A new study published by the Official Journal of the American Academy of Pediatrics says that repeat concussions can result in decreased neurocognitive functioning, increased symptomatology, and, at times, catastrophic outcomes.
Last week, we reported on a study that had been released from the Center for the Study of Traumatic Encephalopathy (CSTE), at the Boston University School of Medicine, stating that repeated concussions can cause brain damage. That brain damage, known as chronic traumatic encephalopathy (CTE), was detected in the brain tissue of former NFL players who died young -- some as early as their 30s or 40s. Researchers at the CSTE concluded former NFL player Tom McHale, who died in 2008 at the age of 45, as well as an 18-year-old athlete (the youngest case to date) who suffered multiple concussions, suffered from this brain damage as a result of their injuries.
But according to Gwenn Schurgin O'Keeffe, MD, FAAP, CEO and Editor-In-Chief of Pediatrics Now, the standard of care for concussions in kids is actually different from what was represented based on a January 2009 study on youth sports concussions.
The new 2009 study drives the point home that we need to do more than keep kids out of sports until the symptoms clear, which is how pediatricians used to manage concussions in the office, and how some still do in many parts of the country. The authors give a nice review of the landscape and past studies, concussion treatment theories and the many concussion grading systems and conclude that the only safe way to manage kids is a "stepwise return to play." This is borrowed form the professional sports model and has been done in elite youth sports for a while.
The reason a step wise return to play is so important is that it gives us time to truly evaluate a player and make sure that the increased activity is not to much on the healing brain. This builds in a safe buffer so when the player gets to the "game play" stage, we can be as sure as we can that the brain has healed from the original impact. Additionally, the report suggests we may have to consider neuropsychiatric testing and refer to neurologists much more than we are already doing, even for mild concussions. We used to think that if a child didn't lose consciousness we were good. Not so. Finally, and this we've known for a few years, the report emphasizes that the length of time benched is depended on how many prior concussions there have been in a child's past.
Also, it's well known in pediatrics that cheerleading is not a benign sport and is considered a "contact" sport due to the high injury rate of fractures and even head trauma. It turns out that cheerleaders have a 3.5% chance of getting a concussion and a very, very high likelihood of breaking a bone. Some of the worst dislocations and lacerations have been in cheerleaders.
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