Concussions

On this episode of the podcast/newsletter, we welcome Dr. Luke Berghoff. He is a sports medicine physician specializing in non-operative orthopedic care, which just so happens to include managing a lot of concussions. We thought he would be a great guy to sit down and have a chat with to sort out this topic. We thought a lot of parents would find this conversation helpful.

Concussions can be tricky for a few reasons. First, there are no diagnostic tests (such as an MRI, CT scan, or blood test) that confirms that you officially have a concussion. It can really be boiled down to 2 questions: 1) Did you hit your head? and 2) Are you having symptoms other than the immediate head pain when you hit your head? The list of signs and symptoms is long and includes: dizziness, confusion, loss of consciousness, balance issues, vomiting, fogginess, headache, blurred or double vision, light and/or noise sensitivity, etc. This leads to the other issue why concussions can be tricky, and that is being sure to find a specialist that can manage these cases effectively. We have heard stories of how a kid ends up at their doctor and they simply ask a few questions, tell them they have a concussion, and instruct them to simply take a few weeks off and they’ll be fine. The science of concussions has advanced and we can offer much more guidance now.

We discussed this study about when an athlete should be pulled out of their sport and how recovery can be significantly longer if this is not done. It led to a discussion on how we are handling these issues much better now. In the state of Indiana, if there is a suspicion of a head injury, you need to be cleared in order to return to sport participation. Also, the school trainers are pretty good about pulling kids when they suspect something. Dr. Berghoff also echoed that concussions are very treatable, and if treated appropriately, a full recovery should be expected (see this study).

So what actually happens in the brain with a concussion? Essentially, when the brain shifts inside of the skull, the membrane to the neuron will stretch. Then, potassium will leak out of the neuron, and calcium will go in to the neuron. This calcium influx causes decreased cerebral blood flow (vasoconstriction). This is not a good thing to happen at a time when the brain will be needing more energy. Thus, there is an energy mismatch happening in the cells and this can lead to different areas of the brain compensating. It could manifest as vestibular symptoms, ocular symptoms, mood symptoms, cognitive symptoms, etc.

Being seen sooner after a head injury is generally advised, as opposed to later. High school aged kids have an expected recovery of 2-3 weeks. Elementary and middle school kids, it’s more like 3-4 weeks. Dr. Berghoff did a great job of walking us through his exam process. It starts with an extensive questionnaire and a cranial nerve exam. Then he does a series of eye movement evaluations where the eyes are holding fixed on an object or perhaps tracking between things in a smooth manner. Finally, he evaluates the patient’s balance in a few different ways. This is what a proper concussion evaluation should look like.

Finally, what does management of a concussion generally look like? Dr. Berghoff states that usually for the first 24-48 hours, he just has the patient take it easy. Rest and limit phone use and screen time. Switch to calling and texting instead of video chatting where you are starring at a screen. Also, watch an actual T.V. instead of an IPad or phone screen. At about 48 hours or so it is ok to go to school and get a little stimulation, but just be able to take frequent breaks as needed. This is where a note from the doctor will come in handy and help guide the patient through school activities. Also, 30-40 minutes of light cardiovascular exercise per day is also recommended and has shown benefit. So the days of just sitting in a dark room for a week and not doing anything are gone. Using your brain as able and getting some light exercise is what is advised. When it comes time to return to sport, there is a gradual 5-6 stage return to play protocol that is given.

We really appreciate Dr. Berghoff taking the time to walk us through proper concussion management!

Listen to the full conversation here… Apple  Spotify  Google  Amazon

Simplified Takeaways…

1. Concussions are very treatable, especially when managed appropriately.

2. If there are symptoms, try to get in with a specialist as soon as possible.

3. Going to school to get some stimulation (with breaks as needed) as well as light cardiovascular exercise are part of the management of concussions.

4. There are no diagnostic tests (such as MRI, CT scan, or blood test) that confirm a concussion. That is why proper evaluation is important.

5. Recovery from a concussion for high school aged kids is about 2-3 weeks.

6. What are the big symptoms that should prompt a parent to take their kid to the ER instead of waiting for an appointment: Ataxia (trouble with walking or general coordination), Vomiting, slurred speech, or an inability to keep their eyes open. These were the big 4.

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