Wednesday, April 23, 2014

Better data needed on youth concussions

By Lee Bowman

For all the recent attention focused on the hundreds of thousands of hits to the head teens and children take each year, the amount of solid scientific information about concussion and recovery remains surprisingly sketchy.

A new report from the Institute of Medicine and the National Research Council released Wednesday found that research evidence about youth concussions is limited and that young athletes still face a “culture of resistance” to reporting when they might have a concussion and complying with treatment plans.

Most information about the injury comes from tracking done by colleges and some high schools, and reports from a select group of emergency departments.

“The findings of our report justify concerns about sports concussions in young people,” said Dr. Robert Graham, head of a national health quality program at George Washington University and chairman of the committee that produced the 306-page report. He said there are “numerous areas in which we need more and better data.”

The committee said there’s little solid evidence on the best way to diagnose concussion or on how head impacts affect youths in difference stages of brain development.

It recommended that the federal Centers for Disease Control and Prevention set up a national surveillance system tracking concussions in organized sports among players ages 5 to 21. It urged the National Institutes of Health and Defense Department to conduct more studies on the short- and long-term effects of youth concussion and on the injury risks of various activities.

The committee called on sports administrative groups, such as the National Collegiate Athletic Association and National Federation of High School Associations, to support more research into rules and techniques that might lower concussion risk — and to make extra efforts to change attitudes on and off the field about the injury and the need for rest and treatment.

One recent guideline update from the American Academy of Pediatrics underscores the dearth of research. The guideline was based not on studies, but rather expert opinion and adaptation of one concussion management program developed at the Rocky Mountain Hospital for Children in Denver.

At issue was whether someone ordered to sit out athletic competition should also take a time out from the classroom. Each concussion is different, with individualized symptoms. Not all involve a loss of consciousness; blacking out isn’t considered a sign of severity.

The new guidelines suggest that with severe symptoms — headaches, difficulty remembering, vomiting — that don’t improve, students may need to stay home from school. If symptoms are mild or tolerable — affecting concentration or coordination — it may be possible to go back to school, though teachers and other staff must be informed and should monitor the student, experts say.

While most young concussion victims recover in a few weeks, some symptoms may be more severe or last much longer. That may require more formal academic adjustments such as home tutoring and recorded lectures.

Several other recent studies have shown that cognitive deficits such as the ability to focus and switch tasks easily amid distractions can endure for months, and that some students can falter quickly once they resume even moderate physical exertion.

A group of 20 high school athletes who’d suffered concussions “were still significantly impaired in their executive function” compared with those in a control group free of brain injury, researchers at the University of Oregon reported earlier this year.

A second report, from the University of Pittsburgh, showed that strenuous physical activity can affect the results of cognitive testing. Nearly a quarter of athletes whose tests cleared them to play were found, after a workout of 15 to 25 minutes, to still have verbal and visual deficits.

— Contact Scripps health and science writer Lee Bowman at Distributed by Scripps Howard News Service,

Scripps Howard News Service


Discussion | 2 comments

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  • George VisgerNovember 05, 2013 - 10:20 am

    Concussions at any level are no joke, and youth concussions are even more serious. Studies have shown the earlier you are concussed, the lower your threshold for the next ones. I learned the hard way. I began playing Pee Wee Pop Warner for the 1970 West Stockton Bear Cubs, in Stockton, CA. We had 29 kids on the team, and 3 of us went onto to play for an undefeated, nationally ranked Stagg High squad our senior year in 1975, and we all signed NFL contracts in 1980. Our safety was a kid by the name of Von Hayes, who went onto a multi year Major League Baseball All Star career. During our 3rd year of Pop Warner, I knocked myself out in a worthless Bull-In-The-Ring drill and was hospitalized. Concussions followed me through my 4 years at Colorado, where we played in the 77 Orange Bowl. But none were considered serious, and I never missed a play or practice. In 1980 during my rookie year with the 49ers, I suffered a major concussion in the 1st quarter of a Dallas Cowboy game. The trainers and team doctor laughingly told me later in the week when my memory returned, they administered numerous smelling salts to me during the game to keep me on the field. I never missed a play or practice and several months later, during the beginning of our 81 Super Bowl season, I developed hydrocephalus (water on the brain), and underwent emergency VP Shunt brain surgery. I was told I could still play with a special made helmet, so I returned to the team and worked out on Injured Reserve the rest of the season. Four months after our Super Bowl XVI win, my shunt failed, I survived 2 emergency brain surgeries 10 hrs apart and was given last rites. I was also given the hospital bills and forced to sue the 49ers for Work Comp. In 1986 I returned to school at Sacramento State to complete my Biology degree and survived 5 additional emergency brain surgeries and several gran mal seizures during a 10 month period in 87-88. I finally graduated in 1990 at age 32 with a BS in Biological Conservation, 8 brain surgeries under my belt, gran mal seizures, and major short term memory deficits. I've now survived 9 NFL caused brain surgeries and still don't qualify for any NFL benefits. Despite earning an Orange Bowl and Super Bowl ring, due to what this has done to my family, I wish I'd never played. In 2012, due to MAJOR short term memory and cognitive functioning issues I lost my house and was forced to give up my environmental consulting business, and forced to file for disability. I formed The Visger Group - Traumatic Brain Injury consulting to help other survivors and families avoid the hell my family has been through these last 32 years. For anyone in need, please go to The Visger Group website at: George Visger Wildlife Biologist/Traumatic Brain Injury Consultant The Visger Group I

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  • Rich RifkinNovember 05, 2013 - 11:04 am

    "I've now survived 9 NFL caused brain surgeries and still don't qualify for any NFL benefits." ........ I don't doubt that Mr. Visger's very serious brain injuries came from his many years playing football. However, it should be pointed out that he only appeared in 3 games in the NFL, and for very little time in those 3 games. It seems much more likely that his having to have had "9 brain surgeries" were principally the result of Visger having suffered multiple concussions from Pop Warner football up to his years at the University of Colorado. No doubt, the last concussion he suffered, while on the 49ers, was serious. But the effects are cumulative. And thus, it seems very unlikely that the severe effects Visger has endured since were entirely or even mostly caused by that last injury. As such, I am not sure why Mr. Visger should be owed any long-term benefits from the NFL, other than that league has deep pockets.

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