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.

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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.

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Significant Head Trauma Can Occur with Repeated Hits, Not Just Concussions

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

CTE’s connection to football has been in the news for five years now, with a debate centered around whether the number of concussions will affect long-term health and well-being of those playing the sport. Likewise, I’m constantly asked by patients and parents what the future effect of this or future concussions will be on their health. A recent study released by researchers at the Boston University School of Medicine (such as Dr. Robert Cantu, Dr. Ann McKee, Chris Nowinski and others) will probably give moms and dads across America a moment of pause before starting a collision sport like football or hockey.

An answer may lie in a concept developed by these researchers called the Cumulative Head Impact Index (CHII). They found individuals who had more hits to their heads—regardless of whether they had a concussion or not, were significantly (i.e., not even close…a large statistic margin) more likely to experience later-life cognitive problems, apathy and depression. The caution here is that the sample size was only 93 individuals and the exposure was only to football.

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A football helmet’s health warning sticker is pictured between a U.S. flag and the number 55, in memory of former NFL player Junior Seau; new research suggests that the accumulation of subconcussive hits may have more significant long-term effects than concussions. (© Mike Blake / Reuters/REUTERS)

The next step is for medical providers and concussion specialists to help families begin to connect the dots throughout the developmental hurdles of a child’s life. For example, the health outcomes for two 7th grade beginning hockey players if they have a different history. One student may have fallen off a changing table as an infant and suffered a skull fracture, have been in a motor vehicle accident, and have fallen multiple times during winter sports, while the other 7th grader may not have suffered any head injuries or significant head trauma. Baseline neurocognitive testing like the ImPACT® test might look different on these two young students, and the outcome and recovery time of any current injuries sustained by each of them could be considerably different.

I’ve often said that kids can’t live in a bubble as much as parents are sometimes inclined to want to wrap their kids in bubble wrap. Young people—really, people of all ages—are going to be in car accidents, bike accidents, and slip and fall just going through life. Parents need to make their own unique, informed decision about how much additional risk of physical injury to which they want to expose their child, given his or her medical history and athletic abilities.

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.

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.

HeadFirst Hosts ImPACT Symposium

HeadFirst Sports Injury and Concussion Care, a program of Righttime Medical Care, hosted its first ImPACT Workshop on Saturday, May 5, at the Severn School in Severna Park, Md. Jamie Pardini, Ph.D., neuropsychologist at the University of Pittsburgh Medical Center, discussed the ImPACT neurocognitive assessment program as a tool to diagnose concussions. Also presenting at the workshop were Milford H. Marchant, Jr., M.D., orthopaedic and sports medicine specialist at MedStar Harbor Hospital, and Christopher G. Vaughan, Psy.D., pediatric neuropsychologist at Children’s National Medical Center. More than 50 physicians, physical therapists, certified athletic trainers and other professionals attended the workshop to learn about helping students and their families navigate the road to recovery and make a safe return to play following a sports-related concussion.

For information about potential upcoming educational events, please email contact information to HeadFirst Program Director Amy Knappen.

HeadFirst Concussion Workshop

ImPACT workshop presenters Dr. Jamie Pardini (left), of the University of Pittsburgh Medical Center and Dr. Milford H. Marchant, Jr. (right), of MedStar Harbor Hospital, are joined by Dr. Robert G. Graw, Jr., CEO of Righttime Medical Care, at the first event sponsored by Righttime’s new program, HeadFirst Sports and Concussion Care.