Concussion treatment continues to evolve
As the problem grows for the younger generation, OHSU is performing cutting-edge research
You need a sturdy constitution to participate in contact sports.
Helmets crash each weekend in National Football League games that attract millions of fans each year. Autumn fog and rain seldom keeps fans away from the fun and tradition of Friday night high school football. Yet numbers show an uptick in the number of concussions suffered by our youth. Findings announced this summer at the American Orthopaedic Society for Sports Medicine revealed a 60 percent increase in concussion incidence among people ages 5 to 24 from 2007 to 2014.
A doctor who practices in Portland keeps his eyes trained on concussions. Dr. James Chesnutt is a sports medicine physician who is also medical director of the Oregon Health & Science University concussion program. Chesnutt says concussion is a growing problem among our young population.
"Yes, there are more reported concussions amongst youth," he said, noting that concussions can be found in boys' sports such as football, lacrosse and hockey. "The girls' sports that have the most concussion are, basically, girls' lacrosse and girls' soccer. Those are sports that are supposed to be non-contact (no helmets). Girls tend to collide with girls more commonly in high school sports, then, also, knock each other to the ground. That seems to be one of the reasons that girls have a higher concussion rate than boys (comparing girls' and boys' high school soccer)."
Symptoms of concussion can include pain (headache), balance dysfunction, vision problems, cognitive problems and sleep difficulties. After the initial injury, an assessment (for instance on the football field) includes testing a number of factors, including eye function, balance function and motor function. Memory and hand motions can be examined.
Chesnutt, who is also co-director of the Oregon Concussion Awareness and Management Program, "Yes, there is an alarming number of kids that are getting concussions," he said. "I think we need to pay a little more attention as parents and coaches and, hopefully officials, of decreasing the aggressiveness in sport that's associated with concussion."
In soccer, for example, Chesnutt sees a concussion risk with the act of heading the ball. A player could be knocked over, thrown to the ground or receive an elbow to the head. "That's when people get concussions," he said. "We also know that head-to-head contact in football is associated with concussions."
Sounding an optimistic note, however, Chesnutt added there are approved methods of coaching that are associated with less helmet-to-helmet contact.
"Area schools are doing a good job," Chesnutt said, pointing out that some schools are a little more in tune with the problem than others. He said there's work at the state level to improve the standard of care of concussions, such as removing a player from the field and finding appropriate medical care. But before a player returns to play ball, there needs to be a "return to learn."
"One of our big focuses right now with the Oregon Department of Education as well as the Oregon School Activities Association is to focus on a 'return to learn' program that helps the student athlete get back to school appropriately, before they get back onto the field," he said.
"We don't want to delay the return to play — academics are very important and we want to make sure there's a process by which the academic accommodations are given to students early in an equitable manner."
Looking ahead, Chesnutt sees advances that could further help concussion patients.
"I think I'm optimistic that we're soon going to be able to correlate the biology of what's going on through the clinical outcomes," Chesnutt said, pointing out more sophisticated biomarkers are becoming available. "Imaging is becoming more sophisticated."
He notes better neuroanalytics are being developed, which are objective measures of neurologic dysfunction, such as testing for balance.
According to Chesnutt, "I always say we should treat concussions as well as we treat sprained ankles. You rest them (ankles) a little bit, we get back on them, start exercising and rehabbing and get them strong. Then you get back, as soon as possible, without reinjuring."
FACTS ABOUT CONCUSSIONS
Concussion is a change in brain behavior after a force to the head that could include changes in mental function, in balance, in vision, in your mood, in your sleep patterns, in a variety of areas.
The brain is affected by impact to the head. Cells do not function properly after concussion and there's an abnormal chemical environment in the brain.
The brain recovers by re-wiring around some of those injured areas; it can take time to heal if it's a significant injury.
There have been thousands of medicine trials for brain trauma. None of them have been particularly helpful in affecting concussion recovery.
For concussion patients, early rest is effective, as well as a re-introduction to activity early without risk of getting your head hit. Aerobic activities are helpful. Sleep is helpful.
— Dr. James Chesnutt