Health Update from Your Nurses
Drs. Gordon, Nussbaum, and Lappin  

May 31, 2011
Head Injuries   
Concussion? What Concussion?!

Common though they may be, injuries involving any impact to the head cause lots of worry and concern. They range anywhere from an infant or toddler rolling off the bed or falling down while at play, to a teenage athlete colliding full-speed with a ball or another player. These injuries are worthy of our concern and should always be thoroughly assessed.


Other than the initial first aid for any resulting cuts, scrapes, or bumps, the next consideration is to assess for a concussion--the issue foremost in everyone's mind. 


What exactly is a concussion?

Concussions can be somewhat loosely defined as a complex process of temporary injury to the brain, induced by mechanical trauma; in other words, any impact to the head, face, or neck strong enough to cause the symptoms we define as a concussion:  possible loss of consciousness, headache, confusion, dizziness, drowsiness, nausea and/or vomiting, memory loss, or balance or other motor problems.   


Other symptoms can be disturbances of sleep, mood, and energy. The most common symptoms are headache and confusion, along with an inability to remember events around the injury. Loss of consciousness actually occurs in fewer than 10% of concussions. The symptoms come on rapidly with usually short-term effects on the nervous system which resolve over time; it is more an impairment of function rather than injury to body structures.    


Very young children certainly have their share of tumbles and falls, but for numerous reasons are less likely to sustain a concussion. Not only do their bodies absorb the impact of falls better, but young children also have more cushioning fluid around their brains than older children and adults.  


After a fall, an infant or toddler may cry at first (a good sign that they are still conscious!) and be clingy, subdued, and upset for a bit, but they usually bounce back and resume their normal behavior after being comforted. If it's naptime soon or they seem sleepy, you can allow for an hour of sleep then check on them. Wake them to be reassured they're not too lethargic to arouse--more sleep can be allowed then if they're fine, but nap time may just be over at that point! Most serious problems set in during the first 6 - 8 hours after an injury, so often by bedtime the same level of concern no longer exists. Please call us so we can help you through this worrisome experience!


The "hot topic" now is the older child and the sports-related concussion. 

It's important to raise awareness of new research and protocols, especially because there is an increased incidence nationwide of this type of injury. The highest rate of concussion is among adolescent girls in soccer.  Interestingly, despite how dangerous it may appear, research shows that doing "headers" to control the ball in soccer is rarely forceful enough to cause a concussion.  Most soccer head injuries result from players colliding together or a ball hitting a player's head unexpectedly.


In the past, athletes were often sent back into the game after a head bump if they seemed able, but that's no longer considered safe. Current opinion is that under no circumstances should an athlete with a suspected concussion return to play the same day. It is now recognized that even a minor "ding" should never be trivialized but given thorough professional attention.


After the initial medical assessment, returning to normal activities should be individualized and taken in steps at least 24 hours apart over the course of 5 or more days. Some backtracking may be necessary along the way if symptoms return. Most patients follow a structured plan that gradually returns them back to school, sports, and so forth. The goal is to be symptom-free both at rest and when active.   


The first step is complete rest, not only of the body, but of the mind as well --a newer finding and a very important one. Complete physical rest is essential, necessitating a short break from school and all physical exertion--not just sports, workouts, and training, but even a bike ride or lap around the track. Not only is this necessary to avoid re-injury and a worsening condition, but to help prevent symptoms persisting longer than usual and delaying recovery.


Completely resting the mind, or "cognitive rest," is a newer finding now considered as crucial as physical rest. Mental activities that require concentration and attention, such as television, reading, video games, texting, using a computer, etc., tax the brain and should be avoided. Temporary allowances for homework, tests, and other school activities must be made for the student until fully recovered. In general, the rehabilitation stages range from no activity at first--complete physical and cognitive rest--through a graded and gradual increase in activity until medically cleared to resume one's normal lifestyle.


Can concussions be prevented?

Of course, the best outcome of all would be prevention, and to that end education at all levels is vital--from the physicians and coaches to the athletes themselves and their families. While it's impossible to prevent every head injury in a high-risk sport, research continues on this front. So far, helmets and other protective headgear seem to vary in effectiveness. They work best in preventing concussions in skiing and snowboarding, and are recommended for these sports. More to the point will probably be some changes in game rules, improved equipment, better training, and increased awareness of concussion symptoms and rehabilitation measures.


With so many children now participating in active, high-risk sports, education and recognition are the most important tools we have to care for them--targeting the whole team of individuals involved in our children's sports experiences will give us the best chance of keeping them safe and healthy as they grow.


And as always, call us with your questions or concerns--we'll talk you through it, and let you know if you should head on over.




Your Nurses