Transcription:
Concussions in Youth Sports

Melanie Cole (Host):  An estimated 10% of all athletes in contact sports such as football, hockey and soccer suffer a concussion each season. Both parents and coaches should be aware of the signs and symptoms of a concussion to protect the well-being of their players. My guest today is Dr. David Harsha. He’s a sports medicine specialist with Hendricks Regional Health. Welcome to the show, Dr. Harsha. First tell us:  what is a concussion.

Dr. David Harsha (Guest):   A concussion, Melanie, is a short-term, in most cases, change to brain function that is the result of an impulsive force to the head usually from a head-to-head hit or a head-to-ground hit but it can also happen just from a violent twisting action. They usually last seven to ten days, but some last quite a bit longer. That’s what a concussion is. It results in a set of symptoms that can include headache, nausea, dizziness, visual and hearing disturbances. Many times those take up to several days to go away. Balance can also be thrown off by a concussion and can be a problem for a few days in most cases.

Melanie:  During play, how do you even know or how does the coach know…what do they look for – red flags – when the kid is out on the field and they haven’t come walking off – that they might have even suffered a concussion?

Dr. Harsha:  That’s a great question because that is something that coaches and parents need to be really attuned to. When you see a child who gets up slowly or doesn’t seem to be walking steadily, is off balance, stumbles, or is confused about what they should do next, or if they are having trouble following directions from the coach, or if they complain of a headache, or they complain of feeling dizzy or off balance. They need to be pulled from the sport and evaluated and make sure they know whether they’ve had a concussion or not.    

Melanie:  The buddy system – getting the other players out on the field to recognize some of those symptoms--is important as well. If your child has suffered a concussion, then what? Is this an emergent situation? Do you keep them out of school? Are they not allowed to watch TV and use the internet? What do you do, Dr. Harsha?

Dr. Harsha:  The first thing is to identify whether they’ve had a concussion. In most cases, that means they should be evaluated by a medical professional, either a physician or athletic trainer, to determine if they have had a concussion or not or is it just a bump on the head or some bruise. If they’ve had a concussion or any symptoms of a concussion after they’ve taken a hit to the head, they need to be pulled from that sport for at least 24 hours and evaluated by a medical professional, generally within 24-48 hours, in most cases. If they have anything that is involving numbness or tingling in their arms or legs or they are knocked out unconscious for any length of time more than a few seconds, then that becomes a more emergent situation that should be evaluated by an emergency physician in an emergency room. If after a concussion, they go home and they are acting funny, their behavior changes, or they start throwing up more than once or twice, then, again, that is a red flag that child and/or young adult needs to get to the emergency room and have an evaluation completed. In general, I do recommend that they stay home from school if they have trouble concentrating or they have severe symptoms that are really quite bothersome and keep them from being able to pay attention and do school work. We know that if they do really focus and try to work hard in school when they have severe symptoms from a concussion they, many times, don’t remember what they are trying to learn anyway and their learning becomes very inefficient.

Melanie:  Tell us about the impact testing and safe return to play. When can you child go back? Some kids are going to be like, “I want to go back now. Please let me go back.” Some kids know when they have to sit out. What is the impact testing and how do you know if it’s safe to go back?

Dr. Harsha:  Again, that is one of those pieces of evaluation of concussion that we use. It’s one tool in our bag of trying to make sure that we know somebody is safe to return to sport. I tell parents and athletes that there are four things that they need to have happen. Their symptoms need to be gone. They have to have a normal physical exam with me in my office. They have to return to normal on their impact test and I’ll explain that in a moment. They have to go to a return to play progression of five days of increasing levels of exertion to make sure their brain and body are ready to handle the level of sport they’re playing without any reoccurring symptoms or problems. The impact test is a neuropsychological computerized battery that takes about 20-30 minutes. In most cases, we try to get a baseline because it tells us what normal function is for that athlete. As I mentioned as one of those four things for return to play, that should be retested when symptoms resolve. We do that in the office and interpret it and determine if they are back to normal or if we need to hold them out longer and wait for their brain function to return to normal. It’s one of those barometers of how well they are thinking, concentrating, and remembering that helps us determine that they are safe to return to play and go back to hitting.

Melanie:  Now, let’s talk prevention. Is there such a thing as prevention? Parents look at these helmets – they are very expensive--the pads; all of the different equipment for all of the different sports, hockey being – yikes. We look at this stuff and we put our trust in it. Should we be doing that? Are these things technologically advanced enough to protect our children from concussion or is there more we can do?

Dr. Harsha:  There is no helmet that is concussion proof yet.  Certainly, there is a lot of work being done to try and find that option for people. The better the helmet and the better the fit of the helmet, the less likely of the severity of the concussion will be something that holds the player out for a longer period of time. I encourage people to consider using the a Virginia Tech rating of helmets and the higher rating on those helmets gives an option for parents if they want to try and get a four or five star helmet that gives them the best chance of minimizing the forces that their child’s head will see when they have a hit in sport. That is a great option. Many institutions try to use those ratings to try and pick the best helmet but there is no concussion proof helmet but we can lessen the potential for a more severe concussion by having good equipment. I get asked a lot about mouth guards also. Mouth guards are great to prevent jaw injuries, fractures to jaws, dental injuries but, again, there is no evidence that we’ve seen that they can prevent a concussion.

Melanie: There’s been some recent activity with no more headers in soccer for children under 10 and checking in hockey. Do you think that some of these measures are going to help to reduce some of these injuries that you see?

Dr. Harsha:  I do think when rule changes are made in a sport, there is usually good reason to believe that we can reduce the risk of a severe injury or even an injury at all. Hockey, for example, as you mentioned, is a great example. They increased the age before the players can hit. We know that the younger the child that many times the longer it takes to recover from a concussion because they are developing brain just takes longer to recover. Children heal well but when it comes to concussions, they offer take longer and things can cause a significant loss of playing time. If we can delay the things that lead to hits that can cause concussion, then we should be able to reduce their risk of an injury.

Melanie:  Just take a minute here to speak about general sports injuries and cross training, Dr. Harsha. How important and what do you tell parents about cross training their children to avoid some of the chronic injuries that you see as a sports medicine specialist?

Dr. Harsha: That’s a hot topic these days and certainly there is some research evidence that shows that playing multiple sports and cross training leads to better athlete development and less risk of, for example, focusing on one sport and doing the same repetitive activity over and over and over. Prevention becomes cross train, have your body well prepared, give appropriate rest periods because everybody needs rest. There is certainly a drive to always look at more is better but sometimes more isn’t better. Having periods of rest built in as well as doing a great job with following a very good sports nutrition diet will help keep the athlete in the best shape to prevent injury and be well throughout their year. Many times it is helpful to have a month or two off in the summer and heal. Those rest periods can be helpful for athletes. If people really want to focus in on a performance plan to develop in their sport, then sports-specific plans can be a great way to prepare, be in great shape, be strong and prevent injury.

Melanie:  In just the last minute, your best advice, Dr. Harsha, for parents and keeping their children safe and their little athletes safe and why they should come to Hendricks Regional Health and see you.

Dr. Harsha:  We can assist certainly on the end when injuries do occur. We stand ready to help with a great set of resources including our computerized testing, our physicians that are well versed and trained in management of concussions. We have a spectrum of care beyond that with our physical therapy where we sometimes need vestibular rehabilitation as part of concussion. We have great resources to plug our patients in that can give them a complete spectrum of care with specialists, should they be needed. We have them all here at the hospital and through our system to serve the needs of each individual.

Melanie:  Thank you so much. It’s such great information. You’re listening to Health Talks with HRH, Hendricks Regional Health.  For more information you can go to Hendricks.org. That’s Hendricks.org. This is Melanie Cole. Thanks so much for listening.