What Happens During Concussion Testing?

What Happens During Concussion Testing?

by | Nov 1, 2023 | Sports Medicine

What Happens During Concussion Testing?

As a parent, ensuring the safety and well-being of your young athlete is a top priority. While injuries are inevitable in sports, one concern that often arises is the risk of concussions. A concussion is a mild traumatic brain injury that causes a temporary loss of brain function. These injuries can negatively affect balance, coordination, reflexes and speech, among other skills. 

Concussion testing plays a crucial role in diagnosing and making treatment decisions about a child’s head injury and provides accurate information about your child’s neurological health.

Baseline Concussion Testing With ImPACT

One of the most effective concussion tests your child can have happens before the injury occurs.

A baseline test known as ImPACT measures your child’s memory, reaction times, reasoning skills and abilities in other areas to establish what’s normal for your child. If your child sustains a head injury, specialists can perform the test again. Physicians compare the results to determine if your child has a concussion and, if so, what treatments your child may need.

Your child will take the baseline test online, ideally before the sports season begins. It takes about 20 minutes and asks your child questions appropriate to their age and developmental level. 

The post-injury tests are similar, but if your child is younger than 11, you may need to answer questions about his or her symptoms. A specially trained provider will review the results and provide them to your child’s healthcare team.

Signs Your Child Needs a Concussion Evaluation

Concussions occur following a fall or a blow to the head. The force of the impact shakes the brain, damaging cells and triggering chemical changes. 

It can be difficult to detect a concussion without testing. Some athletes don’t experience symptoms for hours or even days after the event, and kids don’t always think their symptoms are serious enough to sit out the rest of a practice or game.

Contact a sports medicine specialist about an evaluation if your child displays any of the following signs of a concussion immediately or in the days after a head injury: 

·       Acting dazed or stunned 

·       Blurred or double vision 

·       Changes in mood (more anxious, irritable, upset or sad) 

·       Clumsy movements 

·       Confusion 

·       Difficulty concentrating 

·       Dizziness or loss of balance 

·       Fatigue and trouble sleeping 

·       Headaches 

·       Increased sensitivity to light and noise 

·       Slow, slurred speech 

·       Nausea and vomiting 

·       Numbness or weakness in the arms and legs 

Concussion Testing After an Injury 

If your child experienced a head injury, concussion testing helps determine if the event impacted brain function. However, the type of concussion test your child has will depend on the extent of the injury.

Sports medicine physicians use a variety of concussion assessment tools, often starting with a physical exam to review your child’s balance, coordination, hearing, reflexes and vision. 

During a post-injury concussion evaluation, the doctor will ask questions about the injury, including: 

·       What caused it

·       Any signs and symptoms your child has experienced or that you have noticed 

·       Whether or not your child lost consciousness and for how long

Your child’s physician may order imaging tests, such as CT scans and MRIs. These can’t tell you whether your child has had a concussion, but they can reveal bleeding or other injuries resulting from the collision. Bloodwork that checks for proteins associated with mild concussions may also help the physician identify other injuries. 

If your child had a baseline test, he or she will also have a post-injury cognitive test.

Your Child’s Return to School and Play

Depending on the results of the physical exam and post-injury cognitive test, your child’s doctor will begin treatment, which usually focuses on management of concussion symptoms with medication and rest until the concussion fully heals. Kids may need to stay home from school for a few days and gradually return with shorter days, reduced workloads and more break periods.

You’ll want to work with your child’s doctor, school nurse, athletic trainer and coaches to ease your child back on the field or court. Work with the school’s athletic department or local sports organization, as well, because they may have different protocols about when your child can return, even if the doctor clears him or her for participation. 

Accurate concussion evaluation is essential for proper healing and the prevention of further concussions and complications. In addition, following the doctor’s orders about when to return to sports and other activities is critical. If your child participates in sports before a concussion heals and has another injury, he or she may experience severe brain damage. 

Scottish Rite for Children Orthopedic and Sports Medicine Center offers high quality care for concussions and other sports injuries from a dedicated team of sports medicine specialists. Call 469-515-7100 to schedule a baseline testing appointment with one of our athletic trainers and learn more about our concussion program. 

Movement Science – Breaking Down Movements in Young Baseball Players

Movement Science – Breaking Down Movements in Young Baseball Players

by | Oct 27, 2023 | Sports Medicine

As part of SAFE (Sports-specific Assessment and Functional Evaluation), our team is developing sport-specific protocols for the use of motion capture technology in sports medicine that are being used across the country. There are only a handful of sports that have received attention in the motion capture world, and those are typically performance-based models. The models that our team are creating evaluate foundational movements to help us predict injuries and improve return to play protocols. To do this, we will need to record a great deal of data from a large number of athletes.

For the past two summers, our Movement Science Lab team in Frisco has collected data sets on our baseball program participants and some other volunteers. Though we are just getting started on the total number of athletes to test, we are making great progress on tweaking the protocol and looking at preliminary results to understand where to go next. Here are a few things that we are looking at in the study:

Trunk mobility – specifically in the thoracic spine. We’ve identified the best way to capture the mobility of the upper spine. We believe that tightness there may affect the stress on the shoulder during throwing.

 
Motion throughout the body while throwing. Because our movement science lab is spacious, with 14-camera motion capture system, we can monitor joint angles, speed and forces throughout the body during high velocity pitching. We believe some movements are directly related to the development of elbow and shoulder injuries, particularly when there is a high volume of throws without rest.

 
Single leg stability with motion. Most sports require movement of the legs, and most of the time, only one leg is in contact with the ground. We are measuring the differences from side to side and between athletes to identify asymmetry in static and dynamic single leg movements. We believe asymmetry is a factor for increased injury risk in all athletes.

 
Leader of the project and assistant director of the Movement Science Lab in Frisco, Sophia Ulman, Ph.D., says, “Early results from this study are helping us to establish an evidence-based return to play decision-making model.” Many have heard of functional testing or return to play testing for athletes returning to sport after a significant knee surgery, such as an ACL reconstruction. This new upper extremity program is much needed in the pediatric sports medicine community. As we continue to collect information about healthy athletes, we will use the results to continue to modify the upper extremity return to play program. This is an example of where our clinical teams of physicians, physician assistants and physical therapists collaborate with our research team to make changes that impact athletes today.

We are continuing to work on this baseball project and invite healthy young athletes to help us. We schedule testing dates periodically and would be happy to send you the calendar to sign up or work with your team to find a date to do testing together.

To learn more about Movement Science, please call 469-515-7160 or email [email protected]. 

Progression from “Pop” Back to Pitching

Progression from “Pop” Back to Pitching

by | Oct 20, 2023 | Sports Medicine

A young baseball player hears a pop and immediately feels pain in his throwing elbow while playing club baseball. At his first visit to Scottish Rite for Children’s Fracture Clinic, Parker and his family were told that surgery was necessary to reattach a separated piece of bone in his elbow. That was tough news for this young pitcher nearing his 12th birthday.

A Note About Sport-Related Overuse Injuries in the Elbow in Baseball

Though a completely displaced fracture in this area is uncommon, pain and injury on the middle side of the elbow is common in young throwers. There are immense stresses placed on the elbow during throwing.

Many pitchers and others perform many throws during practice, private training and year-round games and tournaments, and the damage continues and worsens. For many young athletes, early recognition and rest can prevent the condition from worsening to the point of an acute injury, like a medial epicondyle avulsion fracture, that needs surgery. Learn more about preventing elbow overuse injuries in young athletes in this article, Injury Prevention Tips for Young Baseball Players and Parents.

“This area of the elbow is weak in young throwing athletes around Parker’s age, he was 11 at the time of this injury,” occupational therapist Savana Ashton says. The area is an epiphysis, a growth center, where the bone fragment is connected to the humerus by cartilage that will become bone when growth is complete. With or without a history of overuse, a sudden and forceful injury causes the muscle tendon attached to the fragment to pull it off the humerus completely, this is called an avulsion fracture. Like Parker, an athlete often describes hearing a “pop” and instantly feeling severe pain with this injury.

Parker was in good hands. Pediatric hand surgeon, Chris Stutz, M.D., performed the ORIF surgery where he used a screw to reattach the piece of bone. The procedure is called an open reduction and internal fixation (ORIF) of the medial epicondyle. After surgery to secure the bone fragment back in place, patients require intensive rehabilitation to return to activities and sports that are meaningful to them. In occupational therapy (OT), Ashton provided many therapeutic interventions including skin care and scar management as well as exercises to regain motion in the elbow and strength in the entire arm.

“From the beginning of Parker’s journey, he was eager to return to baseball, so a strategic path through postsurgical rehabilitation including safely reintroducing throwing was critical,” Ashton says. “Once Dr. Stutz cleared him for throwing, I advanced Parker’s plan to include evidence-based throwing programs, which include general baseball strengthening exercises and a multiphase guide to gradually return-to-pitching.”

Similar to other young athletes recovering from a serious sport-related injury, Parker was ready to be discharged from formal rehabilitation, but he was not quite ready to return to full activity, including baseball. In September, Parker transitioned from OT to the Bridge Program, a group training option offered by our Therapy Services team at Scottish Rite for Children. The program provides athletes like Parker a safe “bridge” to maintain progress made in therapy and continue strengthening in the previously injured area. Simultaneously, the coaches emphasize proper body mechanics and total body strength and conditioning, which will likely help reduce the risk of reinjury. “We were grateful Scottish Rite had an environment for him to continue his recovery,” Parker’s mom, Michele, says. She has entrusted Scottish Rite to care for several of her children now.

The program is not baseball-specific, but it is beneficial for baseball players and many others. Certified strength and conditioning coach Justin Haser, M.S., CSCS, says, “The kids that consistently come in, give a good effort and are coachable see great improvements in their movement economy and improvements in their overall strength outputs.” When athletes enroll in the Bridge Program or Athlete Development Program, they can attend up to three times each week.

In pediatric orthopedics, follow-up visits are particularly important when a growth area was involved in the treatment. Complications with this treatment are rare, but monitoring periodically and confirming recovery is on the right path ensures there won’t be surprises later.

Parker is now 13 and has been happily back on the mound and hitting home runs. “Parker is thrilled to be back playing baseball after his full recovery from surgery,” Michele says. To help other young throwers like himself have a safe season, Parker helped us create instructions for evidence-based exercises for all throwers. These are designed to be performed before practice or a game and can help to reduce elbow injuries.

Download the Thrower’s Program PDF (English | Spanish)

Three Areas Of Focus To Stay Fueled Through Busy Sports Seasons

Three Areas Of Focus To Stay Fueled Through Busy Sports Seasons

by | Oct 17, 2023 | Sports Medicine

Parents of student-athletes are familiar with the long days of practices before school, hours of schoolwork and games in the evening. Our sports dietitian, Taylor Morrison, M.S., R.D.N., CSSD, L.D., shares everything parents of busy young athletes need to know about fueling well, eating enough and staying hydrated to support their stacked schedules.

When trying to ensure your athlete is getting enough fuel and enough nutrition for sports and school, start by focusing on three key things:

  1. Maintain energy levels with meals and snacks that provide both quick and sustained energy.
  2. Stay hydrated.
  3. Recover well.

Maintaining Energy Levels
It’s important that young athletes keep their brains and muscles well-fueled throughout the day, starting when they get up in the morning. This is crucial so they not only perform their best in school but also so that they show up for sport practices energized with plenty of fuel in the tank to use for their sport. When athletes show up to practices with depleted energy stores, they run the risk of dizziness and fatigue in the short-term and decreased strength and overall performance long-term.

To know what foods to choose in their fueling strategy, it’s important that they have a basic understanding of the macronutrients, including carbohydrates, protein and fat:

  • Carbohydrates are the best and quickest source of fuel for the brain and muscles. This macronutrient can be used for energy in a young athlete in anywhere between 15 and 60 minutes after consumption, depending on the specific food they choose. These should be included in all meals and snacks throughout the day and can be a great snack 15 to 60 minutes before a practice. Foods high in carbohydrates include grains, such as bread or granola, and starches, such as potatoes or rice.
  • Protein is important for building and maintaining muscle and for injury recovery. It takes a little longer for the body to use protein for energy, so it is best left out of the pre-practice snack unless the athlete has a good 90 minutes or more before start time. It is, however, an important part of meals and the athlete’s recovery snacks. Foods high in protein include meats, such as beef, chicken, turkey, fish and seafood and eggs, and dairy products, such as milk or yogurt.
  • Fat is another important energy source for young athletes. These foods can also help fight inflammation and are crucial for the body to absorb certain vitamins (specifically A, D, E and K). However, it takes the body the longest to digest fat, so it should be kept out of the pre-practice snack and saved for the post-event meal or for meals and snacks that are a few hours away. Foods high in fat include certain cuts of meat, cheese, avocados, nuts and eggs.

For more information on how to incorporate meals and snacks around a busy training session, refer to our Tournament Nutrition guide.

Staying Hydrated
Athletes should understand the importance of drinking water and fluids throughout the day, starting when they wake up in the morning. Drinking 24 ounces from a water bottle 10 minutes before warmup will not make up for the fact that the athlete forgot to drink any water earlier that day. It will likely just leave him or her uncomfortable during the event and needing to take a bathroom break.
When asked what is best to drink, water should be the go-to drink of choice. If an athlete has trouble drinking fluids during the day, remember that foods can help hydrate as well. Sports drinks are best for when an athlete has been practicing for an hour or more or it is a very hot and humid environment.  There are a few other instances where a sports drink is helpful, and these special situations include:

  • The athlete has trouble eating solids before or during an event due to nerves.
  • The athlete is a salty sweater.
  • The athlete struggles with muscle cramping during events.

A factor to consider when choosing drinks and electrolyte packets is the age and stage of development the athlete is in. Before puberty, an athlete regulates body temperature differently than an adult, relying less on sweat to cool the body and, therefore, losing less electrolytes. An 8-year-old basketball player will likely not need the electrolyte replacement that a 17-year-old basketball player will need.

For more support in helping your young athlete hydrate, check out our Hydration for Young Athletes handout.

Recovering Well
Just because the game or practice is over does not mean athletes should forget about nutrition. This is especially true when the athlete is in back-to-back events or has a quick turnaround time between games. This could mean multiple games in a day, or it could look like a game ending in the evening and the next game early in the morning. During these small windows, the recovery fuel counts.

The three key components of a great recovery snack are:

  1. Carbohydrates

Carbohydrates replenish depleted energy stores in the muscle, which then prevents the body from breaking down protein (muscle) for fuel moving forward.

  1. Protein

Protein that the athlete eats helps to rebuild and repair the muscle that is naturally broken down a little with exercise. It will also help maintain the athlete’s strength.

  1. Fluid

 
Fluid will rehydrate the body to keep energy levels up and prevent dehydration.
For more info on recovery snacks, check out our handout, blog post or the below video!

For more sports nutrition information, visit www.scottishriteforchildren.com/nutrition.

How to Spot Signs of a Concussion in Kids

How to Spot Signs of a Concussion in Kids

by | Oct 10, 2023 | Sports Medicine

Head injuries in children, especially children who play sports, can have long-lasting impacts. Knowing the signs of a concussion in kids will help you get the treatment your child needs to avoid serious complications.

Concussion Basics

A concussion is a mild traumatic brain injury that can occur when a child experiences a sudden blow to the head. The impact causes the brain to jostle around the skull’s interior, damaging brain tissue and brain cells.
Although concussions during football get a lot of attention, these head injuries can also be caused by falls, collisions during other sports, bicycle accidents, and even minor car accidents. Particularly concerning is that having a concussion increases a child’s risk for having another one.

Immediate Warning Signs of Concussions in Kids

When your child hits his or her head, it’s natural to wonder if they’re okay. You may see your child jump up and keep playing, and you assume they aren’t injured. But you should monitor them closely for signs of a concussion because not all children will show immediate symptoms. In fact, according to the International Concussion Society, 90% of concussions that occur during sports don’t cause the person to black out or become unconscious.
“When in doubt, sit them out,” said Shane M. Miller, M.D., sports medicine physician and concussion expert. “If your child seems dazed, stunned, dizzy or is complaining of a headache, it’s safest for you or their coach to remove them from play immediately. The ‘tough it out’ mentality could prolong recovery and make them more susceptible to a more severe injury.”
Immediate symptoms of a concussion to look out for include:

  • Confusion
  • Dizziness
  • Memory loss
  • Nausea
  • Severe headache
  • Vomiting

If any of these symptoms are present, stop your child from playing or participating in an activity. More than 50% of child athletes continue playing a sport after experiencing a concussion, often because they don’t realize they’ve had a concussion or they don’t think their symptoms are that serious. However, continuing to play can slow recovery, increase the chances of having another concussion and lead to long-term symptoms, such as a headache that lasts for months.

Delayed Symptoms

Concussion symptoms can appear a few hours and even days after a concussion. Some symptoms may show up as much as a week after a concussion.

Even if your child seems fine after a short time, watch out for the following signs and symptoms:

  • Changes in alertness, such as difficulty staying awake, becoming unusually tired or having trouble paying attention
  • Difficulty concentrating
  • Emotional and behavioral changes, such as mood swings, irritability, a sudden change in your child’s personality and unexplained emotional outbursts.
  • Headaches, especially persistent headaches, and those that worsen over time
  • Losing consciousness
  • Memory problems
  • Nausea and vomiting
  • Sensitivity to light or noise
  • Trouble with balance and coordination, for example, unsteady movements, clumsiness and stumbling

When to Take Your Child to the ER for a Concussion

Concussions are always serious, but in some cases, the injury requires immediate medical attention from specialists at the closest emergency room (ER). Signs that a visit to the ER is necessary include:

  • Prolonged confusion
  • Seizures
  • Vomiting repeatedly
  • Worsening symptoms

At the ER, health care providers will perform a detailed physical exam, looking for visible injuries and symptoms, such as headaches and dizziness.

The ER team will also take your child’s medical history and ask about the incident and any previous concussions. The providers may order a comprehensive neurological assessment to test your child’s cognitive function, coordination, reflexes and responsiveness. They may also send your child for an imaging test, such as a CT or MRI scan.

Creating a Long-Term Plan for Concussion Recovery

In general, concussions heal in a few weeks. However, children require more recovery time from a concussion than adults, so help your child be patient during this process. Remind them that not taking enough time to heal could result in a more severe injury, including another concussion. The more concussions a child endures, the higher the likelihood of long-term damage to the brain.

Your child’s pediatrician can work with you to develop a plan to treat your child’s concussion. This plan will include plenty of time to rest and recover.

Gradually, your child will be able to return to normal daily activities, including sports, but only after you get the all-clear from their pediatrician or sports medicine specialist.

“Concussion management is a team approach, but the care is individualized to the needs of each athlete,” Miller said. “Unfortunately, injuries occur during sports, but how you respond is critical. Early recognition and treatment, with a supportive family and coaches leads to better outcomes and a quicker return to play.”

If your child took a baseline concussion test before the injury occurred, the goal is for their test results to be back to baseline levels.

Even after your child gets back on the court or field, you should monitor them for symptoms mentioned above. Symptoms that don’t go away or reappear after your child starts playing again could be signs of post-concussive syndrome, a rare condition that can develop in children who have had more than one concussion.

Trust your instincts when it comes to your child’s health. If you suspect a concussion, call our expert team now at 469-515-7100. We provide specialized care to ensure your child’s well-being and quick recovery.

Bryce’s Treatment is a Home Run

Bryce’s Treatment is a Home Run

by | Sep 30, 2023 | Sports Medicine

Header image courtesy of Eddie Kelly/ProLook.

When an injury threatened to keep Bryce off the baseball field for nine months, he and his family turned to Scottish Rite for Children to get him back in the game.

Bryce has always loved baseball. “I’ve been playing baseball pretty much ever since I could walk and get a ball in my hand,” he says. His mother, Johnette, first saw glimpses of Bryce’s outstanding athletic ability when he was 4. “When the other team was batting, it didn’t matter where Bryce was playing, he would go all over the field to get the ball,” she says. “He was kind of like a one-man-team.” Bryce started pitching when he was 8, and Johnette saw a drive and a passion that were unlike what she saw in other young athletes. When Bryce became a teenager, he played on select baseball teams, and he spent several summers traveling for games. Bryce’s drive and determination paid off his freshman year at McKinney High School when he made the varsity baseball team.

Like many star athletes, Bryce played several sports, and enjoyed football when he wasn’t playing baseball. Sport diversification can help prevent injuries caused by overuse, but unfortunately contact injuries are harder to prevent. In his junior year, he and his team had made it to the second round of the playoffs. During practice, to get ready for the big game, Bryce went for a block and, after contact, felt his arm go completely numb. “I thought it was just some bumps and a bruise because it’s football,” says Bryce. “So, I played that second round, and played every snap on offense and felt fine, but it turns out, it wasn’t too great.” The day after the game, he and a friend went to the baseball field to throw the ball around, but Bryce quickly realized that there was a problem. “I couldn’t even throw the ball five feet, because it was hurting so bad,” he says. 

Bryce had sustained a labral injury to his shoulder, which likely occurred when he subluxated (shoulder almost dislocated) or possibly dislocated (shoulder completely out of the socket) his shoulder. When the shoulder joint is injured this way, it can cause damage to the structures around the joint, including the labrum. The labrum is a ring of cartilage around the socket part of the ball and socket joint of the shoulder. When torn, the labrum is commonly thought to need surgery, but not always. 

Bryce,-MVP-(1).jpg

Initially, Bryce was told that surgery was necessary in order to return to sports and may take as long as nine months. This news devastated Bryce, so when his parents returned, they turned to the Scottish Rite for Children Orthopedic and Sports Medicine Center for another opinion. Pediatric orthopedic surgeon Henry B. Ellis, M.D., reviewed Bryce’s files and MRI, and felt that they could get him back to baseball with physical therapy instead of surgery. He felt with proper rehabilitation (physical therapy) and allowing enough time to allow the labrum to heal, Bryce could avoid a surgery and possibly be back to baseball sooner. However, this did mean that Bryce would have to give his shoulder enough time to heal before throwing a ball again.

Though encouraged by the option to avoid surgery, Bryce remembers being a little shocked at how difficult physical therapy was from the start. “It kind of killed my confidence a little bit and frustrated me, because I’ve always played a lot of sports and I always want to be the best that I can be. But once I saw improvement in how my body and my shoulder felt, I finally started getting back my confidence, so it was good.” Scottish Rite coordinated with the McKinney High School athletic trainers on a program to get Bryce back on the field as soon as possible.

Bryce was cleared to play in February, right before the team began preparing for the upcoming season. After all the hard work he had put into building back his shoulder, he was very excited to be with his team again. They were glad to have him back too – in Bryce’s first week back, he hit three home runs. Things were going great until COVID-19 forced an early end to the season. “All this is a little different,” says Bryce. “It’s like a curveball being thrown at us. But you just have to adapt and be able to adjust and focus on what you are there for.”

Bryce has complete confidence in his shoulder now. “I feel like I can do anything and everything that I’ve always been capable of doing,” he says. “If it wasn’t for Scottish Rite, I wouldn’t be where I am now.” Bryce recently verbally committed to play baseball at Northeast Community College in Mount Pleasant, Texas, and plans to continue his journey to Major League of Baseball.

Bryce is very grateful to Dr. Ellis. When others were recommending surgery, Ellis presented the pros and cons of a nonoperative plan. Bryce says he learned a lot from his experience. “When you go through hard times, you always have to keep your head straight and focus on the main goal, because you are going to go through ups and downs, but you just have to focus on the end result, and that was big for me. Not focusing on the negatives, but on getting back to where I needed to be.”

 

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