Selected Podcast
Concussions: What Should You Do If Your Child Experiences A Head Injury?
Dr. Jeff Holloway and Dr. Alex Wagner lead an interactive discussion on concussions.
Featuring:
Jeff Holloway, MD is a Physician and Assistant Professor of Clinical Pediatrics UofSC School of Medicine Columbia.
Alex Wagner, MD | Jeff Holloway, MD
Alex Wagner, MD is a Pediatric Hospitalist at Prisma Health Tuomey, Assistant Professor of Clinical Pediatrics UofSC School of Medicine.Jeff Holloway, MD is a Physician and Assistant Professor of Clinical Pediatrics UofSC School of Medicine Columbia.
Transcription:
Joey Wahler (Host): We hear a lot about well-known athletes suffering concussions and about advances in diagnosing and treating them. But those much younger and less famous, namely kids, suffer the same injuries. So we're discussing concussions, what should you do if your child experiences a head injury?
Welcome to flourish. A podcast brought to you by Prisma health. Thanks for joining us. I'm Joey Waller our guests, Dr. Jeff Holloway medical director at the pediatric concussion clinic at Prisma health children's hospital and Dr. Alex Wagner, who practices pediatric sports medicine at Prisma health.
Gentlemen. Thanks so much for being with.
Let's start, Dr. Holloway, with you and, simply put, what exactly is a concussion for those that don't know and how serious is it if you get one?
Dr Jeff Holloway: Yeah, thanks for having us. The answer to what is a concussion can be very complex. The medical definition starts with the word complex. So it's a complex pathophysiological process affecting the brain induced by traumatic biomechanical forces. So basically, if you hit your head and it messes with your brain, that's ultimately a concussion.
So when we put that into context with traumatic brain injury, which is again, any injury to your brain, those affect the functioning of your brain, and then we also have to contextualize it with if it's a life-threatening problem, kind of like a brain bleed, then that's a different entity in and of itself. But ultimately, concussions are something that should go away over a few weeks' time. But unfortunately, it can cause some long-term problems in various domains with the brain's functioning and those sorts of things. So ultimately, it's something that can be very complex, but ultimately very easy to look at and say, "That's a concussion," and then we treat appropriately.
Joey Wahler (Host): And speaking of saying that's a concussion or it's not, Dr. Wagner, for you, what are the most common symptoms in determining whether someone is concussed or has another type of head injury?
Dr Alex Wagner: Yeah, I just wanted to also say thanks for having us on today. When it comes to the symptoms of concussion, every concussion really is different. Oftentimes in kids, parents are able to recognize the most common symptoms associated with concussions. Those that they kind of see in the media, that includes headache, dizziness, blurred, vision, confusion, sensitivity to light or sound. Oftentimes it's also important to realize that symptoms of a concussion can be more subtle and include changes in sleep patterns, mood disturbances, confusion, difficulty concentrating, or really anything that your brain controls, which for us is about everything.
Like Dr. Holloway said, any hit to the head or that cause kind of a jarring force on the head, if a child has suffered that, it's important to pay close attention to the recognizable symptoms that people are more familiar with as well as any changes in the way a child is acting or behaving. And also getting back to the point of a more serious brain injury, it's important to look out for some of those red flags symptoms, including neck pain, double vision, weakness, changes in consciousness, vomiting, or increased agitation. Any of these symptoms might be a sign that there's something more serious going on than a concussion.
Joey Wahler (Host): So back to you, Dr. Holloway, as a parent, should someone do if they think their child may have a concussion and how fast should they act?
Dr Jeff Holloway: So the way we kind of differentiate it is the urgency becomes one of those where, again, if any of those red flags Dr. Wagner mentioned are present, we need to evaluate for a life-threatening injury. So that's going to the ER. Now, unfortunately, the way the ER and other places look is they're trying to make sure we're not missing some of that. So sometimes they don't necessarily look into a concussion. So then, I would say it's very important that we figure out if your child has a concussion early on by getting them evaluated in the second step or second tier. So that's where bringing them to your pediatrician or bringing them to our office will allow you more information. And that I think is an important part where you don't overlook some basic things because, ultimately, we would recommend you being an advocate for your child. If you don't think something is right after your child has sustained an injury of any sort, a concussion, unfortunately could be there and there's ways that we can help further define that for you.
Joey Wahler (Host): So Dr. Wagner, if left untreated, what are the dangers of a concussion, especially in a child?
Dr Alex Wagner: When we talk about concussions being untreated, I kind of think of two things. First is a scenario where a kid suffers an injury, they're playing sports or in some other setting where the concussion isn't immediately recognized and they continue to play. In this situation, what can potentially happen is a child's at increased risk of suffering a more serious life-threatening brain injury called second impact syndrome. And the avoidance of this condition is really why there's such an emphasis on properly recognizing and identifying players or kids who have suffered a concussion. This is why leagues like the NFL have an independent neurologist to try to look out for these injuries because we want to avoid that second impact syndrome. And so preventing that life-threatening injury is one reason recognizing and initial treatment and removing someone from play is important.
In the second scenario, if a concussion is maybe not identified right away, then just starting the recovery process is delayed. It's just like a lot of other medical issues where earlier intervention can be important to get long-term recovery going off on the right foot. And so trying to get these principles started earlier helps optimize the recovery process.
Joey Wahler (Host): So back to you, Dr. Holloway, again, using the NFL analogy that I mentioned at the top, those of us that follow football or even other sports, especially when it comes to the pros or major college athletes, we hear a lot in the news about someone sitting out during a concussion. Concussion protocol is a big phrase that's used nowadays. We'll hear someone remains in concussion protocol, they're out of concussion protocol. What does some of that terminology mean? What are you doing as doctors during that period to actually treat the concussion so that someone can go from in to out of that period?
Dr Jeff Holloway: So that can be a very complex process. But most of the time, luckily, it's a pretty simple protocol like you were saying. And actually a lot of it starts with proper education and following the right steps like we would with a lot of injuries of relative rest and then increasing slowly. So ultimately, concussions are an energy problem, that your brain needs energy to heal, so you don't want to be doing too much and, again, risking that reinjury like Dr. Wagner mentioned, but ultimately trying to increase slowly back.
So a couple of the basic things, especially for kids that doesn't apply as much to the NFL is things like returning to learn, so returning to school. So while it can be stressful for your brain, at the same time, it can be rehabilitative. So we want to make small adjustments, increase back slowly to increase that demand as progressively as possible without making things worse.
Unfortunately, we don't have pills or injections or anything like that that'll make concussions go away. So sometimes it's short-term treatment, making sure that we're doing the right thing early on is the way to prevent it from getting worse. And then it's a slow increase. So again, avoiding significant physical activity, staying out of contact sports, but doing some progressive exercise can be beneficial.
And then, ultimately, a concussion should just go away by definition. But after about three or four weeks, we switch to a more active treatment. And those things include things like physical therapy, vision assessments, cognitive evaluations, overall things to decrease the dysfunction that has now occurred.
And so overall, there's two big phases of concussion treatment and protocol. But then, ultimately, it can be a pretty simple process as long as we're following some basic values in that care.
Joey Wahler (Host): So Dr. Wagner, if you're a kid that's gotten a concussion, naturally you're at some point going to want to know when you can get back on the field, when you can get back to school, as Dr. Holloway alluded to. Is there a thumbnail timetable for the average child concussion or is it just too varied to specify?
Dr Alex Wagner: Yeah, that's one of the most popular questions I get asked by both parents and kids of when can they get back to doing their sport or their activity that they love doing. And it's a tough thing to answer. What we kind of know is that approximately 80% of pediatric concussions resolve within that three to four-week time period Dr. Holloway was talking about. And during this time period, recovery really is just following those general treatment principles of slow progression back to activity, trying to limit symptom worsening. And like you said, often these principles are enough to support complete recovery. Although sometimes it's not and, like I said, 80%. So that leaves a window, one out of every five may have some prolonged dysfunction. It's important for parents to pay attention to kids, to notice any gradual worsening or failure to improve or return to baseline, because these may be indicators that further assessment and evaluation may be necessary to try and tease out some of the nuances of that child's individual concussion.
Joey Wahler (Host): So Dr. Holloway, is there anything a kid can do or a parent can do for their kid, whether it be equipment-wise or otherwise to protect yourself and try to prevent concussions as much as possible yourselves?
Dr Jeff Holloway: So one would definitely be, if you've had one concussion, not going back in, because unfortunately we can't prevent all. So one thing we do know is if you've had a concussion and, unfortunately, keep pushing yourself, you're eight times more likely to have prolonged recovery, so trying to avoid that. But certainly, things like helmets can be of benefit, wearing them properly in the proper fitting, the proper technique are all pieces of it. There's some data that's saying wearing a helmet with skateboarding and things like that decreases your risk of a brain injury by 88%. And so those things along with proper techniques in tackling and just being kind of aware of your sport and surroundings, so you're not putting yourself in harm's way is one of the best ways. And then certainly, being fully evaluated afterwards in case you had a concussion is something that we always push on too as a way to kind of protect from concussion being a bad problem for you.
Joey Wahler (Host): And then in closing here to sum this up, Dr. Wagner, it seems as though treating concussions, maybe even diagnosing them as well, has come a long way in recent years. Is that true? And what services in particular does Prisma Health offer concussion patients, especially children?
Dr Alex Wagner: Definitely, there's been a change in more recognition and diagnosis of concussions. And I think Prisma Health has done a really good job to keep up with that. So there's a lot of services available through Prisma. I like to think that we start at the grassroots level, so Prisma Health has a team of athletic trainers that cover various high schools and organized sports leagues, trying to help recognize concussions at the time of injury. They oftentimes work with our orthopedic department, who does some concussion treatment and evaluation, as well as the clinics that Dr. Holloway and I host here in Columbia and Sumter. Our clinics here help do kind of a comprehensive assessment. We have about hour-long visits where we put patients through cognitive evaluations, exercise tests when appropriate. We study heart rate variability and see how all of these potential subtle factors could influence a kid's concussion and their brain function.
In addition to here in the Midlands and the Upstate, there's an acute concussion clinic run through a pain medicine clinic. And that's kind of the approach to concussions through physicians that Prisma Health offers. In addition, there's physical therapists who have some specialized training in concussion, and, here in the Midlands, we have a few therapists who are very well-trained in that and can help with the recovery process.
Joey Wahler (Host): Well, folks, we hope you now have some valuable information if you think your child may have a concussion. Doctors Jeff Holloway and Alex Wagner, thanks again for being with us.
Dr Alex Wagner: Thanks
Dr Jeff Holloway: Thank
Dr Alex Wagner: Thank
Dr Jeff Holloway: you.
Joey Wahler (Host): Well, for more information, you can visit prismahealth.org/flourish. If you found this podcast helpful, please do share it on your social media. And thanks so much again for listening to Flourish, a podcast brought to you by Prisma Health. Hoping your health is good health, I'm Joey Wahler.
Joey Wahler (Host): We hear a lot about well-known athletes suffering concussions and about advances in diagnosing and treating them. But those much younger and less famous, namely kids, suffer the same injuries. So we're discussing concussions, what should you do if your child experiences a head injury?
Welcome to flourish. A podcast brought to you by Prisma health. Thanks for joining us. I'm Joey Waller our guests, Dr. Jeff Holloway medical director at the pediatric concussion clinic at Prisma health children's hospital and Dr. Alex Wagner, who practices pediatric sports medicine at Prisma health.
Gentlemen. Thanks so much for being with.
Let's start, Dr. Holloway, with you and, simply put, what exactly is a concussion for those that don't know and how serious is it if you get one?
Dr Jeff Holloway: Yeah, thanks for having us. The answer to what is a concussion can be very complex. The medical definition starts with the word complex. So it's a complex pathophysiological process affecting the brain induced by traumatic biomechanical forces. So basically, if you hit your head and it messes with your brain, that's ultimately a concussion.
So when we put that into context with traumatic brain injury, which is again, any injury to your brain, those affect the functioning of your brain, and then we also have to contextualize it with if it's a life-threatening problem, kind of like a brain bleed, then that's a different entity in and of itself. But ultimately, concussions are something that should go away over a few weeks' time. But unfortunately, it can cause some long-term problems in various domains with the brain's functioning and those sorts of things. So ultimately, it's something that can be very complex, but ultimately very easy to look at and say, "That's a concussion," and then we treat appropriately.
Joey Wahler (Host): And speaking of saying that's a concussion or it's not, Dr. Wagner, for you, what are the most common symptoms in determining whether someone is concussed or has another type of head injury?
Dr Alex Wagner: Yeah, I just wanted to also say thanks for having us on today. When it comes to the symptoms of concussion, every concussion really is different. Oftentimes in kids, parents are able to recognize the most common symptoms associated with concussions. Those that they kind of see in the media, that includes headache, dizziness, blurred, vision, confusion, sensitivity to light or sound. Oftentimes it's also important to realize that symptoms of a concussion can be more subtle and include changes in sleep patterns, mood disturbances, confusion, difficulty concentrating, or really anything that your brain controls, which for us is about everything.
Like Dr. Holloway said, any hit to the head or that cause kind of a jarring force on the head, if a child has suffered that, it's important to pay close attention to the recognizable symptoms that people are more familiar with as well as any changes in the way a child is acting or behaving. And also getting back to the point of a more serious brain injury, it's important to look out for some of those red flags symptoms, including neck pain, double vision, weakness, changes in consciousness, vomiting, or increased agitation. Any of these symptoms might be a sign that there's something more serious going on than a concussion.
Joey Wahler (Host): So back to you, Dr. Holloway, as a parent, should someone do if they think their child may have a concussion and how fast should they act?
Dr Jeff Holloway: So the way we kind of differentiate it is the urgency becomes one of those where, again, if any of those red flags Dr. Wagner mentioned are present, we need to evaluate for a life-threatening injury. So that's going to the ER. Now, unfortunately, the way the ER and other places look is they're trying to make sure we're not missing some of that. So sometimes they don't necessarily look into a concussion. So then, I would say it's very important that we figure out if your child has a concussion early on by getting them evaluated in the second step or second tier. So that's where bringing them to your pediatrician or bringing them to our office will allow you more information. And that I think is an important part where you don't overlook some basic things because, ultimately, we would recommend you being an advocate for your child. If you don't think something is right after your child has sustained an injury of any sort, a concussion, unfortunately could be there and there's ways that we can help further define that for you.
Joey Wahler (Host): So Dr. Wagner, if left untreated, what are the dangers of a concussion, especially in a child?
Dr Alex Wagner: When we talk about concussions being untreated, I kind of think of two things. First is a scenario where a kid suffers an injury, they're playing sports or in some other setting where the concussion isn't immediately recognized and they continue to play. In this situation, what can potentially happen is a child's at increased risk of suffering a more serious life-threatening brain injury called second impact syndrome. And the avoidance of this condition is really why there's such an emphasis on properly recognizing and identifying players or kids who have suffered a concussion. This is why leagues like the NFL have an independent neurologist to try to look out for these injuries because we want to avoid that second impact syndrome. And so preventing that life-threatening injury is one reason recognizing and initial treatment and removing someone from play is important.
In the second scenario, if a concussion is maybe not identified right away, then just starting the recovery process is delayed. It's just like a lot of other medical issues where earlier intervention can be important to get long-term recovery going off on the right foot. And so trying to get these principles started earlier helps optimize the recovery process.
Joey Wahler (Host): So back to you, Dr. Holloway, again, using the NFL analogy that I mentioned at the top, those of us that follow football or even other sports, especially when it comes to the pros or major college athletes, we hear a lot in the news about someone sitting out during a concussion. Concussion protocol is a big phrase that's used nowadays. We'll hear someone remains in concussion protocol, they're out of concussion protocol. What does some of that terminology mean? What are you doing as doctors during that period to actually treat the concussion so that someone can go from in to out of that period?
Dr Jeff Holloway: So that can be a very complex process. But most of the time, luckily, it's a pretty simple protocol like you were saying. And actually a lot of it starts with proper education and following the right steps like we would with a lot of injuries of relative rest and then increasing slowly. So ultimately, concussions are an energy problem, that your brain needs energy to heal, so you don't want to be doing too much and, again, risking that reinjury like Dr. Wagner mentioned, but ultimately trying to increase slowly back.
So a couple of the basic things, especially for kids that doesn't apply as much to the NFL is things like returning to learn, so returning to school. So while it can be stressful for your brain, at the same time, it can be rehabilitative. So we want to make small adjustments, increase back slowly to increase that demand as progressively as possible without making things worse.
Unfortunately, we don't have pills or injections or anything like that that'll make concussions go away. So sometimes it's short-term treatment, making sure that we're doing the right thing early on is the way to prevent it from getting worse. And then it's a slow increase. So again, avoiding significant physical activity, staying out of contact sports, but doing some progressive exercise can be beneficial.
And then, ultimately, a concussion should just go away by definition. But after about three or four weeks, we switch to a more active treatment. And those things include things like physical therapy, vision assessments, cognitive evaluations, overall things to decrease the dysfunction that has now occurred.
And so overall, there's two big phases of concussion treatment and protocol. But then, ultimately, it can be a pretty simple process as long as we're following some basic values in that care.
Joey Wahler (Host): So Dr. Wagner, if you're a kid that's gotten a concussion, naturally you're at some point going to want to know when you can get back on the field, when you can get back to school, as Dr. Holloway alluded to. Is there a thumbnail timetable for the average child concussion or is it just too varied to specify?
Dr Alex Wagner: Yeah, that's one of the most popular questions I get asked by both parents and kids of when can they get back to doing their sport or their activity that they love doing. And it's a tough thing to answer. What we kind of know is that approximately 80% of pediatric concussions resolve within that three to four-week time period Dr. Holloway was talking about. And during this time period, recovery really is just following those general treatment principles of slow progression back to activity, trying to limit symptom worsening. And like you said, often these principles are enough to support complete recovery. Although sometimes it's not and, like I said, 80%. So that leaves a window, one out of every five may have some prolonged dysfunction. It's important for parents to pay attention to kids, to notice any gradual worsening or failure to improve or return to baseline, because these may be indicators that further assessment and evaluation may be necessary to try and tease out some of the nuances of that child's individual concussion.
Joey Wahler (Host): So Dr. Holloway, is there anything a kid can do or a parent can do for their kid, whether it be equipment-wise or otherwise to protect yourself and try to prevent concussions as much as possible yourselves?
Dr Jeff Holloway: So one would definitely be, if you've had one concussion, not going back in, because unfortunately we can't prevent all. So one thing we do know is if you've had a concussion and, unfortunately, keep pushing yourself, you're eight times more likely to have prolonged recovery, so trying to avoid that. But certainly, things like helmets can be of benefit, wearing them properly in the proper fitting, the proper technique are all pieces of it. There's some data that's saying wearing a helmet with skateboarding and things like that decreases your risk of a brain injury by 88%. And so those things along with proper techniques in tackling and just being kind of aware of your sport and surroundings, so you're not putting yourself in harm's way is one of the best ways. And then certainly, being fully evaluated afterwards in case you had a concussion is something that we always push on too as a way to kind of protect from concussion being a bad problem for you.
Joey Wahler (Host): And then in closing here to sum this up, Dr. Wagner, it seems as though treating concussions, maybe even diagnosing them as well, has come a long way in recent years. Is that true? And what services in particular does Prisma Health offer concussion patients, especially children?
Dr Alex Wagner: Definitely, there's been a change in more recognition and diagnosis of concussions. And I think Prisma Health has done a really good job to keep up with that. So there's a lot of services available through Prisma. I like to think that we start at the grassroots level, so Prisma Health has a team of athletic trainers that cover various high schools and organized sports leagues, trying to help recognize concussions at the time of injury. They oftentimes work with our orthopedic department, who does some concussion treatment and evaluation, as well as the clinics that Dr. Holloway and I host here in Columbia and Sumter. Our clinics here help do kind of a comprehensive assessment. We have about hour-long visits where we put patients through cognitive evaluations, exercise tests when appropriate. We study heart rate variability and see how all of these potential subtle factors could influence a kid's concussion and their brain function.
In addition to here in the Midlands and the Upstate, there's an acute concussion clinic run through a pain medicine clinic. And that's kind of the approach to concussions through physicians that Prisma Health offers. In addition, there's physical therapists who have some specialized training in concussion, and, here in the Midlands, we have a few therapists who are very well-trained in that and can help with the recovery process.
Joey Wahler (Host): Well, folks, we hope you now have some valuable information if you think your child may have a concussion. Doctors Jeff Holloway and Alex Wagner, thanks again for being with us.
Dr Alex Wagner: Thanks
Dr Jeff Holloway: Thank
Dr Alex Wagner: Thank
Dr Jeff Holloway: you.
Joey Wahler (Host): Well, for more information, you can visit prismahealth.org/flourish. If you found this podcast helpful, please do share it on your social media. And thanks so much again for listening to Flourish, a podcast brought to you by Prisma Health. Hoping your health is good health, I'm Joey Wahler.