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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 MSL.Frisco@tsrh.org. 

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)

Getting Back to Action: The 6 Stages of Concussion Recovery

Getting Back to Action: The 6 Stages of Concussion Recovery

by | Oct 18, 2023 | Sports Medicine

If your child sustained a concussion in a recent game or practice, recovery won’t happen overnight. There are six stages of concussion recovery necessary before returning to action.

A young athlete might think of a concussion as simply a sports injury, but because it involves the brain, a concussion is more complex. A concussion is a traumatic brain injury that occurs after a blow to the head or a hit to the body causes the brain to move back and forth within the skull. 

While a concussion can occur during any type of activity or simply when you bump your head on a bathroom cabinet, it’s more likely to happen when playing sports, such as football and soccer. These contact sports pose a high risk of physical injury, which, unfortunately, can involve your child’s head.

Recovering After a Concussion

After a concussion, your child may want to get back to the court or field quickly, but it’s essential to be patient throughout the full recovery process. Prioritize rest and quality sleep during this time since both will help your child’s brain while they recover.

As your young athlete begins feeling better and symptoms, such as headache and sensitivity to lights or sounds, disappear, a medical provider may recommend a gradual return to normal activities. Encourage your child to listen to his or her body and resume activities as able but not to overdo it. 

If your child’s concussion symptoms linger or get worse, it’s important to talk with a medical provider. Physical and mental symptoms that don’t go away can be a sign of post-concussion syndrome, which can last for weeks or even months. 

When will your child be ready to get back in the sports action? Full recovery isn’t always obvious, and working with your child’s doctor, coach and an athletic trainer, if one is available, is crucial to ensuring your child returns to sports safely.

Generally, concussion recovery follows these six stages.

Stage 1: Back to Regular Activities

In the initial days after a concussion, your child should not return to sports. Normal activities, such as work or school, may be OK, if your child’s medical provider says so. Your child may only tolerate a few hours of school, so keep an eye out for symptoms. 

Stage 2: Light Aerobic Activity

After a few days without symptoms, your child may receive clearance to participate in brief bursts of gentle physical activity to increase his or her heart rate, such as short walks. Avoid weight-lifting at this stage.

Stage 3: Moderate Activity

The next step for recovering from a concussion is progressing to moderate activities that increase your child’s heart rate and involve body and head movement. Activities may include jogging or slow running, along with moderate-intensity weight training.

Stage 4: Heavy, Noncontact Activity

At this point of your child’s concussion recovery, your child’s provider may say it’s acceptable to participate in activities, such as sprinting, weightlifting or noncontact, sport-specific workouts. 

Stage 5: Practice and Full Contact

If your child has progressed through the first four stages without a return of symptoms, his or her provider may give the all clear to participate in contact activities in a practice setting.

Stage 6: Competition

Once your child has participated in sports practices without a return of symptoms, he or she may be approved to return to actual competition. Be careful, though. Having one concussion makes your young athlete more susceptible to future concussions, so talk with the team’s coach or athletic trainer or your child’s provider about precautions your child should take to prevent another head injury.

The Bottom Line on Concussion Recovery

Returning to sports isn’t as simple after a concussion as after a sprained ankle, for example. Head injuries need to fully heal before your child returns to activities, and you should work closely with a health care provider to determine when to move through each recovery phase.

As your child recovers after a concussion, carefully follow the treatment plan outlined by your medical provider. If your child progresses and then his or her symptoms return or new ones develop, hit the pause button and seek medical attention.

After a concussion — and even if your child has never had one — take precautions to protect your athlete’s head and avoid future concussions. Be sure your child uses the required sport-specific protective gear, including a well-fitting helmet. If your child damages his or her helmet during a game or practice, replace it. A helmet that’s cracked or broken can be ineffective.

Baseline testing before your child’s sports season can be another helpful step to discuss with your child’s pediatrician or coach. This type of evaluation provides valuable information that can be used to determine the extent of a head injury if one occurs.

It’s also a good idea to familiarize yourself with the signs of concussion and to talk through them with your child. A medical provider should promptly check out any symptoms after a hit to the head.

Is your young athlete recovering after a concussion? Call 469-515-7100 to discuss your child’s care.

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.