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Concussions

Sport activities are as American as (put your favorite pie here.) From pre-school through college many kids are playing one sport or another. Sports that can cause a brain injury - and there are many- are some of the most demanding, and some of the most popular.<br> <P style="LINE-HEIGHT: 14pt; MARGIN: 0in 0in 0pt; BACKGROUND: white; VERTICAL-ALIGN: baseline" class=MsoNormal><span style="COLOR: #333333; FONT-SIZE: 10.5pt; mso-bidi-font-family: 'Times New Roman'"><?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p>&nbsp;</o:p></span></P>

Sport activities are as American as (put your favorite pie here.) From pre-school through college many kids are playing one sport or another. Sports that can cause a brain injury - and there are many- are some of the most demanding, and some of the most popular.

New research suggests that a blow to the head might affect a child's brain differently from an adult's.

That's good news on one account, because the study shows that a concussion appears to cause less injury to a kid's brain than it does to an adult's. Unfortunately the study also found that the symptoms from a concussion often last longer in kids. Symptoms like decreased reaction times, memory and concentration problems, irritability, insomnia, and fatigue.

That could mean that coaches and parents may be putting kids back in the game while they are still vulnerable to re-injury.

"Those may be the kids who are at greatest risk for more severe effects of concussion," says researcher Todd A. Maugans, MD, a pediatric neurosurgeon at Cincinnati Children's Hospital Medical Center.

What happens is that children who suffer a second sports-related concussion within a month or two of the first injury might experience a rare -but devastating- phenomenon called second-impact syndrome. Second -impact syndrome causes the brain to swell rapidly in response to repeated head injuries. It can cause catastrophic injury to the brain; even death.

"We need to better refine that timetable for recovery," Maugans says.

The study used imaging techniques to watch what was happening to the brains of dozens of kids -ages11-15- after they experienced a sports-related concussion.

Researchers expected to see changes in kids' brains very similar to what they see when adults have a serious blow to the head. Those changes include damage to nerve cells or chemical abnormalities that suggest decreased brain function.

"We didn't find that at all," says Maugans.

What they found instead were changes in how blood flows to the brain.
In two of the youngest children, blood flow in the brain increased after a concussion. But in most children, blood flow decreased significantly.

Too much blood in the brain (hyperemia) can cause intracranial pressure, which can compress and damage delicate brain tissue. Too little blood flow (ischemia) can cause brain tissue to die, causing death.

In the case of a 13-year-old wrestler who had the most severe symptoms of the group, blood flow to his brain dropped by 60%.

It's still unclear how circulation changes happen or even what they mean, but researchers found that they can last long after symptoms are gone.

After 2 weeks, kids with concussions passed a computerized test that measured their concussion symptoms, but MRI scans produced an entirely different picture.

"We found that by two weeks, 63% of the kids were still abnormal," Maugans told WebMD. "And after 30 days, a third of the kids still had alterations in blood flow to their brains. What that says is that you've got a [physical] change, but you've got a patient that looks normal."

The study was performed with a small group of kids, and experts agree that the findings are important, but they suggest that more research - with larger groups- should be repeated.
"It's kind of patchy data in a small group. That being said, those data are interesting," says Ron Kanner, MD, chairman of the department of neurology at North Shore University Hospital and Long Island Jewish Medical Center in New Hyde Park, N.Y.

"I think it lends further credence to the idea that you shouldn't send kids back into sports too fast [after a concussion]," he says.

Sports related concussions are now beginning to get a lot of attention in school and professional sports.

According to the Centers for Disease Control and Prevention, an estimated 300,000 sports-related traumatic brain injuries (TBIs) occur in the United States each year.

The popularity of contact sports in the United States exposes a large number of athletes (children, professionals and "weekend warriors") to risk for brain injury. Recurrent brain injuries can be serious or fatal and may not respond to medical treatment. However, recurrent brain injuries and second-impact syndrome are highly preventable. Physicians, health and physical education instructors, athletic coaches and trainers, parents of children participating in contact sports, and the general public should become familiar with the updated recommendations put forth by The American Academy of Pediatrics.

 Children or adolescents who sustain a concussion should always be evaluated by a physician and receive medical clearance before returning to play.
 After a concussion, all athletes should be restricted from physical activity until they are asymptomatic at rest and with exertion. Physical and cognitive exertion, such as homework, playing video games, using a computer or watching TV may worsen symptoms.
 Symptoms of a concussion usually resolve in 7 to 10 days, but some athletes may take weeks or months to fully recover.
 Neuropsychological testing can provide objective data to athletes and their families, but testing is just one step in the complete management of a sport-related concussion.
 There is no evidence proving the safety or efficacy of any medication in the treatment of a concussion.
 Retirement from contact sports should be considered for an athlete who has sustained multiple concussions, or who has suffered post-concussive symptoms for more than three months.
 
Young athletes are more susceptible to the effects of a concussion because their brains are still developing. Although preventing all concussions is unlikely, there are several ways to reduce the risk, including protective gear (such as helmets and mouth guards), adhering to the rules of the sport, identifying athletes at risk, and educating parents, teachers, athletes, school administrators and trainers about the dangers of concussions.

The study was published in the journal Pediatrics.


 

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