Most of the research deals with NFL, College, and HS? Are there any studies that deal with younger athletes?

We are looking into this currently at Penn State Hershey. Grant funding has historically gone to professional sports and the military. Many researchers are now looking into the effects of concussion on children and adolescents.

I think the new NFL Settlement is also going to provide more money to study concussions in youth sports. There has been a big push in this country to start studying kids… There is very little literature to guide clinicians in treating concussions in youth sports.

Should younger boys be doing contact football because they are not muscularly developed?

Kids are beginning to play sports at an earlier age and commonly specialize in one sport (hoping to improve or extend the longevity of their sports career in college and/or professional sports). The main focus in youth sports should be working on technique instead of contact. This is now the major focus in a variety of youth sports such as hockey. Youth football is still determining how best to protect their athletes. One misconception is that if you don’t let kids hit, they won’t be able to compete when they are older. This is a myth! Tom Brady’s parents did not allow him to start playing football until he was in 9th grade.

Have the Ivy League Schools limited their contact practices to two days a week?

Many schools have done away with contact in practice completely. Why place the players at risk during practice when they have are guaranteed contact during competition? Even a lot of NFL teams are now moving away from hitting during the week to save the “blows” for the games. This lessens the cumulative amount of head contact a player experiences throughout any one season and their career.

Why do kids with concussions get the headaches in the days after the hit? – What is going on in the brain to cause the headaches?

No one knows. We would know a lot more if we were able to biopsy the brain after a concussion, but there are not too many athletes that would sign up for that studyJ What we do know from animal studies is that when an athlete gets hit, he/she temporally loses blood supply to the area of affected brain, resulting in decreased oxygen and blood sugar. Our brains do not have reserves like other parts of our bodies. In other areas of the body, a person can lose some blood supply, blood sugar and oxygen and that area of their body does not “shut off”. The brain is functioning fully all the time with no reserve of extra oxygen or sugar. Researchers think that this lack of reserve in combination with the “instant” decrease in blood supply, blood sugar, and oxygen after a hit stuns the brain and causes neurological issues on the cellular level. Why does that lead to all the symptoms kids have? Probably because it is not isolated to one part of the brain, it’s a global injury, so it affects the entire brain. The damage is at the cellular level so a concussion could theoretically affect any part of the brain. This is why we think we see all these different symptoms occurring from concussions. Headache in particular is interesting as 70% of adolescents with a concussion will have one. This seems strange to me as we commonly assume that every kid with a concussion will experience a headache as a symptom. Athletes, parents, coaches, and clinicians need to remember that 30% of adolescents with a concussion will not report a headache.

Why does it seem that in the morning my son (who has a concussion) feels fine, but as the day goes on his symptoms get worse?

This occurs because he is exerting his mind throughout the day. Physical exertion increases symptoms as the concussed brain is exerted. When a concussed child goes to school, they are asked to use their mind. This can overwork the brain and increase symptoms. This is why we commonly place academic modifications in school. Concentration, multi-tasking, filtering out noise/bright lights, ignoring distractions – all of these actions take energy and can easily overwhelm a brain that is not back to functioning appropriately.

Is it doing them any more damage? (sending the athletes to school with a concussion?)

No. I always say school is kind of like their job and our job is to try and make school as easy for them as possible while they are recovering. This decision regarding school and accommodations is always made on a case by case basis. The social aspect of being around friends is also quite important!

Is it acceptable to take NSAIDs during a concussion?

Yes, but we recommend Tylenol (Acetaminophen) for the first 24 hours. NSAID’s can theoretically increase an athlete’s risk of bleeding and if a brain bleed is present, could make this situation worse.

Is there a restriction on driving?

This decision depends on the scenario. For example: If they fail their reaction time on the Impact test, or are having dizziness then it would not be recommended for them to drive.

What is your opinion on these “sub-concussive” hits?

The risks of sub-concussive hits are poorly understood. What researchers did was put sensors in football helmets and measure blows to the head. The question that arose was whether there were a certain number of hits with a certain amount of force that were more likely to cause a concussion – a person’s “threshold”. The problem is that a given person’s threshold is highly individualized. Complicating this research are sub-concussive hits (athletes that have no symptoms) and the fact that they have been shown to actually create brain changes on functional MRI’s (again without the athletes being aware as they are asymptomatic). No one knows what that means or whether this finding will be a problem or not for the athlete in the future.

Is there anything that you can forecast for us, as to what we will see in the coming years pertaining to concussions?

You will probably hear a lot more about how we treat concussions such as speech therapy and visuospatial rehab. In the next 5-10 years I think we will hopefully have more data on youth and concussions. I also expect that we will see further changes to how athletes play certain sports with new rules, training, equipment, etc.

Are there any dietary concerns for kids who have concussions?

They are looking at Omega 3- Fatty acids, especially with memory difficulty after concussions, but it is still in the early stages of research.

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