Concussion Awareness Spreads with News Headlines

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

Regardless of age and profession, motor vehicle accidents and falls are the most common ways that people can sustain traumatic brain injuries. Even first responders – police, fire, and ambulance crews – regularly go into harm’s way and risk personal injury that includes concussions, as recently happened when two firefighters in New Jersey slipped while jumping off their fire engine at a house fire.

firefighter_injuries_600x300x

Even firefighters and other first responders are vulnerable to concussions (Photo: AP/Wide World)

Although sports like football, soccer, and lacrosse get a majority of the press about head traumas and traumatic brain injuries, most of the traumatic brain injuries that we see in HeadFirst Concussion clinics are due to everyday events such as slips and falls and motor vehicle accidents.

Some doctors tell me that the “concussion craze” is going to burn out soon. However, I think the way concussion specialists and medical providers diagnosis and treat traumatic brain injuries will continue to evolve. Other clinicians believe that education, evaluation and treatment of mTBIs will continue to grow in different directions.

Some considerations for the future may include:
– people who carry weapons, work with hazardous materials, or are employed in high-risk jobs could require baseline neurocognitive testing with their employment physical in the event they suffer a brain injury
– schoolchildren of all ages, including the elementary school level, may receive education, baseline testing, while training may be required for all parents and coaches about traumatic brain injuries (it is presently only required for high school kids)
– employers may insist employees to get baseline neurocognitive testing prior as a condition of employment

What we have found in HeadFirst Concussion clinics is that 60-70% of mTBIs are not sports related and more than 95% of our injured patients have not had baseline neurocognitive testing. While concussions continue to make the news and diagnosis increase as public awareness spreads, we encourage people of all ages to schedule a baseline neurocognitive test.

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

660_footballplayers.jpg

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.

The Right Time to put your Head First

by Tori Simonetti, ATC/L
HeadFirst Concussion Care Educator

The most important test a healthy student athlete can take is a baseline ImPACT test.

The baseline test is a computerized neurocognitive assessment of the athlete when he or she is injury-free. We hope an athlete never gets hurt, but if a suspected head injury does occur, the athlete retakes the test. The two results are compared and, together, become a tool in assessing the extent of the athlete’s injury, and when he or she safe to return to playing sports.

concussion_impact_testSince most high schools recognize the dangers posed by concussions and the risk of returning to play too soon, baseline testing is becoming a standard best practice at more schools. The majority of private and public high schools in Maryland are making the baseline ImPACT test mandatory for all student-athletes.

The test is set up in a series of brain games and takes about 30 minutes to complete. It measures your student athlete’s memory, reaction time, brain processing speed and concentration. To ensure your athlete is prepared to take the baseline test be sure he or she:
•  gets a good night rest;
•  takes any medications as he or she is normally prescribed;
•  wears his or her glasses or contacts;
•  take his or her time and reads the instructions thoroughly and carefully; and
•  stays focused, especially when taking the test at school or with the entire team.

Lastly, remember to relax and don’t be nervous! The test is not measuring how smart the athlete is and is not comparing their results to anyone else. It is designed to compare to any subsequent tests they may take in case of an injury.

The AB and ZZZZZs of Sleep for Athletes: Get Your Rest Before Taking Your Baseline Test!

by Sherray Holland, PA-C
HeadFirst Concussion Care Provider

It is recommended to get a good night’s sleep on a regular basis, but how much is considered a “good” amount? How long do you sleep?  I am mainly asking high school and college athletes here. And I know sometimes it is easier said than done when you factor in homework, sports, other extracurricular activities….maybe even a job!

Picture this: You are eager to start your season.  Then your coach or athletic trainer tells you to take a baseline test. You may have heard about it from other students or not at all. Most schools and many organizations, including HeadFirst Concussion Care, are using the ImPACT® baseline test to measure the way an athlete’s brain functions, including cognitive thinking, memory and reaction time. The computerized test takes about 25 minutes to complete (as cited in Lovell, 2010) and is intended to give your coach, trainer, and provider a baseline measure of your normal brain function. In the unfortunate event of a concussion, you will take the ImPACT test over time (usually every office visit) to help your healthcare provider, coach, athletic trainer, and teachers make proper decisions for school and returning to play as you recover.

Getty Images

Getty Images

Okay, back to the subject at hand. Now it is the night before the baseline test. How long should you sleep? A recent study published in the American Journal of Sports Medicine reported that athletes who slept fewer than seven hours before the baseline performed worse on three of four ImPACT scores and reported more symptoms related to their brain injury (as cited in McClure, et al., 2014).

Here’s the bottom line: it is important to get enough sleep on a regular basis, aiming for more than seven hours. If you do not get enough sleep before your ImPACT test, it may not represent your academic ability at its best, especially if you have to go through the entire day and take it after school. Many times in the HeadFirst clinic, I have seen the results of a patient’s test after a suspected concussion better than his or her baseline!  Remember, this is a serious matter so make sure to put your best effort forward. I hope you found this helpful and would like to hear your thoughts.

Tips for Getting a Good Night’s Sleep

Having trouble falling or staying asleep? Here are some helpful advice for healthy sleep habits:

  • Keep a regular bedtime routine every night
  • Do not exercise or eat a heavy meal three hours prior to going to bed
  • Do not drink or eat foods with caffeine three hours prior to going to bed
  • Avoid naps. If you are tired and must take a nap, make sure it is a short nap and not close to your bedtime.
  • Rest and unwind before heading to bed. Avoid stimulating television shows or video games.
  • Make sure your room is quiet, comfortable, and without bright lights.
  • If you do not go to sleep after 30 minutes,  try reading , listening to music, or other quiet activities to encourage relaxation.

Ms. Holland typically works at HeadFirst Waugh Chapel clinic. She received her Bachelor of Science in Physician Assistant Studies/Certificate in Primary Care at Howard University. Ms. Holland is a Board-certified Physician Assistant and is a member of the American Academy of Physician Assistants and an American Academy of Physician Assistants Veteran’s Caucus Member.

Helping Our Athlete’s Make the Right Decision to Sit It Out!

There is no doubt about it whether it is football, soccer, wrestling, cheerleading, tennis or race cars, athletes love their sport. Therefore, the last thing they want to do is sit out of a game, match, competition, or race.  It is a hard but necessary step in recovering from a concussion and preventing second-impact syndrome.

Dale Earnhardt Jr. is learning this first hand. In late August he had his 1st concussion from a crash on a raceway in Kansas. He thought he was okay. He felt good, but on October 7th, he sustained another concussion from another, less severe crash. His symptoms returned. He saw his doctor for a headache that would not go away. Dr. Perry made the right decision and would not allow him to race last weekend or in the race this weekend either. Perry wanted Earnhardt, Jr. to be evaluted by professionals, and Earnhardt, Jr. is lucky to have such a proactive team. They spent Tuesday at University of Pittsburgh Medical Center’s Sports Medicine Concussion Program consulting with Dr. Micky Collins, a concussion specialist, formulating a return to play that included ImPACT testing before returning to the raceway.

 

Earnhardt talks about needing someone else (his doctors) to make the decision for him not to race because the love of racing would keep him behind the wheel even though he knows that concussions are serious.  Our athletes are no different. As parents and coaches, we owe it to our athletes to be that “voice of reason” when we suspect a concussion. From the moment we even think our athlete has sustained a concussion, they must SIT IT OUT!  Even though it is hard, we must be proactive in protecting our brain…we only have one for life.

White Sox’s Konerko Felt Helpless & Depressed After Concussion

Last month, Chicago White Sox first baseman Paul Konerko suffered a concussion after being struck in the right temple by Kansas City Royals outfielder Jarrod Dyson. After a gradual return to play, which included working out a little more than a week after the concussion, Konerko is now back on the team in full force.

What’s refreshing about Konerko, aside from the fact he took his concussion seriously enough to stay out of the game until he healed, is his honesty about the alarming effects of concussion.

In a video interview with Comcast Sportsnet, Konerko described feeling helpless, depressed, unmotivated and lethargic immediately after his brain injury.

“You just feel like a different human being. You just feel like out of the world. It’s just a weird feeling,” said Konerko, who took the ImPACT test after his injury to help diagnose the concussion. He described his emotional state not feeling like himself. “You almost feel, you don’t care about anything.” Konerko also said it hurt for several days just to shift his eyes.

In the video below (will open in a different page), Konerko provides an incredible glimpse into the physiological and psychological symptoms of brain injury.

The one part we take exception to is Konerko’s account [beginning at 1:16] of being blindsided by the actual impact which allowed for a “better chance of getting rattled and the brain moving.” The fact is we know that nothing, not even anticipating a blow, can prevent the brain from moving inside the skull.