If you are a parent of a particular age, you probably grew up in a day when hits to the head and brief periods of unconsciousness were just part of being a kid. That’s changed, so that’s why I went to last week’s presentation on concussions organized by SRS by Swarthmore Recreation Association’s Linda McCullough. The presentation was by Dr Steve Stache, a sports medicine physician at the Rothman Institute (Jefferson Comprehensive Concussion Center. If you want some insight into how interested he is in student concussions, check out his publications list.
I went because I have kids who do dangerous sports, but took notes in case other parents might be interested (only 18 people showed up). First, some resources.
- WSSD policies on concussion.
- Policy on diagnosis and treatment of concussion is largely determined at the International Consensus Conferences on Concussion in Sports. Currently, school policies nationwide are influenced by the Zurich Guidelines, drawn up after the 2008 meeting. The most recent, New Zurich Guidelines (from 2012) will change recommend protocols yet again. After every new consensus document it takes a huge effort to get doctors, coaches, parents, and athletes re-educated. He apparently spends a good amount of time each day just dealing with misconceptions, especially among, um, parents. His presentation was toward that goal of re-education, and he is happy to make further presentations to any group who wants to learn more (contact Colette Glatts).
- I located a PDF of the latest consensus statement (atsnj.org/documents/pdf/ZurichGuidelines2013.pdf) in case you are a coach, school nurse, school administrator, or parent of an athlete. Read it during half-time, or whenever you have a lull during your child’s sport. Some sections might make your head hurt, but it is full of good advice.
- The other important resource is the Safety in Youth Sports Act, a Pennsylvania-specific law. Here’s a short summary. Again, coaches, school nurses, and school administrators should know this document well. Parents should probably read it, too.
- CDC has good site on concussion. Here’s the page on symptoms. And this is the PDF for parents.
Some highlights from Dr Stache:
- Concussions are like pregnancy — you have a concussion or you don’t.
- Common protocol during games/practices is “when in doubt, take ‘em out.”
- Many people (coaches, officials, school representatives, etc.) may remove a player for concussions … but coaches cannot return an athlete to play (or practices). That’s where doctors come in.
- Concussion symptoms can manifest later, so even if a player seems fine (or claims to be fine), issues can reveal themselves at a later time. There’s no way to predict this, unfortunately, so it’s best to be cautious.
- When observing a player who might be at risk (e.g., might have had earlier hit), sometimes a coach or trainer is tasked with visually following that player closely.
- Concussions are usually a mild form of brain trauma on the Glasgow Coma Scale. Can be caused by too-rapid rotation of the head in addition to standard jolt. Jolt can also be transmitted to brain via a hard hit to chest.
- Second injury can be much more damaging to brain. First hit causes micro-trauma to axons, changes in brain physiology … brain is for some reason fragile because of such changes.
- Parents should relay concerns to coaching staff but are asked not to run onto the field/ice screaming … that never helps. But parents are best judge of changes in behavior and cognitive behavior, so if you notice something off about your kid, it might be concussion related EVEN IF YOU OR COACH DIDN’T SEE THE CONCUSSION. Sorry about the all caps — that just seems very important given that teens can seem off all the time. Parents also can be good family historians/detectives, so if your kid comes back from sledding on a Snow Day seeming sluggish, you might ask about the broken sled …
- Sometimes massive hits to the head don’t cause concussions. When parents see this, they typically freak out. So don’t automatically freak out.
- If your kid gets a hit and is diagnosed with a concussion, don’t rush off to ER to demand a CT scan. Hospital will probably comply (they want your money, plus they don’t want to be sued) … but you’ll have subjected your kid to a radiation dose equivalent to 120 x-rays. The CT scan will not help diagnose a concussion or evaluate its severity. All it will do is increase the chance your kid will develop cancer.
- If your kid has a concussion, don’t allow them to sleep all day. That slows recovery.
- Mouth guards do not protect against concussions, even if the mouth guard claims that on the package. Might increase risk, in fact.
- Head guards don’t seem to decrease concussions in soccer. [If they wore football-style helmets??]
- There are apps for smartphones that help with diagnosing concussions. Search for “concussion” (of course).
- Pre-season cognitive testing is extremely helpful. After a hit, coaches, trainers, and physicians can administer a variety of tests to measure cognitive ability and balance, but if your kid has preexisting issues with both, he or she might be needlessly tagged with concussion status. Baseline testing can eliminate these false diagnoses. Testing is not mandatory, but strongly recommended. Doctors can do this (costs money, I’m sure).
- Once diagnosed, recovery usually involves abstinence from reading as well as from all electronic devices. Teens hate to be taken out of games, but really, really hate to be removed from their electronic world. Recovery usually involves balance therapy, cognitive therapy, and occasionally medications.
Some further thoughts (of mine).
- Football helmets are now being sold with accelerometers (those devices in your phone that measure phone movements) — coaches can download data to iPads to view hits for players that might be under concussion watch. With football, coaches’ and trainers’ eyes are often on the ball, not on all the players colliding with one another every play, for hours. It might be the case that hard hits, multiple hits, or dangerous rotation movements are missed. The accelerometers clearly don’t protect from hits (duh), but they can give exposure data just like those radiation badges that some scientists wear in the laboratory. Regardless of whether WSSD adopts these helmets, researchers will probably use these helmets to gather information on whether and how different types of hits translate into concussions. We will need to wait a few years for these data.
- I am left wondering whether girls soccer should use a lighter ball. Concussion risk in girls soccer is higher than in boys games (like all injuries, apparently), fyi. Seems like resizing the ball would be good given the cognitive effects of heading. (Girls basketball, at NCAA level, at least, uses lighter ball.)
- Cheerleading is often left out of discussions on concussions, yet the sport/activity has the highest rate of concussions by far. Surprisingly, the risk is not for the girls at the top of the pyramids (the fliers), it’s for the lower level of girls.