Brought to you by Dr. David Alter
First came the stories about cognitive problems (e.g., early onset dementia) experienced by retired professional football players. Then came increased concerns about active professional athletes who suffered on-field concussions and the guess-work as to when they could return to the playing field. Next came stories about athletes under age 18 who suffered concussions, and the legitimate questions as to whether their younger brains made them more vulnerable to the effects of repeated blows to the head sustained in the course of their chosen sports. Other questions about managing concussions in young athletes abound. For example:
- Should kids be required to leave the game after their “bell is rung” or they “see stars?”
- What is the timetable for a safe return to play?
- On what basis is the decision to return to play made?
These and other questions have been raised about how to balance the benefits of participation in school sports with the need to manage the near-term and potential long-term consequences of concussion in athletes younger than 18 years of age.
Current statistics indicate that more than 140,000 youth suffer concussions each year, with approximately one third of them suffered in the course of playing organized sports. Most of the injuries occur as a result of participation in football and ice hockey, but according to a recent article in Scientific American (February 2012), soccer, wrestling and other sports, contribute their fair share to the total.
Identifying the Signs of Concussion
Concussion involves when a blunt force to the head produces altered concentration, memory, judgment, balance or coordination problems, however transient. Loss of consciousness is not a required symptom. The alteration of normal mental status, which often lasts only a short period of time, nevertheless indicates a minor traumatic brain injury has been sustained.
Evaluations Can Guide Safe Return to Play
There are a number of factors that limit accurate assessment of when it is safe to return to the field of play. Players themselves, their coaches, and on occasion even parents may encourage resumption of play prematurely. Legislation recently passed in Minnesota requires a physician’s note attesting that the athlete can safely return to play. This begs the question of how to establish when a return to athletics and academic activities is safe?
A neuropsychological evaluation assesses key functions that are sensitive markers of readiness to resume play:
- Attention, concentration, and vigilance
- Reaction time, divided attention, and mental flexibility
- Learning and memory abilities (verbal and non-verbal)
- Problem-solving, planning and reasoning skills
A neuropsychological evaluation of the athlete at the Institute for Brain-Behavior Integration (IBBI) carefully examines these cognitive abilities and determines whether current levels of functioning are consistent with estimates of how they have functioned in the past. IBBI uses this data to help guide subsequent treatment plans and assist in making decisions related to safe levels of activity that the athlete can be engaged in during the various phases of recovery.
Managing the After-Effects of Concussion
It is said that, “time heals all wounds.” How much time is really needed to heal the wound of concussion? In the case of pediatric concussion, several issues combine to determine the length and extent of an individual’s recovery. 1) What was the baseline functioning prior to the concussion? 2) Was this the first concussion and what was the interval of time between the current and prior concussion if there was more than one? 3) Have changes in the functions or behaviors seen in Post-Concussion Syndrome been observed? Answering these and other questions as part of the IBBI evaluation helps determine the optimal plan for each affected athlete (or for a child or adolescent who has sustained a concussion for any reason).
Clinical Collaboration is the Key to Treatment Success
Managing the after-effects of concussion is challenging because in addition to cognitive concerns, problems with sleep, emotional disturbance, somatic complaints and also changes in family and peer relationships prove to be very challenging. At IBBI we actively work with the referring team of health professionals to formulate the optimal plan of care for each patient. Our professional staff is available to address the psychological, interpersonal and behavioral issues that can arise with the patient and his/her family.
Prompt & Actionable Evaluation Findings
At IBBI, we work to schedule and evaluate patients as soon as possible after their injury. Following the evaluation process, we provide prompt results to the referring physician, which contain comprehensive and actionable recommendations that guide the student, his/her family and treating physicians in how best to manage the neuropsychological and psychological aspects of the post-concussion recovery process. Also, we remain available to consult with the physicians throughout the evaluation and treatment process.