When a blow or jolt to the head during sports causes concussion, student athletes can suffer from symptoms that make school, play, social activities and just getting through the day a real challenge — even if they walk off the field seemingly fine.
Concussion symptoms can set in gradually. When overlooked and not properly treated, symptoms can worsen or make young athletes vulnerable to re-injury and more time out. Most concussions don’t cause a loss of consciousness. The varied signs and symptoms range from behavioral changes and clumsiness to forgetfulness and repeatedly asking questions. More obvious red flags are severe headache, nausea, balance issues, vision problems and feeling “in a fog.”
Education and early identification are critical to determining when a child needs help, says Dr. Richard Figler, co-medical director of Cleveland Clinic’s Concussion Center. Cleveland Clinic treats concussion with a multi-disciplinary approach. “We consider ourselves the quarterbacks,” Figler says. “The earlier we treat, the better — and the faster these athletes will improve because we can intervene and not allow symptoms to snowball.”
Treating concussion at the Concussion Center involves a comprehensive approach, including sophisticated neurological testing, says co-medical director Dr. Andrew Russman. “We are evaluating athletes on the sidelines and in the office, and we implement a whole series of protocols that we have refined over time,” he says.
For example, at many Cleveland area/Northeast Ohio schools, Cleveland Clinic-certified athletic trainers monitor players from the sidelines and use the Cleveland Clinic C3 concussion app to measure physical and cognitive performance, which can help identify concussion. The app serves as a tracking mechanism to measure cognitive and motor skills compared with a student athlete’s baseline. The technology is one tool Cleveland Clinic Concussion Center utilizes for diagnosing concussion early on, tracking treatment progress and ensuring that athletes get comprehensive care.
Depending on the severity of the injury, addressing concussion can involve a range of specialists, including physical and occupational therapists, neurologists, orthopaedic and rheumatologic specialists and sports medicine physicians.
Quarterbacking Care
Concussion is defined as a short-lived brain injury, so if the brain is overworked during recovery, the stress will slow treatment progress and can even cause student athletes to backslide. Concussion treatment is a balancing act, and students need to be allowed to gradually ease back into school and everyday activities — and eventually get back in the game if and when advised by a physician.
Sometimes, schoolwork can “exercise” the brain more than a student suffering from concussion can manage. “If a kid broke his ankle and had a cast and crutches, you would not take away the cast and crutches and say, ‘You can’t use these in school,'” Figler says. “Brain injury due to concussion takes time to heal, too.”
A “return to learn” plan includes instructions for parents and the school. Plans include information about red flags to watch for — at home and in the classroom — that could indicate a worsening condition, Russman explains. Meanwhile, athletic trainers continue to track progress.
The C3 app is also used to perform tests to determine whether a student is ready to get back in the game. Today, Ohio state law requires that a child athlete receive medical clearance from a specialist before being permitted to return to play. “Highly standardized care practices help us make sure that every individual student athlete is protected from the risk of another injury,” Russman says. “We know that students who return to play before they are completely recovered will have more persistent symptoms and risk second-impact syndrome or post-concussion syndrome.”
“Wrap-around” concussion care is critical for addressing the whole athlete. The mental game of recovery is challenging. Parents should encourage their children to be honest about how they feel, and not rush back to practice or competition before full recovery. Athletes can feel like they lose their identity when they’re sidelined, or like they’re letting down the team. Reassure them that winning back their health by easing into activity one step at a time is the goal.
Figler likes this analogy that a Cleveland Clinic athletic trainer uses to help student athletes understand their need to heal before they head back on the field: “Your brain is like an iPhone. If you have all of the apps open at one time, the battery drains faster. If you only have one app open, your phone will work more efficiently and the battery charge lasts longer,” he says of gradual, monitored re-entry to activities. “Focus on one thing at a time, and conserve the battery while you heal.”
Concussion Red Flags
How do you know if your child suffered a concussion during a game? Even if a student athlete walks off the field with no visible symptoms after a head jolt or blow, concussion red flags can manifest within 48 hours and worsen during the course of a week or two. These 20 red flags could indicate a concussion.
Parents, coaches and teammates should watch for:
— A dazed or stunned appearance
— Personality or behavior changes
— Confusion
— Loss of consciousness — even if brief
— Clumsiness
— Forgets plays or assignments
— Seems “out of it”
— Forgetting events prior to or after a “hit”
— Slow response to questions
— Repeatedly asking questions
Student athletes should report signs, including:
— Headache
— Nausea
— Balance problems
— Double, blurry or changed vision
— Sensitivity to light and/or noise
— Fatigue or drowsiness
— Altered sleep patterns
— Trouble comprehending, concentrating and/or paying attention
— Feeling irritable, nervous, emotional or sad
— Feeling “just not right” or “in a fog”
Rebounding from Concussions
There were no answers when Zachary, then 11 years old, suffered a helmet-to-helmet collision during a 2013 football scrimmage and lost consciousness for about 15 seconds. There were no physical signs of injury and Zachary did not have a headache, but he was sensitive to light and couldn’t think straight in the following weeks. Eight weeks after the collision, doctors allowed Zachary to play again. Then, in 2014, Zachary took another hit during practice. To read Zachary’s story, go to clevelandclinic.org/concussionZachary.
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Breaking Through the Haze of Concussions originally appeared on usnews.com
