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Doctor Ashare busts myths about concussions

By Alan B. Ashare, M.D.
Special to Reminder Publications

Sports and recreation offer great value and lessons for people young and old, but the risk of injury is always an inherent danger. One such risk is concussion, a serious injury that affects millions of people each year, both on and off the playing fields. With increased recreation in the summer and as athletes prepare for fall sports, it's important to remind ourselves about the basics of this all-too-prevalent injury and the consequences it can bring.
• What is a concussion?
A concussion is a mild traumatic brain injury (MTBI) caused by a bump or jolt to the head or body. The blow causes the brain to move quickly inside the skull, which changes how the brain functions.
• What are the consequences?
Concussions can have serious short-term and long-term effects on health. MTBI can impair thinking, language, learning, emotions, behavior, and sensations. Recent research with professional athletes who have sustained multiple concussions has even linked head traumas to a higher incidence of early dementia.
• What are the symptoms of a concussion?
They are many and varied. You don't need to be 'knocked out' to cause damage; even a mild so-called 'ding' can be serious. Symptoms include headaches or 'pressure' in the head, confusion, nausea, vomiting, blurred or double vision, blank stares, ringing in the ears, slurred speech, loss of balance, sensitivity to light and noise, personality changes (anger, crying, anxiety), or feeling groggy or sluggish. These may occur in any combination.
• Who is most susceptible to concussion?
Sports and recreational activities cause as many as 3.8 million concussions each year according to the Centers for Disease Control. The two age groups most at risk are children up to four and 15 to 19-year-olds. But concussions can happen to anyone, at any age, at any time. Some 1.4 million people annually sustain a traumatic brain injury, according to the Brain Injury Association of America, with 50,000 deaths resulting. The leading causes are falls (28 percent), motor vehicle accidents (20), struck by events (19), and assaults (11).
• What sports see more concussions than others?
In high-school sports, football is the leading cause of concussions for males; soccer, for females. Among youth age five to 18, the five leading causes of concussions are bicycling, football, basketball, playground activities, and soccer.
• How can you protect against the risk of concussion?
For sports and recreational activities, follow four steps: (1) wear a helmet certified for the sport or recreation you're engaged in; (2) wear a mouth guard, preferably one fitted by a dentist; (3) stay hydrated by drinking fluids; and (4) for contact sports, be aware of what's going on around you and don't put your head in situations that may be dangerous, like tackling head-on in football. At home, guard against falls by installing hand-rails on stairs and in bathrooms, securing throw rugs, and tending to ice and snow in winter. In vehicles, wear seat belts and use head restraints.
• What should you do if you suspect someone has sustained a concussion?
Seek medical attention immediately. If it occurs in sports, coaches should remove the athlete from competition at once and have the individual examined by a physician. Be aware that symptoms can persist days after the initial injury a condition called post-concussion syndrome and are a sign that the brain has not yet healed enough to participate in any athletic activity. Coaches should be guided by the following: When in doubt, sit them out!
• How soon can someone return to normal activity?
That depends on how long the symptoms persist and how fast cognitive abilities return. Each case must be determined individually, especially in sports. Generally, players can return in one or two weeks, depending on age. More time is required for younger players. Players should not return to any athletic activity for a minimum of five to seven days after all symptoms have disappeared and only then after being cleared by a physician or certified training. Rest is the only known method of treating concussions.
• Where can I find more information?
The Centers for Disease Control has lots of information and free materials for coaches, parents, and athletes at www.cdc.gov/concussioninyouthsports. The Massachusetts Medical Society at www.massmed.org offers "A Coaches' Guide for Sideline Evaluation" that includes an evaluation card and thoughts about return-to-play decisions.
Alan B. Ashare, M.D. a physician at St. Elizabeth's Medical Center in Boston, is chair of the Massachusetts Medical Society's Committee on Student Health and Sports Medicine and Chair of the Safety and Protective Equipment Committee for USA Hockey. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult their personal physician for treatment.


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