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Concussions: The Silent Brain Injury

LITTLE ROCK, Ark.  (Mar. 3, 2010) -- Concussions are nothing to ignore.  In fact, the Centers for Disease Control and Prevention (CDC) says these brain injuries need more attention from coaches, parents and athletes. Of the estimated 4 million recreation-related concussions that occur in children age 5 to 18 each year, as many as 80 percent of the injuries go unrecognized.  Of those, concussed athletes are often returned to practice or games, taking the chance for a second impact injury that could leave them hospitalized - or dead.  High school athletes are at the greatest risk for serious injury and are a key focus of National Traumatic Brain Injury Awareness Month in March, 2010.

"Any trauma to the head is serious, but it's the teenage brain we worry about most.  These athletes are bigger, they hit harder, and there's a tendency in high school athletics to ignore injuries and get back in the game to win at all costs," said Darrell Nesmith, MD, a physician in the Sports Medicine Plus program at the Adolescent Center at Arkansas Children's Hospital.  Nesmith also is an associate professor of Pediatrics at the University of Arkansas for Medical Sciences (UAMS) College of Medicine.  "The majority of concussions occur at the high school level, and it's not uncommon for these athletes to return to the game sooner than they should."  Nesmith says an average of 10 percent of high school athletes receive a concussion each season. 

Second Impact Syndrome occurs when a second concussion occurs before the prior concussion has completely healed.  Brain swelling or bleeding can lead to permanent brain injury or death.  A second-impact injury, a secondary concussion that occurs before the brain has fully healed, can cause swelling of the brain, severe bleeding on the brain, permanent brain damage and even death.  Most high schools don't have athletic trainers to help coaches identify the signs of a concussion: headache, nausea, imbalance, confusion, altered mental status, changes in vision or emotions. Symptoms of a concussion most often occur immediately after impact and may last days or weeks.  The treatment of a concussion is rest until all symptoms have resolved followed by a gradual return to classroom activities and sports. 

When coaches, parents or an athlete suspect a concussion, the athlete should immediately be removed from practice, evaluated by a physician or certified athletic trainer, and restricted from practice or games until the injury has healed.  The 2009 college football season brought a great deal of attention to concussion injuries after University of Florida quarterback and Heisman Trophy recipient Tim Tebow was forced to sit out because of a concussion.  Some states have even passed laws that require concussed athletes to be cleared by a health professional before returning to the game.  At the very least, educational training for coaches to help them identify the symptoms and dangers of a concussion is being encouraged nationwide.  

Before athletes return to the game, they must first be able to return to school.  Until the brain heals, a child with a concussion may have trouble concentrating on school work or comprehending what a teacher is saying. After several days or more of complete rest and symptoms have resolved, students may transition back to the classroom by attending school for half-days.  Modifications to the classroom instruction and homework may be necessary before the student can return to a full-time schedule and work load. 

"Focus on these students' cognitive recovery is the priority," said Nesmith.  "Their ability to perform in the classroom is a key indicator of the healing that has taken place, or the healing that has yet to take place.  Returning to sports comes last."  Nesmith and the Sports Medicine team at the Adolescent Center at Arkansas Children's Hospital manage concussed children and athletes with a program used by the National Football League, the National Basketball Association, the International Olympic Committee and scores of other national and collegiate sports-related organizations.  The ImPACT® test is a clinical tool that helps determine a child's readiness to return to school and sports by evaluating their visual and auditory memory, reaction times and other domains 

"Ideally, we perform baseline testing on the athletes we follow.  If they get a concussion, we are able to compare their own baseline scores to post-injury scores to determine their cognitive function," said Nesmith.   Athletes or children who are not tested for a baseline score can still undergo management for their concussion at the Adolescent Center, which evaluates patients from age 12 to 21.  The majority of concussions are sports-related, occurring in football, basketball, soccer, wrestling and other sports.  However, concussions can occur during any injury to the head, such as injuries on playgrounds, bicycle or automobile accidents and even falls.  Blows to the body that cause the head to move back and forth also can result in a concussion.  For athletes who face the possibility of repeated injury, the best practice is to sit it out if you suspect you may have a concussion.   After all, it's better to miss a game than to miss a season - and it's better than missing the rest of your life.

About Arkansas Children's Hospital

Arkansas Children's Hospital is the only pediatric medical center in Arkansas and one of the largest in the United States serving children. The campus spans 29 city blocks and houses 316 beds, a staff of approximately 500 physicians, 80 residents in pediatrics and pediatric specialties and more than 4,200 employees. The private, nonprofit healthcare facility boasts an internationally renowned reputation for medical breakthroughs and intensive treatments, unique surgical procedures and forward-thinking medical research - all dedicated to fulfilling our mission of enhancing, sustaining and restoring children's health and development.ACH is ranked 85th on the 2010 FORTUNE 100 Best Companies to Work For®. For more information, visit .

About UAMS

UAMS is the state's only comprehensive academic health center, with five colleges, a graduate school, a new 540,000-square-foot hospital, six centers of excellence and a statewide network of regional centers. UAMS has 2,652 students and 733 medical residents. Its centers of excellence include the Winthrop P. Rockefeller Cancer Institute, the Jackson T. Stephens Spine & Neurosciences Institute, the Myeloma Institute for Research and Therapy, the Harvey & Bernice Jones Eye Institute, the Psychiatric Research Institute and the Donald W. Reynolds Institute on Aging. It is the state's largest public employer with more than 10,000 employees, including nearly 1,150 physicians who provide medical care to patients at UAMS, Arkansas Children's Hospital, the VA Medical Center and UAMS' Area Health Education Centers throughout the state. Visit or .



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