TELLURIDE – “It really does take a village to manage this,” Melinda Roalstad, a physician’s assistant at Utah’s Coalville Health Center, told a scanty audience at Monday night’s Concussion Symposium organized by Telluride Middle/High School Athletic Director Mike Hughes and concerned parents.
Roalstad, who works with Think Head First, which describes its mission as “promoting awareness and management of concussion,” was in Telluride to deliver some sobering statistics about the prevalence of concussion among young athletes, and the short- and long-term effects of head injuries on developing brains.
Her presentation kicked off with a short PBS documentary outlining the range of concussion’s after-effects, including everything from headaches, nausea, dizziness, fatigue and memory problems to personality changes to the potentially lethal “Second Impact Syndrome,” which causes, she said, “fifteen to eighteen deaths a year” among young people.
“Young people,” whose brains are developing are, she emphasized, particularly “vulnerable to recurrent head trauma.”
But survivors of Second Impact Syndrome experience life-altering consequences, as well, Roalstad said, and it’s something to which any child who has had a concussion can be vulnerable.
In the US, she said, at least “55,000 high school football athletes have concussed,” with the overall rate of concussion “one in 10” among football players. Young lacrosse, soccer and ice hockey players have a similar rate of concussion, she said, and among all young athletes, once a concussion occurs, the risk of danger from a second is high.
Eighty percent of the time that a concussion occurs, she said, “there is no loss of consciousness,” and “between thirty and fifty percent” of concussions go undiagnosed. A concussion is especially dangerous because it’s internal. “Unlike a bruised quad,” she said, “you can’t see it.” With a bruised quad, where “you see the bruise, it hurts; you can feel it.
“You can’t do that up here,” she said, pointing to her head. “The only way you see it is in how the kid is functioning.”
Among her recommendations for children who have concussed, in addition to the standard “rest” and “medical evaluation,” are “no movies, no computer. You want to take out anything inputting into this brain – you want to take out all input to allow them to recover.” And recovery is slow, as well: “One thing at a time,” instead of going “all back at once.”
Regarding concussion among young athletes, Roalstad continued, “females are at higher risk,” being more vulnerable, she explained, because their necks are “less muscular.”
A blow to the head is not necessary for a concussion, she added. “You can be concussed by being checked, in hockey, hard.”
Most parents know the symptoms of concussion – pinprick pupils, headaches, nausea, dizziness, fatigue, seeming dazed and confused and unable to recall events that came immediately afterwards.
But Roalstad emphatically dismissed the long-held attitude of mounting a 24-hour watch for symptoms, and then declaring possible concussion victims home-free.
Sending a head-injury victim back into play, she intimated, is downright barbaric. “They may seem fine, but then an hour later, you see them deteriorate.” That deterioration is an indicator of danger, she said, that “a mild injury has become very significant,” something that can happen with head injuries “when they’re not managed well.”
And managing head injuries is what Think Head First is all about.
Roalstad, who works with the US Ski Team and other athletic programs, suggested one quick low-tech test for athletes sustaining head injuries: “A single-leg stance for 30 seconds,” she said. “You wobble, you’re out.” And once you’re out, she said, “With any athlete under 18, you do not return them the next day.” And while the management of concussion is, she emphasized, “subjective,” taking into account information gleaned from “immediate post-concussion assessment,” the concussion history and neurological testing are key. She pronounced neurological testing “a cornerstone for protective management” that can, when a large enough institution adopts a testing program, cost as little as $10 to administer.
“We have learned so much in the last ten years” about concussion, she said. “How we manage these injuries has changed dramatically.”
But attitudes about concussion need to catch up, she suggested. Too often, “kids keep going to a different doctor” until one signs the release form needed to get back into play. Legally, she said, parents can still overrule a doctor’s decision that their child cannot compete, by signing a form stating: “I accept all responsibility, against medical recommendation,” for further decline.
For more information, please visit thinkheadfirst.com/
The Many Faces of Concussion
Fact: Concussion is one of the most serious and prevalent medical problems at the high school level. Symptoms of concussion can be highly variable and present themselves at different times over the recovery process depending on many factors.
Individual assessment and recognition of any of the following symptoms is important to be aware of with mild head injuries. Often times these symptoms will be exacerbated during physical or cognitive activity.
Sensitive to Light and Noise
Thought Processes Mentally
Feeling Slowed Down
Sleeping Less than Normal
Sleeping More than Normal
Trouble Falling Asleep
– Source: Think Head First