By Mary Ellen Ostrander
With high school and college sports about to begin, young athletes may sustain injuries. While a broken bone, sprain, or cut may result in a visit to the doctor’s office—even the emergency room—a bump on the head may be dismissed.
Yet that bump on the head may be a concussion and should be taken seriously. Is it possible to sustain a concussion and not know? Yes, says the Centers for Disease Control’s Heads Up Concussion in High School Sports Program. (www.cdc.gov/concussion).
We saw evidence of this on September 1 at the U.S. Open when 10th seeded Victoria Azarenka, 21, from Belarus collapsed on court in the middle of a match. During a warm-up session, she had tripped on her own sweatpants and hit her head on the ground. Although she complained of a mild headache, she never considered withdrawing from the match, never believing that the injury was serious, according to her trainer, John Tobias. After leaving the court in a wheelchair, Azarenka was taken to the hospital and diagnosed with a mild concussion.
Azarenka’s experience is a sobering reminder that even mild symptoms, like a headache, should not be dismissed. And young people may be more at risk. In fact, the American Academy of Pediatrics states that even a mild bump or blow to the head may be more serious for teens and younger children than the adult population. The medical organization believes that head injuries should be treated with great care and the injured child be given adequate time to recover.
A concussion occurs when the brain is jarred in the skull by a jolt, bump, or blow. Because this action causes changes on a cellular level, no bruise may be seen in an MRI. Another alarming fact: evidence-based research confirms that an athlete who sustains one concussion is at a greater risk for another!
Following a head injury, some symptoms and changes are noticeable, such as a change in sleep patterns, mood, thinking and physical functions. Other effects, however, may not be so obvious. A child, although initially stunned and dazed after being hit in the head, may seem otherwise all right, even having eyes that dilate equally. However, over the long term, that child may experience cognitive, physical, and emotional effects.
After a head injury, don’t leave the student alone!
Consult your doctor if you observe symptoms or are concerned about any head trauma.
Signs to watch for over a 24 to 48 hour period include:
• A headache that gets worse
• Drowsiness or can’t be awakened
• Unable to recognize people or places
• Repeated vomiting
• Unusual behavior or confusion or irritability
• Weakness or numbness in extremities
• Unsteady gait
• Slurred speech
For the brain trauma to heal, the physician will restrict physical activity and cognitive activity based on physical and neurological testing. The web site, www.schoolhealthservicesny.com, gives the ACE (Acute Concussion Evaluation) care plan for the student who is diagnosed with a concussion. It facilitates a slow and timely return to daily activities, school, and play.
The school nurse can assist the primary physician, assessing the child daily by using a specific evaluation tool, such as the SCAT 2 (Sport Concussion Assessment Tool 2). It is the school nurse who will advocate for the student who needs academic concessions and will report any physical, emotional, or cognitive changes to the parents and physician.
One to two weeks of healing, or longer, depending on medical evaluation, is not unusual. There is the possibility that months might be needed to return to full activity. As a follow up, the student may need further neurological testing for as long as two years.
Dr. Ralph Lopez, who practices adolescent medicine on the Upper East Side, said that he has been advocating for some time that all his patients, not only athletes, get a base line neurological evaluation in case they ever suffer a concussion. This test enables physicians to gauge the severity of the head trauma and the amount of rest needed before a patient can return to normal activity. Dr Lopez referred to the guidelines of ImPACT (www.impacttest.com/about/background).
ImPACT offers a computerized neurocognitive test that is evaluated by a neuropsychologist. The results are given to both the patient’s physician and parents. Dr Lopez pointed out that not all concussions are sports-related. Many occur as a result of daily activity. A tree limb falling on someone’s head can cause a concussion as easily as a student’s head hitting into a goal post.
The research is compelling that one concussion can have long-term effects, and repeated concussions can have devastating outcomes. Knowing the symptoms and establishing a neurological baseline (through a test such as ImPACT) can minimize the lifetime of problems one may suffer due to a concussion.
Mary Ellen Ostrander is a school nurse in Brooklyn.