By Dr. David Bertone
PT, DPT, OCS
The statistics are staggering and the media has started to more frequently discuss the problem of concussions in youth sports. The Center for Disease Control (CDC) reports that there are 38 million boys and girls aged 5-18 who participate in organized sports within the US. Surprisingly, 1 in 10 or 3.8 million will sustain a sports or recreational-related concussion each year. Parents and coaches need to be more aware of the signs and symptoms associated with concussions and what can be done objectively to determine if your child is ready for return to play.
Concussions are basically a Mild Traumatic Brain Injury caused by a direct or indirect blow to the body or head. The brain gets jolted within the skull, which can affect the person’s brain function, including motor function and/or thinking capabilities. Every person responds differently to head trauma and the rate of recovery is even more unique per individual. The cumulative effects of a traumatic brain injury can be devastating demonstrated by the early retirement of some prominent professional athletes like Troy Aikman and hockey player Eric Lindross. Second Impact Syndrome is the most dangerous consequence of returning to play too early before the athlete has healed from their concussion. The second impact can cause brain swelling and bleeding, which can result in death. Those at highest risk for this syndrome are athletes under the age of twenty.
The symptoms of a concussion are quite variable and do not always require a loss of consciousness. In fact, only about 10 percent of concussions demonstrate a loss of consciousness. If it does happen, a more serious injury may have occurred requiring immediate emergency medical attention. Most of the signs and symptoms can be divided into four categories, including physical, cognitive, emotional and sleep changes. The physical changes can be things like headaches, vomiting, nausea, visual and balance problems. The cognitive signs are feeling foggy, difficulty concentrating, loss of memory and slow speed in answering questions. The emotional changes can be demonstrated by irritability, sadness, emotional or nervousness. Lastly, the injured athlete can demonstrate difficulty falling asleep or sleeping too much.
In 2010, Governor Chris Christie signed one of the most comprehensive concussion prevention laws in the country by mandating school districts to have a concussion management program in place for the 2011-12 school year. It also requires that athletic trainers receive 24 hours of continuing education dedicated to concussion management. This will help at the high school sports level, but has no impact on youth sports or club/travel teams. This is where coaches and parents play a vital role in determining the status of an injured athlete. After an injury occurs, where there is no loss of consciousness, a sideline cognitive and functional assessment can be critical in determining a return to play. But the most prudent thing to do when in doubt, is to sit them out.
Sideline testing should include cognitive testing like being oriented to person, place and time; being able to recall words and recent events in the game and demonstrating the ability to concentrate by repeating days and numbers backwards. Functional testing includes balance, eye movement testing, visual ocuity and physical activity to see if it impacts their symptoms. These tests are then repeated 15 minutes after injury. If the player is asymptomatic, and they pass the sideline assessment, return to play can be considered. But it remains prudent to hold the adolescent athlete out of further play until cleared by medical personnel. These guidelines can be found at www.dborthopt.com/concussion.
Research has demonstrated that one of the best practices for concussion management is to perform baseline cognitive and balance testing before an injury occurs. This allows for an objective comparison of function to a level prior to injury. A few of the cognitive testing tools are ImPACT, SCAT/SCAT-2 and Axon Sports Computerized Cognitive Assessment Tool (CCAT). These are quick and cost-effective baseline testing of cognitive skills by documenting speed of processing, memory, reaction time and attention span. The balance component of functional testing can be even more critical. Baseline, pre-injury balance testing can objectively measure the body’s sway/balance control, which is often impacted by head trauma. After injury, these tests are re-administered and results are compared. This will be utilized by your physician in determining readiness for return to play. Many professional and college teams have already been utilizing baseline testing. But now, high school and youth sports leagues are starting to require it. If not required, parents should take the prevention route and take their athlete to a qualified professional to administer these tests and be available to re-administer them if an injury does occur to determine true readiness for return to play.
Dr. Bertone is a Doctor of Physical Therapy and a Board Certified Orthopedic Clinical Specialist by the American Board of Physical Therapy Specialties with extensive experience in the area of concussion management. He is currently offering comprehensive baseline concussion testing for youth sports, high school and college athletes with online registration at www.concussionRXcare.com. His practice, db Orthopedic Physical Therapy, has locations in Manalapan and Middletown. Dr. Bertone can be reached at 732-747-1262 or via e-mail at info@dborthopt.com. For more information, check out his website at www.dborthopt.com.
