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00:02 Jayme Monacelli: This is Med Talk presented by HCA Midwest Health. I'm Jayme Monacelli with Dr. Lori Boyajian O'Neill, Sports Medicine Specialist at Centerpoint and Overland Park Regional Medical Center. We're talking concussions today. According to the Centers for Disease Control and Prevention, up to 3 million mild-to-moderate sports and recreation-related concussions happen each year in the United States. Most of the people experiencing those are young men between the ages of 16 and 25. Although most of those athletes will recover quickly and may never lose consciousness, others may experience physical, cognitive and neuro-behavioral difficulties, related to the injury.

00:39 JM: Dr. Lori, these statistics on concussions are pretty scary. I know when we grew up, the word concussion just didn't exist. In fact, I remember hearing, "He just had his bell rung." How do parents or coaches know if their child or athlete had a concussion? And what are the signs or symptoms they should be looking for? 

00:55 Dr. Lori Boyajian O'Neill: Well, you're absolutely right, the statistics are frightening, and as more and more research is done, and we learn more about the prevalence, the incidence of concussion, it is very frightening. I think that you touched upon something that's really important, the recognition of a mild traumatic brain injury or concussion is so important, and there's a lot of information out there related to how a person with a concussion presents and how they behave, and everybody's a little bit different. Headache is the most common symptom. Some folks don't have a headache. So one of the myths of a concussion is; if you didn't have a headache or you don't have a headache it's not a concussion, when we know that that's not true. Also, symptoms evolve, so you may have an incident where you don't have a headache right off the bat, but as days go by, the headaches develop.

01:47 DO: Another myth of concussion is loss of consciousness. So, most folks with concussion do not have a loss of consciousness. So a myth goes something like, "Well, if you didn't get knocked out, you don't have a concussion." When we know that that's not true. So, headache is the most common symptom related to concussion, but there can be other physical symptoms that are very common that you can look for, headache, dizziness, light-headedness, light bothering you, sound bothering you, balance problems, those are all very common. And so, if somebody needs assistance standing up to get their balance, after they've had a blow to the head or sustained some other force that goes through their body, maybe a bobble-head effect that can also cause them to have a shaking of the head, which causes the brain injury, the concussion, that's not normal to have somebody have to help you up. That's not normal to stand up and be dizzy, and have to catch yourself, touch a wall or touch a table or a teammate to catch your balance. So those are common physical symptoms related to a concussion.

02:55 DO: Other cognitive symptoms include difficulty with memory, focus, concentration, attention, easy distractibility, changes in mood, more emotional, maybe tearful and you don't know why. Crying and you can't stop yourself, more angry, more irritable, less patient, more nervous or scared, more sad. And then changes in sleep, very common, sleeping all the time and you're still tired, exhausted but you can't fall asleep. You fall asleep alright, but you're up all night. And so, this is a pattern or a picture of what a concussion looks like. No two concussions are alike. Everybody responds differently. But what parents can watch for are changes in those ways, kids complaining of these physical symptoms that I just mentioned, parents observing other changes in mood, in sleep, in thinking. Maybe the child complains that they're having more difficulty with homework or difficulty with reading. Those are the types of things to look for.

03:58 JM: I wanna talk about sports for a minute, because it's a question that we get a lot about what sports maybe are better for kids if you have kids that really wanna play sports. I have a lot of my friends that are new parents that are worried about letting their kids play football or might be worried about one sport or another. If parents are listening and have kids that wanna play sports, are there sports that you would steer them more or less toward, based on the possibility of a concussion? 

04:21 DO: Well, we are big advocates for sports and recreation participation. That goes hand in glove with overall well-being, from walking to cycling, to team and competitive sports, I think it's very important. And I think that the American Academy of Pediatrics, the American Osteopathic Academy of Pediatrics, family medicine organizations, etcetera, all promote sports and recreation as really important to overall emotional development. And it's just a lot of fun.

04:52 JM: It is.

04:53 DO: Good physical. But the questions arise, what's a safe sport and what's not? Probably no sport is particularly safe. You can overdo anything, from walking and stress fractures and running and stress reactions and stress fractures. But the collision and contact sports, like football and lacrosse and rugby, are known to have much higher incidence of concussion. And so, those are sports that you see on ESPN. Those are sports that you read about in the paper, when athletes, youth or elite athlete, professional athletes have concussion and can't play, and that becomes headline news, and football is front and center to that. And a lot of the initial concussion awareness came through football. And so there is a lot of discussion about youth football. There's a lot of discussion about when there should be tackle in football. Similarly, in hockey for example, there's a lot of discussion on when there should be checking, for example, when there can be collision and contact aspects to sports as kids advance from early sports, when they're very young, to more advanced, maybe more competitive sports, as they get older.

06:10 JM: Let's talk about concussions outside of sports. I've heard a growing trend of everything from playground accidents to the e-scooters that are so popular now.

06:18 DO: Yes. We are seeing a lot of concussions related to e-scooters, and primarily it's because people shouldn't be on scooters to begin with, and it looks so much fun in your downtown whether that's Kansas City or Atlanta or Denver or wherever, and it looks like great fun, and you hop on that. I tell my patients in the clinic, "You don't have a skateboard till the neighbor boy brings it over and it just looks like it's so much fun, it's too tempting." So if you have no training on a skateboard, don't get on it. It does look like fun, and it's great fun to watch somebody who knows what they're doing, be on a skateboard, be on roller skate, be on a hoverboard or an e-skateboard type thing, but don't do it. It's just too risky; it's too risky. If you wanna get some training on it, and get some classes or some teaching, fine, but that impulsive, I'm gonna hop on that, often ends up not well.

07:11 JM: We hear a lot about pre and post-concussion testing. What exactly is that? And when should a child or athlete have a test like that? 

07:20 DO: I think what you're really referencing is a software program that provides information about how a child or an adult, for that matter, thinks, in the way of memory, focus, concentration, word memory, design memory, how they're processing information that comes their way in a series of exercises on the computer. It takes about 25 minutes or so. There are a couple of software programs out there that do this. Impact is the most common. It was developed at the University of Pittsburgh, and we've been using it for over 15 years. It is a nice tool for us to have. When we are examining a person who has a concussion, we can make comparisons between how they were thinking before the concussion and how they are thinking now, in a way that we can get data that we can't otherwise obtain. The benefit also of having like a pre-concussion type of test is the education piece that should come with that.

08:24 DO: These tests that are often given with groups of folks, teams can come in and maybe the entire team's getting tested at once, those are good. But in the context of, are they learning about what a concussion is? Going back to what you said earlier. Can we have a situation where we can identify concussions more readily, whether that's a parent, or a coach or a teammate? So when a team comes in to get tested through our pre-concussion program, the most important thing, in my view, is not the test itself, but it's the education piece that those kids get before they even sit in front of the computer to take their baseline test, so they can learn how to recognize a concussion in themselves and in teammates. So in themselves, maybe they'll be quicker to say to a coach or say to a parent, "I'm feeling this way and that way." "I got hit, and now I feel this way." And it will bring to mind, "Maybe I have a concussion?" Or, if they see in a teammate some confusion or they don't just... They're not speaking correctly in a huddle, for example, or on the sidelines, maybe they think that kid is off. Maybe they will be a good teammate. Maybe they'll show leadership, and talk to a coach or talk to a parent.

09:37 JM: This has been Med Talk presented by HCA Midwest Health. I'm Jayme Monacelli.