Sports Related Concussion in Youth: Not as Harmless as Thought

Millions of concussions are sustained each year by children, adolescents, and adults while playing sports. These mild traumatic brain injuries are complex due to multiple neurologic symptoms like cognitive and motor deficits.

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In the US, the majority of people playing football aren’t NFL or collegiate players. They are youth who are usually under the age of 14. And until recently there hasn’t been an independent evaluation of the helmet effectiveness for this age group. Virginia Tech Helmet Lab is renowned for its work with rating football helmets for varsity players and checking helmet safety for other sports as well (hockey, baseball). Data from their studies of head impacts among youth football players made it possible for them to devise specific testing reflecting the types of impacts these athletes actually experience on the field. Now parents, players, and coaches have access to independent information. After all, youth are not just scaled down adults; concussion risks are different in both groups. Their brains are still growing and their necks are weaker. It is those features that change how they react to impact and increases the risk of concussion (VA Tech, 2019).

Need to Study Proper Age Group
This study was done to demonstrate the usefulness of not just to evaluate traumatic brain injury persistent post-concussion syndrome and for normal neurological examination to look for abnormalities in the age group 2-18 years. TBI is one of the leading causes of hospital visits in the US. It is classified in a number of ways but most commonly quantified by use of the Glasgow Coma Scale (GCS). A score of 13 to 15 is considered mild, 9-12 is considered moderate and eight or less is severe-often resulting in death or severe complications. There has been an increase in children coming to the ER partly due to an increase in public awareness and partly because of legislation requiring a healthcare provider to clear the child to be able to return to playing the sport. Studies are being done to document the effects on the developing brain by looking at pediatric concussions. Thankfully, 90% of concussions are transient with the symptoms resolving within four weeks. There are a small number of patients who remain symptomatic several months post injury. Of the 86 participants followed in the study, only 11 (12.79%) lost consciousness at the time of injury. The most common way they were injured was direct impact (88.37%) as a result of a collision with other objects. They admit one limitation to their study was because of the small number followed (Torres et al, 2019).

Changes So Far
In the fall of 2018, the CDC published an evidence-based guideline to help healthcare providers with treating mild TBI and concussion. Six important clinical questions guid3ed the systematic review of this evidence. One important note is the use of mild TBI, minor head injury, concussion are often used interchangeably. While for the person using them the meaning is clear, frequently for the families, researchers and other healthcare professionals may misunderstand. That was why the CDC came up with their guidelines. Athletic trainers are primary health care providers for millions of young athletes nationwide. They are on the frontline to implementation and reinforcement of the CDC guidelines. They also have recommended the support for continued use of age-related validated and appropriate symptom checklist for mild TBI evaluations in children. In one area healthcare providers and athletic trainers can take action to support the recovery and return to activity (for sports and non-sports) process for athletes. In many cases it is the athletic trainer who educates parents, coaches, and school professionals about mild TBI. In this way they can impart the CDC guidelines reinforcing the likelihood of positive outcomes. These guidelines are offered for free and are publically available. They can be accessed at http://www.cdc.gov/HEADSUP (Register-Mihalik et al, 2019).

Post-concussion syndrome is when the patient’s concussion symptoms last longer than 4-6 weeks; it affects 10-30% of concussion patients. It presents a significant source of morbidity to patients and a management challenge to providers. In children, persistent symptoms are generally defined as concussion symptoms lasting more than four weeks and may continue for longer than three months. Concussion symptoms tend to cluster into four main groups: Autonomic dysfunction (headaches, postural hypotension, lite/sound sensitivity, sleep trouble), Vestibular-ocular dysfunction (dizziness, poor balance, nausea, vision changes), cognitive symptoms (feeling foggy or slow, easily distracted, decreased memory, increased concentration), and emotional symptoms (irritability, anxiety, moodiness, sadness). Vestibular-ocular dysfunction is often seen among children and adolescents with sports-related concussions. PCS presents a unique challenge. Successful management of PCS is a multidisciplinary and individualized approach. However the study found there remains a significant need for further research especially looking into outcomes and effective interventions (Kapadia et al, 2019).

Recently health-related quality of life (HRQOL) has emerged as an important measure in clinical and research studies among children and adolescents with a variety of acute and chronic health conditions. One condition that has the potential to result in immediate and long-term consequences in HRQOL is sports-related concussion. With proper medical assessment, education, and gradual return to school (RTS) most adolescents make a complete recovery in one to four weeks. This study was to compare the effects of sports-related concussion on HRQOL in adolescents. Initial cognitive scores were found to be worse than reported in previous studies. And impairments observed among sports related concussion patients who experienced delayed recovery reported significantly worse cognitive function. In addition it was found that a history of a previous concussion was associated with worse physical, emotional, social and overall HRQOL. There was also a connection noted between patients who had symptoms of concussion past the four week mark and impaired HRQOL. This study feels further studies are warranted to investigate the role of active rehabilitation strategies in acute sports related concussion should include HRQOL measures (Russell et al, 2019).

Conclusion
Empirical investigation of the consequences of sports related concussion has increased dramatically in the past decade with most attentions placed on professional and collegiate athletes. This review explored the effects sports related concussion had on school-aged and adolescent student athletes. Overall conclusion has found that a solid understanding of both short-term and long-term emotional and behavioral sequelae of sports related concussion in pediatric population continues to be wanting. Attention to how these factors affect children is much needed. It has been found 73% of concussed athletes may require academic accommodations in order for them to return to school. And while most schools have a concussion policy in place, only 53% of school nurse and 44% of athletic trainers reported awareness of return to learning policies (Wilmoth et al, 2019).

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Work Cited
Goble, D.J. et al. (2019). Normative data for the BTrackS balance test concussion-management tool: Results from 10,045 athletes aged 8 to 21 years. Journal of Athletic Training, 54(3).

Kapadia, M. et al. (2019). Review of the management of pediatric post-concussion syndrome-a multi-disciplinary individualized approach. Current Reviews in Musculoskeletal Medicine,12 (1).

Register-Mihalik, J.K. et al. (2019). Considerations for athletic trainers: A review of guidance on mild traumatic brain injury among children from Centers of Disease Control and Prevention (CDC) and National Athletic Trainers’ Association. Journal of Athletic Training, 54(1).

Russell,K. et al. (2019). Health-related quality of life following adolescent sports-related concussion or fracture: A prospective cohort study. Journal of Neurosurgery Pediatrics.

Torres, A.R. et al. (2019). Brain MRI in children with mild traumatic brain injury and persistent symptoms in both sports and non-sports-related concussion. Cureus, 11(1).

Virginia Tech. (2019). First rating for youth football helmets address sport’s largest pool of athletes. Virginia Tech Helmet Lab.

Wilmoth, K. et al. (2019). Current state of literature on psychological and social sequelae of sports-related concussion in school-aged children and adolescents. Journal of Experimental Neuroscience.

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