Your concussion questions answered... | |
Q:How many concussions can my son sustain before he should stop participating in high risk activities such as contact sports?
Unfortunately,
there is no “magic number” for
concussions. Some athletes can
have several concussions without ever
needing to retire while other unlucky
athletes have to retire after just one
concussion. We know each
concussion makes an athlete more likely
to have another one in the future.
We also know that athletes with multiple
concussions tend to have symptoms longer
than athletes that have never had a
concussion. We get very
concerned when athletes that have a
history of several concussions start
having: · Concussions that happen after smaller and smaller blows to the head · Increasing number of symptoms · Increasing severity of symptoms · Increasing duration of symptoms When we see this pattern, we may recommend that an athlete consider changing sports or retiring from contact sports entirely. Athletes that have had more than one or two concussions should consider seeing a specialist to discuss these issues. |
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Q:My teenage daughter was playing basketball and collided with a teammate. They bumped heads under the basket and seemed stunned at first, but neither of them lost consciousness. My daughter seemed a little slow after that but both girls said they were fine. Should I be worried? Collisions occur frequently in sports, especially girls' basketball, and we need to do a better job recognizing them when they occur. It is important to watch athletes that have been involved in collisions for developing signs and symptoms of concussion. We know that less than 10% of concussions involve any loss of consciousness so we have to be aware of other, more subtle signs like headache or confusion. Many athletes, including teens, are unfamiliar with other important symptoms of concussion such as sensitivity to light or noise, balance problems, etc. If you, or anyone, is concerned that your daughter may have suffered a concussion, she should be removed from play immediately, evaluated with a sideline assessment, like a SCAT 2, which should include an exertional challenge. It's important to observe the athlete after the collision as some symptoms don't show up right away. If she feels well, does not have any symptoms, and performs well on her sideline testing she can return to the game if cleared by the sideline medical staff. Remember, when in doubt, sit them out. CDC Heads Up to Schools: Know Your Concussion ABCs for additional information and downloadable materials for school nurses and other school personnel.
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Q:It's not uncommon for students who have suffered concussions to return to school with headaches and other symptoms. Should they stay out of school until they are completely symptom-free? They typically want to return so they don't fall behind. In general, we prefer to have student-athletes get back to school as quickly as possible even if it requires a modified schedule. One solution is to make use of easy changes to avoid the athlete’s main symptoms. We often suggest shortened school days, decreased homework, frequent breaks during class, and extended test-taking time. If the symptoms are too severe and the athlete simply cannot attend school successfully, we do recommend that the student-athlete stay home temporarily. If you have a student that is having difficult returning to school after a few days, I would recommend that they see a physician. CDC Heads Up to Schools: Know Your Concussion ABCs for additional information and downloadable materials for school nurses and other school personnel
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Q:Why are girls more at risk for concussion than boys, statistically speaking? A: Dr. Scott Laker Seattle Sports Concussion Program
We know that
female athletes have
more concussions than
male athletes even when
playing the same sports.
Several studies suggest
that females have more
symptoms immediately
after their injury and
have longer overall
recovery times than
males. While no
one knows for sure why
this happens, there are
several possible reasons
that could be behind
these differences.
Gender roles still
play a part when and if
males try to “play
through the pain” or
minimize their symptoms
in order to show their
toughness. We do feel
that there is something
beyond gender roles that
may be causing these
differences.
One possible
explanation is that the
presence of estrogen in
females is a factor in
slow recovery. The
mechanical differences
in head and neck size
and overall neck muscle
strength differences
between males and
females may have a role
to play. Males and
females also have
differences in blood
flow and energy uptake
in the brain that may
affect their initial
symptoms and overall
recovery times.
A review of this
topic titled
The Female
Athlete: The Role of
Gender in the Assessment
and Management of
Sport-Related Concussions is being published in early 2011 by Dr. Tracy
Covassin.
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Q:Many times it's the athletes who first realize something is wrong, that one of their teammates is not acting quite right in the huddle or on the bench. Can you address the importance of alerting a coach or another adult immediately? A: Ann Whitley, PhD Sport Psychologist, University of Alaska, Anchorage The coach has to have the leadership skills to instill in every member of the team the understanding that health and well-being are everyone's number one concern. This is important because young people have their own code about what they sometimes may think is “snitching.” Coaches must dedicate training time to team building, health education and symptom identification, particularly with head injuries. A safety plan must be in place for the entire team that is both smooth and immediate. For example, all adults involved with the organization should be considered safety officials for every athlete on that team. If everyone knows what to do ahead of time and procedures are in place before an injury occurs, the chances of a good outcome are dramatically increased. Training for athletes could include information regarding the dangers of not reporting an injury and student-athletes, coaches, and parents should be required to complete a pre-season safety education program. If everyone is involved the pressure is on the adults, not the athlete to follow through. The most important objective is building trust so that the youth athlete knows he is doing the right thing by reporting an injury, either his own, or his teammate's.
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Q:Could concussions have contributed to the recent suicides of three young athletes? A: Chris Nowinski, CoDirector, Center for the Study of Traumatic Encephalopathy, Boston Univ. Medical Center There's no way to know for sure at this time. Suicide is extremely complex. In addition, it would be impossible in a single case to link suicide to a brain injury or brain disease. However, there have been a number of recent suicides among confirmed CTE (chronic traumatic encephaolopathy) victims, and the two high school football players who committed suicide after suffering concussions this year is concerning. Having suffered concussions and post-concussion syndrome, I am certain that you aren’t your “usual self” for a period of time after a concussion, and it is clear from research that your brain is not functioning normally. We need to explore this link further, as there may be opportunities for prevention.
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Q:Do mouthguards prevent concussions? A: Dr. Scott Laker Seattle Sports Concussion Program
The most recent
systematic review on
this topic (Br
J Sports Med
2009;43:i56-i67)
basically states that no
strong evidence exists
to suggest that mouth
guards prevent
concussions. The
studies on mouth guards
are of variable quality,
use different
definitions of
concussion, and
represent a very small
number of athletes.
There are several mouth
guards on the market
that claim to prevent
concussions but there is
no high-quality data to
support those claims.
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Q:I am concerned about radiation exposure from a CT scan, and if most CTs and MRIs are negative for concussion, how do the doctors decide who needs one? A: Dr. Scott Laker Seattle Sports Concussion Program
As you mentioned,
imaging in concussions
is almost always
negative and doesn’t
often help guide the
athlete’s treatment
plans. CT scans
and MRI’s don’t “rule
in” concussions but they
do “rule out” more
serious intracranial
bleeds and other less
common brain diseases
that may mimic
concussion symptoms.
CT scans are
usually ordered as part
of an emergency room
workup for patients that
may have bleeding inside
of their skulls.
These bleeds are rare
but can be extremely
serious and may require
surgery. After the
first few days, CT scans
have less of a role in
concussion management.
MRI’s are usually
ordered in outpatient
clinics once emergency
problems have been ruled
out.
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Q:If all the doctor is going to tell us to do is rest after a concussion, why should I schedule an appointment for my child? A: Dr. Scott Laker Seattle Sports Concussion Program
Concussions are a
serious injury to the
brain. Thankfully,
the majority of these
injuries heal quickly
and don’t cause any
permanent issues.
Most families benefit
from sitting down with
an experienced
healthcare provider to
learn more about the
condition and to have
their questions
answered.
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Q:As a coach, I remove any athlete that I think may have suffered a concussion, from practice or a game. But how do we decide when to call an ambulance? We don't have medical help on the sideline. A: Dr. Scott Laker Seattle Sports Concussion Program Here are some important guidelines for deciding who should be transported to the hospital by ambulance, NOT mom/dad's vehicle. Any athlete who exhibits:
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Q:My son suffered a concussion and can't remember the play that caused his injury. Should we ever expect him to remember what happened, and is this memory issue indicative of the severity of the injury or his recovery outcome? A: Dr. Scott Laker Seattle Sports Concussion Program This problem with
the memory around the time of the
injury is known as post-traumatic
amnesia (PTA) and is a very common
symptom after concussions.
Essentially, the trauma that caused
the concussion temporarily causes
the brain not to be able to create
or store memory. This “blind
spot” in the athlete’s memory may
take weeks to months to fill in, and
in many cases, it never returns.
There is also retrograde amnesia
(RGA), which is difficulty
remembering the events that happened
before the concussion. The RGA
and PTA both tend to shrink and the
athlete tends to remember more and
more around the time of the injury.
Athletes may never fully regain
those memories, but it is not a sign
that the brain has not recovered.
Neither RGA nor PTA are considered
“symptoms” for recovery or
return-to-play issues. |
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Q:My 14-yr-old daughter has not played soccer for three weeks due to a concussion. She is more moody and irritable than normal. Can a concussion actually cause these symptoms? I know she's frustrated. A: Dr. David Coppel Seattle Sports Concussion Program Along with physical and cognitive symptoms associated with concussion, athletes can also experience emotional symptoms, which often involve some moodiness and irritability. In some cases, concussed individuals just feel more emotional in general or their emotions are "closer to the surface." Because these symptoms can be common to teenagers pre-injury, the description of the athlete being more moody and irritable than normal, is the key.issue. Some concussed athletes are able to self-report these symptoms, but in some instances, parents and other available observers may have important input about these symptoms. It is also important to note that for some athletes, their sport involvement is an outlet for their stress and a strong structure for their identity and social interactive lives, and thus, the loss of that activity for an extended period of time can produce some of these emotional symptoms. Many concussed athletes do not experience or endorse depression per se, but will describe being frustrated, disappointed, or impatient (with being concussed and the recovery process).
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Q:How many concussions can my son sustain before he should stop participating in high risk activities such as contact sports? A: Dr. Scott Laker Seattle Sports Concussion Program
Unfortunately,
there is no “magic number” for
concussions. Some athletes can
have several concussions without ever
needing to retire while other unlucky
athletes have to retire after just one
concussion. We know each
concussion makes an athlete more likely
to have another one in the future.
We also know that athletes with multiple
concussions tend to have symptoms longer
than athletes that have never had a
concussion. We get very
concerned when athletes that have a
history of several concussions start
having: · Concussions that happen after smaller and smaller blows to the head · Increasing number of symptoms · Increasing severity of symptoms · Increasing duration of symptoms When we see this pattern, we may recommend that an athlete consider changing sports or retiring from contact sports entirely. Athletes that have had more than one or two concussions should consider seeing a specialist to discuss these issues.
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Q: My teenage son has had multiple concussions but has been symptom-free for 9 months. Can we assume his brain has fully healed and permit him to play contact sports again without worrying about "Second Impact Syndrome"? A: Dr. Scott Laker Seattle Sports Concussion Program Second Impact
Syndrome (SIS) is a devastating result
of a second concussion that happens
before a first concussion has fully
healed. It causes massive brain
swelling and results in death or severe
disability. SIS can happen weeks after
the first concussion. This is one of
the main reasons why doctors recommend
that no athlete should return to sports
before the symptoms of their concussion
have completely resolved. Once an
athlete is symptom-free, we have them go
through
several days of exercise trials
before returning to practice or play.
This makes sure that the athlete is safe
to return and that we can prevent SIS. |
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Q: How can I make sure that my doctor is knowledgeable about current return-to-play guidelines? I don't want my daughter cleared too early. A: Dr. Scott Laker Seattle Sports Concussion Program Most doctors’ office staff will know exactly what their doctors specialize in. Ask them before you schedule your appointment if the doctor takes care of concussions frequently. Once you are at your appointment, feel free to ask how many concussions your doctor manages, how they manage them, and how they make their decisions for return-to-play. You should hear answers that involve a stepwise return-to-play and never allow a symptomatic athlete to return early. However, if your athlete has had multiple concussions or has severe or long-lasting symptoms, I recommend that they see a doctor that specializes in sports concussions. |
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Q:I'm a coach and one of my players was cleared by his doctor, but I've heard from others that he still has headaches. What should I do? A: Dr. Scott Laker Seattle Sports Concussion Program
This is a tough position to be in
for any coach. You know your athletes
better than anyone and have a clear
decision to make. If you are concerned
that the athlete is still having
symptoms, sit them down and ask them
exactly what they are feeling. Be
specific and make sure that they are
totally symptom-free before putting them
back in the game. If they are still
feeling sick, then do not return them to
practice or play. If you need
clarification, ask the athlete’s parents
to have the doctor contact you to
discuss the case. No doctor wants to
return an athlete if his or her coach
thinks they aren’t ready and should be
happy to talk with you once they get
permission from the parents. If you are
still concerned, sit the athlete out and
recommend a second-opinion before
returning them. It’s the right thing to
do and it will make sure you and your
team have a healthy season. |
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Q: My high school does not have a concussion policy and we do not have a state law either. What can I do to ensure that athletes are properly cared for? It is great that you are working to keep your athletes safe this season. The most important thing that any school can do is to make sure that the athletes know the symptoms of concussion and report them to their coaches or trainers immediately. At that point, the athlete should be removed from play or practice and not return to sports until symptoms resolve. When in doubt, sit them out. You can also work to find a doctor in your area that specifically takes care of athletes with concussions. This may be a physiatrist, neurologist, orthopedist, or pediatrician. Your family doctor or team physician is a great person to ask for a recommendation on a doctor in your area that can help take care of your athletes with concussions. The CDC just released a new concussion video for coaches which would be of great value, particularly in schools where there might be limited information. Coaches, parents, and athletes should be encouraged to view the program and distribute the accompanying free, downloadable CDC materials to all concerned. Education really is the key to protecting your athletes, along with the other avenues I mentioned. Keep up the good work. |
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Q: Now when I watch my 9-yr-old daughter play soccer I am concerned that she will suffer a concussion and I won't know it. Are the symptoms different in younger children than in high school athletes? Recognizing concussions on the field can be challenging, regardless of age. The symptoms of concussion are similar in young athletes and older athletes. It is important to remember that our younger athletes might not recognize that something is wrong. An athlete is having balance problems, confusion, or is simply not “acting like themselves” should be removed from practice or play and evaluated. For that reason, we recommend our coaches and parents be even more careful with younger athletes |
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Q:It's not uncommon for students who have suffered concussions to return to school with headaches and other symptoms. Should they stay out of school until they are completely symptom-free? They typically want to return so they don't fall behind. (submitted by school nurse) In general, we prefer to have student-athletes get back to school as quickly as possible even if it requires a modified schedule. One solution is to make use of easy changes to avoid the athlete’s main symptoms. We often suggest shortened school days, decreased homework, frequent breaks during class, and extended test-taking time. If the symptoms are too severe and the athlete simply cannot attend school successfully, we do recommend that the student-athlete stay home temporarily. If you have a student that is having difficult returning to school after a few days, I would recommend that they see a physician. CDC Heads Up to Schools: Know Your Concussion ABCs for additional information and downloadable materials for school nurses and other school personnel
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Q: What happens inside the brain when a concussion occurs, and what are we waiting for as the brain heals? A: Dr. Stanley Herring Co-Medical Director, Seattle Sports Concussion Program
Essentially, it’s
a mismatch of supply and demand.
The brain cells need energy to repair
themselves during a time when they can’t
get enough. These changes that
happen during concussions occur at the
cellular level. While the brain
tissue itself appears completely normal
on MRI or CT imaging, the brain cells
are not functioning properly.
After the initial hit that causes the
concussion, there is a release of
neurotransmitters that cause ions to
move in and out of the brain cells
abnormally. Calcium rushes in
while potassium rushes out of the cells,
disturbing the balance of electrical
charges. The brain cells have to
work very hard and use a large amount of
energy to restore their normal balance.
At the same time, there is a decreased
blood flow to the brain, limiting the
cell’s energy supply. It is this “energy
crisis” is why the brain is so
vulnerable when an athlete is concussed.
What are we
waiting for as healing takes place? The
management of concussion is largely
keeping the athlete safe while the
supply and demand mismatch resolves.
The majority of athletes resolve over
the course of 1-2 weeks but some
athletes may take months to completely
recover. There are a number of
factors that seem to influence recovery
time including past medical history,
previous concussions, age, etc. It
is vital that athletes do not return to
play while still having symptoms of a
concussion. |
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A: Dr. Gerard Gioia Chief, Division of Pediatric Neuropsychology, Children's National Medical Center, Wash DC Computerized baseline neuropsychological tests can work but only if handled properly by the appropriately trained personnel. It is important to recognize several important points: (1) Do not be fooled by the apparent “ease” of this testing simply because it is delivered on a computer. They are complex cognitive measures that must be handled properly. (2) The tests must be properly administered by trained testers, and taken seriously by the student-athlete to obtain valid findings. (3) The tests are only one part of the post-concussion clinical exam. Symptom assessment, assessment of balance, and response to cognitive and physical exertional activities must also be considered. (4) The interpretation of the neuropsychological test findings is a complex process, and should include a well-trained neuropsychologist at the very least as a consultant to the school district.
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Q: My teenage daughter was playing soccer and collided with a teammate. They bumped heads, both were knocked to the ground, but neither of them lost consciousness. My daughter was a little slow getting up but both girls said they were fine. Should I be worried? A: Dr. Scott Laker Seattle Sports Concussion Program Collisions occur frequently in sports, especially soccer, and we need to do a better job recognizing them when they occur. It is important to watch athletes that have been involved in collisions for developing signs and symptoms of concussion. We know that less than 10% of concussions involve any loss of consciousness so we have to be aware of other, more subtle signs like headache or confusion. Many athletes, including teens, are unfamiliar with other important symptoms of concussion such as sensitivity to light or noise, balance problems, etc. If you, or anyone, is concerned that your daughter may have suffered a concussion, she should be removed from play immediately, evaluated with a sideline assessment, like a SCAT 2, which should include an exertional challenge. It's important to observe the athlete after the collision as some symptoms don't show up right away. If she feels well, does not have any symptoms, and performs well on her sideline testing she can return to the game if cleared by the sideline medical staff. Remember, when in doubt, sit them out.
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