Be Head Smart: Concussion management key to recovery
Fall brings us the start of school and the beginning of another season of sports like football, lacrosse, soccer and volleyball. Along with the excitement for games and the rush of a big win comes a very big risk for youth athletes: concussions.
Concussion prevention is key when it comes to keeping student athletes healthy and in the game. The number one prevention tool for concussions is teaching athletes safe playing techniques. Athletes should never lead with their head in collision or contact sports. Young athletes should be taught the safety rules of the sport and coaches enforce the rules.
Helmets should always be in good condition and worn properly. This rule of thumb applies to all riding and contact sports. While helmets can reduce the risk of skull fractures and brain injury, no helmet is “concussion-proof.” For this reason, even with a helmet, athletes should avoid direct hits to the head.
Even with safety and prevention measures, concussions happen. If there is even a suspicion of a potential head injury, parents or coaches should take action. Anytime an athlete feels he/she or even a team mate may have had a hit to the head or is showing signs of concussion, it is important to let their coach, athletic trainer or parent aware. These signs include:
• Nausea or vomiting
• Balance problems or dizziness
• Double or blurry vision
• Sensitivity to light
• Sensitivity to noise
• Feels sluggish, hazy, foggy or groggy
• Has concentration or memory problems
• Does not “feel right” or is “feeling down”
Once a head injury is identified, it is vital that the athlete follows these care recommendations, particularly in the first few days after the injury:
1. Get lots of rest in a stimulus free environment (dark, quiet room). Go to bed early and sleep late as needed. Do not stay up late on school nights or weekends.
2. Take daytime naps or rest breaks when you are tired or when you have an onset or increase of symptoms.
3. No physical activity, including sports practices and games, weight lifting, PE classes, running, biking, skateboarding, etc.
4. Limit cognitive activity including homework, school attendance, reading or computer work. Any activity that involves a lot of thinking and concentration should be limited as you recover, particularly if the activity aggravates the athlete’s symptoms.
5. Drink lots of fluids and eat carbohydrates and protein to maintain blood sugar levels.
6. No texting, no video games, no computer work, no TV, no movies, no reading, no iPod, no Facebook and no email.
During recovery, it is perfectly normal for the athlete to feel frustrated and sad when they are not feeling right and cannot be as active as normal. As symptoms start to decrease, you can start discussing a gradual return to learning with your child’s teachers. It’s important to note that if any of your child’s concussion symptoms – like headaches – return, you should scale back cognitive activities and help your child rest until the symptoms improve.
Because a concussion is a brain injury, this return to the classroom and other cognitive activity should be gradual. The following stages are recommended for recovery and returning to the classroom:
Stage 1: Complete mental rest: No school, computers or other mentally engaging activities like computer work.
Stage 2: Reintroduction to mental activity: Start small and focus on gradual increases. You can relax previous restrictions on activities like watching television or using a computer for very short amounts of time, say 5-15 minutes at one time. If symptoms return, resume complete mental rest.
Stage 3: Introduce mentally engaging activities: Your child can begin to work on larger and more demanding homework assignments. To increase mental stamina, you can increase time spent on mentally engaging activities to 20-30 minutes at one time. If symptoms return, decrease activity.
Stage 4: Return to school: Your child can start back to school on a part-time basis once they are able to tolerate one to two cumulative hours of homework at a time. Special accommodations should be made for your child so that recovery is not hampered by doing too much too soon.
Stage 5: Increase to a full day of school: Continue to increase the mental workload as your child’s brain heals from the concussion. Special accommodations should remain in place as your student returns to a full day of school work. At this point, the brain is still not fully healed.
Stage 6: No restrictions: Once the brain has fully healed, your child can resume a full cognitive workload. This includes a full return to classes without restrictions or other accommodations.
Now that your young athlete has recovered enough to return to school fully, they can return to the practice field and gradually return to their full playing schedule. Even though most concussions (80-90%) resolve in seven to ten days, it is important for athletes to stay out of both practices and games until they are completely symptom free.
Experts agree the rule of thumb is “when in doubt, sit them out.”
Once symptoms subside and your child is ready to get back into the game, their return to the sport should be gradual and done in a step-by-step manner in order to not overburden the brain as it continues to heal. This includes limiting practice time, building up to full practices and remaining out of full contact games until the brain is fully healed.
This step in recovery, referred to as “Return to Play” is important to take gradually to avoid re-injury and issues like Second Impact Syndrome.
Second Impact Syndrome happens when the brain is not fully recovered from a previous head injury and sustains a second injury. The main risk factor for this life-threatening condition is returning to play too early and before symptoms have resolved from the previous concussion.
Because medical professionals are not sure what causes Second Impact Syndrome and because medical imaging like CT scans and MRIs aren’t able to determine when a brain is fully recovered from a concussion, it’s very difficult to predict who will develop Second Impact Syndrome. It is known that the syndrome most often impacts athletes under 18. This is why it is critical to watch for symptoms and other red flags that do not go away. These symptoms and red flags are the only reliable markers to determine if a brain is fully recovered from a concussion.
The road to concussion recovery can feel like a long journey, but in the end is worth it.