bike or rollerblading trip. It's not possible to protect them at all times so what can we, as parents, do to reduce risk of injury to our kids, and if they get injured how can that injury be properly managed?
A properly fitting helmet is of course your first defense against injury. But brains can still be injured even when a helmet is worn. The best way to protect your child is through education and knowing what the signs of a concussion are.
According to Dr. Michael Sparks, M.D. Dartmouth Hitchcock Medical Center, a concussion is a brain injury caused when the head hits an object or an object strikes the head. Sports activities, falls and car accidents are the most common causes of concussion. Headaches and loss of consciousness are some of the symptoms.
Seek immediate medical attention and call 911 if you or someone you know shows signs such as: · Repeated vomiting · Unequal size of pupils · Mental confusion or going in and out of consciousness · Seizures · Weakness on one side of the body · Inability to wake up (coma)
“The problem with the youngest kids is that often they can't verbalize how they are affected by a traumatic event.” said Chris Nowinski, Co-Director for the Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine. “What happens in a brain during a traumatic event doesn't correlate with what you can see. A concussion needs to be evaluated on a clinical, functional and metabolic level. Using multiple criteria, physicians can then make an educated guess on the severity of the damage.”
“We need to take precautions. Some kids can take tons of hits but others can't. Everyone is different.” Nowinski added.
One of the ongoing problems has to do with teams such as youth football where there is no athletic trainer or team doctor on board. On these youth teams, especially with younger children, often kids are encouraged to hit and to hit hard. Spectators applaud the aggression and parents are pleased: their kids are tough, heck, if they play hard enough it might even mean a scholarship for them down the line.
“We need to change the culture so that we can recognize concussions. With regard to kids in contact sports, I'm not saying that everyone has to get out of the pool, but I am saying we need to take care of our kids; they have one brain for the rest of their lives.” said Nowinski.
No one can predict when a concussion will occur but focus has recently been put on high school-level contact sports, such as football, lacrosse, hockey, skiing and soccer where the rate of brain trauma from impact can run as high as 12 percent.
Persistent symptoms, called Post-Concussion Syndrome, may include chronic headaches, fatigue, sleep difficulties, personality change (e.g. increased irritability, emotionality), sensitivity to light/noise, dizziness when standing quickly, and deficits in short-term memory, problem solving and general academic functioning.
In addition to Post-Concussion Syndrome, suffering a second blow to the head while recovering from an initial concussion can have catastrophic consequences as in the case of Second Impact Syndrome, which has led to permanent injury and even several deaths over the past decade.
To protect their contact sport athletes some New Hampshire schools have started using tools such as ImPACT 2005, which is a user-friendly, Windows-based computer program that can be administered by a team coach, athletic trainer or physician with minimal training.
The result of the testing provides a baseline. If an athlete then gets injured during the competitive season, retesting can be done to aid in the evaluation of any brain dysfunction.
"This program gives us one more piece to the puzzle for evaluation" said Stuart Glassman, M.D. of Granite Physiatry, who has been associated with the ImPACT program since 2009. "Treating a brain injury is not like treating an ankle or knee injury. There can be long-term implications."
"When we treat these athletes, we work with the athletic trainer, the school nurse, the athletic director and the guidance counselors. It’s a whole package. Any athlete with a brain injury needs to have a graduated return to the sport. Once an athlete is symptom-free, based on testing, only then can they begin a standardized return to exercise protocol."
Recognizing that standardization of treatment is needed, the New Hampshire State Advisory Council on Sport's Related Concussion, created to provide guidance on concussion management, issued a statement in 2010 to guide the creation and implementation of a best practice model for sport-related concussion management including safe return to sports and return to school.
The document aims to educate coaches, parents, athletes and physicians in the recognition of brain injury and subsequent treatment of their athletes. It outlines standardized procedures for: signs and symptoms of concussion, concussion grading scales, multiple concussions, second impact syndrome and the role of baseline testing in the management of concussion.
Val Bucher, the athletic trainer at Alvirne High School in Hudson for the past four years, was originally introduced to the ImPACT program while a student at University of Southern Maine where it is standard for all the high schools to have a program like this. When asked about success stories with the program she responded that "to be fair, any child that participates in athletics and receives a concussion and is able to return safely is a success story."
"I think that this program, since being fairly new to the primary care doctors in the area, has started to make the family physicians more aware of concussions in sports." Bucher said. "The NATA and neurologic standards for adolescents are that the athlete should not return to sports until they have been completely symptom free for seven days. Here at Alvirne I also put them through a physical exertion test to see if their symptoms come back with stress. If they are cleared with the MD and my physical test they are then released slowly back to play."
"More parents and athletes need to be aware of what a concussion is and how to take care of someone with one. The old standards are out, but many people/parents are unaware of the consequences if a concussion is not taken care of properly and their child is returned too early after having received one," Bucher said.
The Impact program costs about $2 per athlete and provides 1,000 baseline tests and 100 post injury tests.
"Think of it as an insurance policy, Glassman said. “It’s not effective until you need it, but when you need it, boy, is it effective. Kids can be treated without a baseline but the more information you have before they get hurt, the more you have to work with in order to treat them correctly and to avoid future injury.”
To find out more about the ImPACT program, or to find a certified physician, go to www.impacttest.com. The Concussion Council Consensus Statement Version 1.1-January 2010 document can be found at the NHIAA website: www.nhiaa.org
Wendy Thomas lives in Merrimack with her husband and six children, and has been published in various regional magazines and newspapers. Check out her blog, Simple Thrift-Creative Living on Less, at http://simplethrift.wordpress.com.