Does a child in your family play sports? If so, there are things you should know about the risks and dangers of childhood concussions.
Concussions are serious, traumatic brain injuries that get worse each time they happen. It’s important to know the warning signs when you may be dealing with something as serious as brain trauma.
Peter Gray is here to help you learn your ABC's: Assess the situation, Be alert for the signs and symptoms, and Contact a health care provider when there is a head injury.
Learn more about Concussions
Selected Podcast
Do You Know the Signs of Childhood Concussion?
Featured Speaker:
Peter Gray
Peter Gray is the Head athletic trainer at Henry Clay High School. He also works at the UK HealthCare Turfland Clinic. Transcription:
Do You Know the Signs of Childhood Concussion?
Melanie Cole (Host): Sport-related concussion is a hot topic in the media and in medicine. It’s a common injury that’s likely underreported by pediatric and adolescent athletes. 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, a fall on the playground, or yes while playing sports. My guest today, is Peter Gray. He’s an Athletic Trainer at the UK Healthcare Turfland Clinic and Head Athletic Trainer at Henry Clay High School. Welcome to the show, Peter. What is a concussion?
Peter Gray (Guest): When we’re talking about sports-related concussions, we’re talking about a trauma-induced change of mental status either by a direct or an indirect blow to an athlete. It can result in confusion, impaired memory, reduce the speed of processing, and doesn’t always have to have loss of consciousness, but that is a big, red flag to us for a concussion. The onset can be immediate; it can be gradual. For the most part, they can go away right away, or they can be prolonged for months. They can happen from an acceleration, deceleration, or a rotational force that is basically acted on the brain.
Melanie: Who’s at risk for a concussion? What sports are particularly vulnerable to this situation?
Peter: Well, definitely football and those big contact sports like hockey, men’s lacrosse, soccer, but all of these sports we play have an inherent risk of injury, and about 5% of most injuries are concussions. And because it’s a direct or an indirect force to the head – so, even a force that’s to the chest that is transmitted through the neck and into the head – can cause a concussion to our brain.
Melanie: So Peter, parents, coaches, even the athletes themselves put a lot of emphasis and a lot of – they’re really confident with the equipment. Does the equipment protect from concussions? We’re looking at helmets, and things, and pads, do these things work or are they – do they just help to maybe reduce the severity?
Peter: Right, so I’ll start by saying there are no concussion-proof helmets or pads. There is a lot more studies going on as far as helmets in football. Originally, helmets were only tested, and they would do a drop test, which would show the resilience to a skull fracture or things like that. Now, we’re doing a lot more testing as far as the forces that are being transmitted through the helmet to somebody’s brain. But yeah, none of these helmets or pads really prevent concussions, and now, more tests are being done – and studies are being done that are showing that they’re more effective for, I guess, the severity, but even a minor concussion is an important thing to look at. So yeah, the equipment is still not on par, and we do put a lot of faith in our equipment, but at the same time, it’s not 100% concussion-proof. We’re seeing that in football because obviously, we’re still having concussions in football with these advances in helmets.
Melanie: You mentioned some of the symptoms before – memory impairment, you mentioned a few, but let’s talk about the symptoms for a minute because sometimes an athlete is going to want to keep continuing to play. Is it everybody’s job to look out for some of these symptoms, not only the coach and maybe the parents on the sideline, but other athletes on the field as well to keep track – the buddy system -- to see that everybody is keeping an eye on each other and making sure is experiencing some of those symptoms? What should they be looking for?
Peter: Right, it’s very important to have the coaches, the other players, the referees, all on the same page as far as recognizing when another player is not behaving right. In kids, we have special considerations because they’re all at different developmental stages as far as cognitive learning. A lot of high schoolers still feel that they’re invulnerable and those are the kids that typically you see hiding concussions and continuing to play through symptoms.
Now, symptoms, there is a lot to do with mental status as far as impaired recall, disorientation, and there are behavioral changes as far as feeling depressed, anxiety, sadness. And then the things that show up on the field are the physical changes as far as balance, vision, fatigue, headaches, ringing in the ears, things of that nature. They usually have a head trauma associated with them, but some indirect blows can cause these kids to have concussions. The symptoms might present right away; they may present later on in the game; they may present after the game. It’s hard for an athletic trainer to always recognize every concussion and that’s why I would stress emphasizing players, coaches, referees, and other players because we all know these athletes. Just really keep an eye on it. Other players should definitely not be quiet about it when they know their friend – even though they’re a crucial part of the team – isn’t playing right. They’re forgetting plays, and they’re doing things like that, those are big, red flags to us.
Melanie: Is it emergent? When do you – if a parent notices or if a player comes off on the sidelines, is this an Emergency Room visit or is it something that parents can take their child home and keep them rested? What’s treatment like, and do they have to go to the Emergency Room?
Peter: Well, after any big blow to the head, we do need to check the neurological function and rule out any cranial bleeds, any fractures to the skull. After we rule out anything major like that, a concussion is not a trip to the Emergency Room. It’s more – the initial step would be full and total physical and cognitive rest. We do want them to be seen in clinic with an orthopedist that specializes in concussions, and UK Sports Medicine has two great ones, Dr. Hosey and Dr. Smoot. That just initiates the return to play. They’re going to see a concussion specialist, and in that way, we’re going to start tracking their symptoms. We’re going to monitor them throughout the whole process making sure that something doesn’t come up that could be very serious. And in that case, if somebody does have prolonged symptoms, being seen at the clinic right away we can get them the additional therapies and things that they might need so that their symptoms don’t go on for months and that we can get them returned to play safely.
Melanie: When in doubt, sit it out seems to be the mantra that everybody uses, but when can a parent know that it’s okay to go back to school? Are they allowed to be doing homework using electronics, watching TV, and should a parent be using Motrin or another form of pain relief if there are some symptoms like headaches?
Peter: Right, for the most part, if tolerated, I would recommend just Tylenol or no NSAIDs to mask the symptoms because we do want to monitor the symptoms as much as possible. We like to give it a grade and usually, we are asking their symptom score very often. As far as returning to school and returning to play, that’s 100% based on symptoms. And I’m glad you brought that up about school because usually, we’re thinking about a return to play and not about a return to school. School is very important. Kids can tend to struggle going back to school because they’re having trouble concentrating and things of that nature. It’s important to know that – to talk with teachers and things like that – that there are accommodations that should be made. These kids are usually stressed out about school already, and when you’re cognitively impaired, things are going a little slower, it’s harder to learn, they might have a bunch of tests that week, some accommodations do need to be made for that.
Our return to play, from a physical standpoint we do want them to return symptom-free. It usually takes 24 to 48 hours on the typical, and then we’re going to initiate some light aerobic activity again, staying symptom-free, and then we’re going to move on to more sport-specific exercises, and then non-contact drills, and then full contact. We need to stay symptom-free with all of that. If we do get some symptoms coming back, we take a step back and just continue that rest and then we’ll pick it up where we left off.
Melanie: How many is too many?
Peter: That’s really the million-dollar question, and that’s one of the questions as far as youth sports that we really don’t have the answer to. I’ve read a lot of things that say the more in a shorter period of time is very concerning, but concussions are so different to everyone. Some people might have a concussion that lasts months. Somebody might have a concussion that lasts a few days as far as symptoms go. Now, there are studies saying that some people are more prone to concussions than other people. Really, I think that’s where the research is headed now is trying to really pinpoint down how many is too many, but right now, we just don’t know.
Melanie: So then wrap it up for us, Peter, with your best advice about concussion prevention, if possible, recognizing the importance of those symptoms -- and the ABCs really, about assessing a situation – what you want listeners, and parents, and coaches to know about a concussion?
Peter: Well, the number one way to prevent a concussion is either – well, not playing is the one, but that’s usually not the case. It's really changed in the game. I like to stress that referees play a big role as far as gameplay goes. They can stop play before things get out of hand. They can stop unnecessary hits, especially in football. We see that starting with the professional leagues and they trickle down to the high school level. As far as coaching goes, really taking the head out of the game as far as practices, teaching safe tackling where you can take your head out of the play instead of leading with the head, which is a very good thing to emphasize. Really, concussions shouldn’t happen in practice because you should be able to teach the kids how to play the game without putting them at risk of getting hit in the head. And then the number one way to manage a concussion is recognizing it right away, not allowing kids to play through a concussion, and really because some of the more serious things happen when you get a secondary blow to a head after sustaining an impact to the head – a concussion, already. Just taking them out of the field is important, and then making sure they’re following up with a doctor that’s familiar with concussions that’s not going to clear them right away. We do want to have a gradual return to play, and we want to monitor these kids and making sure that they are safe to return.
Melanie: Thank you so much, Peter, for being with us today. This is UK Health Cast with the University of Kentucky Healthcare. For more information, you can go to UKHealthcare.uky.edu, that’s UKHealthcare.uky.edu. I’m Melanie Cole. Thanks so much for listening. Thank you.
Do You Know the Signs of Childhood Concussion?
Melanie Cole (Host): Sport-related concussion is a hot topic in the media and in medicine. It’s a common injury that’s likely underreported by pediatric and adolescent athletes. 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, a fall on the playground, or yes while playing sports. My guest today, is Peter Gray. He’s an Athletic Trainer at the UK Healthcare Turfland Clinic and Head Athletic Trainer at Henry Clay High School. Welcome to the show, Peter. What is a concussion?
Peter Gray (Guest): When we’re talking about sports-related concussions, we’re talking about a trauma-induced change of mental status either by a direct or an indirect blow to an athlete. It can result in confusion, impaired memory, reduce the speed of processing, and doesn’t always have to have loss of consciousness, but that is a big, red flag to us for a concussion. The onset can be immediate; it can be gradual. For the most part, they can go away right away, or they can be prolonged for months. They can happen from an acceleration, deceleration, or a rotational force that is basically acted on the brain.
Melanie: Who’s at risk for a concussion? What sports are particularly vulnerable to this situation?
Peter: Well, definitely football and those big contact sports like hockey, men’s lacrosse, soccer, but all of these sports we play have an inherent risk of injury, and about 5% of most injuries are concussions. And because it’s a direct or an indirect force to the head – so, even a force that’s to the chest that is transmitted through the neck and into the head – can cause a concussion to our brain.
Melanie: So Peter, parents, coaches, even the athletes themselves put a lot of emphasis and a lot of – they’re really confident with the equipment. Does the equipment protect from concussions? We’re looking at helmets, and things, and pads, do these things work or are they – do they just help to maybe reduce the severity?
Peter: Right, so I’ll start by saying there are no concussion-proof helmets or pads. There is a lot more studies going on as far as helmets in football. Originally, helmets were only tested, and they would do a drop test, which would show the resilience to a skull fracture or things like that. Now, we’re doing a lot more testing as far as the forces that are being transmitted through the helmet to somebody’s brain. But yeah, none of these helmets or pads really prevent concussions, and now, more tests are being done – and studies are being done that are showing that they’re more effective for, I guess, the severity, but even a minor concussion is an important thing to look at. So yeah, the equipment is still not on par, and we do put a lot of faith in our equipment, but at the same time, it’s not 100% concussion-proof. We’re seeing that in football because obviously, we’re still having concussions in football with these advances in helmets.
Melanie: You mentioned some of the symptoms before – memory impairment, you mentioned a few, but let’s talk about the symptoms for a minute because sometimes an athlete is going to want to keep continuing to play. Is it everybody’s job to look out for some of these symptoms, not only the coach and maybe the parents on the sideline, but other athletes on the field as well to keep track – the buddy system -- to see that everybody is keeping an eye on each other and making sure is experiencing some of those symptoms? What should they be looking for?
Peter: Right, it’s very important to have the coaches, the other players, the referees, all on the same page as far as recognizing when another player is not behaving right. In kids, we have special considerations because they’re all at different developmental stages as far as cognitive learning. A lot of high schoolers still feel that they’re invulnerable and those are the kids that typically you see hiding concussions and continuing to play through symptoms.
Now, symptoms, there is a lot to do with mental status as far as impaired recall, disorientation, and there are behavioral changes as far as feeling depressed, anxiety, sadness. And then the things that show up on the field are the physical changes as far as balance, vision, fatigue, headaches, ringing in the ears, things of that nature. They usually have a head trauma associated with them, but some indirect blows can cause these kids to have concussions. The symptoms might present right away; they may present later on in the game; they may present after the game. It’s hard for an athletic trainer to always recognize every concussion and that’s why I would stress emphasizing players, coaches, referees, and other players because we all know these athletes. Just really keep an eye on it. Other players should definitely not be quiet about it when they know their friend – even though they’re a crucial part of the team – isn’t playing right. They’re forgetting plays, and they’re doing things like that, those are big, red flags to us.
Melanie: Is it emergent? When do you – if a parent notices or if a player comes off on the sidelines, is this an Emergency Room visit or is it something that parents can take their child home and keep them rested? What’s treatment like, and do they have to go to the Emergency Room?
Peter: Well, after any big blow to the head, we do need to check the neurological function and rule out any cranial bleeds, any fractures to the skull. After we rule out anything major like that, a concussion is not a trip to the Emergency Room. It’s more – the initial step would be full and total physical and cognitive rest. We do want them to be seen in clinic with an orthopedist that specializes in concussions, and UK Sports Medicine has two great ones, Dr. Hosey and Dr. Smoot. That just initiates the return to play. They’re going to see a concussion specialist, and in that way, we’re going to start tracking their symptoms. We’re going to monitor them throughout the whole process making sure that something doesn’t come up that could be very serious. And in that case, if somebody does have prolonged symptoms, being seen at the clinic right away we can get them the additional therapies and things that they might need so that their symptoms don’t go on for months and that we can get them returned to play safely.
Melanie: When in doubt, sit it out seems to be the mantra that everybody uses, but when can a parent know that it’s okay to go back to school? Are they allowed to be doing homework using electronics, watching TV, and should a parent be using Motrin or another form of pain relief if there are some symptoms like headaches?
Peter: Right, for the most part, if tolerated, I would recommend just Tylenol or no NSAIDs to mask the symptoms because we do want to monitor the symptoms as much as possible. We like to give it a grade and usually, we are asking their symptom score very often. As far as returning to school and returning to play, that’s 100% based on symptoms. And I’m glad you brought that up about school because usually, we’re thinking about a return to play and not about a return to school. School is very important. Kids can tend to struggle going back to school because they’re having trouble concentrating and things of that nature. It’s important to know that – to talk with teachers and things like that – that there are accommodations that should be made. These kids are usually stressed out about school already, and when you’re cognitively impaired, things are going a little slower, it’s harder to learn, they might have a bunch of tests that week, some accommodations do need to be made for that.
Our return to play, from a physical standpoint we do want them to return symptom-free. It usually takes 24 to 48 hours on the typical, and then we’re going to initiate some light aerobic activity again, staying symptom-free, and then we’re going to move on to more sport-specific exercises, and then non-contact drills, and then full contact. We need to stay symptom-free with all of that. If we do get some symptoms coming back, we take a step back and just continue that rest and then we’ll pick it up where we left off.
Melanie: How many is too many?
Peter: That’s really the million-dollar question, and that’s one of the questions as far as youth sports that we really don’t have the answer to. I’ve read a lot of things that say the more in a shorter period of time is very concerning, but concussions are so different to everyone. Some people might have a concussion that lasts months. Somebody might have a concussion that lasts a few days as far as symptoms go. Now, there are studies saying that some people are more prone to concussions than other people. Really, I think that’s where the research is headed now is trying to really pinpoint down how many is too many, but right now, we just don’t know.
Melanie: So then wrap it up for us, Peter, with your best advice about concussion prevention, if possible, recognizing the importance of those symptoms -- and the ABCs really, about assessing a situation – what you want listeners, and parents, and coaches to know about a concussion?
Peter: Well, the number one way to prevent a concussion is either – well, not playing is the one, but that’s usually not the case. It's really changed in the game. I like to stress that referees play a big role as far as gameplay goes. They can stop play before things get out of hand. They can stop unnecessary hits, especially in football. We see that starting with the professional leagues and they trickle down to the high school level. As far as coaching goes, really taking the head out of the game as far as practices, teaching safe tackling where you can take your head out of the play instead of leading with the head, which is a very good thing to emphasize. Really, concussions shouldn’t happen in practice because you should be able to teach the kids how to play the game without putting them at risk of getting hit in the head. And then the number one way to manage a concussion is recognizing it right away, not allowing kids to play through a concussion, and really because some of the more serious things happen when you get a secondary blow to a head after sustaining an impact to the head – a concussion, already. Just taking them out of the field is important, and then making sure they’re following up with a doctor that’s familiar with concussions that’s not going to clear them right away. We do want to have a gradual return to play, and we want to monitor these kids and making sure that they are safe to return.
Melanie: Thank you so much, Peter, for being with us today. This is UK Health Cast with the University of Kentucky Healthcare. For more information, you can go to UKHealthcare.uky.edu, that’s UKHealthcare.uky.edu. I’m Melanie Cole. Thanks so much for listening. Thank you.