How to Mismanage a Child’s Concussion

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director
and Ann-Marie Sedor, HeadFirst Concussion Care Marketing

Lots of myths and misinformation exist about how parents and coaches can supervise the recovery of a child’s concussion. Some of the most common ones stem from advice that was given years ago. But better understanding of brain injuries and new imaging technology has changed how concussions are treated. Here’s what NOT to do when managing your child’s injury.

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1  — Waking Every Hour or Two
Decades ago, healthcare providers encouraged parents to wake up their concussed children frequently to monitor their mental status. However, with modern imaging and clinical evaluations, patients who have been cleared by a concussion specialist can sleep soundly. In fact, remaining asleep 12, 15 or even 20 hours following a head injury is actually helpful, restful, and promotes faster recovery.

2 — Return to the Game Too Soon
Most concussion laws in every state have a provision in which a child is removed from play when a concussion is suspected and can only be cleared to return by a concussion specialist. Unfortunately, clinicians will periodically encounter an overly ambitious parent wanting to return his or her child to play prior to making a full recovery from the concussion. Depending on the timing, this can be exceedingly dangerous. If it is too soon, the child may be in danger of secondary impact syndrome, which can be fatal.

3 — Keep Away from Friends and Electronic Devices
Socialization is an important part of adolescent development. Keeping a child completely isolated from friends and electronic devices can lead to a sense of isolation, and in some cases, even depression. Providers and parents need to be mindful of balancing remediation with a young person’s sensitive self-esteem.

4 — Promote Completely Inactivity and Darkened Rooms
Although some rest is thought to be useful from 48 to 72 hours after the head injury, extensive rest and inactivity in a dark room is actually thought to do more harm than good. The brain can actually have more difficulty to returning to normal activity following an extensive period of inactivity.

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World Cup Again Brings Up Concussion Debate

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

It’s no secret in my family that I’m a die hard sports fanatic. I count the U.S. Women’s National Soccer Team’s win over China in 1999 as one of the greatest sporting events in our country’s sporting history – rivaled only by the win of the U.S. Hockey team over the Russians at the 1980 Olympics. Naturally, I was glued to the TV over the past few weeks while our U.S. Women’s National Soccer Team again clinched the World Cup championship last week.

Backtracking to the team’s semifinal game against Germany, analysis stated the U.S. did a great job on offense and defense, although the Germans came out hard with a flurry of shots and dominated the first 20 minutes of the action. Then, iIn the 28th minute, Germany’s Alexandra Popp went to head a ball on a free kick and USWNT’s Morgan Brian was having none of that and went up to meet her. The action happened so fast you could really tell what happened until FOX sports showed the replay. It turned out that Popp’s and Brian’s heads had violently collided.

Jun 30, 2015; Montreal, Quebec, CAN; United States midfielder Morgan Brian (14) and Germany forward Alexandra Popp (18) collide attempting a header during the first half of the semifinals of the FIFA 2015 Women's World Cup at Olympic Stadium. Brian and Popp were injured on the play. Mandatory Credit: Eric Bolte-USA TODAY Sports ORG XMIT: USATSI-230278 ORIG FILE ID:  20150630_ajw_bb5_045.jpg

Jun 30, 2015; Montreal, Quebec, CAN; United States midfielder Morgan Brian (14) and Germany forward Alexandra Popp (18) collide attempting a header during the first half of the semifinals of the FIFA 2015 Women’s World Cup at Olympic Stadium. Brian and Popp were injured on the play. Mandatory Credit: Eric Bolte-USA TODAY Sports ORG XMIT: USATSI-230278 ORIG FILE ID: 20150630_ajw_bb5_045.jpg

We all know the showmanship that sometimes appears in soccer when players grab a shin or a knee and throw themselves to the ground only to be up and running about at full speed moments later. But, when players are truly injured, their teammates are taught at a young age that whomever has the ball should kick it out of bounds so the hurt players can be attended to by medical personnel. The Popp-Brian collision was the first time I can ever remember the referee stopping the play prior to the ball actually going out of bounds.  After slamming heads, both Popp and Brian fell awkwardly to the turf.

Medical personnel from both teams game out and examined both players for 4 minutes and both teams played 10-on-10 for several minutes before both players returned to play the remainder of the game. Although neither player was knocked unconscious, the mechanism of injury was serious enough to have warranted a full 24 hours of observation before they should have been permitted to return to play.

Actions that FIFA can take to help teams and doctors make play safer for the players could include:
– have an impartial doctor on the sidelines, much like the referees who are from countries other than the teams playing, who can help assess injured players and protect the organization from future lawsuits; and
– add a substitute for teams in case a FIFA doctor rules that an injured player can’t return to the game to eliminate some of the pressure to keep playing.

Injuries like the Popp-Brain collision help drive home the point that kids younger than 14 shouldn’t be using their heads in recreational games until they are taught the right techniques and when their bodies have fully developed.

I’ve always said the benefits of sports far outweigh the risks, but that precautions need to be taken seriously. The risk of a head trauma is that athletes returning too quickly to play can suffer a second injury that could prove to be career-ending or, in the worst possibly case, fatal. Clinicians, parents, coaches and league administrators need to continue to evaluate the rules of sports collisions to ensure the safety of our children, the vast majority of whom will need their brains for something other than headers in the World Cup.

Honoring Brain Injury Awareness Month

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

Since HeadFirst Sports Injury and Concussion Care launched just three years ago, we’ve already seen the tide turn about the public’s understanding of concussion (mild Traumatic Brain Injury or mTBI). We’ve gone from hearing “It’s a only a mild concussion,” and “You just got your bell rung a bit,” to an acknowledgment of the severity of this silent injury.

Locally here in the Capital region, HeadFirst has been extremely active in hosting educational seminars for coaches and parents, and participating in dozens of community outreach programs.

In 2014 alone, HeadFirst’s team of professionals participated in more than 80 community events reaching more than 180,000 people. These events included partnerships and sponsorships with the Brain Injury Association of Maryland, Hockey for Heroes (benefitting the Wounded Warrior Project, USA Warriors Ice Hockey Program and Disable Veterans of America), Sports Legacy Institute, Touchdown Club of Annapolis, as well as educational seminars for school and county recreational coaches and athletic directors, presentations for school nurses on concussions and mental health, and attendance at community health fairs.

These groups have welcomed our educators with open arms to help their coaches and athletic trainers understand the right protocol in managing a suspected head injury, from those critical first moments to long-term treatment for proper healing.

Our outreach programs are one of our cornerstones, we’d like to think they’ve helped change the traditional way of thinking about concussions.

HeadFirst is also a gathering point for professionals from around the region to share their expertise. Our monthly Concussion Consortium pulls together physicians, neurologists, neuropsychologists, physical and vision therapists, and other specialists, school administrators and nurses, athletic trainers and coaches, who discuss scientific research and resources for concussion treatment and protocols.

The Consortium often hosts a respected guest speaker who shares information about specific topics and issues related to concussion. Next week, we’re welcoming Sarah Loeffler, LCSW-C, of The Neuropsychiatry Program at Sheppard Pratt Health System in Baltimore, Md., who will discuss mTBI’s connection to anxiety and depression.

Also next week, HeadFirst Chief Executive Officer Robert G. Graw, Jr., M.D., and HeadFirst Program Director Tony Doran, Psy.D., are presenting their lecture, An Integrated Community Model for Concussion: Update, at the Brain Injury Association of Maryland’s annual conference.

Of course, all of this is in addition to our 11 clinics throughout the DC-Baltimore region, which is our reason for existence. From the thousands of neurocognitive ImPACT® tests we’ve administered to the patients for whom we have cared, we’ve heard amazing, heartfelt stories of the trials of living with a concussion and the willpower to overcome it. These serve as our inspiration to push ever forward.

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We continue to read emotional articles in the news about concussion awareness, including yesterday’s announcement of San Francisco 49er linebacker Chris Borland’s decision to retire due to the high potential of long-term brain injury from playing. Turning away from a lucrative career in the name of your health surely must be one of the most incredibly difficult decisions to make, and we applaud this young man for having the guts to make this choice.

HeadFirst Sports Injury and Concussion Care is proud to honor March’s designation as Brain Injury Awareness Month, as well as Brain Injury Awareness Day today, March 18. Looking back, it’s been a fulfilling journey, albeit a short one. The starting line is still in our sights and we know the finish line is a long way off—and very likely will continue to move even as we do.

Concussions can and do happen to anyone, anytime, anywhere. The non-discriminatory nature of this injury is what continues to motivate us to do our work.

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.