A global concussion discussion
A TV studio is nestled among the treatment rooms and surgical suites at Akron Children’s Hospital. That’s where a crew of cameramen, audio engineers and producers quietly guide a video broadcast.
Pediatric surgeon Todd Ponsky coordinates the hospital’s GlobalCastMD online seminars.
He says about 500 physicians and sports trainers from 36 states and five countries took part in the six-hour discussion about concussions on July 30th.
Dr. Joseph Congeni, director of sports medicine at Akron Children’s, is one of the experts leading the seminar.
"We have to make a cultural change," he says. Young athletes learn how to take a blow and deliver a blow to play American football, but Congeni says, "you can’t tough out brain injuries.”
But what exactly is a concussion?
A concussion is a blow to the head that injures the brain. But Congeni says the injury to the brain is a cellular injury. "It’s a functional injury to the brain, so you don’t see it very obviously and it’s hard to diagnose.”
Congeni say cells in different parts of the brain controlling different functions can be damaged.
So there are at least six sub-types of concussion, according to Congeni. The most common injuries affect thinking abilities because that’s the biggest part of the brain.
A concussion causes problems with memory loss and problem solving, and Congeni says, "the brain just works and moves really slow, and that can be the only symptom.”
Other types of concussion cause more concern
Another type of concussion affects moods -- causing depression, anxiety or irritiability. Others cause fatigue or migraines. One that is often most troubling for doctors causes dizziness and vertigo.
Congeni describes this as a vestibular concussion, "where the balance centers of the brain seem to be involved the most.”
He says he's sending vestibular-concussion patients to physical therapists that take them through a very slow, gradual process of getting blood flowing again through aerobic conditioning. Congeni says new studies show, "significant improvement if you do that in the first week.”
"You can't tough out a brain injury."
-- Dr. Joe Congeni
Congeni takes me on a tour of what looks like a high-tech gym at Akron Children’s sports medicine center. It’s here that he often sends young patients with the dizziness type of concussion instead of prescribing the traditional bed rest in a darkened room.
Congeni says physical therapy rebuilds connections in the injured brain through repetition of specific patterns of body movement.
He says within two to three weeks of the injury, 85 percent of young athletes recover.
The 15 percent that worries doctors the most
But it’s the 15 percent that don’t heal right away that has Congeni and other experts worried.
“We see kids here that take six months, a year, two years, three years, and some that never really get back to where they were before, and those are concerning cases to us,” says Congeni.
And that’s where he says early assessment of the type of concussion is crucial. Congeni says, “The best we can do is tell parents, or coaches, or officials to be aware of abnormal behavior."
All athletes now need a doctor's clearance to return to play.
Youth sports - like a pool without a lifeguard
Congeni says about 60 percent of Ohio high schools have athletic trainers capable of recognizing concussions. But, he says, they’re rare at the youth-sports level, especially at big tournaments.
“It’d be like going to a swimming pool without a lifeguard,” he says.
Congeni is seeing more cases of concussion at Akron Children’s. He says that could be a good thing because, despite the increased number of concussion cases, "we think some of that is heightened awareness.”
Congeni was on the panel that in 2013 created new concussion rules for Ohio youth sports. The NCAA last month created new voluntary rules that are intended to reduce brain injuries in college athletes.
After years of apparent denial, professional and amateur sports leagues, coaches and trainers are teaming with healthcare providers in campaigns to prevent concussions not just for the sake of athletes, but for the long-term health of contact sports itself.