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Concussions in Adolescents/Young Adults

Concussions in Adolescents

What we know

  • Repetitive concussions may have serious consequences over a lifetime
  • Consecutive concussions prior to resolution of previous concussion may have detrimental long-term effects
    • Called Secondary Impact Syndrome
  • Most Concussions do not involve loss of consciousness
  • Many concussions go unreported, increasing the risk of repeated traumas
  • Youth injuries (5-14) are most often sports/bicycle accidents 
  • Children and adults experience the same post-concussive symptoms (DeMatteo, 2015)

Symptoms-Headache (71%), Distractible (57%), Memory Dysfunction, Dizziness (55%), Fogginess (53%), Sensitivity to light, Fatigue (50%), Blurred vision. 

Youth Legislation

  • H.R. 469 (2011) protects student athletes from concussions.
  • Each state required to develop a standard plan for concussion safety
  • All states have sports concussion laws as of 2014

Return to Play Protocol-Zurich Method

 

  • Student athlete needs to return to the classroom first!
  • One stage per day minimum without recurrence of symptoms

Stage 1-Cognitive rest-No TV, texting, computer. Resting stage until symptoms are free (at least 1 week.)

Stage 2-Stationary bike, TM (10-15 mins), low level activity

Stage 3-Mod exertion, more running drills. Sport specific activity.

Stage 4-At least 30 mins continuously, more cognitive load. Weight training. 

Stage 5-Allowed contact in practice for the first time. 

Stage 6-Has to be cleared by the physician before returning to game activity.

Current Multiple-Concussion Return to Play Guidelines

  • Positive neuroimaging for 2 or more concussions= 3 months off contact sport
  • 2 concussions in 3 months= 6 months off contact sport (From latest injury)
  • 3+ concussions in 1 year=1 year off sport and retirement consideration

References

  • www.Vestibular.org
  • https://www.congress.gov/bill/112th-congress/house-bill/469
  • Field, M, Collins, MW, Lovell, MR, Maroon, J. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J Pediatric. 2003;142:546-553.
  • Toledo, E, Lebel, A, Bercerra, L. The young brain and concussion: imaging as a biomarker for diagnosis and prognosis. Neurosci Behav Rev. 2012;36:1510-1531
  • DeMatteo, Carol et al. Development of a Conservative Protocol to Return Children and Youth to Activity Following Concussive Injury. Clinical Pediatrics. 2015 54(2) 152-163. 
  • Leddy J et al.  A Preliminary Study of Sub symptomatic Threshold Exercise Training for Refractory Post-Concussion Syndrome. Clinical J of Sport Med 2010
  • Burke, C. Stony Brook Neuro Concussion Assessment, 2017

About the Author - Nick Lacey

Nick grew up in New Jersey and attended New York University for undergrad. His NYU club baseball teammates are still some of his closest friends. After 3 years working for HBO sports in television production, he decided to return to school for a DPT degree. A 2018 Stony Brook graduate, he is new to Southern California. His clinical interests include orthopedics and neurological disorders of movement. When not in clinic, you can find him bouldering, playing ukulele on the beach, reading and going on the occasional run.