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Monday, September 1, 2008
Treating head injuries very important
Western Arkansas, AR
By: Dr. Jim Bryan OrthoArkansas
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Photo(s) By: Kyle Danztler/MyActionPortraits.com
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Concussions deserve attention before the season starts
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The best recommendation for preventing concussion is to screen for the athletes with previous concussions at the time of the pre-participation physical evaluation — the sports physical.
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Concussion resulting from contact varsity sports remains a common problem despite the 1976 rules defining and prohibiting spearing and football. As the 2008 football season gets into full swing, we begin to get injury reports about players being held out for observation for a week or two following a concussion. Those that occur on Friday night or Saturday competitions obviously get more attention than head injuries sustained in practice, and surveys with athletes show the available injury data tends to underestimate the actual incidence of concussion.
Concussion, as defined by the Concussion in Sport Group, an international panel of head injury experts, is “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces”. This means that when the head is impacted or shaken violently, changes occur in the blood flow delivered to the brain along with a temporary increase in the brain’s use of glucose for energy, leading to a spectrum of widely varying symptoms that may persist for weeks. This alteration may increase the vulnerability of brain cells to a second insult. There is a poor understanding of how long this mismatch of energy demand and blood flow persists, but in some individuals it can last for months. While any loss of consciousness constitutes what is now classified as a complex concussion, so does a case where the athlete continues to experience headaches, confusion, nausea, poor balance, poor concentration, and even clinical depression. The most dreaded form of head injury in sports is known as second impact syndrome — a commonly fatal event caused by rapid brain swelling after trauma as trivial as a helmet slap, following an unresolved concussion, regardless of its initial severity.
The most current recommendations of the Concussion in Sport Group include the elimination of the old classification system of Grade I, II, and III concussion severity, simply using the terms simple concussion and complex concussion. No athlete with persistent symptoms of head injury should be allowed to resume contact activity. The recommendations state that cognitive rest is necessary as well. This means that the student-athlete should be given accommodations from rigorous academic demands while symptomatic. Examples of accommodations may include postponing tests and major projects, and allowing the student-athlete to have copies of the instructors’ lecture notes for review. This also means no intensive video gaming during the recovery period!
The best recommendation for preventing concussion is to screen for the athletes with previous concussions at the time of the preparticipation physical evaluation — the sports physical. Educating players, coaches, and officials on the importance of observing and enforcing the spearing rules is equally important. Having a certified athletic trainer involved with the team frees the coaching staff from making difficult return-to-play decisions during the course of a game or practice session. Athletic trainers are highly trained and uniquely skilled health professionals who are among the best at evaluating an athlete for ongoing symptoms of concussion. I urge all parents of varsity athletes to insist that their schools employ athletic trainers.
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About the author: Dr. Bryan practices primary care sports medicine in Little Rock, AR. In June 2008, he joined the multispecialty group OrthoArkansas, P.A. While athletic injuries are his main focus, his practice includes a large number of patients with osteoarthritis of the knee. He is the team physician for the Arkansas Travelers and for Henderson State University Athletics, where he is a volunteer faculty member in the Athletic Training Education Program.
Raised in North Little Rock, Dr. Bryan graduated from Hendrix College in Conway. Upon completing his medical degree and family medicine residency at UAMS, he completed a fellowship in sports medicine at Eastern Oklahoma Orthopedic Center in Tulsa. He is a Fellow of the American Academy of Family Physicians and holds board certification in both family medicine and sports medicine. He is a Senior Aviation Medical Examiner for the Federal Aviation Administration. Professional memberships include the AAFP and the American Medical Society for Sports Medicine.
This research was recently presented to the 61st Annual Scientific Assembly of the Arkansas Academy of Family Physicians in North Little Rock and to high school coaches attending the OrthoArkansas Sports Medicine Workshop at Baptist Medical Center in Little Rock.
http://www.orthoarkansas.com/physicians/bryan.shtml
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