Diagnosing and treating concussions in student-athletes

[Parenting NH Administrator]

By Karen Plumley

 

Boys are playing tackle football at the age of 6. Girls are out on the soccer field heading balls and suffering impact injuries before they make it to third grade. These kids are feeling the pressure and stepping up to the plate, and parents and coaches need to as well, when it comes to head injuries.

 

Risky business

For boys, the sports that carry the greatest risk of concussions are boxing, wrestling, football, soccer, lacrosse, rugby and hockey. For girls, the sports that put them at greatest risk for concussions are soccer, cheerleading, basketball, lacrosse and hockey. However, every sport and every activity will have risks of head injury associated with it.

 

According to Susan Barnard, trauma nurse at St.Joseph’s Hospital in Nashua, “Any sport or activity where protective equipment is not used properly, and there is a potential for a hit to the head is a high risk. There are some estimates that put the risk of concussion for young athletes in contact sports as high as 19 percent.”

 

William Storo, MD, FAAP, Chair of the Department of Pediatrics at Dartmouth-Hitchcock in Concord, has this advice to give to parents who are concerned that their sons or daughters might have received a concussion: “A child complaining of any symptoms of possible concussion after trauma to the head should be removed from play and should not return the same day and/or until evaluated and cleared by a provider (an MD, DO, nurse practitioner, physician assistant, certified athletic trainer) who is knowledgeable in the diagnosis of concussion.”

 

Symptoms of head injury can include any of the following:

1. Headache
2. Nausea and vomiting
3. Balance problems and dizziness
4. Fatigue, trouble falling asleep, sleeping more or less than usual
5. Sensitivity to light and/or noise
6. Irritability, emotional, sad
7. Nervousness
8. Numbness/tingling
9. Mentally foggy or difficulty concentrating and/or remembering
10. Visual problems

 

According to Dr. Storo, many children who have received concussions may be able to return to play in three weeks, but others may take months or even years to heal completely. Recovering from a head injury is highly personal, and is dependent on the severity of the impact and the individual child.

 

According to the Centers for Disease Control and Prevention there is an estimated 1.7 million traumatic brain injuries per year in the U.S., and about 75 percent are concussions or other forms of mild traumatic brain injury. Concussion awareness has definitely increased and more people are realizing the importance of reporting suspected concussions and concussion symptoms.

 

According to Susan Barnard of St. Joseph’s Hospital, “…children are getting into contact sports at earlier ages than they were five or 10 years ago, and they are playing at more competitive levels at earlier ages, putting them at more risk of concussions.”

 

Dr. Storo of DHMC in Concord said, “Youth are more susceptible [to concussions] because they have developing brains and less well-developed musculature to absorb and brace for impact. In addition, they tend to be risk-takers and feel invincible, thus are less likely to protect their heads, whether with a helmet or smarter, ‘heads-up’ play.”

 

Dr. Storo also notes that girls are more susceptible than boys. According to Storo, there may be multiple factors influencing the higher rate of concussion in girls, including: 1. They are more likely to report their concussion symptoms, 2. Their neck musculature is less well developed to help stabilize their heads and absorb an impact, and, 3. There are hormonal factors that make the brain more susceptible to injury.

 

It’s the law

On Aug. 17, 2012, the Youth Concussion Law went into effect in New Hampshire, making this state the 39^th to enact such a provision to protect high-school student athletes who may have received a concussion.

 

According to the law, teens must be removed from play immediately if a concussion is suspected and cannot return to the game or to play until such time as a medical professional clears them to do so. Also, parents must provide their permission in writing to the sports organization before a child will be allowed to play. Unfortunately the law does not require coaches, athletes or parents to be educated on the dangers of concussions annually, as is legislated by the National Football League. Luckily, there are many educational resources online available for parents and coaches.

 

Good coach, bad coach

Parents today need to take a serious look at the sport they have decided to put their child into. And a huge part of the decision should be a thorough evaluation of the coach, as well as the youth sports organization itself.

 

Brian Frechette, Director of Rehabilitation Services for Elliot Health System and a youth sports coach in the Pelham Outlaws Lacrosse organization explained: “Assessing a youth sports coach is hard as a parent. As a parent of kids in contact sports, there is always a concern that the coach has the child’s best interest in the proper perspective, that is, ahead of winning. Thankfully, there has been a strong evolution of coaching knowledge with respect to head injuries and overall player safety in the last decade.”

 

“Many organizations, such as U.S. Lacrosse, have in-depth educational programs that stress safety and sportsmanship,” he said, “and also educate coaches about safety with respect to head injuries and other concerns. While coaches are often the key link to your child’s participation, it may actually be better to evaluate your child’s sports organization(s), as they set the policies and training requirements for their coaches, and as such, determine the level of significance that their coaches place on injury prevention and management.”

 

Does equipment matter?

Dr. Storo of DHMC said there is no equipment that truly protects against concussions.

 

“Helmets are best at protecting against skull fractures (especially in skiing and snowboarding), which dramatically reduces moderate to severe traumatic brain injury due to intracranial bleeding often associated with skull fracture. Well-fitting and certified helmets help protect against such injury. They have some benefit in absorbing impact and perhaps reducing the severity of brain injury, though concussions are still sustained wearing helmets.”

 

“Companies, like Riddell, have made tremendous strides in their technology, and they have developed equipment that better deflects force and disperses the energy absorbed in the impact to the helmet. These are great advancements as they have improved the overall safety of sports equipment,” Frechette said.

 

However, Frechette concurrs with Storo, saying that helmets simply do not prevent concussions. “While expensive helmets may deflect the forces better, the challenge is the inherent problem of the brain hitting the skull in a head collision, and helmets cannot truly eliminate this.”

 

Testing for concussion

According to Susan Barnard of St. Joseph’s Hospital, the ImPACT test is the biggest “buzz” in recent concussion management.

 

“This is a test geared for ages 11 and older. It is ideally taken prior to a sports season, and then retaken if necessary after a concussion has occurred in order to compare the baseline with the post concussion test. The purpose of this test is to help decision making for when the child should return to playing their sport,” she said.

 

Barnard notes that parents should be very impressed with any coach who recommends his team members take the ImPACT test prior to the season.

 

The ImPACT test is great for those who have a baseline to measure by, but for those that don’t, there really isn’t much in the way of conclusive testing to determine whether a child has sustained a concussion. Nothing shows up on an MRI or CT scan, unless there is actual bleeding involved. Therefore, parents and coaches are encouraged to listen to their children to determine if symptoms are in line with a possible head injury. If so, there is no reason why that child needs to return to the game.

 

Karen Plumley is a freelance writer and mother of two from Pelham. She can be reached at [e-mail].

Image courtesy of Shutterstock.com.