Tag Archives: Concussions

Sports Medicine Expert on Concussion Symptoms and Dangers

Posted on: October 14, 2014

Concussion Management. Assessing the Symptoms.

By Dr. Eric Small

While a headache is among the best-known and first symptoms of a concussion, there are often delayed symptoms that indicate ongoing mild brain damage and require treatment. Ten percent of symptoms don’t present for a week or more.

For this reason, it is essential that parents and teachers as well as emergency room physicians and pediatricians recognize the need to monitor a young injured athlete for the full spectrum of possible symptoms. In my experience, when the athlete gets over the initial headache, or perhaps never experiences this symptom, parents and youngster often push for a quick return to all activities. But that can put a young person at serious risk.

Today’s best concussion management involves assessing all symptoms – early and late, including many that can seem unrelated to the injury — to determine the proper timing of an athlete’s return to play and also to learning, that is, the resumption of a full academic load.

Often-overlooked symptoms of a concussion include sleep disturbances and personality changes, in which, for example, a very sociable teen becomes quiet. It’s also important to know that post-injury cognitive impairment often causes academic difficulties to emerge over time. For example, an A student in math becomes, two or three months later, a B student. I particularly advise parents to keep an eye on their child’s performance in math and foreign language. As both subjects require doing multiple mental tasks simultaneously, and rely heavily on memory, they are usually the most affected. When I see a young athlete who appears fine after a concussion, I ask two targeted questions: First, “How are you sleeping?” And always – “Are you having problems with math?”

Be aware that cognitive symptoms may not surface until triggered by a heavy cognitive stress, such as back-to-back tests in school – and that this delay in symptoms can lead to dangerously delayed treatment. A little-known fact about this type of injury is that an untreated concussion can keep getting worse.

Another surprising fact to most people is that a broken nose or broken tooth suffered during sports can also cause head trauma, causing the same set of often-delayed symptoms. This is why I strongly advise that even a symptom-free child see a doctor within 48 hours of the injury, and that visits continue as the child is watched for late-arriving symptoms.

It is now recognized that proper concussion rehabilitation often involves not only physical rest and rehabilitative therapies – but rest and rehab for the brain. Ideally, a physician prescribes personalized guidelines for modifying physical and mental activities. The guidelines typically encompass texting and computer screen time, both of which can add visual over-stimulation to the stress of cognitive processing.

For day one post-concussion, I typically recommend that the student go to school a few hours late. If they tolerate that, day two is a full day. But during non-core classes, such as gym and music, I recommend they rest in the nurse’s office. And no tests. Similarly, a return to play might start the student off with a little jogging, then add push-ups. What you don’t want is the old method of rehab where the athlete stays out of school for a period of time and then returns to a full regimen. A gradual progression is a must.

Editor’s Note: Dr. Eric Small is a past chairman of the AAP committee on Sports Medicine and is active in creating national policy regarding children and sports. He has been named Sports Medicine Best Doctor in New York Magazine and Westchester Magazine  since 2007, and has over 20 years of experience with athletes.

For more information on concussions, visit www.cdc.gov/concussion


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Westchester Pediatricians Discuss New Concussion Guidelines with Northern Westchester Hospital

Posted on: September 12, 2012

Protecting the Student Athlete

An Interview with Dr. Louis Corsaro and Dr. Elliot Barsh

Concussion Guidelines

You don’t really have to be a sports fan to have heard about the concern over concussions. Every few months, it seems, the national news carries another report about a former professional football player or boxer and their career filled with head trauma. But according to Northern Westchester Hospital pediatricians Elliot Barsh, MD, and Louis Corsaro, MD the damage these athletes suffered as professionals most likely began much earlier—when they were just youths playing in town and school sports programs.

We sat down with these leading Westchester pediatricians to understand the toll these school sports programs can take.

“I’ve seen very serious concussions in athletes as young as 12 and 13,” says Dr. Corsaro who, like Dr. Barsh, serves as a school physician for local Westchester County school districts. “We really need to educate youth coaches, trainers, parents, and athletes in all sports—football, soccer, lacrosse, basketball, hockey, baseball—on how to recognize the signs of a concussion and the steps to take to prevent lasting damage to the brain.”

The problem, says Dr. Barsh, is that the signs of a concussion can be maddeningly vague—especially when you consider that loss of consciousness is rarely one of the symptoms. “In 90% of concussions, the patient doesn’t lose consciousness,” he says. “And the other signs, such as headache, nausea, dizziness, fatigue, can be caused by any number of things.”

Wearing a snug helmet offers necessary protection for the skull, but it won’t prevent concussions, the doctors say. “If you think of the brain as a gelatinous-like organ,” says Dr. Corsaro, “you can picture how a sharp blow can cause a wave to pass through the brain. That wave can destroy neurons, and it will take time for the body to repair.”

The doctors both praise recently released New York State Concussion Guidelines that address concussions. The guidelines recommend that any athlete who takes a hit to the head and feels woozy immediately head for the sidelines. “Once you’ve suffered one concussion,” says Dr. Barsh, “you’re much more vulnerable to subsequent concussions, and to further cognitive consequences.”

“The guidelines help us manage the recovery process.” The athlete should rest quietly—no cell phones, video games, television, or schoolwork for 3-5 days following the injury. “Any cognitive strain or stimulation can delay the recovery,” shared Dr. Barsh. When the athlete is symptom-free for one week, he or she can begin a gradual return to play.

Dr. Corsaro also likes the idea of preseason cognitive testing of healthy athletes so that coaches and parents have a baseline measure. “If there’s an injury, we can do testing and compare it to the baseline to get a clear idea of the potential damage.” Several districts have already implemented such testing, he says.

Both doctors have met resistance to the new guidelines. “Parents, coaches, and kids really don’t like taking time off,” says Dr. Corsaro, “but that’s the only way to heal.” And the consequences of not respecting the downtime are severe: Memory loss, increased irritability, poor impulse control, increased risk of substance abuse, and depression are just a few of the potential outcomes. “Some parents can’t understand why I’m preventing their kids from playing,” says Dr. Corsaro. “I want that athlete out of play because I’m thinking about their future.”