May 6, 2007
Column: HEALTH
Concussion caution
Brain injuries can lead to problems later if not detected or if athletes return too fast
Author: KATHY RICKETTS
Gazette Reporter
Edition: Schenectady/Albany; Final
Section: H: Lifestyles
Page: H1
Greg DuCharme, 15, doesn't remember much about the day he sustained a concussion during a hockey game in Saranac Lake last December.
I felt a ringing in my head, sort of like when you hit a glass," recalled DuCharme, a 10th-grader at Niskayuna High School. "After that, I really didn't know what was going on."
Greg's father, John, an attorney in Clifton Park, remembers vividly what happened.
"Greg was hit in his jaw by another player's elbow, and when Greg went down on the ice, he looked a little dazed before he skated off, recalled John DuCharme. "He sat on the bench for five minutes, then went back into the game."
When the game was over, however, DuCharme was startled when he saw his son.
"He came out of the locker room, and he could not remember anything about the game," said DuCharme.
Normally a happy-go-lucky, quick-witted boy, Greg's mannerism was very flat, said his father, who took him! to the emergency department in Saranac Lake, where it was confirmed that Greg had sustained a concussion.
Now, health care professionals at Sunnyview Rehabilitation Hospital in Schenectady are in the process of starting a Concussion Management Program for high school and college athletes, as well as others.
"We want to arrange though different schools to have all student athletes do pretesting before they play a sport so we have a data base of their cognitive performance," said Dr. Kenneth Shapiro, medical director of the Brain Injury Center of Excellence at Sunnyview Rehabilitation Hospital. "Then should something happen during the year, we have that database so when they come to us after an injury, we can direct their recovery."
A concussion is a disturbance in brain function that occurs following either a blow to the head or as a result of the violent shaking of the head. People do not have to lose consciousness.
Common signs and ! symptoms include headache, nausea, balance problems or dizziness, doub le or fuzzy vision, feeling foggy, sensitivity to light or noise, change in sleep pattern and concentration or memory problems.
Because concussions do not show up on X-rays or usual diagnostic scans, until recently doctors have had to depend on patients to describe the severity and duration of symptoms.
"We've learned more about this injury in the past five years than in the previous 50 years," said neuropsychologist Michael Collins of the University of Pittsburgh Medical Center.
Experts at the University of Pittsburgh Medical Center have designed a 20-minute computerized test called IMPACT (Immediate Postconcussion Assessment and Cognitive Testing) to gauge attention span and memory and help determine whether a person has a concussion.
Sunnyview Hospital recently began using the IMPACT test on student athletes or anyone suspected of having a concussion.
"You can also compare people to other subjects of the same age so you ca! n really see where they fall on that cognitive chart and see if they had any kind of drop-off from what would be considered normal," said Paul Novak, occupational therapist and program director for Brain Injury Services at Sunnyview.
"The beauty of IMPACT is because its computerized, the kids really take to it, and it takes a lot of the subjectivity away from diagnosing the person and the rate of recovery," Novak added. "Through repeat visits, we can see how they improve going back to their baseline test."
While the program will center on athletic injuries, the same treatment would apply to a concussion for any other reason.
"The goal of the program is to educate the athletic community and parents about concussions so they are aware of any signs of concussions and to get the word out about prevention, early detection and proper systematic management so concussion is not mistreated " said Novak.
In the United States, sports-related con! cussions occur about 300,000 times a year. For an athlete in a contact sport, the rate may be as high as 19 percent per season, according to researchers at the University of Pittsburgh.
Recovery time needed
When someone sustains a concussion, there are metabolic changes that take place in the brain, explained Novak.
"We're learning that if you send someone back to play or back to strenuous activity too soon, they are vulnerable to additional injury or a slower recovery time before they get back to normal," he said. "So we are finding it's not good to push through the pain. The best thing you can do is rest and then gradually return to activities, making sure you remain symptom-free as you slowly increase your activity level."
Shapiro said signs of a concussion can appear in subtle ways.
"Kids and professional athletes sustain concussions, and it can be very difficult to recognize sometimes," he said. "Changes in their behavior may be the only sign that something is wrong. The person who has the concussion may not even realize that something is wrong. That's why it's so important that parents, coaches and t! rainers are sensitive to this."
If the brain is not allowed to heal properly, and the athlete sustains further concussions, the result could be "postconcussive syndrome" that months later could result in impulsive behavior, easy frustration, impaired social judgment and personality changes.
In some cases, young athletes under the age of 21 suffering a second blow to the head while recovering from an initial concussion can have catastrophic consequences as in the case of "second impact syndrome" which has led to approximately 30 to 40 deaths over the past decade.
Some professional athletes have recently begun to speak about the devastating effect concussions have had on their lives. Ted Johnson, a middle linebacker who helped the New England Patriots win three Super Bowls before he retired in 2005, sustained repeated concussions on the field. Today at 34, he is showing signs of dementia.
After the IMPACT test at Sunnyview showed that ! Greg DuCharme's cognitive function was impaired, he stayed home from s chool for a few days to rest his brain.
"I had a small headache that lasted all the time, and I was just kind of out of it for a while," DuCharme recalled.
When he returned to school, he went for half days for a few days. After two weeks, he got back on the ice for practice but only to skate and shoot a little as long as he remained symptom-free. Three weeks later, he was cleared to return to play after the IMPACT test showed his cognitive function was back to normal.
"The worst part was sitting on the bench. It was boring," said DuCharme, who now plays lacrosse, and plans to play hockey again next year.
To help prevent a concussion, always wear a helmet. Unfortunately, Shapiro said people who wear helmets can still get a concussion.
"Helmets protect the skull from fracturing, but it's harder to protect the brain," said Shapiro. "You can sustain a concussion from a whiplash injury when your brain shakes around."
"The important thing is if it's recognized early and treated properly with rest and pain control, people will get well and stay well," he concluded.
Reach Gazette Reporter Kathy Ricketts at 395-3183 or kathyr@dailygazette.com.
Memo: 'We've learned more about this injury in the past five years than in the past 50 years.'
Michael CollinsNeuropsychologist, University of Pittsburgh Medical Center
Copyright (c) 2007 The Daily Gazette Co. All Rights Reserved. Record Number: 118E6712A9150B48
