Concussion: New guidelines improve safety

You may have read and heard a lot about concussions lately. I recently cowrote a clinical report on sports-related concussions in children and adolescents that will be published today in Pediatrics. There have been some positive changes in the NFL and NCAA to improve safety, but you will be glad to know the Wisconsin Interscholastic Athletics Association has been following these improved rules for a few years now.

Concussions are brain injuries and need to be taken seriously. They don’t just happen in professional sports, they happen in every sport, at any age, to boys and girls.

Concussions are treated much differently now than they were 10 years ago. While we have learned a lot about concussion, medical professionals continue to learn how to better recognize, treat and prevent short- and long-term consequences.

A concussion is a brain injury that temporarily alters brain functions. It usually happens after a direct blow to the head, but it also can happen from a blow elsewhere on the body where the force gets transmitted up to the head. Most young people are not knocked out, and many kids have no memory loss. Even a child with a normal MRI or CT scan of the brain can have a concussion, because it’s a functional injury, not damage to the brain’s structure.

After any hit to the head, it’s important to watch your child for any symptoms or signs of a concussion. Symptoms fall into four categories:

  1. Cognitive. (Confusion, disorientation, memory loss, slow to answer questions and follow commands, easily distracted.)
  2. Physical. (Headaches, nausea or vomiting, dizziness, clumsiness or balance problems, blurry vision, poor coordination, sensitivity to light or noise, or loss of consciousness.)
  3. Emotional. (Nervousness or anxiousness, sadness, irritability or mood swings, inappropriate behavior.)
  4. Sleep problems. (Difficulty falling asleep, frequent waking at night, fatigue or tiredness during the day.)

Any athlete with a concussion should stop playing immediately. He or she should never return to any activity (even jogging or weight lifting) the same day the concussion happened. This is important even if the symptoms last for 15 minutes then seem to go away.

All athletes with a concussion should be evaluated by an appropriate health care professional before returning to activity. Athletes also shouldn’t return to a sport while they are still having concussion symptoms.

Concussions in young people can last weeks or months. In fact, adolescents with concussions heal more slowly than adults. Symptoms of concussion can interfere with school, social activities and family relationships. Athletes who have had a concussion are at least twice as likely to suffer another one. Each concussion needs to be treated individually, and athletes who suffer multiple concussions will have more problems with recovery.

Treatment for a concussion involves rest from sports and physical activity. Through Children’s Hospital’s Concussion Clinic, we educate families, athletes, coaches and teachers about concussions, and guide a safe return-to-play program. We also use ImPACT™, a computerized testing program to help guide concussion treatment.

I can’t stress enough that all concussions are brain injuries and need to be taken seriously.

Kevin Walter, MD- Kevin Walter, MD, pediatric sports medicine specialist, Children’s Hospital of Wisconsin

Dr. Walter is the program director of Pediatric and Adolescent Sports Medicine at Children’s Hospital of Wisconsin and assistant professor of Orthopedics at the Medical College of Wisconsin.

Comments

Concussion: New guidelines improve safety — 3 Comments

  1. I look forward to reading your article. I am a family physician, my interest in sports medicine has increased especially as my own children’s participation in sports has increased. I am often called upon to be “team physician” for sports injuries. My husband coaches pee wee football and I would like to provide the coaches with concussion management information. OUr high school athletes have the benefit of using IMPACT testing but this is not available to our younger athletes.

  2. I’m a nurse working in an elementary school so I see the new guidelines regularly in practice. My concern is that this has created a hypervigilance amongst parents/teachers not unlike what has happened in the peanut allergy awareness campaign. The restrictions are so many and applicable to such a variety of agenda, the parents/teachers are freaked out when their students with post concussion syndrome “appear to be tired…appear restless….appear to be having a bad day….that they immediately send this student to the nurse for evaluation to cover their backside. I think to an extent this is overkill and has created a panic like atmosphere with parents who are terrified with every little nuance post trauma correlating the event to the concussion….ie.. a student who sasses his parents is dismissed because this is a behaviour related to the concussion. I’m not saying we dismiss the new guidelines but it’s become the theater of the absurd in reality. Common sense has left the discussion and the guidelines appear to be driven in large part once again to liability issues.