Before You Go - May 2015
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Injury Awareness
Effects of Concussions Warrant Constant Attention

By Deborah L. Vence

With concussions on the rise in youth sports, coaches, trainers and athletic directors need to know how best to deal with such an injury and recognize the issues that have an impact on recovery.

"At the minimum, all of these groups should know what a concussion is, in general terms, and what causes it, including that a forceful jarring of the body can cause a concussion‚ÄĒnot just a blow to the head. All should appreciate that a concussion is an indication of an injury to the brain," said Michael F. Bergeron, Ph.D., FACSM, executive director, Sanford Sports Science Institute and National Youth Sports Health & Safety Institute.

Research on concussions in youth sports that appeared in the April issue of the American College of Sports Medicine's (ACSM) flagship journal, Medicine & Science in Sports & Exercise, indicated how returning to pre-injury levels of physical activity affects recovery of walking balance, cognitive function and symptom severity.

The study, "Return to Activity After Concussion Affects Dual-Task Gait Balance Control Recovery," out of the University of Oregon, showed that high school athletes who returned to the field with medical clearance within 60 days experienced a recovery reversal in their ability to maintain balance while simultaneously walking and performing mental tasks. The regression was not observed when performing walking or mental tasks alone, nor on the symptom severity.

"Concussions in youth sports are of particular concern due to the potential vulnerability of the developing brain to withstand head trauma," he said. "We have published another recent study indicating that adolescents may be affected by a concussion to a greater degree than young adults. Thus, translating the timing of returning to activities following concussion for collegiate or professional athletes may not necessarily match the expected time course of recovery for pediatric or adolescent populations." (Howell DR, Osternig LR, Chou L-S. Adolescents demonstrate greater gait balance control deficits following concussion than young adults. The American Journal of Sports Medicine. 2015; 43(3):625-632).

"Qualified healthcare professionals, such as certified athletic trainers and sports medicine physicians, are trained specifically in the diagnosis, management and referral procedures of concussions. Thus, such proper medical personnel should be present during any contact sporting event, so that if a concussion is sustained, it can be properly identified and diagnosed," Chou said. "As a result of the deleterious effects of concussion, legislation has been enacted in all 50 U.S. states to protect high school athletes from returning to play too soon after a concussion."

Those who completed the study's protocol comprised 25 local high school students who have experienced a concussion while participating in school sports and 25 individually matched control individuals. Of the 25 participants who sustained a concussion, 19 (16 men/3 women) returned to physical activity within the two months of testing after the injury yielding 19 pairs of concussion and control data used for study analyses. Six of the 25 individuals with concussions did not return to physical activity within two months post injury, and their data were not used in the study.

"Coaches and ADs should know how to recognize when an athlete may have a concussion and the importance of prompt removal from activity and seeking medical help. Athletic trainers should know this and more clinical depth regarding signs and symptoms, treatment and progressive return-to-play procedures/protocols," said Bergeron, who also is a professor in the Department of Pediatrics at Sanford School of Medicine of The University of South Dakota; and senior scientist at Sanford Children's Health Research Center.

"Return to play needs to be with evaluation and clearance from a licensed medical professional who has sufficient training and experience with sport concussions," he said. "Importantly, return to school also needs to be approached progressively and with appropriate accommodations as needed."

Thus, the study, compiled by authors David R. Howell, Louis R. Osternig and Chou, reinforces the need for continued monitoring beyond the point of clinical recovery and the resumption of physical activities. Moreover, the research indicated that little is known about the residual effects of returning to activities after concussions.

Coaches should look out for "Any unusual behavior or performance, as well as any return of symptoms and/or complaints from the athlete," Bergeron said.

He also said the most compelling piece of information from the research involves the fact that "While the impact frequency was lower, the distribution of head impacts in the youth football players (11 to 13 years old) was remarkably similar in magnitude (force) and location as in high school and collegiate football."

In addition, Chou said "The Oregon study identified that athletes experienced increased deficits to balance control while walking and completing a mental task after they returned to pre-injury levels of physical activity. They did not, however, experience increased symptoms, cognitive deficits or single-task walking deficits. This suggests that many of the tests utilized in concussion return-to-play decisions may not capture the full range of deficits, which take longer to recover after a concussion."

Chou advised that coaches "rely on medical personnel to guide athletes through this stepwise progression. However, open communication between the athletes and coaches without placing pressure on an athlete to return to the field too fast will allow for more honest symptom reporting.

"Although physiological impairments have been repeatedly documented to outlast symptoms following a concussion," he added, "increased symptom severity with increased physical activity represents an obvious sign that the individual is not ready to return to vigorous athletic endeavors."