LINGERING HEADACHE FOLLOWS CONCUSSION
NEW BRAINTREE, MA October 29, 2011 Headaches occur with regularity after traumatic brain injury - especially injuries of the concussive variety. As a practitioner interested in concussion I always ask athletes to keep a headache diary because it serves as something of barometer of the "rest" they are getting after injury. Research suggests that 20-40 percent of athletes experience headaches after concussion with a subset of these cases that go on and develop chronic head pain. Arguably, when a player complains of a lingering headache in the days after a suspected concussion it is likely that a connection exists between bump on head and lingering head pain. Some do not make this connection especially when they have eyes set on returning to play.
It is surprising that so many people fail to see the connection between the impact of concussion and residual headaches. It is among the most common symptoms immediately following a concussion. Headaches are associated with the decreased efficiency of processing that results from the neurological cascade after injury. Headaches are a signal that the brain has not returned to homeostasis following the injury. After concussion the treatment of choice involves rest - physical and cognitive. A headache sometimes signals the lack of rest and may be a sign that an athlete is putting their recovery at risk. Post-exertion headaches may be a symptom of the onset of postconcussion syndrome and should delay the progression of further activity. Athletes should return to play in a step-wise fashion that affords them time to return to baseline.
Saturday, October 29, 2011
Thursday, October 13, 2011
RETURN TO PLAY AFTER CONCUSSION
CONCUSSION MANAGEMENT - Return to Play decisions
NEW BRAINTREE, MA October 13, 2011 Return to play should be carefully managed by the team physician and trainer. It is now well known that for many years athletes have returned to play before they were fully healed from concussion. No player should go from zero percent play to 100 percent play without monitored, "symptom free" exertion.
In the context of youth sports, CAMP offers preseason training and support to coaches, parents, and players about concussion and the consequences of returning to the game before being fully healed. As with other medical history, it is a good idea to have an idea which athletes may be more vulnerable to concussion before competition begins. Returning to play after concussion requires a stepwise process that monitors athletes at each phase of their return. Athletes are followed during recovery with exertional testing and should not play if they are at all symptomatic. Acute symptoms include: headache, decreased short-term memory, sensitivity to light and sound, irritability, confusion, fatigue, and others.
In cases where no physician or trainer are available coaches and parents often supervise the specific exertion protocol outlined by the physician or concussion specialist. I have urged members of the emergency services to become familiar with the acute assessment and treatment of concussion. A specific return to play protocol outlining gradual increase in activity has been established by the Concussion in Sport Group as follows (Aubry, Cantu, Dvorak, Graf-Baumann, Johnston, Kelly, Lovell, McCrory, Meeuwise, Schasmasch, 2001. Clinical J. Sports Med.)
www.concussionassessment.com
NEW BRAINTREE, MA October 13, 2011 Return to play should be carefully managed by the team physician and trainer. It is now well known that for many years athletes have returned to play before they were fully healed from concussion. No player should go from zero percent play to 100 percent play without monitored, "symptom free" exertion.
In the context of youth sports, CAMP offers preseason training and support to coaches, parents, and players about concussion and the consequences of returning to the game before being fully healed. As with other medical history, it is a good idea to have an idea which athletes may be more vulnerable to concussion before competition begins. Returning to play after concussion requires a stepwise process that monitors athletes at each phase of their return. Athletes are followed during recovery with exertional testing and should not play if they are at all symptomatic. Acute symptoms include: headache, decreased short-term memory, sensitivity to light and sound, irritability, confusion, fatigue, and others.
In cases where no physician or trainer are available coaches and parents often supervise the specific exertion protocol outlined by the physician or concussion specialist. I have urged members of the emergency services to become familiar with the acute assessment and treatment of concussion. A specific return to play protocol outlining gradual increase in activity has been established by the Concussion in Sport Group as follows (Aubry, Cantu, Dvorak, Graf-Baumann, Johnston, Kelly, Lovell, McCrory, Meeuwise, Schasmasch, 2001. Clinical J. Sports Med.)
www.concussionassessment.com
Saturday, October 8, 2011
AWARENESS AND TIME NEEDED AFTER HEAD INJURY
ARE CONCUSSIONS UNDER REPORTED - EMS should always consider brain injury
NEW BRAINTREE, MA October 8, 2011 There is a common feeling that the incidence of mild TBI - AKA concussion is not well reported. In today's NY Times, Bob Cantu, M.D. said the biggest danger area is the amount of concussions that go undiagnosed, leading to potentially more debilitating and even fatal second-impact injuries. Early in my career I conducted a post hoc chart review at a local emergency room at the community hospital in La Palma, CA. What I found at that time is that patients were being incorrectly coded once they were admitted to the ED. For example, a child sustains a fall from the swing at the local park. He is transported to the local ED and treated for a fracture of his right wrist. What may be missed is the fact that he also received a significant bump on the head and had a period of post traumatic confusion that cleared by the time he was admitted to the emergency service. According to Cantu, in sports like football and hockey the number of actual concussions is six or seven times higher than the number diagnosed. Trainers and EMS providers need to become better trained in the diagnosis and management of concussion.
For several years I have provided on field medical coverage as an EMT. It is fun and rewarding service to your community and school system. During this service I treated many individuals whom I believed had sustained a concussion. I was vigilant about taking the helmet of the player I did not want re-entering the game. These players were given an on field assessment of their mental status called the SCAT-II - it screened for altered cogntive status and for most athletes it is an easy measure of current functioning. However, the athlete who is recovering from concussion may have difficulty remembering the words on the memory test or another mental activity shown to be sensitive to the acute effects of concussion. The Boston Uniuversity School of Medicine is collecting data from brains that are donated by former athlete's following death. They are looking for the tell tale signs of a degenerative nerve disease call Chronic Traumatic Encephalopathy (CTE). CTE is a form of dementia and results in often dramatic changes in mood and behavior associated with the loss of neuronal integrity in certain centers of the brain. Some believe repetitive concussion may contribute to increased risk of developing this disease. Their findings are available in peer-reviewed journals as well as the lay press. The key is making the diagnosis of concussion early and allowing full recovery before returning to the game. See www.concussionassessment.com for further information on concussion and to take a pre-injury baseline test.
NEW BRAINTREE, MA October 8, 2011 There is a common feeling that the incidence of mild TBI - AKA concussion is not well reported. In today's NY Times, Bob Cantu, M.D. said the biggest danger area is the amount of concussions that go undiagnosed, leading to potentially more debilitating and even fatal second-impact injuries. Early in my career I conducted a post hoc chart review at a local emergency room at the community hospital in La Palma, CA. What I found at that time is that patients were being incorrectly coded once they were admitted to the ED. For example, a child sustains a fall from the swing at the local park. He is transported to the local ED and treated for a fracture of his right wrist. What may be missed is the fact that he also received a significant bump on the head and had a period of post traumatic confusion that cleared by the time he was admitted to the emergency service. According to Cantu, in sports like football and hockey the number of actual concussions is six or seven times higher than the number diagnosed. Trainers and EMS providers need to become better trained in the diagnosis and management of concussion.
For several years I have provided on field medical coverage as an EMT. It is fun and rewarding service to your community and school system. During this service I treated many individuals whom I believed had sustained a concussion. I was vigilant about taking the helmet of the player I did not want re-entering the game. These players were given an on field assessment of their mental status called the SCAT-II - it screened for altered cogntive status and for most athletes it is an easy measure of current functioning. However, the athlete who is recovering from concussion may have difficulty remembering the words on the memory test or another mental activity shown to be sensitive to the acute effects of concussion. The Boston Uniuversity School of Medicine is collecting data from brains that are donated by former athlete's following death. They are looking for the tell tale signs of a degenerative nerve disease call Chronic Traumatic Encephalopathy (CTE). CTE is a form of dementia and results in often dramatic changes in mood and behavior associated with the loss of neuronal integrity in certain centers of the brain. Some believe repetitive concussion may contribute to increased risk of developing this disease. Their findings are available in peer-reviewed journals as well as the lay press. The key is making the diagnosis of concussion early and allowing full recovery before returning to the game. See www.concussionassessment.com for further information on concussion and to take a pre-injury baseline test.
Tuesday, October 4, 2011
CONFLICTING MEDICAL OPINIONS - Parents often confused about recovery
NEW BRAINTREE, MA October 4, 2011 There is growing awareness that post-concussive recovery tends to take longer in children than in adults. Pediatricians and the American Academy of Pediatrics have developed a consensus statement regarding the return to play following traumatic brain injury. Like anything, changes in the delivery of care and treatment protocols take time to trickle into the mainstream of pediatric practice. As a result, athletes sometimes get conflicting recommendations after sports-related concussion. In one recent case two female soccer players bumped heads resulting in both athletes being diagnosed with concussion. One athlete was to be held out 2 weeks followed by one (or more) weeks of return-to-play rehabilitation. The second athlete was cleared by her physician after 5 days without a plan of action to safely return to the field. Neither plan is right or wrong and I am not finding fault with the individual physician's decision. But readers can see how confusing it can be for athletes and their parents.
Greater consensus is needed on behalf of student athletes by their medical providers. I think this consensus is on the way. But no one can be faulted for taking a conservative approach to medical clearance for high school athletics after concussion. Athletes must be symptom free for at least one week before any substantive exertion can be initiated. Otherwise, they are at high risk for repeat injury that can be more damaging and career ending. Computerized testing is a useful tool to assess neurocognitive functioning. Teams are using neurocognitive testing to assess preseason baseline functioning. Post-injury assessment using neurocognitve tests are essential to measure the lingering impact of concussion.
Greater consensus is needed on behalf of student athletes by their medical providers. I think this consensus is on the way. But no one can be faulted for taking a conservative approach to medical clearance for high school athletics after concussion. Athletes must be symptom free for at least one week before any substantive exertion can be initiated. Otherwise, they are at high risk for repeat injury that can be more damaging and career ending. Computerized testing is a useful tool to assess neurocognitive functioning. Teams are using neurocognitive testing to assess preseason baseline functioning. Post-injury assessment using neurocognitve tests are essential to measure the lingering impact of concussion.
Monday, October 3, 2011
FRIDAY NIGHT LIGHTS - Athletes require time for healing
NEW BRAINTREE, MA October 3, 2011 Head injuries that occur on Friday nights rarely heal by Monday morning. "FRIDAY NIGHT LIGHTS" refers to the weekly high school or college football game that takes place under the lights. Whether home or away on Monday morning the Concussion Assessment and Management Program receives many calls from school nurses and parents about concussions. How long will my son or daughter need to stay out of football or soccer?
When students are injured during their games they frequently come to school to eagerly seek out the nurse or trainer with eyes on re-taking the ImPACT test. What is the rush you may ask? Most athletes have come to know that the sooner they achieve a normal "baseline" score on ImPACT the sooner they can return to the games they love. Not so fast!
Students need to be certain that they are examined by a physician following a concussion. Athletes do not need to loose consciousness to be diagnosed with a concussion. Symptoms of a concussion include: headache, decreased concentration, lack of focus, poor short-term memory, sensitivity to sound and light, and a host of emotional changes including anxiety and depression. I have had telephone calls from the parent of an injured high school athlete pushing me to allow his son to play in a Wednesday scrimmage after being injured playing lacrosse on Saturday. That adds up to only 3 days and could be a recipe for disaster.
SECOND IMPACT SYNDROME
If an athlete returns to play before his brain is healed he puts himself at risk for second impact symdrome - a potentially fatal condition that results from cerebral dysregulation and rapid swelling that occurs from a second blow to the head before the first injury is fully healed. Some believe Pittsburgh Penguin captain Sydney Crosby is suffering from a variant of second impact syndrome. This may be why he has had post-concussion symptoms for over 6 months. In younger athletes there is a 5 times greater likelihood that a second injury will result in prolonged symptoms and a substantially longer term of recovery. In most cases the recovery time from concussion is 1-2 weeks. Athletes who are recovering from a second or third injury require extra time and a slower return-to-play protocol. Remember, no player can go from not playing to game action unless he or she has completed a stepwise rehabilitation program monitored by a trainer or coach. In Massachusetts, the MIAA now requires education about concussion before a student can play varsity sports. On the website readers can access the ImPACT test and MIAA education material. www.concussionassessment.com
When students are injured during their games they frequently come to school to eagerly seek out the nurse or trainer with eyes on re-taking the ImPACT test. What is the rush you may ask? Most athletes have come to know that the sooner they achieve a normal "baseline" score on ImPACT the sooner they can return to the games they love. Not so fast!
Students need to be certain that they are examined by a physician following a concussion. Athletes do not need to loose consciousness to be diagnosed with a concussion. Symptoms of a concussion include: headache, decreased concentration, lack of focus, poor short-term memory, sensitivity to sound and light, and a host of emotional changes including anxiety and depression. I have had telephone calls from the parent of an injured high school athlete pushing me to allow his son to play in a Wednesday scrimmage after being injured playing lacrosse on Saturday. That adds up to only 3 days and could be a recipe for disaster.
SECOND IMPACT SYNDROME
If an athlete returns to play before his brain is healed he puts himself at risk for second impact symdrome - a potentially fatal condition that results from cerebral dysregulation and rapid swelling that occurs from a second blow to the head before the first injury is fully healed. Some believe Pittsburgh Penguin captain Sydney Crosby is suffering from a variant of second impact syndrome. This may be why he has had post-concussion symptoms for over 6 months. In younger athletes there is a 5 times greater likelihood that a second injury will result in prolonged symptoms and a substantially longer term of recovery. In most cases the recovery time from concussion is 1-2 weeks. Athletes who are recovering from a second or third injury require extra time and a slower return-to-play protocol. Remember, no player can go from not playing to game action unless he or she has completed a stepwise rehabilitation program monitored by a trainer or coach. In Massachusetts, the MIAA now requires education about concussion before a student can play varsity sports. On the website readers can access the ImPACT test and MIAA education material. www.concussionassessment.com
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