Concussions - What to do?

Ready or not, the school year is here! I know my kids are excited to get back to the school year routine and the academic, extra-curricular and social opportunities that come with each new school year. At San Luis Valley Health Pediatrics Clinic, we are busy seeing kids for their yearly physicals and sports physicals, and I’m thrilled to see so many kids participating in after school activities. Kids that participate in after school activities do better in and out of the classroom, using the skills, confidence and social networks that they build through these activities to achieve higher grades, move on to college and avoid temptations to engage in unsafe activities. So thank you, parents and families, for getting your kids to and from all of these activities on a day to day basis and thank you, to schools and community organizations, for continuing your financial commitments to keep these activities available to our kids.

With active kids comes the risk of injury though. Muscle and bone injuries are well cared for by our Orthopedic and Physical Therapy teams but when it comes to concussions, we in Pediatrics and Family Practice clinics are your go-to providers.

At San Luis Valley Health we have been working to bring state and national standards for concussion care to our youth here in the San Luis Valley. Adams State University has a very good plan of care for concussed athletes at the collegiate level so our athletes at the high school level have been our focus with the ultimate goal of expanding these systems of care for our athletes at the middle school and youth levels as well.

A concussion is a bruise to the brain. It can be caused by a hit to the head, by another player or an inanimate object like a floor or wall, or a whiplash-type injury to the neck. Like any other bruise, a bruised brain requires time to recover and protection from re-injury while recovering. It is important to know that concussion is not defined by loss of consciousness and that in the heat of play an athlete may not immediately have symptoms concerning for concussion. Athletes that are allowed to continue to play with concussion, or allowed to return to play before complete resolution of concussion, take twice as long to recover (on average 6-8 weeks vs 3-4 weeks) suffering from headaches, dizziness, fatigue, irritability, difficulty concentrating and sleeping that cause problems at home, in the classroom and on the field or court.

Untreated and repeated concussions are even more concerning putting our athletes at risk for two things:
1) Chronic Post Traumatic Encephalopathy, which is an irreversible brain injury that, on the autopsy of professional athletes that suffer death from other causes, is an actual loss of brain matter that results in loss of cognitive function but also memory and emotional regulation.
2) Second Impact Syndrome, which is a diffuse swelling of the brain that occurs in the setting of a second injury to the brain without a prior brain injury resolving and while rare, can be fatal. In Colorado, the Jake Snakenberg Youth Concussion Act of 2012 was the result of a freshman football player at Grandview High School who died in 2004 of second impact syndrome and locally, Monte Vista High School’s football field is named after 17-year-old Adrian Gutierrez who collapsed during a game with Alamosa in 1991 and died 5 days later from second impact syndrome.

I believe that it is our duty as spectators, parents, family, friends, coaches, athletic directors and academic personnel like teachers and principals to:
1) recognize that concussions are real and serious injuries,
2) be knowledgeable about the mechanisms of injury that lead to concussions and to protect our youth athletes by removing them from play and not allowing them to return to play until they have been evaluated by a medical provider knowledgeable about concussions and current on recommended care of concussed athletes as supported by organizations such as, but not limited to, locally, Children’s Hospital Colorado and Colorado High School Activities Association, nationally, American Academy of Pediatrics, American Academy of Neurology, American Medical Society for Sports Medicine and internationally, Concussion in Sport Group, and
3) support concussed athletes in their return to the classroom and athletic commitments in a standardized and supportive way that ultimately promotes their safety and success.

Research is leading to improved education, identification, treatment, and prevention of concussion in our professional athletes and as I said, has made its way to the collegiate level. It’s our duty as parents, coaches, and communities to expect that for our high school, middle school, and youth athletes as well. My dream is that every school-aged student will have a yearly physical done with their regular care provider in what we call their “medical home.” During that yearly physical, a provider will not only evaluate their growth and development but also screen and educate for things like concussions.

Good luck to all our athletes this year and just let us know here at San Luis Valley Health if you have any concerns or needs related to concussions or any other topic.

Mikaila Pence, MD, San Luis Valley Health Board Certified General Pediatrician and Credentialed ImPACT Consultant (CIC)