Carl Maronich (Host): Welcome to Children's Health Checkup, where we answer parents' most common questions about raising healthy and happy kids. I'm Carl Maronich. And today, we're unraveling concussion myths with Dr. Erin Reynolds, a sports neuropsychologist at Children's Health, and the Program Director for Concussion and Sports Neuropsychology at Children's Health Andrews Institute of Orthopedics and Sports Medicine. Stay with us as we talk about the things parents really need to know about concussion symptoms, recovery, and keeping your child safe. Dr. Reynolds, welcome.

Erin Reynolds, PsyD: Thank you so much for having me.

Host: You are very welcome. We appreciate your time. And let's start maybe by explaining just what a concussion is and how it may differ from other head injuries.

Erin Reynolds, PsyD: A concussion is a type of mild traumatic brain injury that happens when someone sustains a hit. So, either directly to the head or indirectly to the body with enough force that it causes the brain to shake inside the skull. The movement from the brain shaking, then disrupts normal brain function. And this is on a temporary basis, but it causes all of the brain cells to stretch and twist, which then allows certain brain chemicals to release and leak into areas that they aren't usually in. So, this type of injury is a metabolic injury, meaning the disruption is in the brain chemistry, and it's not a structural injury like a bruise or a lesion.

And because of that, concussion won't show up on routine imaging like a CT scan or an MRI. So if we wind up doing imaging, it's typically to rule out something more significant like a skull fracture or bleeding in the brain, which you would see on a scan. And that's the major difference between concussion and other head injuries.

With concussion, we're dealing with functional changes. So, physical symptoms like headaches and dizziness or cognitive changes like difficulty concentrating. Like if you think about the brain as a computer, when we talk about concussion, we're not talking about a hardware problem, but rather a software problem in which the brain circuitry is temporarily disrupted.

Host: Yeah. Interesting. Now, going back to the causes you mentioned not just an impact to the head, but also what I see in my mind is you talk about a whiplash effect.

Erin Reynolds, PsyD: Yes.

Host: So, that's what can cause that shaking of the brain, as you said, that causes all the things you mentioned.

Erin Reynolds, PsyD: Yes, even taking a hard hit. So, think about a sport like hockey, being slammed into the boards on the side. Maybe it's just the side of your body. But if it's enough force, it can travel up to the brain. So, we can see concussions happen that way too.

Host: And you do a lot of work with sports teams. You are a neuropsychologist for a team. Some folks may have heard of the Dallas Cowboys, the Dallas Wings, FC Dallas, and the North Texas Soccer Club as well. So, a lot of sports-related things, but concussions can happen from non-sports activity as well, isn't that right?

Erin Reynolds, PsyD: Certainly, yes. So, motor vehicle accidents, falling. We see a lot of concussions from the playground, so like recess or PE at school. It does not have to be sports specifically.

Host: We may get into some more sports things a little bit. But let me ask this, we talked about breaking some myths and being MythBusters when it comes to concussion. I think a lot of people think you must have to lose consciousness for it to be a concussion, and I don't think that's necessarily the case.

Erin Reynolds, PsyD: You do not have to lose consciousness for it to be a concussion. And in fact, most people will not lose consciousness. So, the research tells us that about 10% of concussions involve someone being knocked out, but it's far more likely that what happens is the injury occurs and the person will lose a little bit of their memory around the injury rather than actually being unconscious.

Host: I don't know if this is a myth or not, but needing to stay in a dark room after having suffered a concussion.

Erin Reynolds, PsyD: Well, we recommended that for many years, and I'm happy to now say that we no longer recommend that. For a long time, we thought that strict rest was the best treatment for concussion. And now, we know that while a brief period of we call relative rest, so the first 24 to 48 hours or so, is good. Acclimating back to normal activities and environments is really best practice. We actually refer to that dark room treatment as cocooning. And we know that there are many adverse consequences to that. So, think about if you sit in the dark for too long, negative mood changes, people start to hyperfocus on their symptoms, and it actually winds up taking a lot longer when we do that.

Host: So, eyesight, wearing dark glasses, kind of like sitting in a dark room, does that play into the recovery at all? Or are you seeing double or is eyesight an indicator or something that can happen from a concussion?

Erin Reynolds, PsyD: Yeah. So, we can see visual changes. So, the most common ones would be just seeing blurry vision or sometimes double vision. And then, that sensitivity to light is very common as well. So, all of these things are important things that we assess for, and we want to track through the recovery and treat if we need to.

One little myth out there too, a lot of people think if they have sensitivity to light, it is better to, say, wear their sunglasses more, but wearing those sunglasses inside can actually make it worse, because it conditions the brain to want to be in that shaded environment rather than acclimating back to the normal environment.

Host: Yeah, that makes sense. As we're talking about this, maybe we could discuss other symptoms and things parents should watch for. And they try to make a determination if their child may have had a concussion and when they should go to the emergency room.

Erin Reynolds, PsyD: There's kind of two categories. There's concussion symptoms, and there's concussion signs. So, the signs are typically seen right away. And often these are things that you might see as a parent or a coach or a teammate. So if someone is looking dazed or confused, maybe confused about the score of the game or what play just happened, if they're moving clumsily or stumbling around or repeating themselves over and over. Some of the more obvious signs would be loss of consciousness or vomiting on the field. But every concussion looks a little bit different. So, not everyone will have all of those. Some kids will have none of those signs.

And then, the symptoms, they can show up right away as well, but they can also be delayed and start sometimes hours or even days later. So, common symptoms, we kind of have these four categories. The physical symptoms would be things like headaches, dizziness, nausea, that sensitivity to light or noise, visual changes. Cognitively, we see fogginess, feeling slowed down, difficulty concentrating or remembering things. You may see emotional changes, so things like increased irritability or more sadness or worry. And then, you can also see some sleep changes. So, sometimes people are more tired, sometimes they sleep too much or they can't fall asleep and they're sleeping too little.

Signs that you should head to the emergency room would be things like a 10 out of 10 headache or the worst headache you've ever experienced, repeated vomiting, slurred speech, pupils that are looking like they're different sizes, or like excessive drowsiness where the kids are falling asleep. And the reason for that is that those are all signs that could indicate something more significant going on. So, we would want to do neuroimaging in those cases and make sure we're not dealing with bleeding or swelling of the brain.

Host: The recovery process once a child has had a concussion, what is that like? And I suppose it's probably different for every child, but what are some of the things parents can think about relative to recovery?

Erin Reynolds, PsyD: Recovery will vary. As I mentioned, everyone will experience concussion a little bit differently. Things like someone's medical history, their learning history. So, like any history of attention problems or learning differences. Even biological sex and age can play a role. But in general, research tells us that teenagers take about three weeks, and kids younger than that take about 30 days. That being said, we see many kids who get better much faster than that. And we see a handful of kids who take much longer than that.

To support recovery at home, we recommend keeping kids on a very regulated schedule with similar bedtime and wake time every day. Making sure they're well hydrated, they're eating enough, they're getting daily physical activity, and we provide specific recommendations around helping them to manage their stress and deal with school. But it's kind of a day-to-day process. And we check in very regularly with our patients to help advise and guide that process.

Host: Back to something we discussed a little bit earlier of vision, I'm thinking of vision and watching TV, playing video games. Is that something that you would speak to with regard to concussion and the recovery?

Erin Reynolds, PsyD: That is a hot topic of conversation in our clinic with our patients. We used to tell kids don't use screens at all, and we don't do that anymore because that's not realistic. Their whole lives are on screens. The school day is mostly on screens. And so, we advise they take breaks, they have to listen to their symptoms. Some kids will get more strict restrictions if, for example, they're having some visual issues. Video games are the hardest because, in the beginning, we do try to really limit those, and none of our patients want to do that. But the more we can get ahead of it early on, the faster we can get them back to what they want to be doing.

Host: How is it determined when a child's ready to go back to school or to normal activity?

Erin Reynolds, PsyD: Years ago, I started treating concussions back in 2012. And back then, kids were missing a lot of school. And we've come a really long way in terms of how we're getting kids back to school. We like to get them back to school right away. So, we provide a lot of support so that they can ease back into things.

And I think that's actually one of the benefits of seeing a specialist for this injury, because we are able to provide individualized return-to-learn plans based on the student's clinical presentation, their performance on our neurocognitive testing, their course load, specific course load in school. So, we provide structure and specific recommendations for teachers that allows the kids to be in school pretty much from the beginning-- same day or next day-- and start acclimating to that environment without being just completely overwhelmed and falling behind academically.

In terms of sports, we also start kids in-- we call it the return-to-play-- process right away. The standard return-to-play protocol is a six-stage progression with the first three stages being a graduated increase in physical activity. And then, the last three stages being more of a true return-to-play where they're doing practices. But the first three stages can be started very early while the athlete is still experiencing symptoms. And it actually becomes part of the treatment.

So, physical activity after concussion is really beneficial when done correctly. And the return-to-play protocol allows us to guide physical activity in a safe manner while monitoring symptoms and ensuring that the athlete isn't potentially overdoing it or pushing too hard.

Host: And, Doctor, as we mentioned earlier, you do a lot of work with professional teams, and anyone who watches an NFL game these days sees that the protocols are pretty strict. They go into the tent, they have a great protocol system. In youth sports, I'm sure many do also, but all might not. What would you tell a parent whose child's active in sports and if they have a concern that a concussion isn't being addressed fully or to the point they would like? What should a parent do?

Erin Reynolds, PsyD: Yeah. So, my best advice to parents would be to say that you are going to be your child's number one advocate. Here in North Texas, by the time the kids get into middle school, there's a lot more structure through the schools and the coaches. But youth sports, you're not always going to have that.

And so, I don't think parents should just assume that their youth coaches have training or any background in concussion. And if they're concerned, it's really important that if someone sustains a concussion, they don't continue to play through it. It's important to pull them from play, because the kids who play through the injury tend to have much longer recoveries. But also, that's when something really bad can happen if you sustain two concussions in one game, let's say.

So, parents have to be really vigilant. And I know sometimes it can be uncomfortable to interject in a youth sports environment. But at the end of the day, we all have to look out for our kids. And so, I think just being educated on what to look for and being comfortable raising your hand or interjecting when needed is important.

Host: Is there anything else, Doctor, we didn't touch on that you want to make sure parents understand about concussions? Any other myths that might be out there?

Erin Reynolds, PsyD: Well, not necessarily myths, but there's definitely three takeaways that I think are important. And I end all of my talks with these three takeaways. So, number one is that concussion is fully treatable. A lot of parents think there isn't anything we can do for it and we just have to wait it out. But it is really important to see a specialist who performs a comprehensive evaluation, because that allows us to actually treat the injury with targeted active treatments and that gets kids back to play faster and safer. Concussion's ultimately an invisible injury. So, we're not going to see it. So, we have to apply a variety of tests to truly understand what's going on and determine when it's safe for the kids to get back to play.

Number two is that active recovery piece. So, active recovery is the key. And that goes back to getting kids back to school and progressing in return-to-play as soon as we can. That prolonged rest and inactivity pretty reliably is going to lead to more longer and more complicated recoveries.

And then, finally, I think it's really important to just touch on the importance of team sports for kids. There's a lot of fear around concussion. But playing team sports is incredibly valuable for kids. Being on a team teaches life lessons about teamwork, resilience, how to be part of something bigger than themselves. And the friendships, the confidence that kids build through team sports are really invaluable.

And so while concussions are certainly a risk, especially with contact sports, if you understand how to recognize a concussion and have a plan for if and when it happens, the physical, social and emotional benefits of playing team sports far outweigh the risks.

Host: Dr. Erin Reynolds, great advice and a lot of great information about concussion and the cautions parents should take. Thank you for being with us today.

Erin Reynolds, PsyD: Thank you so much for having me. It was fun.

Host: Thank you for listening to Children's Health Checkup. For more information on how to prevent or treat concussions in your young athlete, visit childrens.com/sportsconcussion. If you found this podcast helpful, please rate and review or share the episode. And please follow Children's Health on your social channels. Thanks for listening and have a happy, healthy day.