Thursday, February 18, 2010

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Concussions and Kids

Laura Davidson writer

Lately it’s been hard to miss all the news surrounding concussions and professional athletes. “Yellow Flag on Brain Trauma” quips the Boston Globe. “Ex-N.F.L. Executive Sounds Alarm on Head Injury,” frontlines The New York Times. “A Blow to the Brain” was CBS’s 60 Minutes’ succinct caption. Even Congress has joined the discussion, devoting hearings to the issue of football-related brain injury.

Prompting all these headlines is a host of new research linking long-term health consequences to multiple concussions. What’s more, some findings are now pointing to the negative impact of repeated smaller blows to the head. While the science pertaining to elite athletes may seem worlds away, communities like ours are not immune to sports-related brain injury. And when it comes to kids and concussions, a little knowledge can go a long way towards averting disaster.

“It was like a record on a different speed,” describes Weston’s Marla Stone. “He had memory issues. The morning routine would take over an hour because he couldn’t remember what he’d done. He couldn’t make decisions, couldn’t say what he wanted for dinner, couldn’t make up his mind.”

“She had headaches every day. She couldn’t get through a day of school,” recalls Wellesley’s Mary Kaye Chryssicas. “This is a girl that’s really funny, outgoing, fun-loving, and she became really quiet and withdrawn. She wanted to be in a dark room.”

Weston’s Sharon Levitan has similar recollections: “The headaches were so bad, all the time. Terrible mood swings, anger, fear, depression. It was severe.”

What these parents share is the strikingly similar agony they experienced after their child sustained a concussion. At fifteen, Doug Stone went headlong into the boards during ice-hockey practice. One year later, he got another blow to the head when he accidentally hit a coat rack. Ashton Chryssicas was thirteen when, in a Wellesley girls Division 1 soccer game, she collided head to head with an opponent. Harrison Levitan, then seventeen, was playing indoor recreational soccer during the summer before his senior year when he was checked into a cement wall.

Each child was diagnosed with a concussion that took months to heal. Each one had to take time off from school. And each one experienced symptoms that were distressing for both parents and children alike.

“The hardest part was to see the personality change,” recalls Chryssicas. “I could live without the sports and the academics, but to see your child’s personality change is really hard.”

While these stories illustrate the extreme, they also appear alarmingly common; word of mouth brought to light any number of similar examples in our area. Statistics indicate we are no exception. According to researchers at the Center for Injury Research and Policy at Nationwide Children’s Hospital in Ohio, sports are second only to motor vehicle crashes as the leading cause of traumatic brain injury in 15- to 24-year-olds. The Brain Injury Association of Massachusetts estimates that 60,000 concussions occur in high school athletics each year, the leading cause being football. Other sports with high numbers of concussions are soccer, ice hockey, basketball, and lacrosse. Studies have also shown that girls are statistically more likely to sustain concussions than boys.

The rate of concussion in youth is greater now than in the past for a variety of reasons. Kids spend fewer hours in unstructured free play, where such collisions are less likely to occur, and more time in organized sports. They start these sports at younger ages and play them all year. Add to this the fact that kids are bigger, faster, and stronger than ever before.

“Years ago, when a high-schooler played football, you went to training camp two weeks before the season, they beat you into shape, and after the season you were done,” says Neal McGrath, Ph.D., a neuropsychologist with Sports Concussion New England who consults with Wellesley and Weston Public Schools. “Kids condition and weight train year round now,” he explains.

Head case
A concussion is a mild traumatic brain injury, caused by a blow to the head or body that causes the brain to move rapidly inside the skull. Dr. Pierre d’Hemecourt, with the Sports Medicine Division of Children’s Hospital Boston, describes a concussion like this: “The most common mechanism is a deceleration injury combined with rotation. This disturbs the electrolyte transmission across the nerve cell membrane which is crucial for proper nerve firing patterns.” Put simply, a concussed brain cannot function properly.

One misconception is that concussion must be accompanied by a loss of consciousness. This is not the case. Common symptoms of a concussion include headache, dizziness, nausea, vision or balance problems, sensitivity to light or noise, drowsiness, grogginess, and confusion. Some symptoms show up immediately following a blow and quickly disappear, but others can develop hours or even days later.

Because these symptoms can’t always be seen and are only subjectively felt, many young athletes continue to play after a hit to the head. For reasons of competitiveness, desire to play, expectations of toughness, pressure from parents and coaches, or simply because they do not recognize the potential severity of their injury, kids all too often try to “shake it off.”

“I got back up and kept playing,” Doug Stone remembers. “I was stunned when I got up. I thought it was just the shock of hitting the boards.”

Mary Kaye Chryssicas recalls similar confusion when Ashton was hit. “She did not get knocked unconscious. She tried to keep playing but was disoriented and couldn’t see. She was wandering.”

When it comes to getting back in the game after a hit to the head, however, it is important to err on the side of caution, as a developing brain is at greater risk from injury than an adult’s. Not only has it been shown that a child who sustains a concussion stands a greater chance of getting another, they are also at risk of the rare but potentially deadly “second impact syndrome.” Unique to the child and adolescent athlete, this massive brain swelling and possible death can occur if a child sustains a second concussion before symptoms of the first have resolved.

Modern medicine has found no treatment for a concussion other than rest and time. In the case of a severe concussion, complete physical and cognitive rest can entail no schoolwork, no television, no computer, even no reading.

For Ashton Chryssicas, this meant being out of school for a month and then cancelling all her summer plans. “She had to sleep a ton,” says her mother. “She slept in every day, she took naps. We had to keep the household quiet.”

Sharon Levitan says at first they made Harrison go to school before realizing this was a mistake. “Before the concussion he had been a good student who didn’t struggle,” she says. “What would normally take Harrison a half hour to write would take him two weeks!” Harrison ended up taking several months off school and spent a lot of time sitting in the dark or in bed.

“It’s a very slow, tedious, up and down recovery,” says Levitan.

Several different guidelines have been developed for determining when athletes should return to playing their sport after a concussion. While such recommendations can be helpful, there is no one schedule that can be applied across the board, as the amount of time it takes for symptoms to resolve will be different for each individual, ranging from a few days to several months.

There is wide agreement, however, that children should not return to play until all their symptoms are gone. Generally speaking, recovery should be gradual and monitored, and a child should not return to athletics until allowed to do so by a physician experienced in the management of sport-related concussion.

Such caution may seem extreme, but Dr. McGrath says it is warranted. “Someone in early development with years of social, emotional, and psychological growth ahead of them, we don’t want anything to interfere with their learning and development.”

The good news is, much is being done in Wellesley and Weston to ensure the safety of young athletes - at least at the high school level. Both schools have dedicated athletic trainers that use ImPACT© (Immediate Post-Concussion Assessment and Cognitive Testing), computerized neuropsychological testing that provides a baseline reading for every athlete. These results can be used in the event of a head injury to indicate the severity of a concussion and, most importantly, to guide decisions about when a child can safely return to play.

Below the high school level, however, it is incumbent upon individual coaches and parents to become educated and remain vigilant.

Head first
All the children profiled made full recoveries, but not without enduring repercussions. Ashton Chryssicas is back playing competitive soccer, now wearing protective headgear. Harrison Levitan, who ended up dropping a few classes his senior year, is now a freshman at George Washington University. Doug Stone was unable to graduate with his class due to his injury. He is applying to college but can no longer play contact sports.

When asked what advice she has for other parents, Doug’s mother Marla didn’t miss a beat. “I think if there’s a question of a possibility of a concussion to take it seriously,” she urges. “Don’t worry that your kid’s going to miss a game or a tournament. There can be long-lasting implications.” Mary Kaye Chryssicas seconds that vigilance. “My feeling now is, if your child ever gets hit in the head at all, pull them from the game.”

For more information on concussions and high school sports, visit the Centers for Disease Control’s Web site:

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