Kids With Past Concussions Take Longer to Recover

Study has implications for how long children should wait to resume activities, experts say

By Amy Norton

HealthDay Reporter

MONDAY, June 10 (HealthDay News) -- Kids who suffer a concussion may have a substantially slower recovery if they've sustained one or more blows to the head in the past, a new study finds.

Researchers report that among 280 kids and young adults who sustained a concussion over one year, those who'd suffered one in the past took twice as long to recover -- typically 24 days, versus 12 days for kids with no history of concussion.

What's more, the number of past concussions, and the timeframe of kids' head injuries, appeared key. Young people who'd sustained a concussion in the past year had a prolonged recovery from the current one -- typically 35 days.

Recovery was also slower for those who'd had two or more concussions in the past, at any time. It typically took 28 days for their symptoms to fully resolve.

Experts said the findings, reported online June 10 and in the July print issue of Pediatrics, have implications for managing kids' head injuries.

When they have had multiple concussions, or a relatively recent one, parents and doctors should probably be "extra cautious" about letting them back into sports, said lead researcher Dr. Matthew Eisenberg, of Boston Children's Hospital.

Sports are a major cause of young people's concussions -- and accounted for almost two-thirds of those in this study. In general, experts say those kids should not get back into the game until all of their symptoms have resolved, and a health professional gives them the OK.

So be even more patient when a youngster has a history of concussions, Eisenberg said. That means not only waiting until any symptoms go away to get active again, but gradually moving back into the normal routine.

"You do not want them to go from zero to 60," Eisenberg said.

That gradual return is important any time an athlete has had a concussion. But it's probably even more vital with repeat concussions, agreed Keith Yeates, chief of pediatric psychology and neuropsychology at Nationwide Children's Hospital in Columbus, Ohio.

"It's been part of the medical lore, this idea that multiple concussions are 'bad,' and having a repeat concussion within a short amount of time is bad," Yeates said. But this study, he added, helps confirm that.

One of the big remaining questions, though, is whether kids with repeat concussions suffer any long-term consequences, Yeates said.

"We don't know if there are any effects on long-term cognition or memory," study author Eisenberg agreed. There have been reports that professional athletes who suffer blows to the head may be at heightened risk of degenerative brain diseases later on. A recent study found increased risks of Alzheimer's and Lou Gehrig's disease in retired pro football players, for example.

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New Guidelines Raise Safety Bar on Concussions

If head trauma is suspected, health care professional should determine it is safe to return to play, recommendations say

By Alan Mozes

HealthDay Reporter

MONDAY, March 18 (HealthDay News) -- Any athlete who suffers a suspected concussion should be withdrawn from play and stay on the sidelines until a qualified health care professional determines that all symptoms have subsided and it is safe to return to the field, new guidelines state.

Issued by the American Academy of Neurology, the latest recommendations aim to keep young athletes as safe as possible.

"With the older guidelines, we were trying to rate concussions at the time of the injury and predict recovery times, but now we know, 'When in doubt, sit 'em out,'" said guideline co-author Dr. Christopher Giza, an associate professor of pediatric neurology and neurosurgery with the David Geffen School of Medicine at the University of California, Los Angeles, and Mattel Children's Hospital.

"The point is that no single quick test is really a litmus test for a concussion," he said. "We know now that we need to make sure a player has had a thorough and proper evaluation, involving a symptoms checklist, a standardized assessment and balance and cognitive testing, before being returned to play. This evaluation has to be done on a case-by-case basis, so each person goes through an individualized recovery process."

Giza and his colleagues reported the new guidelines in the March 18 online issue of the journal Neurology.

According to the academy, upwards of 1 million professional and amateur U.S. athletes suffer a concussion every year.

The new guidelines were issued following a thorough look at all the available concussion research through June 2012.

Among the conclusions: experiencing a concussion raises the risk for experiencing a second, and perhaps more debilitating, one. That risk was found to be highest in the 10 days following the initial injury.

One expert said the new guidelines are needed.

"One of the big problems is that we have a culture within many sports that still encourages young people to play through the pain, including head pain," said Dr. Gail Rosseau, a clinical assistant professor in the department of neurosurgery at the Northshore University Health System in Chicago.

"But one of the most important things we now know is that until those who have had one concussion are fully recovered they are more likely to have a second concussion," Rosseau said. "The stories we hear that are horrific to every parent and every coach is the child who gets a concussion and goes back to play too soon, and gets a second one with devastating consequences."

Just how devastating it can be was outlined earlier this year in the Journal of Neurosurgery: Pediatrics, which detailed the harrowing double-concussion experience of Indiana high school student Cody Lehe. Resuming football too soon after an initial concussion, Lehe suffered a second concussion. Severe brain injury ensued, leaving Lehe mentally impaired and largely wheelchair-bound.

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Football Players and Concussions: Prevention, Effects, and More

What's being done to protect football players from concussions and their effects.

When a football player suffers a concussion during a game or in practice, whether they're a pro or a student, it's serious business. And the sport is taking it seriously.

Doctors, coaches, and researchers are focused on the damage concussions can do to football players’ brains as a result of the many tackles they endure.

What should be done when a football player (or any other athlete) has a suspected concussion? Read expert advice on immediate treatment and when the player can return to training and competition. 

Football Concussions: What to Do

© 2011 WebMD, LLC. All rights reserved.

Research shows that athletes who have repeated concussions are more likely to get long-term brain damage, including a condition known as chronic traumatic encephalopathy (CTE), a brain disease that mimics dementia.

Former NFL players who have had CTE include the late Junior Seau, Chris Henry, and Dave Duerson.

In a concussion, the brain shakes so forcefully that it hits the inside of the skull. That injures the brain.

Symptoms of a concussion can include:

loss of consciousnessdrowsinessconfusionheadachenausea or vomitingblurred visionloss of memory of events surrounding the injury.

If a concussion leaves someone unconscious for more than a few minutes, the concussion is clearly serious. But sometimes even seemingly mild concussions can do damage.

"A minor hit on the field can take a long time to recover," says Mark Lovell, PhD, founding director of the University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program.

How many concussions are too many? That may be the wrong question.

"It's not as simple as how many concussions someone's had -- it's total brain trauma" that matters, says Boston University neurosurgery professor Robert Cantu, MD, who is a senior advisor to the NFL's Head, Neck, and Spine Committee.

"Linemen who've had almost no concussions have the majority of cases of chronic traumatic encephalopathy, because on every play they get their brains rattled, trying to block with their head," Cantu says.

In 2011, the NFL set rules to determine whether an athlete who’s taken a powerful hit and sustained a concussion will be benched or sent back into the game.

The guidelines include checking the player's symptoms, attention, memory, and balance, starting immediately, on the sidelines.

"It incorporates the most important aspects of a focused exam, so that injury is identified, and athletes with concussion and more serious head and spine injury can be removed from play," says Margot Putukian, MD, chair of the return-to-play subcommittee of the NFL's head, neck, and spine committee.

No athlete should be allowed to participate in sports if he or she is still experiencing symptoms from a concussion, according to the American Academy of Neurology. And before they go back to play, they should first see a doctor who's had proper training to make sure they're ready.

That often doesn't happen, though. Many concussions go unreported. Athletes are often eager to get back in the game. They may think they feel fine, or at least good enough.

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