Concussion: A Game Changer

Playing It Safe

By Steve Calechman

“You only get one brain,” he says. “You can’t replace it.”

Football PlayerTaylor Twellman suffered a concussion in 2008 when he ran into a goalie while playing for the New England Revolution. The lingering effects forced the one-time Major League Soccer MVP to retire last year at age 30. Today, more than two and a half years after the brain injury, Twellman still deals with headaches and occasional fatigue.

It wasn’t his only concussion. He had seven diagnosed over 17 years of playing soccer. The first came at 14.

Twellman tried to play through the 2008 injury because soccer was his job and, as a star player, he was the face of the New England Revolution. As a result, the concussion went untreated for too long, ultimately ending his career.

That, he says, is why no child should feel pressured by the “suck it up” attitude that still exists in youth and professional sports today

“You only get one brain,” he says. “You can’t replace it.”

Concussions have always been a risky side effect of sports. But they’ve gotten a lot more attention in the last five years. Check a newspaper or sports news website and there are seemingly daily items on the latest athletes struggling with concussions. Sidney Crosby in hockey. Lindsey Vonn in skiing. Justin Morneau in baseball.

As professional sports leagues try to formulate policy on how to best deal with the injury in their athletes, states are following suit to protect kids – who are more vulnerable to concussion’s dangers of brain swelling, permanent brain damage and even death. Currently, 14 states have a sports concussion law, which may require that an athlete must removed from play with a suspected concussion and not allowed to return without written medical clearance and that school sports and medical staff complete concussion-specific training. (See to learn if your state has a consussion law.)

The new laws reflect a growing understanding that a concussion is no longer a case of merely “getting your bell rung.” Rather it’s potentially serious, and, while football sees the most incidents, concussions do not discriminate. More than 192,000 estimated concussions were reported in high schools nationwide during the 2009-10 academic year, according to the Center for Injury Research and Policy. Of the sports tracked, girls’ soccer had the second highest incidence.

Laws are Just a Start

But while health professionals hail the increased scrutiny and protective efforts around concussions, they recognize that it’s just a start.

“It’s easier to pass a law than to implement it,” says sports concussion expert Robert Cantu, M.D., clinical professor of neurosurgery at Boston University Medical Center, chief of neurosurgery at Emerson Hospital and a co-founder of the Boston-based Sports Legacy Institute, which addresses the sports concussion crisis through research, public education and improved treatment.

Even when the details are hashed out, gaps will likely exist in any concussion policy, Cantu and other health experts say. Concussions aren’t straightforward entities. Symptoms exist and can persist in non-quantifiable ways.

New attitudes help, but lingering, misguided thinking about concussions can minimize the seriousness of this injury and lengthen recovery.

“Education is the challenge, especially for parents,” says Plymouth, Massachusetts athletic director Karl Braun. Some overzealous sports parents, he says, still believe that a concussion isn’t serious enough to bench a young athlete.

But kids themselves pose challenges for dealing with this injury. Adolescent physiology, identity issues and innate impatience all come into play, along with the reality that while the athlete may be off the field, the child recovering from a concussion is still a student with a brain that isn’t functioning at its best.

Understanding the Injury

Girls SoccerMaking sure that kids with concussions are treated and allowed to recuperate means that, first, adults have to know what to look for. It’d be easier if kids always communicated when there was a problem. But fear and stubbornness can inhibit adolescent honesty.

So can benign ignorance. A 2004 study of Milwaukee high school football players found that the third most common reason for not reporting a concussion was lack of awareness about what it is.

Concussion is a head injury, commonly from a direct blow, but also from a whiplash effect. While sports are an obvious contributor, sledding or falling off a swing can do the same damage and be easily overlooked or not considered at all. Regardless of the source, the effect is a metabolic change in the brain that results in slowing down your reaction and processing time, says Bill Meehan, M.D., director of the Sports Concussion Clinic at Children’s Hospital in Boston.

The injury comes with any number of symptoms, among them:

• headaches,

• dizziness,

• nausea,

• light sensitivity,

• fogginess and

• mood changes.

Symptoms can start immediately, or soon after the hit. But they can also start the following day, and the connection is often missed, says neuropsychologist Neal McGrath, Ph.D., clinical director and founder of Sports Concussion New England.

Because concussion hinders the brain’s ability to handle blood flow, any symptoms are exacerbated by physical or mental strain – whether from working out, cramming for a test or playing video games. Decision-making, cognition and focus are all compromised, decreasing performance and leaving an athlete vulnerable to another concussion. A repeat concussion, before the brain fully recovers from the first one, can mean permanent brain damage and even death.

These realities apply to athletes at any level. With kids, however, the risk is greater; their brains aren’t fully developed, are more easily injured and are slower to recover than an adult’s, Cantu says.

But while serious, the situation doesn’t have to be dire. It just needs to be addressed. The body and brain need immediate rest after a concussion and, when symptoms disappear, activities should be slowly ramped back up to full level. Assuming it’s a mild, first concussion, an athlete can be back in play, with no long-term risk, in no more than two weeks, McGrath says.

To a kid, however, two weeks might as well be a decade.
Motivated high school athletes want to play, keep their spot on the team and not appear weak to peers. They also want to have fun, and scoring a touchdown provides an ego-boosting thrill that doesn’t come from the best chemistry test, says Sharon Chirban, Ph.D., sports psychologist at Children’s Hospital.

Parents need to understand that, while it can be a struggle to have a teenager sit out a few games, relenting and ignoring the long-term view could stretch recovery time from days into months.

Let the Brain Recover

Taking any athlete off the field after a concussion is a necessary and mostly accepted component of recovery. But Lindsey Vonn and Sidney Crosby can sit in a dark room all day, focus on getting better, and not have to worry about an upcoming Macbeth term paper.

The student-athlete is still a student, but now with an injured brain.

Along with a physical break, an adolescent needs cognitive rest, says Lauren Smith, M.D., medical director for the Massachusetts Department of Public Health. Behavior has to be modified and activities – both fun (texting) and not so fun (chemistry homework) – need to be monitored, limited and possibly stopped temporarily. The remedy might be staying out of school, going in late, leaving early, or some ever-changing combination.

Parents, coaches and educators have been slower to understand this fluid component of recovery, health professionals say.

Part of the reason is the nature of the injury. It’s a functional, not anatomic problem, Smith says. A concussion won’t show up on an X-ray or MRI. There’s no cast or limp. A child can look just fine, so efforts to recuperate can lead to claims of malingering and milking the issue. McGrath says to expect the following ratio among a child’s teachers: Two will have played sports, experienced concussions and know the realities. Two will need instruction, and two will be skeptical.

It’s the skepticism that adds to the problem – the student knows that something’s wrong, and being doubted can lead to anger and frustration, adds Chirban.

How do parents counteract that? Be patient and supportive at home. Assemble a strong team at school (see sidebar). And, until districts have good concussionmanagement programs in place, make sure that considerations are made during recovery – whether it’s rescheduling tests, consolidating assignments or extending deadlines, anything that allows the student to keep up without worsening the symptoms, McGrath says.

With an injury that doesn’t always reveal itself in obvious ways, impatience can be a natural response. Kids feel it; adults can be prone to it as well. But when the inclination and desire is to push rather than wait and show some discretion, the message is pretty clear.

“Do you want a shorter, faster, more expeditious recovery,” McGrath asks, “or a longer, slower, more painful one?”

Read More

After a Concussion -- If a concussion persists and your child’s schoolwork needs to be managed, here’s where to find support and how to keep everyone informed.

Steve Calechman is a freelance writer in Waltham, MA.

This article originally appeared in the Boston Parents Paper, April 2011.