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.

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.

Is 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.

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.

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!

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.

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.