Host Bridget talks with Dr. David Marshall of Children's Healthcare of Atlanta about severity, treatment and prevention when dealing with concussions in contact sports.
Bridget Snapp: Oh! That looked like it hurt, you know that guy is on the way to the doctor, but what about the less serious-looking head injuries. Today in ClubHouse GAS, we're going to find out what a Concussion is, what signs to look for, and how to treat them. Today, I'm here with a friend of the show Dr. David Marshall, Director of Sports Medicine at Children's Healthcare of Atlanta. Welcome back Dr. Marshall! Dr. David Marshall: Thank for having me. Bridget Snapp: Thank you so much. So, of course, we're now in the middle of football season. It is going on live and you're watching those guys, and they are just getting knocked down, time after time. Our first thing here today is, how common is it for them to be getting the Concussions? Dr. David Marshall: Well, unfortunately, concussions are lot more prominent than we thought. Back in the olden days, Concussions was to be fined as losing consciousness. If you didn't consciousness or didn't get knocked out, then you probably didn't have a Concussion and nowadays that is just not true. The kids severe --Concussion can range anywhere from just kind of feeling in a fog for a brief period of time such as seconds to getting knocked out and having to be rushed to the hospital. More of the terms that was used long ago, and still sometimes now is the bell ringer that coaches or kids will say, no I've never had a Concussion, but have got my bell ring 12 times, and a bell ringer getting ding definitely is a Concussion. Bridget Snapp: Okay! So what are some of these symptoms we want to look for? Dr. David Marshall: Well, the most common symptom that a kid that is Concussed will have is a headache. About two-thirds to three quarters of them will complain of a headache, usually, shortly after the injury, and sometimes lasting weeks, sometimes months, called the Post-Concussion Syndrome. Other ones are feeling slowed down, I've heard kids describe it is like being it from the Pentium 5 to a Pentium 2, they just seem to process information at home and school a lot slower. They feel like they're in a fog. They might feel dizzy or light-headed at times. Bright lights and loud noises will bother them. They have trouble processing the math or trouble doing calculations or concentrating on their homework. They just feel like they're not quite right. Often times, difficulty in sleeping. These kids have trouble sleeping in night, because of the way that they feel. Bridget Snapp: So these symptoms can last for a while post game. Dr. David Marshall: They can last, like I said, minutes, and they can last weeks to sometimes months. Bridget Snapp: Okay, say you're the coach or the parent, you've noticed some of these symptoms, they are dizzy to having hard time focusing, what are kind of the steps you want to take if you're noticing this in the kids? Dr. David Marshall: Well, the first thing you need to do is make sure that kid gets taken out of the game. You certainly do not want to take an athlete that's still --whose brain is still trying to recover from a Concussion and send them back out in for the game and get a second Concussion. That can be really devastating. That can lead to death. There is a thing called a Second Impact Syndrome and that is probably, the main thing that we're doing to try to prevent problem with Concussion. We've tried to prevent the Second Impact Syndrome. If you ever hear the tragic event where a boxer on TV gets knocked around, they get up and they wind up dying in the ring or in the ambulance right on the way to the hospital. They die, that is because of Second Concussion Syndrome. Their brain was unable to recover completely before it suffered another blow. This is what we need to prevent with all athletes. Bridget Snapp: So whether they just got their bell rung, even if it looks like very slight head injury --it is absolutely imperative, do they see their doctor, what do you recommend? Dr. David Marshall: Well, that depends. Years ago, we would divide or we would class Concussions based on grades. The most simplest classification was grade one, grade two, grade three. A grade one Concussion was where your symptoms lasted for 15 minutes and they completely went away. The doctors on the sidelines, the athletic trainers on the sidelines have a battery of tests that they put these athletes through. If they pass the test and the symptoms don't recur and they have normal memory, they can process, they can do simple math, they remember everything around the time of the injury and then with exertion, they still don't have return of symptoms, we'll let that athlete go back. That was termed a Grade 1 or a Mild concussion, or you might have an athlete whose symptoms persist, for over 15 minutes, and that athlete cannot go back to play, and often times it require medical clearance from their doctor to determine return to play. Nowadays, it really doesn't matter what grade it is. We're learning maybe memory loss or losing the memory of the details around the time of the injury. That might be more important than loss of consciousness. And it is kind of hard to determine that with an athlete, specially if you don't see them all the time or don't know them. So really, the important thing is, recognize that the athlete isn't functioning properly. They just don't feel right, they don't look right. Label them as having a Concussion, and then hold them out until all symptoms clear, whether it is within minutes or within days, hours, or weeks. Bridget Snapp: Okay. Then finally, in terms of prevention, what can coaches or parents or even athletes themselves do? Dr. David Marshall: The first key to prevention with Concussions is you have to recognize. Of course, we can't prevent all Concussions in sports that are collision sports such as football, in soccer, lacrosse, ice hockey, where collisions are part of the game, you can't prevent them all. You can't prevent ankle sprains, you can't prevent all collarbone fractures, you can't prevent Concussions. What we need to do is educate people at all levels, from the athletes to the coaches to the trainers to the doctors to the administrators to the parents, everybody needs to be aware that these mild forms of head injuries are indeed Concussions. So educating athletes and teams at all levels is the first step. Kids need to understand and coaches need to understand that if you're still having signs and symptoms of a Concussion, even if they seem mild, you really should not return to play. You can certainly put yourself at higher risk of suffering another Concussion with a lesser blow, the symptoms are going to last a lot longer if you don't fully recover. The effects of a Concussion might be cumulative. In other words, these athletes who suffer multiple Concussions might actually be losing brainpower. They might be actually losing IQ points in the long run. That research is still underway, but these are all concerns that we have about kids going back too soon that have been Concussed. Bridget Snapp: What about some kind of protective headgear? Dr. David Marshall: Yeah, some sports require headgear such as football and ice hockey and things like those sports, they require them, and the headgear always seems to be ever-changing, seems like every year or two the football how much change their shape, they change the padding. Nowadays they have air cells in the helmet to provide a nice cushion of air around the brain to help protect it. There has been some talk about soccer players, soccer players wearing headgear to prevent heading a heavy leather ball. Even rugby players, they're starting to wear headgear now to provide a little of padding around the head, maybe to decrease the risk of a Concussion. And another thing that is kind of new nowadays is, there is neuro-cognitive testing that kids can do. One thing that we recommend is the athlete takes these tests before the season starts, it is called a baseline or a pretest, so we can see how they function normally. And then when they get concussed, they can take a series of tests at day 3, day 5, day 7, day 14, until they're completely resolved. That way we can check how their brain is actually functioning. It is a 28-minute test on the computer that tests memory, processing speed, spatial arrangements, problem solving, and we can get a pretty good idea of how this kid's brain is functioning. So we're recommending the kids have a pretest and then have access to that testing after they do suffer a Concussion if they do. Bridget Snapp: Alright. So we've got the pre-testing, we've got some protective gear, and most importantly just monitoring these kids. Dr. David Marshall: There is a need to educate, people need to be aware that when you have a decrease in your ability to process from a blow, that is a Concussion. Bridget Snapp: We thank you for educating us here today. Dr. David Marshall: Thank you! Bridget Snapp: And we'll talk with you again soon. Dr. David Marshall: Thanks! Bridget Snapp: Alright, thank you for watching this edition of ClubHouse GAS. We'll see you next time.