Q&A: Preventing and treating sports concussions

It's a crisp fall night in the high school stadium. Football! Your son has just made a great play. But he got hit hard. Is he all right?

Concussions are of increasing concern among parents, school officials, and health-care experts. As many as 300,000 high school concussions are reported every year - in a variety of sports.

One of the region's concussion experts is South Jersey physician Robert Franks, medical director of the Rothman Concussion Institute and co-medical director of the Jefferson Comprehensive Concussion Center. He recently spoke to us about what's new in concussion awareness and treatment.

Just how dangerous is it for kids to play football?

Football has the largest amount of concussions. But soccer, at least in our practice, is very much on the heels of football. We also see quite a few concussions with field hockey. Now cheerleading is the fastest-growing group that is getting concussed. We see a lot of stunting and a lot of routines and maneuvers that are akin to gymnastics.

Even though concussion rates are supposedly rising, it's my opinion that we are just getting better at identifying and diagnosing them. We are more proactive. The athletes are more aware. Parents are more aware. Coaches, guidance office staff, and school nurses are more aware.

Are things different now, in terms of how kids are treated on the sidelines?

We continue to evolve with every academic year. We're at the point where all 50 states have some kind of concussion law. They differ somewhat by state, but looking at New Jersey, where the majority of my practice is, we have a policy about who should handle concussions - assessment by the athletic trainer, integration with the academic staff and nursing of the school, and trying to have concussion management done by physicians who have expertise in concussions.

Most districts have an introductory program for the athletes, and often the parents, to teach them what the signs of a concussion are, what things to look out for in case you get home and symptoms come on 24 to 48 hours later, what the school policy is, and what treatment would be like if you become concussed. Rothman outreach has athletic trainers that schools hire. We also have educational programs at the school level and the community level.

In New Jersey, I believe in about 93 percent of athletic events, there is an athletic trainer on the sidelines. That far exceeds the national average. Football we don't play in New Jersey without a physician on the sidelines. Above all, there is the understanding that if an athlete is concussed, they do not go back to activity that day.

What are the symptoms and treatments?

Things that we look for include headaches, dizziness, sensitivity to sound or light, nausea, vomiting, answering questions inappropriately, irritability, emotionality, neck pain, and problems with sleep. If parents see any of those, they should definitely get their child to a health care provider who has experience with concussion.

The most important thing about treatment is that we don't put you in a dark room anymore and when you're better, we let you out. Gone are the days when we kept you home for an extended period of time or tell you to just rest. We are much more active in our treatment paradigm. It involves therapies, counseling, medication, oftentimes academic accommodations.

I look at six different categories of symptoms: neck pain, balance and coordination, ocular signs, cognition, emotionality, and sleep. We have treatments for every one of these categories. The goal is to meet criteria for returning to school and eventually returning to your sport. In order to return to sport, you need to be completely symptom-free for 24 to 48 hours while off all medication. If you are someone who has been given a baseline neurocognitive exam, we need your scores to be at baseline or above. And then we ask you to do a five-step, return-to-activity program that includes physical challenges meant to bring out symptoms to see if you have not fully recovered.

"Concussion," a movie about chronic traumatic encephalopathy - a brain disease in athletes with a history of concussions - is coming out this year, starring Will Smith as the pathologist/neuropathologist who discovered it. Will that help raise awareness?

I've seen the trailers. The story has been well-publicized. But it will probably open the topic to a bigger audience, and not just the sports audience. We're seeing concussions not just in athletes. We're seeing it in dancers, in performers on Broadway, or in Cirque du Soleil. Anything that increases awareness is helpful.

Is there any new technology or equipment, such as new helmet design, that looks promising?

So far, there is no mouthpiece, soccer head gear, or football helmet that can prevent a concussion. The brain is somewhat like the ball in a spray paint can. The paint is the cerebral spinal fluid. Once you start shaking that can, you hear that ball rolling around. The same thing happens to the brain. Once you get impact force, we do not have a helmet that can prevent that movement of the brain.

 

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