Transcription:
Kids and Concussions

Melanie Cole (Host): You may think that concussions only happen to football players but that’s not necessarily the case. Concussions can happen for all sorts of reasons including a bike crash or a fall on the playground and yes, even while playing sports. Here to tell us about concussions is my guest, Dr. Kevin Elder. He’s a Sports Medicine physician with Baycare Health. Dr. Elder let’s start for the listeners with a working definition. What is a concussion and how common are they?

Dr. Kevin Elder (Guest): So a concussion is a blow to the brain either direct or indirect which results in a set of neurologic symptoms. So basically what that means is that the patient has had a blow to the brain either a fall or a hit or whatever it is that results in some brain symptoms such as headache, dizziness, nausea, lack of concentration, a variety of possible symptoms. So that’s the definition of a concussion, and how prevalent or how common are they? Well they’re fairly common. They can happen in any number of ways, playing on the playground, running into somebody, falling off a bike, of course a variety of sports. I think part of the reason we hear so much about concussion and there’s certainly a lot of attention about it, there’s an increased awareness, so concussion is diagnosed more than we did maybe 10 or 20 years ago because there wasn’t as good as knowledge of what a concussion even was.

Host: Well that’s true and we are hearing much more in the media today. So when we talk about concussion evaluation. Before a child even starts a particular sport, maybe a contact sport, there’s now concussion evaluations, impact testing, what do you think of these?

Dr. Elder: I think that any increased data or increased information we can have is always beneficial. So there’s a couple things that happen in starting a contact sport. First of all the parent and the athlete have to get information on what is a concussion and generally get educated on those processes. The coaches have mandatory training on identifying concussions. So again there’s increased awareness and education, which is always very important when we’re trying to make any sort of difference in anything health related. Second of all there can be some increased data gathered regarding baseline testing such as impact you mentioned, which is one of the computerized testing tools that’s used. There’s a variety of those computerized tools, but these are ways to try to provide increased information so that we can try to make our best decisions and provide some objectivity to this as you go along.

Host: That’s very important. So now the child is in a sport. Sometimes parents and even coaches and the child think that the equipment is going to protect them from concussion. That’s not necessarily the goal of the equipment. Is this a myth?

Dr. Elder: Absolutely. So that’s a really good point to bring up. The equipment does not prevent concussion. There is no helmet that has been proven to prevent concussion. What helmets do for us is they protect the face and the skull from getting a skull fracture or various other injuries, but unfortunately they don’t prevent concussion. So properly fitted helmet and equipment does matter and that can help and on the other side of the coin, improperly fitted equipment can actually increase risk of injury including concussion. There are evidence of certain types of helmets and equipment being better than others but unfortunately there’s no perfect helmet or equipment that’s going to perfectly protect someone from concussion.

Host: Then let’s talk about symptoms because parents sitting on the sideline, coaches on the sides, and even the buddy system out on the field, whatever is going in, whether it’s football or soccer or any other sport where concussion might be prevalent, what do you want us to know about red flags and symptoms and how important is it that athletes, young athletes learn to recognize these symptoms themselves?

Dr. Elder: So it’s definitely important. The main way that we are often going to discover or have an idea to look for a concussion might be either something we observed or gain in knowledge by talking or interacting with the athlete. So certainly the teammates know their own teammates well. The coach presumably should know their kids well that are on their team, and of course parents know what’s normal and not normal for their kid. So if we’re watching a game and we’re seeing obvious things like somebody stumbling around or they were knocked unconscious, that’s pretty easy, but if it’s more subtle things like they’re running the wrong direction or they seem to be behaving abnormally or they seem slow and they’re not running, it might be a place to ask questions and say, hey what’s going on? Are you okay? And obviously if we observed the hit then that’s a reason to pull them aside and evaluate them and I think the bottom line with this is it can be a challenge and it can be – sometimes the athlete themselves is conscious of not wanting to leave the event, they don’t want to leave the game, they want to keep playing sometimes, so we have to have our antenna up for these things and as the saying goes I guess in these circumstance, when in doubt, sit them out and with youth sports especially you can always kind of pull things together later on, have a little more time check it out later on after the game, but there’s certainly no reason to take a chance if you think it’s suspicious that there was a concussion.

Host: Well when in doubt, sit them out is certainly the way to go when you suspect a concussion. So is this an emergent situation? When do you advise somebody to seek treatment and what might that treatment, what’s the standard of care if someone goes to the emergency room or to their primary care provider and get told they have concussion, what’s a parent to do? What do want our children to do?

Dr. Elder: So the main thing as you mentioned is to remove them from play that day. We don’t want them returning to competition on the same day and risking additional injury or worsening their current status. If a child is symptomatic, I think the important thing is to remove them from play, allow them to have access to a quiet place. Typically going to go home after the game, be observed by the parent. I don’t think it’s necessary in most circumstances for them to be taken to the ER. That’s neither a good use of resources nor appropriate and these actually also don’t need to be all imaged. CT scan/MRI are not useful at all in diagnosing concussion. They will be normal and you don’t want to be exposing all these young athletes to radiation with CAT scans unnecessarily. In the circumstance where somebody has more significant symptoms such as they were knocked unconscious or they have worsening symptoms. They’re describing a headache that’s getting worse and worse, there’s vomiting, there is some circumstances where you would want to take him to the ER in that case. So if they’re progressively worsening or one of these red flag symptoms we would take him to the ER; otherwise, you want to take him home, limit screen time, have them rest and then the plan would be to take them in if it’s a weekend sport, calling the office, the pediatrician, the first thing on Monday and trying to get an appointment with their pediatrician and/or someone who is trained and specialized in evaluation of sports concussion.

Host: What about returning to school and you mentioned screen time needs to be restricted because that can maybe exacerbate some of the symptoms or slow recovery down. When do they get to go back to school and what about return to play? Because if someone’s a real serious athlete and they love their sport, they want to get back in the game but that’s not always the best idea is it?

Dr. Elder: Absolutely. So we know that concussion will take time to recover and the first thing we want to do is to allow recovery and the way to do that is to eliminate of course any contact and then trying to decrease or allow them some recovery with their academic screen time, but you want to eliminate any extraneous screen time, video games, texting, et cetera. School now for pretty much everybody is all screened. So it’s not a situation we can say no screens. It’s probably not realistic; however, if somebody’s very symptomatic they might have to have a couple days off from school to allow them to come to a place where they can actually tolerate that. Once an athlete is back to school, caught up, and they’re no longer symptomatic, no symptoms, normal exam, normal concussion exam, this is the time when we can talk about what’s called a return to play and that’s a step-wise progression of return to whatever sport or activity, that will then allow them to be fully cleared. So it’s really a series of steps. First being return to the classroom in more or less a step-wise fashion, then second of all being returned to sports in a step-wise fashion.

Host: It’s such important information for our listeners to hear. So wrap it up for us, what you would like the listeners to take from this segment about coaches being knowledgeable in those symptoms and recognizing concussion, parents and athletes as well, prevention if at all possible, and your best advice if someone does suffer concussion.

Dr. Elder: So bottom line is just taking the time – if you’re going to have your athlete, your young athlete, your child playing a sport to take a little bit of time to familiarize yourself with what the symptoms of concussion are, how is it diagnosed, and then realize that it’s a possibility that could happen, but to not have a panic or worry about it and then bottom line is if it does happen, maybe just spend some time to think about, okay does your pediatrician or your primary care doctor, do they treat this or if not is there someone in your community that’s trained in this that you can see in these instances? It’s probably worthwhile if it’s a higher level sport – higher contact sport, looking into what are their plans, what are their protocols? Do they have an athletic trainer there present, which with a contact sport they really should have one there to evaluate. Is there a doctor there covering the game? And then having an idea, what is the evaluation going to be like. So if you’re concerned that this has happened or the athlete brings something to someone’s attention. Then the bottom line is again any concern that it has happened or the athlete comes to you after a day, a week after, you bring that to someone’s attention and remove them from the activity. Until you get it evaluated, you really want to take precaution and again as we said when in doubt, sit them out. It just gives you time to take a breath, get it evaluated appropriately and then move on from there. I think the bottom line we don’t want to be panicking, we don’t want to be shutting down kids from playing sports. That’s not appropriate. What is more appropriate is we just get more education, more appropriate education about recognition and what are the processes, how does it work return to play, and then treat concussion appropriately.

Host: That’s great information, Dr. Elder, thank you so much and you’ve explained it so very well and what really we need to watch out for when it comes to concussion and not to panic, but to take the precautions and to recognize those symptoms. It’s really great that you shared that with us today. Thank you so much. You’re listening to Baycare Health Chat. For more information, please visit baycare.org, that’s baycare.org. This is Melanie Cole, thanks so much for listening.