Rest is the best medication for concussions

Please note: This is the third of three articles on concussions in athletics. The two previous articles on concussions could be found on Greenwich-post.com.

When in doubt, sit it out.

Those words are exactly what people throughout the medical community say when it comes to concussions.

For athletes everywhere, performing their best is a top priority, even if it means playing through pain. In high school athletics, the pressure is consistent on athletes to play at their peak in an attempt to obtain that scholarship or get that scout to watch them compete.

“However, they don’t realize that if you have a concussion, you’re not going to play a good game for the scouts,” ONS Specialists’ Dr. Scott Simon said. “Also, you’re not going to be able to perform academically well. So it’s in their best interest to give it a rest. Concussions are a part of the game, whether it’s in gymnastics or field hockey or lacrosse or football. The more the kids push, the longer the recovery. Also, if an athlete doesn’t recover fully from the first concussion, the athlete is more susceptible to a second concussion.”

After a concussion, the student athlete and parents might have more questions than answers. What should I do? How do I get rid of the symptoms? Can it get worse? When will it get better?

A test to aid in determining when an athlete can return to the playing field is the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Locally, Greenwich High School, Brunswick School, Convent of the Sacred Heart and Greenwich Academy all participate in ImPACT testing, which is a 20-minute neurocognitive test done online by student-athletes prior to the start of the school year and used as a baseline.

According to Impacttest.com, the evaluation measures the student’s attention span, working memory, sustained and selective attention time, response variability, non-verbal problem solving and reaction time. When athletes sustain a concussion, they can only get back on the playing field when they retake ImPACT and it matches the baseline exam.

While ImPACT testing has greatly aided in giving the athlete enough time to recover before retaking the field for competition, Dr. Tricia McDonough Ryan, a practicing neuropsychologist and consultant to the ONS Foundation, believes the test is overused.

“It’s key to know that ImPACT should never be used for children under 13,” Ryan said. “In younger kids, the brain is developing so fast that you don’t know what the normative data on it when you compare kids at that age. There isn’t a lot of normative data on younger kids. The ImPACT testing was developed for professional athletes. Any kind of cognitive testing is age appropriate and ImPACT testing isn’t age appropriate for middle schoolers and below.”

In addition to athletes who are too young for high school, Ryan stated that ImPACT testing is not a good measurement for any youngsters with learning disabilities, attention deficit disorder, children who have anxiety or who have had multiple concussions.

“You can be anxious and do poorly on ImPACT testing when you’re actually fine,” Ryan said. “I just worked with a professional skier who was being held out of skiing because ImPACT testing was showing that she failed her test. When I did more advanced neuropsychologic testing of cognition, she was fine. She was just more anxious that she would fail the test. When you’re anxious, you don’t perform. ImPACT testing can be a good tool, but it’s to be used with caution.”

According to Ryan, there is going to be a pediatric ImPACT that will become commercialized within the next few weeks and could be used with kids 13 years old and younger.

“Kids should see a pediatric neuropsychologist to get a baseline that includes balance and previous symptoms,” Ryan said.

According to Ryan, there is going to be a pediatric ImPACT that will become commercialized within the next few weeks and could be used with kids 13 years old and younger.

Ryan stated that some people think that putting the athlete into a dark room for five to 10 days helps. However, that couldn’t be further from the truth.

“That’s strongly not recommended,” Ryan said. “We want them to have some stimulation, but not overstimulation. We want them to sleep, relax and have some down time, but we don’t want them to be socially isolated or physically isolated. That can cause the possibility of depression.”

When it comes to the recovery of a concussion, Ryan believes the simple recovery is for rest.

“What we are learning now is that younger kids are taking longer to heal than adults and college kids because the brain is at a point of development that requires longer to heal,” Ryan said. “It’s really critical when we think of kids and high school kids that we take that into context and understand that it’s not unusual for kids to take a couple of weeks to heal. That’s not abnormal.”

While a lot of people have opinions on how to recover from a concussion, Simon simply wants kids to take it easy.

“Rest is the big therapy,” Simon said. “The diagnosis of a concussion is not done by imaging or any fancy ENG (electroneurogram). It’s a clinical evaluation where someone says that they have a headache, nausea, vomiting or confusion. They could have all the symptoms or only one of them. If there is any doubt about whether someone suffered a concussion on the field, you should sit them out and evaluate them. It’s actually a state law now that says that the athlete can’t return to play until they are released by a health specialist, whether a nurse or a doctor.”

In general, athletic programs throughout the country are more aware of concussions and their severity.

Back in May 2010, Connecticut followed the footsteps of Washington and Oregon and became the third state in the country to pass a Senate bill that dealt with concussions and student athletes. When athletes shows any signs of a concussion, they are to be removed immediately from play. That athlete will be allowed to return to competition only when there is written medical clearance from a doctor. In addition, coaches now must complete an initial training course regarding concussions and annually review new material provided by the state. Every five years, coaches have to go through a refresher course on concussions.

“Concussions have always been here,” said Danny Simpson, head coach of the Greenwich High School girls soccer team. “Only 15 years ago, if you got hit, you got your bell rung. Players would play through that. Now, people are taking a closer look at concussions, what the effects are on the brain and how important it is to get the athlete out of the play if anybody thinks a concussion happened. It’s all about protecting the athlete, and that’s such a huge improvement from where we were before.”

While a concussion is frightening for everybody involved, Greenwich resident Sarah Brown thinks checking up with the family doctor is the best medication. That’s exactly what she did when her son Doug had his three concussions playing athletics during his time at GHS.

“It’s really important to consider it a brain injury and to work with a doctor,” Brown said. “I think that it’s also important to be conservative about returning to play because the chance of reinjury is so great with a brain injury like this. Once the initial symptoms go away, we had a kid that wanted to get up and do stuff. However, I found it so helpful to go to a doctor and listen to the doctor. If the doctor says the kid can’t play, then he can’t play.”

While Simon understands that society tends to be proactive and wants to do something to help speed up the recovery time for concussions, Simon still is a firm believer that rest is the best and most effective medicine.

“I think the biggest thing is that we recognize them more and we are much more sensitive about them,” Simon said. “I want kids to take a rest and have some down time.”

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