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Concussions Are on the Rise

by Sue Hubbard, M.D.

As our children become more and more involved in competitive athletics the incidence of concussions is also on the rise. Not surprisingly, football still has one of the highest rates of concussions, with one in five high school or college players experiencing a concussion each year. Cheerleading has also seen a rise in number of concussions reported, as cheerleading stunts become more about athleticism and tumbling, putting cheerleaders at risk for a head injury from a fall.

A concussion is defined as a trauma induced alteration in mental status that may or may not cause loss of consciousness. A concussion is a functional rather than a structural brain injury. The injury, typically arising from a direct or indirect blow to the head sets off a cascade of neuro-pathological events leading to a confusional state or memory dysfunction. Because a concussion is more of a metabolic crisis of the brain, neuroimaging studies with CT scans and MRI are rarely helpful. Concussions are typically diagnosed based upon symptoms including amnesia, confusion, impaired level of consciousness, poor concentration, headache, dizziness, fatigue, nausea or vomiting. Many symptoms may be non-specific in nature, but impaired mental status of any degree is the hallmark of a concussion.

Because young athletes want to continue playing, even after a concussion is suspected, it is important to assess the athlete’s mental status immediately after the injury. There are several tests that may be performed even while the athlete is on the field, including orientation to person, place and time; attention; memory and higher cognitive functions. It is also important to assess the athlete’s judgment, and mood. Both coaches and parents should be aware of the hazards of returning a student to play after even a mild “ringing of the athlete’s bell”.

Recent studies have shown that the still developing brains of adolescents and children are slower to heal from concussions. The younger you are the longer it takes to recover from a concussion; the brain is just more vulnerable. Allowing a teen to re-enter a soccer or football game, or cheerleading stunt immediately after a head injury puts them at risk of second – impact syndrome, a rapidly progressive brain injury that can lead to brain swelling and death. Concussions may lead to one fatality for every 300,000 children participating in sports.

Current guidelines regarding return to activity and athletics are tending to be more conservative as studies have shown that the likelihood of long term and permanent impairment in cognitive function increases with each concussion. While a simple concussion typically resolves in seven to 10 days and requires no further intervention than rest, a more significant injury may take more than two to four weeks to reach full recovery. Once the athlete has rested, meaning no exercise or exertion for at least a week and all symptoms of headache, “feeling foggy” and fatigue have resolved, they may begin light exercise, such as walking or riding a stationary bicycle. If there are no recurrence of symptoms with light exercise then running, and resistance training may begin. With each increase in activity level the athlete should remain asymptomatic and may gradually move toward full activity and return to competitive play.

Parents and coaches must remind student athletes that while missed games may feel like an unnecessary restriction, it is really only a minor inconvenience, which will help maintain long-term brain health.

That’s your daily dose, we’ll chat again tomorrow.

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One Response to “Concussions Are on the Rise”

  1. Liz Ditz says:

    Are concussions really on the rise, or have parents, teachers, and coaches become more aware of these mild brain injuries, thus reporting them more? I grew up in the 50s and 60s and competed in equestrian events. Helmets then were merely articles of apparel, not the brain-protecting devices required today. I biked to school — not a helmet in sight. I, like my schoolmates, climbed trees (and fell from them).

    That said, good article.

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