Concussions Can Affect Processing Time in Speech and Language

By Melissa D. Stockbridge, M.Sc.
Guest Contributor

Even a relatively minor head trauma can result in physical, cognitive, behavioral, and social consequences for a young patient. Specific effects of mild brain injury or concussion on language ability can include effects on the ability to think of the names for things, make sentences, and interact with others appropriately in social situations. Many studies have linked brain injury to difficulty reading and telling stories.

Anomia, or difficulty thinking of the names for objects or people (essentially, severe “tip-of-the-tongue” experiences), is the most common reported symptom that affects language. Problems with naming can have big impacts in the classroom. Imagine not being able to come up with the name of the main character in a novel or the particular term you need to name in your science class!

Not only is the accuracy of coming up with the names of objects affected (e.g., saying “dog” when viewing a picture of a dog), but also there is an increase in the time that it takes the patient to come up with the name.

This can be imagined by analogy to a computer connecting to the Internet that may eventually load a webpage correctly, but the connection is much slower than usual.

SpeakExamining differences in the “processing time” required to name an object may be useful in better understanding the cognitive changes that occur during the period of spontaneous recovery directly following a brain injury.

Researchers at the University of Maryland, College Park, are examining
naming accuracy and processing time across the period of spontaneous
recovery from mild head trauma, in order to better understand the
changes in young people with brain injuries.

Patients at HeadFirst Concussion Care between the ages of 10 to 20 years of age are being recruited to name rapidly presented images on a computer that measures how quickly they say the name of that image. It is predicted that adolescents with concussions will demonstrate a steep rate of recovery of naming accuracy to within normal range, with a slower recovery of processing time beyond that point.

It is our hope that this information will improve information available to clinicians and patients in making return-to-learning and return-to-play decisions and will add to what is known about how a minor injury may impact performance in language or in education.

Melissa D. Stockbridge is an M.A./Ph.D. student at the University of Maryland’s Department of Hearing and Speech Sciences

Giving Thanks for our Team, Plus Many Schools Lack in Return-to-Learn Guidelines

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

If this is your first time looking at our blog or visiting the HeadFirst website, we are one of the premier community-based concussion clinics in the country that provides education, evaluation, and treatment of traumatic brain injuries for children and adults ages 2 and up.

Our overall staff commitment to excellence is reflected in the teamwork and service to HeadFirst patients and their families.

Headfirst has seen thousands and thousands of patients this year, has conducted community outreach events with more than 180,000 attendees, provided thousands more ImPACT® concussion baseline tests, and is submitting our fifth research project for publication.

What we do in HeadFirst doesn’t happen by magic….

Providing care to this many patients requires an effort of our entire team: from the support of CEO Dr. Robert G. Graw, Jr., and Senior Medical Officers Dr. Stanford Coleman and Dr. Marc Weber, to Chief Creative Officer and Program Advisor Amy Knappen, to Director of Clinical Services and Training Lauren Burkhead, FNP, to all the medical providers and staff in our clinics. The collective effort of our entire team has lea HeadFirst Sports Injury and Concussion Care to experience tremendous success over the past year.

At this time of the year of giving thanks, I am truly blessed and thankful that I work with such a wonderful team of dedicated and motivated professionals.

I recently received this article from a fellow professional that highlights the widely varying policies of school preparedness for dealing with concussions.

The study was conducted at Nationwide Children’s Hospital in Columbus, Ohio, and surveyed 695 public high school principals about their knowledge of mild traumatic brain injury (mTBI). The findings highlight both good news as well as some opportunities for improvement.

For example:

  • Less than half of those surveyed had taken a concussion management training course
  • About a third of schools provide families with written plans
  • Less than a quarter provide potential academic accommodations to students
  • 80% had case managers assigned to students with concussions, who are usually a school nurse or athletic trainer
  • 86% could identify someone at their school who communicates with students’ health care providers after a concussion in an athlete, while only 79% could make that same identification if the injured student was a non-athlete

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Researchers also noted that preparedness plans shouldn’t concentrate only on school athletes. There is often a greater awareness of return-to-play guidelines than return-to-learn, although students should return to academics before returning to sports. Researchers felt that these findings highlight the need for guidelines governing return to academics.

It should be noted that, presently, only Nebraska and Virginia have return-to-learn laws in place, while all 50 states have return-to-play laws.

HeadFirst-Doc-is-In
Parents need to be their child’s best advocate and ensure that they get accommodations from their doctor for continued school success.  mTBI is the only injury that affects a child’s ability to continue to be successful at school. This injury requires the collective effort of those working closely with the child to be in constant communication, which include the parents, nurse, teachers, and health care providers treating the child’s mTBI.

How Much Do Athletes Know About Concussion Symptoms?

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

Only a few studies have ever been conducted to examine the efforts that hospitals, universities and communities are making to educate children about the symptoms of a traumatic brain injury. Fortunately, the University of Florida is one of the few institutions who has done some work in this area. Their recent survey of 334 varsity high school football players from 11 Florida high schools uncovered some interesting, yet unsurprising, results.

Footballs - Question Mark

The conclusion that University of Florida researchers drew was that most of the high schoolers did not know or could not associate some of the symptoms that they might experience with a concussion, including nausea, neck pain, and trouble concentrating.

In fact, even with parents or guardians signing a consent form indicating they discussed concussion awareness with their child, nearly half of the study’s athletes suggested they had not.

At HeadFirst Concussion Care, our own research team recently conducted a brief survey at a local high school during the athletes’ annual sports physicals.

Our team asked high schoolers if they knew the difference between various medical injuries, including orthopedic injuries, cardiac emergencies, mTBI’s, and dehydration.

We found that these youth athletes had some knowledge of mTBI but we also learned that many of the teenagers in our sample were uninformed about dehydration and cardiac emergencies.

Conducting this research is so important because it shapes the ways we can improve our education and training.  Knowledge is the most important key to reducing the number of concussions, especially multiple traumas.

Monitoring educational programs in high schools, middle schools and recreation programs is extremely important to HeadFirst so we can find out where to direct our educational efforts to keep children, parents and coaches informed.

HeadFirst-Doc-is-InIs it OK to drink alcohol or smoke a joint ever now and then with a mTBI?

As a former military guy, I’m nearly duty-bound to remind others that using cannabis is still illegal in Maryland. This, in itself, should provide additional motivation for avoiding the drug.

As a dad, I’m stunned that more private schools in the area don’t conduct mandatory random drug tests.

Research is still ongoing, but adding chemicals to the brain, including cannabis, when it is injured and recovering would most likely add to one’s recovery time. I recommend staying away from all brain stimulants and depressants while recovering from an mTBI. This includes not only cannabis and alcohol, but also caffeine products.  — Dr. D.

What Are We Teaching Our Kids?

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

Former pro football player Jim McMahon and pro hockey player Jeremy Roenick (below), both of whom suffered concussions during their careers, are joining up to raise awareness about the dangers of concussions at all levels of sports. Their foundation, Players Against Concussions, is planning event sponsorships and has already launched three advisory boards that include leaders in youth sports, research and medicine, and current and former pro athletes.

mcmahon-roenick

Roenick acknowledged that, as long as kids are going to play sports, concussions are not going to go away, but the duo is hoping to educate everyone in sports – from the athletes, to the parents, to the coaches – that early treatment is the best approach.

As Roenick says, “It’s the lack of education that causes people to have problems later in life.” And he’s absolutely right. After all, education is a cornerstone of the HeadFirst program.

As a parent, doctor and scientist, I have several thoughts both after reading this article and, coincidentally, watching a Pop Warner football game over the weekend that left me realizing how far we need to go with the educational process.

More doctors and researchers and educators need to go to Pop Warner football games. While watching 8-year-olds play this past weekend, parents were high-fiving and jumping up and down like they were watching older, more advanced kids at a high school state final or NCAA playoff game.

There were the cheerleader parents, the sideline coach parents, and the parents living vicariously through their kids. But, I’m not sure any of them had safety as their top priority.

As a parent, I wondered, “What are you folks thinking and what’s the point of this game? What are you teaching your kids because they’re watching you jump around!”

As a doctor and coach, I silently asked, “How is your emotional yelling toward these young children affecting them?”

As a scientist, I wonder about our educational efforts for concussion awareness going and also how states compare to one another? I was just traveling not too long ago to another state (I won’t say where but I have extended family in New Jersey) and considered how we could use different states’ “best practices” to help all of us improve our educational programs. This is certainly something to consider.

Be sure to check out next week’s blog when I’ll review some of our results from educational surveys of high school athletes here in Maryland regarding mTBI.

HeadFirst-Doc-is-InAt the Pop Warner game last weekend, I did witness one hard hit. The player was flagged for “targeting” another player and helmet-to-helmet contact. Prior to high school youth players, should be flagged for “improper tackling technique” – helmet-to-helmet contact. Refs, coaches and parents can then instruct the child on the proper football technique.   — Dr. D.

How Many Concussions Are Too Many?

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

Football is just a phenomenal sport.

I’m a season ticket holder of Navy football and also a huge fan of Army and Air Force football. These kids stand for a bit more than just playing football…and if I’m going to spend money I’d rather support the Brigade of Midshipmen and Air Force and West Point Cadets. But that’s a blog post for another day.

The bottom line is that I’m a huge football fan. The lessons that come from football often can’t be taught in a classroom.

NFL wide receiver Wes Welker has incredible numbers for the New England Patriots and now for the Denver Broncos. But for Wes, the most troubling concern is his three concussions in the last nine months. And watching the game last Sunday he looked as though he got clobbered and never saw the hit coming late in the fourth quarter.

Baltimore Ravens v Denver Broncos

Sometimes, parents will ask me “How many concussions are too many and when should I start looking for another sport for my little one?”

Presently there is no definitive number of concussions published in the literature. But three tends to be my number as a provider. If an athlete has had three significant neurological events — a concussion or mild traumatic brain injury —and there was a change in their mental status, that’s worthy of a discussion with the parents.

Clinicians will look at a number of factors such as mechanism of injury, intensity of symptoms, and length of time until complete recovery. I’ve had a patient who had a single mTBI and I had to talk to the parents about potentially choosing another sport after their child took 14 months to recover. Conversely, I’ve worked with parents after their child has had her sixth concussion but recovered in a week.

Wes Welker appears to have just had his fourth concussion in 10 months and I’m sure he’s having talks with his coaches and family about his health and recovery.

Here at HeadFirst Concussion Care, we have thousands of visits to treat head traumas. And, in many of those visits, I am often asked if sports are worth it.

My answer everytime? Absolutely. Kids learn leadership, companionship, competition, exercise, emotional balance, and many other values and benefits of sports.

The primary danger with a head injury is returning too soon before the injury has had a chance to heal itself. Play it safe. When in doubt, sit it out. In almost every case, the brain will heal and the child can return to his or her love of sports.

How Well Do Football Helmets Protect Players from Concussions?

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

One of the most common questions that I get from parents is “How well will my child’s helmet protect against concussion?”

The elusive answer appears to have been provided at the 2014 American Academy of Neurology’s annual meeting. In a study co-authored by Frank Conidi, MD, DO, MS, director of the Florida Center for Headache and Sports Neurology, Assistant Clinical Professor of Neurology at Florida State University College of Medicine, the standard drop test was modified to measure linear and rotational responses in crash test dummies to repeated 12 mile-per-hour impacts.

Conidi, who is also the vice chair of the American Academy of Neurology’s Sports Neurology Section, and his colleagues conducted 330 tests to measure how well 10 popular football helmet designs protected against traumatic brain injury, including: Adams a2000, Rawlings Quantum, Riddell 360, Riddell Revolution, Riddell Revolution Speed, Riddell VSR4, Schutt Air Advantage, Schutt DNA Pro+, Xenith X1 and Xenith X2.

They found that helmets do protect the player from massive injuries like skull fractures in the range of 70 to 80 percent but provide little to no protection against concussion in the range of 10 to 15 percent.

Why is that? While the helmet does its job in disbursing the impact of a hard hit across the helmet to greatly reduce the risk of a skull fracture at one specific site, a helmet cannot stop the brain from shaking inside the skull, thus providing little to no protection against a concussion.

In fact, the team of scientists found that football helmets, on average, reduce the risk of traumatic brain injury by only 20 percent compared to not wearing a helmet. Added to these statistics, Conidi says, “Alarmingly, those that offered the least protection are among the most popular on the field.”

One of the best tools we have available is neurocognitive baseline testing. With the beginning of the school year upon us, please remember to get your child baseline tested. Headfirst Concussion Care offers free ImPACT® baseline testing. Please call 1-855-748-4868 (SIT-IT-OUT) or visit us online to arrange your child’s appointment.

Helmet-Collision

Fall Sports are a Great Time to Learn About Concussion Symptoms

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

Fall sports are right around the corner, which means doctors will see an uptick in the number of traumatic brain injuries.

Here are a few tips for parents to keep their kids safe throughout the season:

#1 – Get educated on concussions and mild traumatic brain injury. Learn what the symptoms are so if your child is experiencing some difficulties, you‘ll be able to identify the problem.  Common symptoms following a concussion are:
•    Physical – headache, dizziness, balance problems, fatigue, light and noise sensitivity
•    Cognitive – problems concentrating or remembering information, feeling foggy, and feeling slowed down
•    Emotional – feeling more irritable or sad, feeling more nervous or feeling more overwhelmed
•    Sleep – feeling drowsy, sleeping to little or too much, and trouble falling asleep

#2 – Talk with your kids about concussions. Let them know about the symptoms and that they should tell their coach and yourself if they aren’t feeling well after a game or practice

#3 – Focus on the goal of why your child is playing sports. Great goals include:
•    the importance of team work
•    discipline (especially if that effort can be translated into the classroom)
•    making friends and getting some exercise.

Keep it in perspective that most of children are not focused on the pros – they’re in sports for the sheer love of playing. If your child is injured, please take a conservative approach and wait until he or she is completely healed (without the above-listed symptoms) before returning to competitive athletic competition.

#4. Familiarize yourself with Maryland law regarding concussion. Every state now has concussion laws regulating traumatic brain injuries in youth sports. These laws generally have three major components: to educate parents, coaches and players about concussions; to remove the athlete from play if he or she is suspected of having a concussion; and to ensure the child is cleared by a medical provider to return to play.

#5. Familiarize yourself with the policies of your child’s school and team. Make sure that your son or daughter gets baseline neuro-cognitive testing in the unfortunate event they do sustain an injury. Doctors can look back and see what your child’s performance was like prior to the sports season.

We have thousands of visits a month to treat head traumas.  I am often asked if sports are worth it. Absolutely! Kids learn leadership, companionship, competition, exercise, emotional balance, and many other values and benefits of sports. The primary danger with a head injury is returning too soon before the injury has had a chance to heal itself. Play it safe. And remember, when in doubt sit it out.

HeadFirst Concussion Care - Fall Sports - Concussions