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Head Cases: Concussions Hit an Increase Among Children


Illustration by Dav BordeleauAs Eagles fans watched wide receiver DeSean Jackson take a vicious hit in last October’s game against the Falcons, talk of concussions was already swirling in locker rooms and hospitals as more and more athletes took bigger, faster, stronger hits.

As the concussion debate continues in the media, pro athletes continue to receive most of the publicity. But one can’t help but wonder: How do concussions impact kids in high school—and those even younger?

Steven Collina is the director of the Crozer-Keystone Sports Medicine Fellowship Program and chief of the Division of Sports Medicine for Crozer-Chester Medical Center and Springfield Hospital. High school patients comprise about 30 percent of his practice, a number that has risen in the last few years, mostly due to the increased attention paid to this type of injury. “The general public and coaches are more aware of concussions now, and that there doesn’t necessarily have to be a loss of consciousness,” he says.

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That’s often a reason concussions go undiagnosed in the first place. “In past, we’d just say, ‘Oh, I got my bell rung.’ We weren’t calling them concussions. Even if athletes only experience mild symptoms, they still have a concussion.”

There are multiple ways to define a concussion and, consequently, many ways to misdiagnose one. At its most basic, it’s simply any injury to the brain caused by force, typically resulting in neurological symptoms like dizziness, nausea, headache and other side effects. Contact sports like soccer, lacrosse and (especially) football are the culprits in a majority of sports-related cases. But a concussion can occur whenever there’s been direct or indirect trauma to the head—even in less aggressive sports.

Collina’s team works with athletes from Ridley, Interboro and Chester high schools, along with the Philadelphia Union soccer team. One of the most difficult parts of the healing process is simply taking the time to rest. “We know that the younger the brain, the longer it takes to recover,” says Collina. “It’s frustrating for a high school athlete to see a pro recover in five to six days, where they need an entire week or two before they’re back in the game.”

And once players return to the field, regulations are still in place to protect them, regardless of medical history. The National Federation of State High School Associations passed a rule that went into effect for the 2010-11 academic year. It states that “any athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be immediately removed from the contest and shall not return to play until cleared by an appropriate healthcare professional.”

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William Wardle, athletic trainer at the Haverford School, concurs that sports-related concussions have increased over the last few years, making up about 5 to 10 percent of athletic injuries that he’s seen. “It’s the nature of sports,” he says. “Kids are just getting stronger, faster and more aggressive, especially in football. The protective equipment can’t keep up with how big and strong and fast the body can be. And the brain is still the brain.”

Preseason baseline testing is one of the most effective ways to diagnose brain injuries. Wardle cites ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) as one of the best tools available. Developed at the University of Pittsburgh, the computerized test is made up of eight sections, including word memory, visual design, reaction time and other cognitive challenges. The data provides trainers, coaches and players with a baseline snapshot of how the brain operates, which is then compared to the player’s mental capacities following a potential concussion.

An effort similar to Pitt’s is in the works at Villanova University’s mechanical engineering department, where professor Hashem Ashrafiuon is working on a technologically advanced football helmet that provides medical professionals with a brain-wave “signature” following trauma to the head. Utilizing sensors that measure brain activity, it will aid in the immediate and accurate diagnosis of a traumatic brain injury. This is especially crucial since the physical and mental response to this type of injury varies from person to person.

“When you get a concussion, you remember things differently and react to things differently,” says Ashrafiuon. “The person may seem fine at the moment, but later on, there’s a much different reaction to it. I had a friend who was playing soccer and hit the ground hard with his head. The doctor said that whatever was going to happen would happen in the first 24 hours. In fact, he was normal for the first 24 hours and it wasn’t until a couple of days later that he noticed symptoms.”

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Varsity jocks may not be executing with the same force as seasoned pros, but the repercussions of sustaining traumatic brain injury are still legitimate concerns—especially if the damage has been done before. A study in the February 2011 issue of Neurosurgery, the official journal of the Congress of Neurological Surgeons, uncovered increased rates of concussion-related symptoms in high school athletes with two or more previous concussions. Led by Philip Schatz of Saint Joseph’s University, the International Brain Research Foundation and the Sports Concussion Center of New Jersey, the study examined 2,500 high school athletes, some who’d sustained one to two concussions more than four months prior to the study.

“There’s one thing everyone knows: The more you get concussions, the more dangerous the side effects are and the more prone you are to get one again,” Ashrafiuon says. “That’s why, if you look at professional athletes who’ve had their third or fourth concussion, they have to retire.”

Recent reports have highlighted the cognitive and psychological aftereffects of repeated concussions, including cases of chronic traumatic encephalopathy, and degenerative brain disease in retired football players and other athletes. “There’s concern that repeated concussions can result in brain pathology that leads not only to cognitive difficulties, but serious emotional [aftereffects] in later life,” Schatz and his co-authors wrote.

Precautionary measures are a benefit to coaches, players and their families. But Wardle knows that enhanced safety and vigilance won’t change the way games are played. “I don’t want people thinking that sports are going to be that much safer,” says the trainer. “We can’t really prevent concussions from happening.”

Concussion Facts on page 5 …

Concussion Facts

1. An estimated 3.8 million sports- and recreation-related concussions occur in the United States each year. (In Pennsylvania, it could be as high as 156,000 per year.)

2. In high school, concussions happen more often in competitive sports, with football accounting for more than 60 percent.

3. Among those age 5-18 years, the five leading sports or recreational activities for concussions are bicycling, football, basketball, playground activities and soccer.

4. For males, the leading cause of high school concussions is football; for females, it’s soccer.

5. From 2001 to 2005, those age 5-18 accounted for 2.4 million sports-related emergency-department visits annually, of which 6 percent involved a concussion.

6. High school athletes who sustain a concussion are three times more likely to have a second one.

7. Some 21,000 Pennsylvania kids under the age of 14 sustain brain injuries each year.

8. Some 287,000 Pennsylvanians are living with a lifelong disability due to a brain injury.

Source: biapa.org

Concussion Symptoms on page 6 …

Concussion Symptoms

• Headache or pressure in the head
• Nausea or vomiting
• Balance problems or dizziness
• Double or blurry vision
• Sensitivity to light
• Sensitivity to noise
• Feeling sluggish, hazy, foggy or groggy
• Concentration or memory problems
• Confusion
• Not feeling right or feeling down

Source: cdc.gov


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