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Brain

Concussions: Setting the record straight

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Symptoms from concussions should resolve in a week or two. If not, it’s important to see a doctor.

In recent years, there have been many headline-grabbing stories about the serious effects of concussions among student and professional athletes. A concussion is a mild form of a traumatic brain injury (TBI) caused by a bump or blow to the head, or by a strike to the body that causes the head and brain to jolt.

Some research suggests that concussions can increase the risk for Alzheimer’s disease, Parkinson’s disease, and other brain disorders. However, most concussions cause short-term symptoms such as headache, dizziness, difficulty concentrating, and irritability and resolve in two weeks or less. Unfortunately, some media outlets misconstrue concussion data in athletics, which has many parents nervous about allowing their children to play sports.

We can’t bubble wrap our kids, and exercise offers greater physical and social benefits than leading a sedentary life, even considering the risk of concussion. The best thing parents, coaches, and caregivers can do is to take a close look at the data in concussion and TBI stories and understand what the researchers mean – not just how reporters present the data.

What do the data really mean?

According to a 2016 study from the American Academy of Pediatrics, nearly 395,000 sports-related concussions occurred in U.S. high school athletes in 2013. However, concussion and traumatic brain injury (TBI) data are complex and shouldn’t be discussed in catch-all statements.

For example, a 2017 article in The New York Times about a study on concussions received a lot of attention. According to the study, which was originally published in the Journal of the American Medical Association (JAMA), of the 111 deceased football players who played in the NFL, 110 were found to have chronic traumatic encephalopathy (CTE), a degenerative brain disease found in some athletes, military veterans, and others who have suffered repetitive trauma to the brain. This statistic, 110 out of 111, sounds like a large number, but those represent highly selected cases and are not representative of all NFL players.

Some news coverage of the study suggests that CTE is a common disorder and that many people are at risk. The truth, however, is that it is rare – there are only about 153 confirmed cases worldwide since the condition was first identified in boxers in the 1920s. Also, we don’t know who is at risk because we don’t understand all the specific factors at play.

Another problem with the study is the criteria by which CTE is diagnosed. The challenge is it can only be diagnosed at autopsy by measuring a protein in certain areas of the brain called, “tau.” Small amounts of tau are required to make a CTE diagnosis, but there’s disagreement among researchers about how much tau is necessary. Not everyone who hits their head ends up with a concussion, and the vast majority of concussions do not result in CTE. Furthermore, we must keep in mind that there are more than 20 other conditions, including normal aging, wherein tau builds up.

When a new study is published, you can’t take what you read at face value. You have to be a consumer of the information, educate yourself, and have a healthy amount of skepticism. Don’t skim the headlines, but go to the original source article. Studies that use large sample sizes and those that replicate findings in other studies are those that are likely to be trustworthy.  

"There’s a lot of discussion in the media about concussions among athletes. The truth is, concussion is a concern for all age groups – especially kids – and there’s a lot that’s still unknown."

– C. Munro Cullum, Ph.D.

Tips to protect children from concussions

Unfortunately, we can’t predict the long-term consequences of concussions – if any – that will occur in a particular patient. For example, one person might suffer only short-term symptoms while another might have symptoms that linger. The good news is that you can take reasonable precautions to prevent a concussion without taking your child out of sports for good. 

Make sure your child is ready

Before pursuing football or soccer try-outs, determine whether your child is physically and mentally equipped to make good choices about personal safety. Also, ask the coach about how they teach tackling and contact techniques, the type of equipment the team uses, whether an athletic trainer will be present at practices and games, and whether there are injury protocols in place.

You should feel comfortable letting your child participate; if you’re not, find another team. I allowed my son to participate in contact sports because we had many discussions about what to do if they take a hard hit, including letting their coach know and being aware of symptoms such as nausea, balance problems, or just not feeling right.

Take appropriate action when a concussion occurs

If a child suffers a concussion, it’s likely he or she will be fine. The vast majority of children recover with no complications. If the concussion occurs during a game, it’s best to err on the side of caution: when in doubt, sit them out. All 50 states now have concussion laws that require removal of a teen athlete from play for a period of time (often a week) after a suspected concussion, and the child must be cleared to return to play by an approved health care provider. If the child loses consciousness (even briefly), has trouble breathing, or is excessively drowsy, head to the emergency room to determine whether a serious injury has occurred.

For most concussions, a brief period of reasonable rest followed by light activity and a gradual return to a normal routine is the best treatment. However, too much rest and isolation from normal routine can lead to psychological symptoms, including depression, anxiety, and irritability, which could be mistaken for concussion symptoms.

Most concussions resolve without any long-term problems. However, if your child has concussion symptoms that don’t go away, or if you’re concerned, visit a doctor to determine whether the child has a more serious injury.

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