This is a post authored by J. Forrest Bennett, ARNP who works in the rehabilitation department and on the concussion team led by Dr Samuel Browd (@DrBrowd), medical director of Seattle Children’s Sports Concussion Program. Forrest has had the unique experience to care for children after concussions in the immediate time after injury and in weeks to months thereafter when symptoms are prolonged. His wisdom can help us all understand the opportunity we have to improve children’s recovery after a head injury. In this post he explains what happens to the brain cells during a concussion, what constitutes risk for concussions, and the 5 things all of us need to know about concussions. I certainly know more after reading this and suspect you will too. Please leave comments or questions if you have them. Click here to read the first post in this series.
What Happens During A Concussion?
A concussion is a complex process affecting the brain, brought on by biomechanical forces (like a blow to the head, car crash, etc.) The force is transmitted to the head and can result in usually short-lived symptoms such as headaches, brief loss of consciousness, nausea, and/or dizziness. These symptoms are believed to be due to a temporary shift in the neurotransmitters (chemicals that allow cells to communicate) in the brain. This helps explain the symptoms associated with a time-limited injury such as a concussion.
This also explains why diagnosing and managing concussions can be frustrating for families and medical providers. Unlike a broken bone, we do not have imagining or blood tests that enable definitive diagnosis of concussion. Medical providers will sometimes order head CTs or brain MRIs to make sure that there is not a more severe injury, but the scans cannot diagnosis concussion.
Diagnosing concussion currently relies on a detailed history and physical exam. If an injury occurs when a child is playing in an organized sport, a sideline assessment should be performed to look for common post-concussive symptoms. In 2017, the guideline for sideline assessment for concussion was updated. Depending on the severity of the initial presentation, one may need to be evaluated in an emergency department to help rule out a more severe injury.
The goal is to prevent injuries, screen for potential head injuries when appropriate, and to diagnose injuries so that we can treat the symptoms and limit the impact.
How To Prevent Head Injuries
Prevention comes down to taking control of what you can influence (and identifying what you can’t) to help reduce your chances of getting injured. Be aware of what sports are high risk. Playing with appropriate protective equipment, preparing for matches and adhering to the rules of the game can be great ways to reduce your individual risk.
Some sports have been termed “contact” sports by the American Academy of Pediatrics (AAP) and are considered riskier than “non-contact” sports. While the AAP classification is imperfect it helps quantify the risk of sport to help parents focus on prevention of head injuries, while still promoting a healthy and active lifestyle.
• The highest risk sports for school-age girls are soccer, lacrosse, and basketball.
• The highest risk sports for school-age boys are football, ice hockey, and lacrosse.
While we continue to improve our understanding of concussions, our work centers around applying the current state of science to manage post-concussive symptoms and prevent more severe injury. The Concussion program at Seattle Children’s Hospital is just one of many specialty concussion clinics nationwide.
5 Things Everyone Should Know About Concussions And Mild Traumatic Brain Injuries
Ask professionals for help
- If you think your child is concussed go to their coach or athletic trainer and allow them to perform a proper sideline assessment. Getting an immediate sense of how your child is doing after impact is the single most important step to protect from worsening sports-related head injuries.
When in doubt – sit it out
- If there is a loss of consciousness, seek immediate sideline assessment.
- You can sustain a concussion without a loss of consciousness.
- If your child is playing in a match or a game and they take a hit to the head (head-to-head contact, head-to-ground contact, etc.) and you are concerned they don’t feel right, get the attention of the coach or athletic trainer.
Rest ALONE is not always the answer
- While 80% of concussions get better in the first 2-3 weeks, prolonged symptoms are not uncommon. As a provider in specialty care, I frequently see the 20% who have not recovered within the first 2-3 weeks. If you have concerns, have your child reevaluated.
- Providers will frequently use either the Standardized Concussion Assessment tool- 5th edition (SCAT 5) or a modified version of the symptom checklist to track symptoms and help determine when you become symptom-free.
- A study evaluated the effectiveness of prescribed rest for concussion. It highlighted how rest following a head injury needs to be applied using an individualized symptom-based approach. Prescribed rest can be ineffective without taking into account an individual’s symptoms and history.
- Interventions including therapies, medications, and activity modulation can help kids shorten the duration of their symptoms that do not respond to rest alone.
Remember to REAP benefits of what we know about concussions
- Rest: Initially, rest is believed to help conserve energy and avoid triggering increased symptoms related to the energy mismatch. Determining the right amount of rest following head injury is one of the most important goals of early evaluation and diagnosis by a trained medical professional.
- Evaluate: Evaluation and monitoring of post-concussive symptoms by a medical professional is important to ensure that your child’s injury is appropriately managed and they don’t return to play too soon.
- Activate: A graduated reentry to academics as well as physical activity is usually beneficial to someone with a concussion.
- Prevent: Once your child recovers from their injury you need to be aware of the relative risk factors and actively reduce these risks so that your child can enjoy sports or recreational activities long term. It is easier to sustain a 2nd concussion than it is the first.
- Be aware of what concussions are, and why they should be taken seriously.
- There are a number of excellent resources online with additional information such as HEADSTRONG, the Brain Injury Alliance (BIA), and the CDC.
Clearly what we do to advocate for our children before and after head injuries can really change their experience and symptoms. Acting fast, taking symptoms seriously after injury and getting children the mental and physical rest they need may really change their recovery from concussion.
Learn more about the Seattle Sports Concussion Program at Seattle Children’s Hospital.
**This post was edited on 3.12.18 to reflect the latest concussion guidelines**