Summertime is Fun But Watch for Risks

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

Each week in our concussion clinics, I am reminded about how seemly innocuous summertime activities can unexpectedly take a turn for the worse. Pool injuries are all too common, especially in older teens and young adults. Though their bodies have changed over the years, people in the late teens and early 20s can forget how much taller they are and more they weigh than in their youth.

Dive-Pool

I recently saw a young women who had jumped into about four feet of water and landed on her head and neck. She needed to be flown out to a regional hospital that manages shock and trauma patients but, luckily, had no life-threatening injuries. Unfortunately, the hospital sent the patient home with instructions to wake up every couple of hours, which goes against concussion recovery guidelines for brain rest. So, our work on educating both the public and professionals goes on.

Another patient I recently treated was a man in his 60s who was playing baseball with his grandson and fell face-first against a tree — hard enough to sustain an eye injury and a concussion. After more than a year of treatment, he continues to have memory and balance problems.

The summer is a fantastic time to hang out by the water, play games in the yard. But, always be careful. Be aware of your surroundings. Frequently stay hydrated and make sure your loved ones around you are doing the same.

Concussion Concerns Raised Again in the World Cup Finals

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

Germany may have won the 2014 World Cup, but their team wasn’t immune to head injury. In Sunday’s final game when Germany won against Argentina, German midfielder Christoph Kramer was hit hard in the face with a shoulder charge and knocked right off his feet. He was slow to get up and clearly disoriented but continued playing for another 14 minutes before slumping and needing help off the field. Even then, Kramer had difficulty maintaining his balance and appeared dazed despite attempting to shrug off the injury.

World-Cup-204-Kramer-Concussion

Hassan Ammar/AP Photo

For the International level and professional level, games committee members will need to change the rule to allow an immediate substitution for a suspected concussion that doesn’t count against a team’s three-substitute rule for the entire game. Coaches and doctors can then immediately recommend subs to relieve the injured players.

For college, high school, club and recreational athletes playing soccer, the hits and concussions seen over the course of the World Cup have been good learning lessons about concussions. For coaches, the World Cup injuries are clear examples of when a child needs to be removed from a game and be evaluated and cleared by a medical professional prior to returning to practice or games.

With the action of the World Cup being, quite literally, on the world’s stage, we hope concussions finally get the attention they deserve.

Online Resources for Concussion Recovery Include Webinars and Apps

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

The Defense and Veterans Brain Injury Center (DVBIC) is a great resource for anyone healing from a concussion. This week, the center released new treatment guidelines for both insomnia and mTBI. You can read more information on their press release at: dvbic.dcoe.mil/press/2014/new-clinical-recommendations-treat-sleep-problems-following-concussion-released.

The DVBIC website has a ton of information for servicemembers, veterans and medical providers as well as family members and friends of anyone recovering from a brain injury. All the details can be found at: dvbic.dcoe.mil.

For medical providers, an ongoing webinar series is offered. The one coming up this Thursday, July 10, from 1:00-2:30 pm (EDT), is titled “Do Helmets Prevent Concussion?” More information can be found at: dvbic.dcoe.mil/webinar/2014/Do-Helmets-Prevent-Concussion

If the webinars are a little too scientific for you, check out the 27 cool apps that are helpful for individuals recovering from mTBI at: dvbic.dcoe.mil/slideshow/27-life-changing-iphone-and-ipad-apps-people-brain-injury. Some are free apps, while others are paid, but all use today’s smartphone technology to simplify everyday life for people with brain injury.brain_injury_apps

These are just two examples of the tons of information that both the scientific community & medical providers, as well as patients and their caretakers, will find useful and educational regardless of your level of understanding of mTBI. Enjoy & I hope you all had a fantastic 4th of July.

That’s a Red Card!

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

Most of the globe is currently watching the World Cup and although football gets the lion’s share of the headlines about concussions, the June 19 soccer game between Uruguay and England is sure to land FIFA in some hot water. During the second half of the match, Álvaro Pereira, one of the stars of Uruguay’s national team, laid unconscious (below) on the field after taking a knee to the head. He fell to the turf and took at least 15 seconds before he showed any signs of consciousness.

Image

Richard Heathcote / Getty Images

It was clear to everyone—the players, the referee, the TV commentators—that Pereira was unconscious. At this stage, there’s no further diagnosis necessary. You will often read that doctors disagree about when to diagnosis a concussion or mild traumatic brain injury but once there is a loss of consciousness all doctors agree that a concussion or mTBI has occurred.

Pereira should not have been let back onto the field. His coach, his team physician and the FIFA physician all should have stopped him. But Pereira insisted on returning to play for the remainder of the game over the objections of his team’s doctor, while FIFA doctors didn’t even examine him until after the game was over.

Sure, any player would be upset but irritability and mild aggression are normal responses following a head trauma. Pereira should have been lead off the field and if the team didn’t get him off the field, they should have been issued a yellow card.

FIFA needs to do more in terms of educating international coaches, players, fans, and their medical staff. Mr. Pereira was cleared an hour after the game by FIFA physicians as being apparently concussion free; no return to normal cognitive activity and no return-to-play protocols needed. That’s a red card!

Keeping It Simple is the Best Medicine

by Daniel Pokrifka, ATC/L
HeadFirst Concussion Care Program Administrator

No matter the type or severity of an injury or illness, the basics of healing are the same: A good night’s sleep, a warm bowl of chicken soup, a walk in crisp, clean air, and a cup of tea can heal all your troubles…or so, Grandma used to say. Well, Grandma now has some science to back her up, even when it comes to recovering from a concussion.

Your Brain Needs Time to Rest
The National Sleep Foundation recommends that adults get seven to nine hours of sleep per night for optimal mental health. The brain needs this time to perform the necessary function of memory consolidation and other essential processing. Without this, one’s mental faculties suffer. While healing from a brain injury, your brain needs more rest to perform these essential functions as well as promoting further healing from the injury. This increase in sleep is only recommended for the few days after the injury. Beyond this, a return to a normal sleep pattern is recommended to allow the body to adjust back to the normal circadian rhythm.

Feed Your Body Well for a Balanced Mind
The human body relies on healthy foods for optimal functioning, growth and healing. A regular diet rich in nutrients not only fuels the body for daily activity, but also it fuels the brain. Daily intake of good foods can also avert long-term problems with depression and anxiety that can arise with a prolonged injury. Colorful fruits and vegetables that are high in antioxidants are also especially good for strengthening blood vessel walls, including those in your brain.

Regular Exercise Promotes Faster Healing
Regular exercise boosts your good cholesterol and reduces your bad cholesterol, both of which keep your blood flowing smoothly and promote healing. Light exercise or therapy after an injury helps reduce pain, increase range of motion, and rebuild healthy muscle tissue. Gentle exercise after a concussion also elevates your brain’s secretion of serotonin, which can make you feel happier and more relaxed. This acts as a natural combatant against post-injury depression and anxiety.

Image

Water is the Source of Life
Proper hydration helps all body process to function properly. Without it your body cannot begin the process of healing. Clear, nonalcoholic and non-caffeinated drinks are best. For variety, add a squeeze of lemon or lime, or drink seltzer water. There is no magic number for the amount of water to consume but don’t wait until you’re thirsty — at that point, you’ll already be on the the way to dehydration.

While a concussion is a complicated injury, healing from it doesn’t have to be. Taking steps that include rest, nutrition, hydration and gentle movement will help heal your brain faster. With all the complexities of medicine it’s nice to know sometimes simple is best.

Are Concussions Being Taken Seriously Enough?

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

This week’s Healthy Kids and Safe Sports Concussion Summit at the White House had the President addressing the increasing number of mild traumatic brain injuries (mTBI). With the White House now focusing on the situation, surely, word is getting out and parents, coaches and trainers are taking this diagnosis seriously, aren’t they?

ImageUnfortunately, though, even with national-level attention, some folks still aren’t getting the message.

Just this week, I saw a BMX (bicycle motocross) parent whose child has suffered a concussion. During our conversation, I heard phrases like “it was only a little concussion” and “everybody gets a little dinged,” proving that the BMX community is another sport where we can still make inroads. HeadFirst Concussion Care is committed to doing just that by attending local and state BMX championship events to educate fans, parents and coaches that mTBI is truly a serious injury.

Another recent case involved a parent who was reluctant to admit her daughter had a concussion, despite advice from several HeadFirst health providers. Several of us had noted oculomotor deficiencies (when the patient has trouble with movement of the eye) and recommended a referral to an ophthalmologist. Four weeks later, the child still had not been taken to the specialist.

After a follow-up exam, I demonstrated to the young patient’s parents that she had bilateral lower field deficits and used the ImPACT test to demonstrate deficits in her peripheral field. For the second time, I emphasized to the parents the importance of following our recommendations and in getting their young child to have an eye examination.

Despite all the press about concussions, I’m still seeing encounters like these all too often. So, what can we do?

One solution may involve a change in semantics. Instead of words like “concussion” and “mild traumatic brain injury,” use terms like “significant neurological event that involves a change in mental status” or “traumatic brain injury that involves (x) symptoms.”

Additionally, emphasize to parents that concussions are a silent injury. Many of them would treat a broken bone or sprained ligament with more care than they would a brain injury. But, a brain injury should be taken just as seriously, if not more so, as a visible wound.

Student Athletes Just Want to Get Back to Playing

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

Parents beware… kids want to get back in the game. Injured or not, playing their sport is, after all, their passion. Who can blame them?

Often in the event of a concussion, the course of treatment is fairly straightforward.  Kids experience a traumatic brain injury and they go through a sequential recovery. After an initial period of rest the patient gradually returns to normal functioning.

Some of latest new research may indicate that the metabolic process of recovery normalizes for most mild head traumas around 30 to 40 days after the initial injury, which coincides with the timeframe of when many youth athletes are recovering from their concussion. However, with spring sports playoffs coming up, some athletes will try to push through their recovery faster to get back onto the field.

HeadFirst-Catcher

Even with all our advances in science and medicine, it still generally takes six to eight weeks for a human bone to heal. And, whether you’re 5 or 65 years, that’s just how long it takes for a bone to heal. When my patients have broken bones, I put brain injuries in perspective by asking if they’d go back onto the field with a break that hadn’t healed.  Inevitably, they answer, “Of course not, because I might do permanent damage.” At this point, I have to draw the parallel to having a traumatic brain injury and that returning to play too soon also could lead to lasting permanent brain damage.

I once treated a 15-year-old elite-level lacrosse player with a traumatic brain injury whose recovery was moving along nicely in the right direction. After 24 days, he had no symptoms and was completely back in school. When I performed a follow-up exam, everything looked great except his ocular-motor functioning, fine motor speed and neurocognitive test reaction time was a bit slow compared to other athletes at his level. He excused his slow performance by saying that he wasn’t trying as hard as he could have, but I saw that there were too many data points and subtle findings to indicate the young man was still recovering.

My patient, like so many athletes, was obviously anxious to get back to the game. He knew his teammates were counting on him but I had to remind him that protecting his brain was of the utmost importance.