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

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.