In my practice, I see about two student athletes a week who have suffered a concussion. A concussion occurs when an athlete takes a blow to the head, and the sudden impact causes the brain to rattle around in the skull.
This can occur when two soccer players go after a header, when a football player moves in for a tackle or when a hockey player hits the ice with his helmet.
Some people think helmets protect against concussions. Although helmets are a good idea and they can prevent some serious head injuries, they do not seem to protect against concussions.
When there is an impact, the gray and white matter of the brain almost slide against each other. A concussion can cause the athlete to experiences symptoms like headaches, dizziness, sleepiness, or memory difficulties.
Many people with concussions do not lose consciousness. In fact, if they lose consciousness, it could be a much more serious concussion and they must be taken to the emergency room.
Typically, what we see during a soccer, lacrosse or football game is the person has an impact, they fall, they get up, they don’t lose consciousness, but they know something has gone wrong. They know that their “bell has been rung.”
Sideline coaches and trainers should be able to recognize a potential concussion. They should immediately take the athlete out of the game to determine if he or she has had a concussion.
One of the techniques from the Centers for Disease Control and Prevention Concussion Guidelines is to ask simple questions like “Do you know where you are?” and “What day is it?” Another is to ask the athlete to follow simple eye movements and to ask them to walk.
If the athlete has lost consciousness and suffered a substantial impact injury, then the patient should be taken to the emergency room immediately. Otherwise, they can be seen in their primary care physician’s office or an urgent care facility for assessment.
We normally see them at Nunnelee Pediatric Specialty Clinics if they are referred to us if they continue to have headaches, vomiting, dizziness or sleepiness.
We will conduct a series of tests to look at such things as the patient’s gait. Those tests are repeated to determine if the patient is improving or getting worse.
The patient also should undergo a brain rest, meaning no TV, no devices, no activities for two or three days. That is followed by a period of slowly reintroducing activities such as riding a stationary bike and other lighter physical activity.
If clinical tests show improvement, then we send them back to school sometimes for half a day.
Next, we gradually reintroduce physical activity, but no contact sports. Before allowing the athlete to return to contact sports, we must make sure they have completely recovered, because second-impact injuries are, in fact, much more severe than the first one.
The CDC Heads Up website offers concussion detection and care techniques for primary care providers, coaches, parents and athletes. Those techniques are excellent and clearly lay out what one should do in case of a concussion, such as when to go to the emergency room.
If you look at children ages 10 and below, boys and girls recover at the same pace – they get better in maybe three to four weeks. In adolescents, however, males recover faster, maybe four to six weeks. Girls recover in about six to eight weeks.
I have found that if the patient gets the proper care, gets the brain rest, and gradually returns to physical activity with no contact sports, they do better than the ones who do not.
Not following concussion protocol can cause lingering effects such as headaches, personality changes, memory problems, and attention problems.
I think if someone can identify the concussion and do the proper management, we can prevent these long-term problems in 70 percent to 80 percent of kids.
Dr. Sasidharan Taravath is a pediatric neurologist and medical director of the Sleep Disorders, Epilepsy Monitoring Unit & Pediatric Neurodiagnostics Program at New Hanover Regional Medical Center.