Wednesday September 23 2020
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Concussions and Second-Impact Syndrome

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As she weighed her fall-sports options, Brianna Battista thought her biggest challenge was choosing between basketball and soccer, which run concurrent seasons where she lives in Pennsylvania.

Instead, Battista, an active, happy and healthy 14-year-old, really needed to worry about something else—simply getting the OK to participate in any sport.

She picked basketball, but before her doctor would approve her to play he wanted to pick her brain about her brain. Because Battista had sustained concussions in the past, her primary care physician insisted on more substantial checks, including a battery of short-term memory tests.

For Battista, the cautionary steps seemed a bit much, but she learned a lot in the process. Perhaps most importantly, she learned she’s not alone.

According to statistics compiled by the American College of Sports Medicine, 300,000 sports- and recreation-related concussions are diagnosed each year. Perhaps more troubling, the group estimates that 85 percent of concussions may go undiagnosed.

More people have become more aware of concussions in general, though, and especially so at the high-school sports level. Still, transferring that awareness to youth sports remains a challenge.

“It’s really not something you typically see among the youngest youth athletes because many are not in competitive leagues until ages 8 or 9,” says Mark Lovell, who directs the UPMC Center for Sports Medicine Concussion Program. “In the past, concussions in that age group or younger children were from falls after jumping on their beds or something.
“But, we are seeing a growing number of concussions among that age group from sports activities.”

Obviously contact sports such as football provide the most fertile territory for collisions and concussions. While football leads the list of sports that produce concussions, every sport has at least a few documented cases.

In addition, some people who sustain a concussion once are more prone to a head injury again.

“We all have different levels of susceptibility, but we really do not know how to determine that ahead of time,” Lovell says. “We’ve found that once someone has three or four concussions there’s a buildup of effects.

“Also, in many cases of repeat concussions a person’s tolerance for injury becomes lower and they develop symptoms with less provocation.”

At UPMC, Lovell serves as the founding director of the concussion program. A nationally known concussion researcher, he has worked with the National Football League, National Hockey League and oversees the concussion testing for NASCAR and the U.S. Ski Team, among others.

He developed Immediate Post-concussion Assessment ant Cognitive Testing (ImPACT), a test that allows doctors to determine a baseline cognitive level for athletes and then compares results of subsequent tests taken after concussions to document injuries and their results.

The ImPACT testing system has been adopted by 19 NFL teams, numerous college and university athletic departments across the country and nearly 200 high schools in Pennsylvania. In western Pennsylvania, many high schools utilize the ImPACT system.

“In communities around Pittsburgh, there’s a lot of familiarity with concussions and their impact,” Lovell says. “We’re really kind of ground zero for concussion research.”

Still, ImPACT has some limitations. While it works well for professional, college and high school-age athletes, it’s not designed to work for people younger than age 11.

At this point, Lovell and his team are working with the Center for Disease Control to expand the test and make it effective for children as young as age 5.

“Awareness at that age level is relatively low,” Lovell says. “But, once people know about the dangers and symptoms of concussions they become conscientious pretty quickly. Really the toughest age group to ‘sell’ on the dangers of concussions may be older youth and high school athletes.”

Just defining a concussion helps convey the seriousness of the injury. While off-hand remarks like “take a few moments to clear your head” or “getting your bell rung” may have been a common part of youth and older sports in the past, most people realize concussions truly are a brain injury—something much more serious than a “shake it off” bump or bruise.

The American Association of Neurological Surgeons defines a concussion as “an injury to the brain that results in temporary loss of normal brain function … usually caused by a blow to the head.”

Because every athlete and every situation or different, what defines a “blow to the head” changes from situation to situation as well.

A concussion can happen as the result of a hard hit in football, an improper header in soccer or even a harmless-looking collision on a basketball court.

“The classic situation is that a kid gets hit and nobody thinks much about it,” Lovell says. “Then, the kid jumps back up and keeps playing—only to have symptoms later.”

In a worst-case scenario, those symptoms include a severe headache and vomiting—symptoms that merit an immediate trip to the emergency room.

Still, those are obvious cases—the instances that get reported. After more than a decade of work studying concussions and creating ImPACT as a tool to improve the health of athletes, Lovell knows concussions do not always display symptoms so overtly.

“More often than not, the parents may not even know much, or that anything happened,” Lovell says. “They may notice at some point that their child is moping, or less responsive and not as energetic as usual.

“Then they’ll work backward and think about what happened and realize some sort of bump to the head was the initial cause.”

Along with energy levels and personality changes, concussion symptoms include headaches, sensitivity to light, sleep problems and slowed responsiveness. Also, Lovell says concussions sometimes prompt athletes to become more emotional or cry for no reason.

He says any significant change in behavior should cause concern and questions from parents.

“Certainly if the pain is severe or the athlete is acting grossly confused, they should be taken to the ER,” Lovell says. “Often, by the time parents work back and determine what happened, things might not seem as severe. Still, they should check with their pediatrician if they have any questions.”

Many resources exist for parents and youth athletes, too. Along with ImPACT at UPMC, the Centers for Disease Control and Prevention publishes “Heads Up: Concussions in High School Sports,” an online resource that provides information useful for athletes of all ages.

It may be found online at http://www.cdc.gov/ncipc/tbi/Coaches_Tool_Kit.html.

Another Web site, http://www.momsteam.com/alpha/features/drcantu/, provides links to dispel myths about concussions and provides links to articles on topics ranging from prevention to treatment of concussions.

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