    
|
||||
|
Marilyn H. Moss, MD Concussions are not uncommon among school-aged children, particularly adolescents. In fact, some experts estimate that one out of every three high school students will suffer a concussion. Yet, concussions are often misdiagnosed and inappropriately treated. It is imperative that those supervising children, whether teachers, coaches or parents, be aware of the symptoms of concussion, as well as be familiar with how to manage them. A concussion is characterized by a temporary disruption of brain function because of trauma to the head. This trauma can be a blow, but it can also be the result of an acceleration/deceleration force, such as "whiplash". Commonly, concussions occur during accidents or while playing sports. The resulting injury can lead to different symptoms of brain dysfunction that resolve over time. The symptoms of concussion are listed in the box. Any of these symptoms, or a combination of symptoms, might be present. Many of these symptoms can be fairly subtle. In addition, the lack of knowledge about concussions hampers the recognition of this injury. Teachers and coaches may not understand the significance of certain complaints. On the other hand, the concussed individual may not be a reliable historian, whether from ignorance, impaired functioning or denial. Careful questioning by the parent or supervisor can help determine if the child is suffering from a concussion. The first symptom listed, loss of consciousness, is a case in point. This symptom refers to any change in consciousness. If questioned appropriately, the person might report seeing stars, not hearing well or being stunned. These all represent subtle signs of depressed consciousness, suggesting a concussion. In the past, loss of consciousness was considered the most serious effect from concussion. However, recent research suggests that amnesia and confusion may be just as important in indicating the severity of a concussion. Again, these symptoms might be difficult to detect. Having the child give a detailed description of the events can unmask memory deficits. Asking playmates about the child's behavior at the time of the trauma, as well as the period following it, can reveal episodes of confusion or abnormal behavior. Consulting a physician may be the best intervention, if a concussion is suspected. Doctors can examine the child more thoroughly and knowledgeably to detect subtle abnormalities. They can also determine if the child needs further evaluation by a neurologist or if the child should have any tests performed. The treatment for concussion is rest. The brain has suffered an injury and needs time to recuperate. Pressure should not be put on the child to resume normal activities prematurely. This includes school work and sports. The patient should be encouraged to sleep and take a more leisurely pace. An estimated 30% of concussion patients will have some lingering complaints, referred to as post concussion syndrome. Some of these persistent symptoms include poor concentration, memory problems, excessive fatigue, mood disturbances, and sensitivity to noise. Post concussion syndrome can last anywhere from weeks to months. These symptoms usually resolve totally. It is important that this syndrome be recognized, however, to minimize frustration for the child. The child must be carefully evaluated to determine the extent of injury to avoid second injury syndrome. Second injury syndrome can occur when an individual suffers another concussion before complete resolution from a previous concussion. Under these circumstances, a second concussion might lead to catastrophic complications, perhaps even death. In addition, evidence suggests that, when compared to people who have never had a concussion, those who have suffered one concussion are four times more likely to suffer another. The reason is not clear; it may be some predisposition of anatomy or some inherent behavior on the part of the individual. Importantly, however, studies have revealed that repeated concussions can lead to cumulative brain damage and are much more likely to lead to poor outcomes. The risks to the child must be carefully considered in determining his future activities An important issue to be considered is when to have the child resume normal activities. A number of clinical guidelines have been developed to help in this determination. The problem with the available scales is that they are not necessarily correlated with scientific evidence. Most use loss of consciousness as an indicator of severe concussion, but as stated above, amnesia and/or confusion might also suggest severe concussion. In addition, research indicates that it may take ten days to fully recover from a concussion. The guidelines available do not incorporate this knowledge, however. With the standard guidelines, those who have suffered a concussion may not be restricted from regular activities for a sufficient amount of time. This may leave children vulnerable to more serious injuries. Since it may be difficult to determine when a concussion has fully healed, a conservative approach to this problem is safest. Once a child's symptoms have cleared, he can be reintroduced to his usual routine in a gradual manner. As the child slowly becomes acclimated, he can be carefully assessed for any recurrence of symptoms. Many researchers in the field of head trauma have begun to advocate a more cautious approach to the management of concussion. One tool that is being evaluated for concussions is neuropsychological testing. Neuropsychological testing consists of a battery of specialized tests to assess brain function. Results can determine when and if the brain has returned to normal. Traditionally, however, neuropsychological tests have taken several hours to administer and have had to be conducted by a specialist. Recently, new, more user-friendly tests have been developed that offer the effectiveness of the traditional tests without the inconvenience. These modified tests are more concise, require minimal training to accurately administer, and are computer-compatible, making them more useful and accessible. Certainly, preventive measures are the best protection against concussion. Children should be required to wear all appropriate safety gear. It is essential to caution children to follow safety rules, as well. Despite every precaution, however, injuries can still occur. Having the knowledge to recognize a concussion, therefore, is an important skill that can benefit our children. Sign and Symptoms of Concussion • Loss of consciousness • Amnesia • Confusion • Headache • Dizziness • Nausea • Fatigue • Ringing in the ears • Sensitivity to light or noise Marilyn Moss is a retired New Haven physician. After retiring from Yale University, she has begun to pursue an interest in writing about health-related issues. Dr. Moss resides in Woodbridge, CT with her husband, also a physician, and her two children. Articles on the Same Topic Father and Daughter |
|||
|
May not be reproduced in any format without written permission. |
||||
