Concussions, for better or worse, have finally entered the national discussion. A week ago, the American Academy of Pediatrics released a study on those popular, inflatable "bouncy houses" showing that children's injuries resulting from their use was on the rise including head injuries.
And just last month, Peyton Manning, whose career with the Indianapolis Colts was ended by a severe neck injury, suffered a minor scare during a game between his new team, the Denver Broncos, and the Kansas City Chiefs, when he was checked for a concussion after a hard tackle. (He was cleared, though Philadelphia's Michael Vick, Chicago's Jay Cutler, and San Francisco's Alex Smith — all diagnosed with concussions earlier this month — weren't so lucky.)
The National Football League has reportedly paid out millions to settle brain injury cases among its players — even as the league, for years, denied a link between their sport and concussions.
Recently, The New York Times reported on two separate stories involving youth football teams — one about a Pee Wee football game that resulted in five players, all under age 10, suffering concussions. While both coaches and game officials have been justifiably suspended over this incident, it should remain concerning that it ever reached that point at all.
Only after the continued threat of litigation has the NFL begun to address player safety with respect to brain injuries, finally putting a player safety and education program in place.
Meanwhile, Pee Wee football has an excellent injury prevention program in place, despite this glaring exception. Here in New York, lawmakers passed more stringent laws to address these types of injuries in school athletes — to "end the macho approach," as a ecent Times Union article succinctly put it.
As a society, we have finally become aware of the potentially serious effects of repeated head injuries. And while prevention is key, education is also important for both parents and for coaches. Recognizing the symptoms of concussion is a good place to start.
Remember, a concussion is a brain injury that may or may not result in a loss of consciousness. The victim may not even be aware of having had the injury. He or she may appear completely normal yet be confused, disoriented, unsteady, irritable or depressed. The coaches and training staff may observe changes in player performance or behavior on the sidelines. Children and teens may complain of headaches, unusual fatigue, difficulty studying, or change in mood. Parents may observe changes in attention, concentration, memory, or behavior. Teachers may notice a change in academic performance or study habits. And all these symptoms may have a delayed onset.
Once suspected, a concussion requires an evaluation. If the injury happens during play, the coach or trainer can administer a standard sideline screening. The child or teen must not return to sports or recreational activities until cleared by the physician. A medical evaluation, beginning with the pediatrician or family physician, will assess the player's condition.
The cornerstone of treatment after a concussion is physical and cognitive rest. This excludes any type of strenuous physical activity, team sports, situations which might put the child or teen at risk of another injury. The school should adjust homework demands. Adequate sleep and hydration are essential.
Until a few years ago, physicians used tables and charts to determine when someone could again play after a concussion. Current recommendations mandate that this be a gradual, individualized process. When the injured athlete no longer has symptoms and has been cleared by a physician, then he/she may begin to do light physical activity. The patient will proceed through further steps of more intensive activity without any problems, as supervised by the physician.
The serious consequences of untreated concussions across the country and the understanding of the results of repeated head injuries in professional football, hockey and other sports raised the awareness of the importance of these conditions. And while laws are a good start, much more needs to be done in terms of prevention — and education.
Because when it comes to traumatic brain injury in school sports, it's not just all in our head.
Jay Selman is chief of neurology at Blythedale Children's Hospital in Valhalla, Westchester County.