I have to start out by saying that most folks get over a concussion or a mild traumatic brain injury. They seem ok at a certain point, and then everyone moves on. We also know that about sixth grade, athletes are a bit more prone for injuries it seems and when it comes to concussion, there is really no accepted gold standard of treatment. There are only the thoughts of individual doctors or groups, but no really solidified best practice measures that are researched by multiple groups, various angles and given a consensus of agreement. I saw it today during a very high profile meeting, you get a group of brain researchers together and virtually everyone has a different opinion. The giant question is, who is right, and how does the outcome of real research and good data impact playing a lot of contact sports?
You have all seen it, mainly on Sunday with the NFL. We should make rules, make guidelines regarding how certain sports are played, and the folks that look at these injuries in younger people have to be able to do more than a levels of consciousness exam. I’m sorry but the quality of exams done are at times terrible and just because you can comment or have a degree that allows you to, does not mean you SHOULD comment. I HAVE SEEN neuro exams done by multiple pediatricians and even neurologists and other clinicians that are board certified practitioners by various organizations. These practitioners are very good with certain conditions, but when you put them in a neurological environment that relates to subtle head injuries and forced to determine present time function, neurological fatigue, fragility and possible inevitable complications, there is typically incomplete information to make such determinations. We are finding that at times, a basic exam is not enough and sometimes instrumentation has to be used to measure true function and make a safe determination.
Some of these aforementioned practitioners are the gate keepers of return to play and they report the data that drives policy and sets the “tone” of the overall problem and even the tone on what research questions need to be answered—–thus we have the articles and papers that you see with a myriad of opinions. Many generalists will make neurological decisions based upon what the patient is saying (subjective) and not based upon adequate exam (objective) data; so MANY cases get marginalized. This sets the patient up for possible glial cell ramification development, degeneration that will not show up for multiple years or worse. By the time the issue becomes clinical, it is way down the road. I have seriously questioned many practitioners capacity to determine true level of function or return to play capacity with what they did during their patient encounter to make such decisions. No cerebellar exam, no ocular movement exam, no cranial nerves, no instrumentation, no cognitive testing, no vestibular examination or common tests such as an IMPACT, and then when you ask them about the cranial nerves for example, they cannot even name them, or if you ask them the function of a particular region like the cerebellum, they cannot tell you about it, how to diagnose a lesion there or any form of stimulation that might change or enhance the Hebbian process of plasticity there.
I hate to be the horn tooter, but do not let credentials be a cover that suggests all general practitioners either adult or pediatric are doing adequate neurological exams, or that they even understand the nervous system or the exam that the do. This can compromise patients, screw up reliable gathering of data and more. We have seen that indeed, most head injuries in youth sports do heal, but there are genotypes, those with underlying co-morbidities and multiplicity of trauma that changes the rules. It is a small percentage, but many patients that are told they are ok, have very microscopic symptoms that are missed which later point to very serious and blooming compromise and they are returned to play or an adult back to work or even back into schoolwork way to early, and then they are set up for another episode that could really allow them to have a neurological trigger occur that can allow physiology to spiral in the direction of neurodegeneration or ongoing symptoms.
This is the basis of the CTE epidemic in the NFL. Time of playing plus repetitive head contact equals microglial ramification, neurological inflammation and brain compromise that keeps going, even when contact stops. In the end I would say this and it is clear……PARENTS, if your child is using their head as a weapon in any sport or it is used as part of the sport……be concerned, be aware and be cautious and when your kid is injured, think about a 2 to 4 week break, even if they have ZERO symptoms and know that most should be better by at least three months, or something is going on that needs to be determined. The beast of head injury is the physiological deception that you cannot see, and you may get better in a few days, but the silent fire that is sparked from aberrant neurological physiology may show up so much later, that connecting the possible future symptoms may be so far from the head injury that the connections is NOT made.
Sometimes the patient does not even include the head injury in their past medical history down the road. This is the danger and can lead to false stats and create the sense of false security and the NOTION, that parents are making this overblown! We are talking about the brain folks!!!!! Don’t screw yours up, because if you do, life is no longer any fun! It may not be tomorrow or right after the head injury, but when depression, insomnia, forgetfulness or something else creeps in out of nowhere ten or so years later, do NOT be surprised. We have to research more to know who is really at risk and how do we identify them? How do we truly determine prognosis with treatment? Which treatments work, which ones do not? What technology coming out is inspiring and which ones are crap which is being made merely by exploiting the fears of the public over this topic. There are a lot of questions. What I can say is this, until we know more, watch out and keep your head safe, don’t get into hurries to return to activity, see a qualified practitioner with experience, not just someone with a degree and see practitioners that can offer treatment