Transcription:
Concussions

Sean O’Connor (Host):   Welcome. I'm Sean O’Connor. I'm a marketing communications rep at Riverside Healthcare and I'm joined today by Sara Barr. Sara, how are you doing?

Sara Barr, MS, AT (Guest):   I've very well Sean. Thanks again for having me.

Host:   You're an athletic trainer here at Riverside, correct?

Sara:   I am an athletic trainer. I actually am the outreach coordinator for orthopedic specialists here at Riverside. It’s a new program and we’re building and I'm very exited to kind of share some of the information and some of the things that we’re bringing to the community.

Host:   This is your second podcast with us, correct?

Sara:   It is. I'm a veteran now.

Host:   You are a pro at this right now. You’ve done fantastic in the previous episode. So I, again, encourage people to take the time to listen to the previous one and follow Sara as she educates us on everything concussion related and athletic training related.

Sara:   Yes. Those are two definitely soft spots in my heart. I enjoy being an athletic trainer. I enjoy dealing with athletes. Concussion is one of my passions. So I'm here to talk about it as much as you want to listen.

Host:   Excellent. So going along with soft spots, today we’re talking about concussions.

Sara:   Correct.

Host:   What is a concussion?

Sara:   So a concussion is, in the easiest terms, a brain injury. Typically when we see a concussion it is a traumatic incident that happens. Be it a fall with head contact to the ground, be it a car accident where you get whiplash. It’s actually just a brain injury. So the mechanism of that injury isn’t necessarily important. It’s the actual effects of that injury to the brain that makes it a concussion.

Host:   Okay, interesting. Concussions, I think a lot of people think of football right away, but concussions don’t just occur in football. They occur across all sports.

Sara:   Absolutely. All sports, activities. Again, even activities of daily living. This podcast is happening right now in January and we’re getting some snow. People will slip and fall. Sometimes, again, a fall, a car accident. You don’t necessarily have to hit the dashboard but, again, a whiplash type accident. Athletics are huge right now with concussion and actually the identification and evaluation of a concussion as it happens. That is one of the hot topics. Football, soccer, wrestling. Those are all contact sports where we do see a prevalence of athletes having this type of issue happen.

Host:   Interesting. So what are some of the signs and symptoms we see with concussions?

Sara:   Again, concussions kind of run the gamut. So there are numerous symptoms. I think the big ones that you would want to look for if you thought you had suffered a concussion or somebody that you knew suffered a concussion would be a headache, memory loss, compromised vision, ringing in the ears, possibly vomiting or nausea. Again, it could be just some pain in the head. If there’s actually a contact to the head you would have a bruise or swelling or anything like that. In and of themselves, those symptoms don’t necessarily make it a concussion but those would be things that you would look for or the worsening of symptoms like that to maybe look for some further diagnostic imaging or suggestions to make sure that it’s not something more severe.

Host:   So how soon do symptoms tend to develop after the initial accident?

Sara:   Sometimes it will take 24 to 48 hours for those symptoms to manifest depending on the severity of the injury. After you get injured—again if it’s a car accident or you get hit during a football game—something else might hurt a little bit worse at that time. So it’s not something that you focus on. Once all those other injuries sift out or maybe it’s not as severe you do notice those symptoms and you do notice that you're having some issues maybe with balance even or something like that. That would be, again, maybe manifesting itself after 24 to 48 hours after the actual incident.

Host:   So it’s important to keep in mind that maybe you don’t experience something right away but after the fact it starts to show up, it is still just as important to get checked out.

Sara:   Absolutely. Again, it may not be something where you are seen right away. Maybe you have a headache right away, but your headache goes away and then all of a sudden you're having some balance problems. They don’t all have to happen at the same time, but those would be things where if it is lasting more than 24 to 48 hours, you probably should make sure that you get that checked out.

Host:   Okay. At what point should someone consider seeking medical attention?

Sara:   When it’s a problem. Again, if there is a specific incident. And loss of consciousness is a big thing. So if you are in a car accident or there's an athletic injury and there's a loss of consciousness, that is typically a red flag to get somebody to the emergency room to have an evaluation. The emergency room will be able to do the diagnostic imaging and make sure that pain is controlled and such. If it’s something where maybe it was something minor, maybe you bumped your head, you didn’t think much of it. You slipped down the stairs and maybe your back hurt worse first and now you're still having that headache, you should make sure that you're functional. It’s when you have that lack of function where the pain of the headache or there's multiple symptoms that are presenting themselves, that’s definitely when you should make sure that you get yourself looked at.

Host:   Okay. What are some of the ways that concussions are treated?

Sara:   Concussions, unfortunately, there's no one way to treat them. That’s why there's a ton of different tools that we use. Here at Riverside we do have a concussion center where we do use multifaceted ways to kind of diagnose, treat, evaluate, and return to function. There are neurocognitive type tests where you can actually look at a computer and go through kind of games to make sure that you do have memory that you can track visually, that there’s no issues with reading, any of those types of things. So there's neurocognitive tests like that. There are sideline tests for our athletic trainers that are able to go through a battery of tests with the athlete as the concussion happened or as it happened to make sure that they are either returning or not returning to play safely.

Treatment, we do have our physical medicine and rehabilitation physician. Dr. Gilbert, she is amazing at making sure that she evaluates and gets a good treatment plan because not only is it return to function but a lot of times with our athletes we’re worried about return to learn. We want to make sure that they are able to do everything at school as well. Sometimes it’s just a matter of maybe putting them in a separate room, maybe giving them a little extra time until the brain heals up. You can't put a brace on a brain. You’ve got to let it heal; you’ve got to give it time. Typically a resting brain is a healing brain. So rest, making sure that you get a good evaluation.

The tests that we have available—Our physical therapy department actually has Biodex, which is a vestibular therapy. Because balance is sometimes an issue that does cause a problem after a concussion. It’s the only Biodex in the area. So we are very happy that we have that available. We are able to baseline athletes as well.  So if an athlete comes in and they are participant of a high impact sport, they can come in and get a baseline before there's an actual injury. Then afterwards we can compare that test to the original test to make sure that they are returning safely.

Host:   Interesting. So you said vestibular, what does that mean?

Sara:   Vestibular is, again, the balance, the proprioception. So within the brain which is why there’s a thousand different ways to treat this. We don’t really know how a brain actually works, how all of these symptoms manifest. Again, if there's a part of the brain that is effected it may effect somebody differently. It may be memory. Maybe there's swelling in one part and not another part of the brain. So the vestibular is the balance part. That is when we’re looking at somebody to return to function. You want to make sure that they can balance, make sure that they can walk appropriately. It’s not affecting their gait so that there's not a problem and they trip and fall and then hurt their knee or something like that. We want to make sure if it is an athlete that they have all of the proprioception so that they can make a quick reaction time. Make sure that they are making good decisions, able to move their head without having any of those dizzy spells or anything like that come back.

Host:   Interesting. What are some of the long term effects that someone with a concussion could experience if it doesn’t go treated or even if they do go treated.

Sara:   Sure. Concussion, again, is a hot topic right now. It’s definitely something where we are finding if you don’t treat it appropriately when it happens there are a lot of long term effects. The Concussion Legacy Foundation is an organization that actually studies the brain. They are studying CTE, which right now chronic traumatic encephalopathy is the actual diagnosis. We assimilate that with football players. However, boxers, hockey players, MMA fighters, soccer players. There are a lot of athletes that are donating their brains actually—Dale Earnhardt, Jr. who is a racecar driver. He has donated his brain—not right now but when the time comes—he has pledged to donate his brain for research for that reason because there are a lot of long term effects that could effect your lifestyle. Again, if it goes untreated it’s treated improperly. There is post-concussion syndrome. That does happen usually we say in about three months if the concussion either is not treated or appropriately or if there are just lasting symptoms, lasting effects. Again, we’re not 100% understanding how the brain works. So there is always that possibility that despite all the treatment and all the tests that we’ve run, everything that we’re able to do, concussion symptoms may just last. Again, that’s what we call post-concussion syndrome. Just making sure that we are able to get people back to function is the biggest goal. Making sure that they're able to return to doing what they like to do.

Host:   Yep, very interesting. So with young students who are in sports, if they seem to have some type of injury is it a good idea to have them checked out every time or is it a wait and see approach? Is it good to put them right back into the sport right away? What's the best approach as a parent perspective as well as a coach perspective?

Sara:   Sure. So I do wear a lot of hats. I am an athletic trainer, I am a parent myself, and I am an athlete. So it is definitely something—Again, concussion is kind of a passion of mine. So if there is a possibility of a head injury, if it is something that you’ve visually seen. You’ve hit your head on the ground. There is no way to concussion proof any athlete. There are helmets out there that say that they are. There are people out there that tote a lot of equipment and stuff like that. There's no way to prevent a concussion. There's ways to lessen the risk. Strengthening, neck strengthening. Again, education is a big part of it. Making sure that you are monitoring symptoms if they are happening. So it is very unsafe for somebody to return to sport if they are having any symptoms following a blow to the head or a whiplash type incident or if they are having any sort of symptoms that are relative or related to a concussion.

We do have, again—With our athletic trainers, we use what’s called the SCAT 5. It’s an actual test that they use on the sideline. They test the athlete when it happens, they test them five minutes later make sure that there's no exacerbation of the symptoms. They test then 10 minutes later to make sure that’s nothing is worsening. Then outside of the symptom score they do have a little bit of objective measurements then to make that call whether or not to send them back in. Now as a parent we don’t have the SCAT 5. Not a lot of people know what that is. Not a lot of people carry that around in their wallet or their purse or on their phone. So it would just be making sure that you are letting your athlete know to be truthful with you. Parents do tend to know their children a little bit better than coaches or even other teammates. However if a teammate or a coach sees that there's something going on, they should report it. If you see it, report it. I know that’s a tagline for a lot of different things, but definitely for concussion as well. If you see it, report it. So if there is something that is popping up as a symptom of concussion—a headache or balance problems, memory issues—they sometime get irritable. It’s a personality change. They have visual issues. That would be something that you would want to get treated, but never something that you would send somebody back into any activities before it gets checked out.

Host:   The irritability with teenagers is always very hard too.

Sara:   Well and a lot of those symptoms too are symptoms of dehydration or malnutrition or they have a sinus infection. So it is, again, a communication piece too. You have to make sure that you are educated. You're educating your athlete that you have discussions with the coaches and those kinds of things. If there are issues, there are things going on. Make sure that everything is aware of it. Again if there is an injury just making sure that that gets checked out before it does become a problem.

Host:   Now what about very young children? So the ones that are two, three, even one that are just learning to walk. As a parent, I know there are multiple times that they’ve hit their heads and it’s like an, “Alright. Are you okay?” Is concussions something that can occur with children at a very young age or is it that there's just still enough padding in there?

Sara:   Well, it is definitely something that you would want to make sure that you monitor. Obviously if there's a bonk to the head, sometimes they get that goose egg. A goose egg is not a concussion. It’s definitely an injury to the brain. They do have a little bit more cushion inside that ginormous melon. So there is a little bit more and for that particular reason. The body is amazing at making sure that it keeps itself safe. It heals itself and that kind of thing. So young kids it would definitely be something where if you are seeing symptoms and irritability, babies cry, that kind of thing. If there is ever a question, it always better to err on the side of safe judgement.

Host:   Interesting. Very interesting. So along with that, what is some good different ways to get in contact with somebody at Riverside that if you’ve seen maybe someone you know or you yourself has experienced a concussion recently?

Sara:   Sure. Well we, again, have a concussion center here at Riverside. We do work with many different departments depending on what area of the concussion we are dealing with. Again, whether it’s the identification, evaluation, treatment, rehabilitation, return to function. So if there is a question going to riversidehealthcare.org would be a great place to go ahead and get started with that search. Again, concussion center is a place that we are not necessarily a brick and mortar building, but we are a collaboration of many different healthcare providers to be able to get our patients to the right area in the most appropriate time available. So, again, riversidehealthcare.org is going to be the best place for you to go ahead and look there for any sort of information if you have questions.

Host:   Well fantastic. Thank you for coming on.

Sara:   Absolutely.

Host:   We hope to have you back again for another episode of sports and athletic training soon.

Sara:   Wonderful. Thank you.

Host:   Thank you very much.