Be Cautious of New Products or Research That Promise to Prevent or Heal Concussions

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

Periodically when I’m seeing patients in our HeadFirst concussion clinics, parents will ask me about a different brain trauma-related studies that they’ve heard about. These questions range from studies about concussion-healing chocolate milk to eye tracking devices to the effectiveness of helmets and different sports bands preventing head injuries. Presently, NO concussion treatments have been approved by the United States Food and Drug Administration (FDA). Likewise, the FDA has yet to approve of any devices that prevent concussions in the first place. No helmets, no mouth guards, no sports band or other piece of technology in any way shape or form has been demonstrated to completely prevent concussions.

I typically advise parents to be extremely cautious with new research or technology, or with the promises of concussion treatment. Instead, parents should seek out a concussion specialist who has years of experience treating these injuries and utilizes multiple methods in their assessment, diagnosis, and treatment planning.

Refreshing Delicious Chocolate Milk

Can chocolate milk heal concussions? Don’t count on it.

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Research Shows Students’ Academics Affected by Concussions

A recent study published in American Academy of Pediatrics June 2015 Pediatrics (published online on May 11, 2015) looked at concussion and its effect on academic performance. The research included a sample of 349 students, ages 5 to 18, who sustained a concussion and whose parents reported post-injury academic concerns on school questionnaires. The type and intensity of the students’ concussion symptoms were measured as an indicator of the severity of their injury.

Researchers found that actively symptomatic students and their parents had heightened concerns over the effects of the students’ concussions on their school performance, as well as increased school-related problems than their recovered peers. In other words, the students’ level of post-concussion symptoms had a direct relationship to the extent of academic effects.

Eighty-eight percent of students with symptoms reported school problems due to headaches, fatigue and concentration issues, while 77 percent reported issues such as needing to spend more time on homework, difficulty taking notes, and studying.

confused_student

Additionally, high school students in the study who had not yet recovered reported significantly more adverse academic effects than their younger counterparts. The greater the severity of their concussion symptoms was also associated with more school-related problems and worse academic effects, regardless of time since injury.

Every state has concussion legislation generally requiring three basic criteria in the event of a concussion:

  • The removal of a child from play
  • A structured return to learn
  • Clearance from a concussion specialist

However, most youth aren’t athletic professionals and many of them do not advance to participate in college and professional athletics. Currently, only Nebraska and Virginia have return-to-learn legislation indicating that concussed athletes may need specific informal or formal accommodations at school and that school personnel should be trained in concussions. In light of students’ limited number of years of sports and because of recent proven research, legislation should be in place in every state to provide more extensive accommodations after a brain injury so that students’ academics are not adversely affected.

To review each state’s legislation, please visit:
http://lawatlas.org/query?dataset=sc-reboot
http://www.ncsl.org/research/health/traumatic-brain-injury-legislation.aspx

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.

March is Brain Injury Awareness Month

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

In the past several years, few medical problems have generated as much public interest as sports-related concussions. Coaches, parents, and players are increasingly aware that a concussion involves an injury to the brain and that an athlete suspected of having a concussion should be removed from play and evaluated by a licensed health care professional. I’d like to share a little bit about myself and how I became interested in the area of mild traumatic brain injury (mTBI).

My name is Dr. Tony Doran. I was a clinical psychologist for the Navy for the past 20 years. The Navy sent me to Harvard Medical School and I specialized in pediatric neuropsychology. Over the course of my career, I have worked in a variety of diverse positions at Portsmouth Naval Hospital, Iwakuni Medical Clinic Japan, and the United States Naval Academy. I have treated kids and adults with everything from adjustment reactions and craniosynostosis to mTBI and PTSD (post-traumatic stress disorder).

As my time in the military was winding down, I began to explore where my next adventure would take me and I naturally gravitated to conducting evaluations for Special Forces Units throughout the United States. After more than 10 years of war, I have treated and evaluated hundreds of service men and women who were dealing with the wounds of war coping with PTSD and mTBI. As the war was coming to a close, I began to look at what other avenues I could explore. My contracting position of evaluating Special Forces Units involved a lot of travel away from my family, which initially was exciting and interesting, but after 3 years was beginning to wear on myself and my family. So I began to look for a permanent position.

Having been a consultant, I had performed some services for a new company in the area of concussion care called HeadFirst. HeadFirst was evaluating and treating hundreds of kids with mTBI and a substantial percentage of these kids had some special needs – autism, learning disabilities, attention problems or other psychological problem. My experience and training in mTBI and childhood disorders would help me treat and evaluate these children. HeadFirst was looking for someone to evaluate the enormous amount of data they were beginning to collect and also help them branch off and start new research projects. My years of data analysis and research in the Navy would assist me in this area. Several weeks later, I was hired as the Program Director of HeadFirst. I look forward to educating parents, children and coaches in the area about mTBI, treating children and teens with mTBI, and conducting research in the area of mTBI.

Dr Doran-Bug-Sm

I was at a meeting the other night with several health care providers and asked them to please share a story about what a concussed child or family member had asked them about after brain rest had been explained to them. As we went around the room, kids and family members asked about playing the drums, going snowboarding, playing football with dad in the yard, sleigh riding, mountain climbing, just shooting baskets or just swinging in a batting cage. Answers like theirs beg the question: Are our kids, families, and coaches getting the message about the seriousness of mTBI?

Pardon the Navy analogy, but sometimes big ships take a while to turn. I am encouraged when I hear teens make comments like “Hey, that kid has to stay out of competition for at least 7 to 10 days” after witnessing a concussion and a parent discussing with a child that she might need to permanently switch to a different sport – like track or swimming – after her fourth concussion in soccer. However, when I still get questions like “Can I go ride my go cart?” after explaining brain rest, I am reminded that we, as providers, educators and researchers, have more work to do.

If you are interested in joining the concussion discussion, please visit this blog as we will be having different providers, coaches, parents and recovering patients contribute. Also please see our website for community events.

The Brain Injury Association of Maryland is having their annual conference March 20th-21st – please see their website to find out more and I hope to see you there.

Concussion TV Offers Online Videos and Webcasts

Concussion TVAs concussion awareness rises, so does the variety of educational resources available. Internet TV Channel, part of the Sports Pro Community Network (SPCN TV) is an online network committed to bringing athletes, parents, coaches, athletic trainers, personal trainers, medical and sports business professionals the latest information on concussions and traumatic brain injury (TBI). The website is filled with free videos and webcasts featuring renowned specialists and parents of youth athletes discussing this “silent injury.”

Mild Brain Injuries Just Don’t Exist

We find it interesting people still call concussions “mild brain injuries.”  Furthermore, culture makes every attempt to break down the preconceived notion that concussions are nothing serious.

“Just shake off,” they say, or “Man-up.” We can thank educational resources like the dictionary and encyclopedia for perpetuating this misconception. Even Wikipedia, the popular online Web site, plainly states that “The terms mild brain injury, mild traumatic brain injury (MTBI), mild head injury (MHI), minor head trauma, and concussion may be used interchangeably.”

If people believe that a concussion is so mild, we invite them to review the following details: 

1) Did you know that the word concussion comes from the Latin word concutere which means TO SHAKE VIOLENTLY.

2) Concussion side effects can include physical,

cognitive and emotional impairments. Think that’s mild? These side effects can range from blurred vision and headaches to convulsion and amnesia. In severe cases, psychiatric disorders and even long-term memory loss (including a greater risk of developing Alzheimer’s) are possible. Hardly mild.

Don’t get us wrong, in nearly all cases, people who sustain a concussion will live a happy, healthy and fully functional life.  We just need to make sure our facts are straight, especially from the resources we use to learn.

Concussions are a brain injury, not a “mild injury,” not a “mild head trauma”…  A brain injury.

Courtesy WebMD