Expert discusses concussion management

By GRADY TRIMBLE

A new autopsy on former UMaine football star Jovan Belcher shows signs of chronic traumatic encephalopathy, or CTE, a degenerative brain disease found to cause dementia, aggression and depression.

While playing for the Kansas City Chiefs in 2012, Belcher shot and killed his girlfriend and then himself.

“Just knowing him in general, and knowing how the players on the team looked up to him, and how he treated everybody, you would never have expected that he would be capable of something like that,” J.P. Stowe, an athletic trainer who knew Belcher, said. “But, again, that shows you the degenerative results of the disease.”

CTE is often found in athletes who have had a history of repetitive brain injuries. According to health experts at Eastern Maine Medical Center, one in 10 athletes who play contact sports will suffer a concussion this year. Marshall Maxsimic, who plays soccer at Brewer High School, got three concussions last season.

Maine lawmakers have shown they take concussions in youth sports seriously. There is a state law requiring every school to have a policy that addresses the prevention, diagnosis and treatment of head injuries. Under that law, any student suspected of having a concussion must be taken out of a practice or game immediately. After an evaluation, the student can only return with written medical clearance from a licensed health care provider.

“If you’re getting three, four, five concussions, and the symptoms are lasting longer and longer each time, it might be worth a sit down to say, ‘hey, you might want to pick a different sport,'” Stowe said.

Source: Trimble, Grady. “Expert Discusses Concussion Management.” Expert Discusses Concussion Management. N.p., 30 Sept. 2014. Web. 30 Sept. 2014.


Heading off concussion trouble

By JACK KELLY

Researchers at University of Pittsburgh Medical Center and the University of Pittsburgh have developed a simple new test that can detect symptoms of a concussion current tests often miss.

The new test concerns the vestibular ocular system, which is responsible for integrating vision, balance and movement. It’s what allows us to keep our eyes focused and stable when we move our head around. It’s located in the vestibulum of the inner ear.

Vision issues, fogginess and dizziness are the symptoms associated with the worst outcomes in concussion patients, said Michael “Micky” Collins, director of the UPMC Sports Medicine Concussion Program.

But existing tests, which focus on balance, often miss these symptoms, said Anne Mucha, clinical coordinator for vestibular therapy. So a research team she headed _ which included University of Pittsburgh experts in other disciplines _ set out to develop a test that would pick them up.

The test they designed _ called vestibular/ocular motor screening _ allows clinicians to be 90 percent accurate in identifying patients with a concussion, she and other researchers said in an article published online in the American Journal of Sports Medicine. The test can be added to current assessment methods such as physical examination, symptom evaluation and computerized neurocognitive testing.

“We were already good at detecting concussions,” Mucha said. “VOMS can tell us what type of a concussion a patient has suffered.”

There are six types, identified by the symptoms they exhibit: vestibular (balance issues); ocular (vision problems); mood and anxiety, migraine headaches, and cervical (problems with the neck).

Most concussion sufferers exhibit several of these symptoms, but one or two tend to predominate, Mucha said.

About 80 percent of people who suffer concussions recover in about three weeks. But it can take months for the remaining 20 percent to recover.

Most of the patients treated by the Sports Medicine Concussion Program who have taken months to recover have had vestibular or ocular issues, Mucha said.

To develop VOMS, researchers studied 64 concussed patients approximately five days after they suffered their injuries, and compared their responses to a control group of 78 healthy patients.

The VOMS test assesses five areas of the vestibular ocular system: smooth pursuits (eyes following a moving object), saccades (rapid eye movement), horizontal vestibular ocular reflex (that stabilizes images during head movement), visual motion sensitivity (related to dizziness), and near-point-of-convergence distance (where eyes can hold together without double vision). The test takes no more than five to 10 minutes, and can be administered with just a tape measure and a metronome.

After each test, such as asking the patient to focus on an object, or to move his or her head rapidly from side to side, the clinician administering the tests asks the patient if he or she is exhibiting any of the key symptoms, so feedback is immediate.

After taking the VOMS test, more than 60 percent of patients exhibited symptoms of concussion, said Anthony Kontos, assistant research director for the Sports Medicine Concussion Program and a member of the research team. If it weren’t for VOMS, their impairments might have been missed, he said.

The addition of VOMS to the “diagnostic tool kit” of other tests, such as those pioneered by the UPMC Sports Medicine Concussion Program that measure neurocognitive deficiencies, “could very well foster a paradigm shift” in the diagnosis and treatment of concussions, Collins said.

Although Collins and Mucha would not get more specific, it was plain both were excited by the possibilities VOMS offers.

If those with vestibular and ocular concussions can be identified immediately, the time it takes to treat their concussions could be cut “very, very substantially,” Mucha said.

Collins agreed: “We’re finally starting to hit this problem in just the right way.”

Source: Kelly, Jack. “Heading off Concussion Trouble.” Toledo Blade. N.p., 29 Sept. 2014. Web. 29 Sept. 2014.


Youth Football Player Collapses on New Jersey Field, Dies

A youth football player who collapsed on the field during a practice in southern New Jersey last week has died.

But authorities say it’s still not clear what caused the death of 12-year-old Jeremiah “Lil’J” Pierce.

The South Jersey Times reports the Salem boy was practicing and running drills with his teammates on Sept. 23 when coaches say he collapsed on the field.

The boy was taken to a local hospital and was later moved to the A.I. duPont Hospital for Children in Delaware, where he died on Sunday.

Source: “Youth Football Player Collapses on Field, Dies.” NBC 10 Philadelphia. N.p., 29 Sept. 2014. Web. 29 Sept. 2014.


Playing it safe: R.I. youth coaches, parents making headway on concussions

By PETER ELSWORTH

There has been a dramatic increase in awareness about concussions in youth athletics in recent years, driven in part by high-profile incidents among both professional and student athletes.

“[Concussion] is in the news all the time now,” said Neha Raukar, director of the Center for Sports Medicine at Rhode Island’s University Emergency Medicine Foundation. She cited this summer’s provisional settlement between the National Football League and former players who suffer long-term effects of the traumatic brain injuries.

That concern is being felt in youth sports as well.

“There’s more awareness,” Raukar said, crediting better training among coaches in recognizing the injury and learning to take the appropriate actions.

Raukar, a professor at the Warren Alpert School of Medicine at Brown University, helped write the Institute of Medicine’s 2013 report “Sports-Related Concussions in Youth: Improving the Science, Changing the Culture.” It cited football, ice hockey, lacrosse, wrestling and soccer as having the highest rates of concussions among male high school and collegiate athletes. Soccer, lacrosse, basketball and ice hockey were the leaders among female athletes.

According to Deborah Sharpe, executive director of the Rhode Island Brain Injury Association, among younger athletes, “With girls, [concussions are] more soccer related, with boys, more football related.”

“People were aware of it in general, [but] there’s more awareness today,” she said.

That’s due, in part, to training for coaches before youth athletes even take the field. Trying to determine whether an athlete has suffered a concussion can be difficult, especially on the sidelines of a game. Coaches are taught to recognize the warning signs, based on a player’s behavior and response to questions.

For the 2014 season, all coaches in the American Youth Football and Cheer league, which covers athletes ages 5-18, were required to complete the CDC’s Heads Up Online Training Course. The free training points out the warning signs of a concussion and details the process for returning to the sport after such an injury. Only a medical professional can diagnose a concussion, but the training gives coaches — and parents — a place to start.

Bryan Stetson, the president of the Cranston CLCF Football and Cheerleading organization, said a lot of new parents ask him about concussion. He said he has been coaching football since 2003 and, “Unfortunately, it happens. It’s a contact sport.”

But he said the aim was not only to try to prevent concussions, but to increase awareness of symptoms — among parents as well as coaches.

Players no longer “get up and shake it off,” he said. If a kid is dazed or on the ground and a doctor diagnoses concussion — every high school football game has to have medical personnel on the sidelines — “the kid is out of the game.”

Stetson said the player would probably not return for two or three weeks, and only with a doctor’s clearance. Even then, he said, training would ramp up. “You’re not going to throw him back into a game,” he said, adding that the coach makes sure the player can exercise without suffering a headache or other symptoms.

The guidelines extend to other sports, as well.

Regulations for the Jamestown Soccer Association say, “If the player is experiencing any pain, dizziness, or nausea, they should be removed from the field and not be considered for re-entry into the game.” The coaches are then required to contact the parents, who will decide whether to take the child to a doctor.

Paul van Leynseele, a soccer coach for a recreational team of 10- to 12-year-olds in Jamestown, said he was required to complete concussion training.

Awareness and willingness to act are two different things, he said.

“You can be aware of the issue, but what are you going to do about it?” he said. “You have to be prepared to lose a player, even a star. [You have to be] willing to take him or her out.”

Raukar said she has attended football games as a medical adviser and has been taken to task by parents for taking a child out of a game.

“I’ve been yelled at, [told] the kid needs to play,” she said, adding that while she may not be sure the player has been concussed, if there is a chance he or she will be hit again, she is unwilling to take the risk. “When in doubt, take them out.”

While soccer is not generally considered a contact sport, van Leynseele said, it does involve heading the ball, which is becoming increasingly controversial with young athletes, particularly girls.

“The literature is so divided whether heading causes head injuries,” said Raukar. At the same time, she said she was concerned about girls because they sustain concussions at lower forces. “Their biomechanical threshold is lower,” she said. “And when girls suffer concussions, it takes them longer to recover,” she added.

And people who have suffered one concussion are more prone to getting another, Sharpe said.

Chris Cowan, an assistant coach of the Jamestown Middle School soccer team, said the town’s soccer association emphasized the importance of recognizing head injuries. And he said the referees were trained not just to focus on the kids heading the ball but also on collisions and falls, which can also cause concussions.

Legislation has also focused attention on the issue. In 2009, Washington became the first state to enact a comprehensive youth sports concussion safety law, named in honor of Zackery Lystedt, a middle schooler who fell into a coma and was permanently disabled after being allowed back into a game minutes after suffering a concussion.

All states have since enacted some version of the law. In 2010, Rhode Island passed its own law, which advocates “immediate removal of [youth athletes] if concussion is suspected” and “return to play only after medical clearance.”

However, Raukar said the law only applied to public high schools, not middle, elementary or private schools and municipal sports programs, such as town soccer leagues.

And, in June, state lawmakers approved a measure that requires school nurses to take an online course in recognizing concussions.

According to the Rhode Island Department of Health, fewer than 10 concussions were reported in 2009; in 2013, that number shot to more than 300.

While there was an increase in Rhode Island after passage of the bill, the numbers have leveled off, according to George Finn, chairman of the Sports Medicine Advisory Committee for the Rhode Island Interscholastic League.

“The action taken now is a lot different than 10 years ago,” said Finn, who is also director of athletics at Barrington High School. “If you provide education, parents will understand.”

Said Raukar: “A lot more moms are educated, and they’re putting their feet down.”

For more information on brain injuries, go to biausa.org/ri/ or bit.ly/1uMPeur. For more on the Heads Up course, go to 1.usa.gov/1vlPykC.

What parents need to know

Learn to spot the concussion danger signs. According to the CDC’s Heads Up course, you should call 911 or take an athlete to the emergency room right away if he or she exhibits one or more of these conditions after a jolt to the head or body:

– One pupil is larger than the other.

– Drowsiness, or can’t be awakened.

– A headache that gets worse.

– Weakness, numbness or decreased coordination.

– Repeated vomiting or nausea.

– Slurred speech.

– Convulsions or seizures.

– Cannot recognize people or places.

– Increasing confusion, agitation or restlessness.

– Exhibits unusual behavior.

– Loses consciousness, even briefly.

Other symptoms can include:

– Sensitivity to light or noise.

– Concentration or memory problems.

– Double or blurry vision.

– Complaints of “just not feeling right.”

Source:  Elsworth, Peter. “Playing It Safe: R.I. Youth Coaches, Parents Making Headway on Concussions.” Providence Journal. N.p., 29 Sept. 2014. Web. 29 Sept. 2014.


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Even suspected concussion cause for concern

By BRIAN CAMMAROTA, MEd, ATC, CSCS, CES

Over the past decade, we have seen a significant change in the management and recognition of concussions. Many years ago, there was substantial dispute in simply diagnosing concussions with many people feeling that concussions only occurred when a person lost consciousness. Terms like “bell ringer” or “dings” were often used to describe and minimize the concern for some head injuries. Fortunately today, recognizing concussions has become much more common practice. In addition to athletic trainers and physicians, youth and high sports have placed responsibility on athletes, coaches, and parents to recognize and report head injuries. So what is a concussion and what should you do if you suspect you or your child may have one?

A concussion is defined as a subset of traumatic brain injury or TBI and is a complex pathophysiological process. Essentially there are many changes occurring in your brain in response to the concussion and since your brain is affected, you may exhibit a host of symptoms.

Concussions occur from either a direct blow to your head, called a coup injury (such as falling and striking your head on the ground), or from rapid deceleration called a counter coup injury (such as a hard tackle in football without head contact or a car accident). In a coup injury, the brain is injured exactly where it is struck (falling on the back of your head creates injury at the back of brain); in a counter coup, the brain is injured opposite to where it is struck as it impacts the skull (falling on the back of your head injures the front of your brain).

Symptoms following a concussion include headache, nausea, vomiting, dizziness, amnesia (loss of memory), cognitive changes (slowed reaction time or inability to answer simple questions), fatigue, change in appetite, irritability, feeling like you are in a fog, loss of consciousness, visual or hearing changes, and others. During athletic events, anyone exhibiting any of these symptoms, or any other unusual symptoms, after a suspected direct or indirect blow to the head must be removed from the game or practice and be evaluated by a qualified medical professional such as a physician or athletic trainer to determine if a concussion occurred. If they are not evaluated or if a concussion is confirmed, the player must NOT return to play on the same day regardless of how much they improve. This is for all athletes, at all levels, regardless of “importance” of the game. Do NOT play with a concussion or a suspected concussion!

If a player is concussed, they must be evaluated by a physician (MD or DO) that is trained to evaluate concussions prior to returning to play. Evaluations check for symptoms; ask a series of cognitive questions checking memory and concentration; and assess balance and coordination. Evaluations are often similar to those on the SCAT 3, in fact many organizations require the SCAT3 be performed. Computer based neuropsychological tests are also often performed, although they are designed to assist with return to play decisions and are not diagnostic. If a concussion is confirmed, the athlete should not play until symptoms resolve and their brain returns to “normal” both with and without exercise. Stay tuned to Sports Doc for future posts discussing return to play following a concussion.

Diagnostic imaging, such as CT scans, are not commonly used as they are not sensitive enough to detect concussions. If you had a normal CT scan it does NOT rule out a concussion, you must still follow-up with a physician specializing in concussions.

Playing through a concussion or returning to play too early, increases the risk of a second concussion which is often significantly worse than the first one as the brain has not fully healed. This may also lead to Second Impact Syndrome in younger athletes, which is often either fatal or causes severe disability.

ANY blow to the head or sudden deceleration that causes ANY symptoms above must be evaluated for a concussion. Early concussion recognition and treatment will keep your head in the game.

 

Source: Cammarota, Brian. “Even Suspected Concussion Cause for Concern.”Philly.com. N.p., 24 Sept. 2014. Web. 24 Sept. 2014.


How well do you know the signs of a concussion?

By TRACY ROMERO

Concussion injuries have been in the news a lot lately and the Rothman Institute, Children’s Hospital of Philadelphia as well as other medical institutions are taking a hard stand on when kids can go back to play or even school after a brain injury. From a parent’s or a coach’s perspective, what should you know about concussions?

Katie Quinn is the manager of Lansing United soccer team in Philadelphia where her son Aidan, age 9 plays. As a mom of an active boy who loves soccer, she is very interested in learning more about how to prevent these types of injuries.

“We don’t do anything to prevent it really right now,” she said. “I have always wondered if there were exercises our kids can do to prevent a concussion from happening in the first place. Everyone responds appropriately when the head injury occurs, but there needs to be more of a focus on prevention.”

When it comes to signs or symptoms of a concussion, Quinn doesn’t feel that most parents know what to look for. “Many people still believe that there is only danger of a concussion when there is a direct hit to the head and that it is only serious when the player loses consciousness,” she explained.

“In fact, only a small percent of concussions lead to unconsciousness. Any shake of the brain, whether from a fall or a direct hit can cause damage,” she added.

Quinn believes that there needs to be more of a focus on concussion awareness and education. She would love for there to be team exercises they can do and more guidelines and training for coaches.

“Programs for the kids themselves like learning how to fall would also be great,” she added.

Quinn’s brother Seamus coaches soccer, basketball and lacrosse and is the director of lacrosse at the Lansing Knights, and from his perspective as a coach, what he struggles with most is parents and kids who don’t understand why he is overcautious when it comes to head injuries.

“If a kid is hit hard, his head could snap back, causing a jolt to the brain. When this happens, I pull the player and watch him. Sometimes parents get upset that their kid is benched and the kid doesn’t want to be pulled from the game because he is only thinking about the competition,” he said.

“I tell my players that if they get hurt, they are done for the day and that their parents need to take them to get checked out.”

Seamus gives his parents a flyer at the beginning of each season with the red flags to look for when it comes to concussions. He said that there are concussion helmets now that are being considered for lacrosse, but right now they are used mostly for college football and only a select few high school athletic programs because they are expensive.

“A sensor in the helmets track the number and intensity of the hits a player takes during the season,” he explained. “What is surprising to many coaches and parents is how many times a player might suffer a small concussion during practice without anybody knowing it happened.”

“It is important that even if your kid doesn’t seem hurt bad, to have him checked out by a doctor,” Seamus added. “Signs I always say to look for are if the child is dazed and confused, balance seems off, or he or she acts clumsier. Behavioral change, headache, nausea, vomiting, vision problems, nervousness, and anxiety are other possible symptoms as well.”

Seamus like his sister would love to have videos and other educational resources to share with his team and their parents and maybe have doctors reach out to league offices to help spread awareness.

Local sports medicine programs like those at the Rothman Institute and Children’s Hospital of Philadelphia do offer free online resources to help parents and coaches, but does more need to be done to get these resources to more people? Rothman offers a concussion guide for parents that includes advice like how to be proactive, what signs to look for and the do’s and do not’s of recovery. They also provide education for coaches, school districts, youth sports leagues and the athletes themselves through their Sports Concussion Institute. One of the things they suggest is that every player should have a baseline cognitive functioning screening which will give doctors something to compare against after a concussion.

At CHOP’s Sports Medicine and Performance Center they have established their “Concussion Care for Kids: MindsMatter” program that offers videos, flyers and other educational material to help with concussion prevention. They too offer resources for families, coaches, and school staff like video FAQs and infographics and posters. They emphasize how much of an important role nutrition and sleep play in concussion recovery. Did you know that Pennsylvania and New Jersey have concussion laws? Learn more on CHOP’s “MindsMatter” site.

Having the whole community –parents, coaches, sports leagues, schools and medical professionals – all working together is definitely the right path for protecting our athletes from debilitating injury.

Source: Romero, Tracy. “How Well Do You Know the Signs of a Concussion?”Philly.com. N.p., 23 Sept. 2014. Web. 23 Sept. 2014.


Crucial Concussion Evaluation Info for Coaches

By DEV K. MIRSHA, M.D.

How should a coach evaluate a young athlete for a possible concussion?

The key word in that first sentence is “possible,” meaning that a coach who is not medically trained should not make the definitive diagnosis of a concussion. Your job is to assess the athlete and determine whether you suspect a concussion, remove that athlete from play, and send the athlete for evaluation by a medical professional trained in sports concussion management.

If your athlete has taken contact and has any one of the features noted on the card you should suspect a concussion and remove the athlete from play:

SYMPTOMS:
* Loss of consciousness
* Seizure or convulsion
* Amnesia
* Headache
* “Pressure in head”
* Neck Pain
* Nausea or vomiting
* Dizziness
* Blurred vision
* Balance problems
* Sensitivity to light
* Sensitivity to noise
* Feeling slowed down
* Feeling like “in a fog“
* “Don’t feel right”
* Difficulty concentrating
* Difficulty remembering
* Fatigue or low energy
* Confusion
* Drowsiness
* More emotional
* Irritability
* Sadness
* Nervous or anxious

If the athlete is unconscious, do not move, shake, or attempt to rouse the athlete. Call for emergency medical transportation immediately. Stay with the athlete until help arrives. If the athlete is unconscious it is a medical emergency.

As our knowledge about concussion has improved it’s clear to us that the definition of concussion needs to change. Long gone are the days when an athlete needed to be knocked unconscious or close to unconscious before it was deemed a concussion.

We know now that even a headache that happens after contact to the player’s head, player’s body, or by the ground to the player’s body can be an early indicator of a concussion. Essentially, the definition of concussion is quite a bit broader than it once was.

What that means for the coach is that there are going to be a lot more suspected concussions. It means that you’ll likely deal with situations where you’ll ask yourself questions such as “it’s just a headache, do I really have to hold this player out after something like that?”

My advice to you: yes, you need to hold that player out of practice or competition and the player should seek medical attention urgently.

Use your best judgment and be overly cautious.

“Any athlete with a suspected concussion should be IMMEDIATELY REMOVED FROM PLAY, and should not be returned to activity until they are assessed medically. Athletes with a suspected concussion should not be left alone and should not drive a motor vehicle.”

Source: Mirsha, Dev K., M.D. “Youth Soccer Insider: Crucial Concussion Evaluation Info for Coaches.” SoccerAmerica. N.p., 22 Sept. 2014. Web. 22 Sept. 2014.


Combating Winter Dehydration

By JUDSON HAIMS

As we all know, our bodies are composed of mostly water. This makes it imperative that we focus on hydration at all times of the year.

Unfortunately, most of us only consider combating our body’s loss of water during the summer months, when it is hot outside and we can feel ourselves losing water through perspiration. That is also the time of year when we most often hear about the need to hydrate. Yet, in winter, the risk of dehydration is also very real. The causes for fluid loss may still be present but without the frequent or commonly thought of warning signs.

Some reasons for lack of water retention include:

• Fever from the flu

• Diarrhea from a stomach virus

• Vomiting from stomach illness

• Increased urination from certain types of medications

• Diabetes

The aging process may also cause a reduction in sense of thirst people feel.

SIGNS OF DEHYDRATION

Below are some of the signs and symptoms of dehydration from the blog of David E. Thomas, M.D.,

• Thirst

• Decreased urine output and urine that is darker in color

• Fatigue

• Headache

• Dry nasal passages

• Dry lips, mouth and eyes

Decrease in sweating

Muscle cramps, nausea, vomiting, lightheadedness (especially when standing) and weakness

• Coma and organ failure if the dehydration remains untreated

Irritability and confusion in the elderly should also be heeded immediately.

PREVENTION IS KEY

As is often the case in medicine, prevention is the most important treatment. Here are six remedies and ways to prevent dehydration:

1, Fluid replacement is the treatment for dehydration. This can include water, juice, soups, clear broth, popsicles, Jell-O, ice cream, milk, puddings, decaffeinated beverages, KoolAid, nutritional drink supplements (Ensure, Boost and instant breakfast drinks) and replacement fluids that contain electrolytes (Pedialyte, Gatorade, Powerade, etc.).

2. Reduce or eliminate dehydrating beverages such as coffee, tea and soft drinks. Beware of alcohol intake, too. Alcoholic beverages increase risk of dehydration because the body requires additional water to metabolize alcohol, and it also acts as a diuretic.

3. If you drink unhealthy beverages, you need to add even more water to your daily total.

4. Eat lots of fruits and vegetables. Most have a high water content.

5. Drink water throughout the day in small amounts. It is not good to suddenly gulp down 64 ounces of water. You can fill a 24- to 32-ounce tumbler in the morning, refill it by late morning and refill it again for the afternoon. Consume that by 5 p.m. Most people need to start limiting fluids one to three hours before bedtime.

6. Individuals who experience vomiting and diarrhea can try to alter their diet and use medications to control symptoms to minimize their water loss. Acetaminophen or ibuprofen may also be used to control fever in these cases.

Keep in mind: If an individual becomes confused or lethargic; if there is persistent uncontrolled fever, vomiting or diarrhea; or there are any other specific concerns, then medical care should be accessed immediately. Call 911 for anyone with altered mental state — confusion, lethargy or coma.

Source: Haims, Judson. “Vail Daily Column: Combating Winter Dehydration | VailDaily.com.” The VailDaily. N.p., 22 Sept. 2014. Web. 22 Sept. 2014.


Concussions require medical attention

By SUSANNE CERVENKA

Jenna Haviland sensed something wasn’t quite right after she headed a soccer ball nearly a year ago, during a preseason tournament she played in Pennsylvania.

But the then 12-year-old tried to shake it off, wanting to continue playing with her teammates.

“Right after it happened I was in a daze and was dizzy,” she said. “It was odd, but I just wanted to keep playing because I didn’t want to be out.”

A couple of minutes later, Haviland was hit in the head with another shot, and she knew what she was feeling really wasn’t right.

“I thought, ‘I’m going to pass out. I think I have a concussion,’ ” said Haviland, now 13, and about to start eighth grade at Wall Intermediate School.

With an increased number of concussions happening in the fall because of sports seasons, experts say it’s the time of year that parents, coaches and especially young athletes educate themselves about the signs, symptoms and potential long- term effects of of the traumatic brain injury.

“The takeaway is the concussion education,” said Dr. Kristine Keane, a clinical neuropsychologist and clinical director of Ocean Medical Center’s Concussion Program. “Be aware of the signs and symptoms and that they are properly cared for.”

Each year, U.S. emergency departments will treat an estimated 173,000 youth ages 19 years old and younger for traumatic brain injuries, including concussions, according to data from the Centers for Disease Control.

Younger people at greater risk

Children and teens are more likely than adults to suffer concussions, and it will take this younger age group longer to recover, the data shows.

And over the past decade, emergency departments have seen a 60 percent increase in traumatic brain injuries among children and adolescents related to sports and recreational activities, according to the CDC.

The increased numbers may be happening because kids are playing more sports and are playing or training for them year round through travel leagues, Keane said.

And the concussion risk in children is believed to be greater than adults because of their size and development: They tend to have a smaller head mass, weaker neck muscles, and their brains are still rapidly developing.

There’s also more attention being placed on concussions, Keane said. A big part of her concussion program includes outreach to the community, offering lectures on sports concussions in schools.

New Jersey’s law also requires high school athletes suspected of suffering a concussion to immediately come out of the game and not return to play until they’ve been seen by a doctor or medical professional.

How concussion happens

Concussion is caused by a direct blow to the head or a hit to the body that causes the brain to hit or twist within the skull.

The sudden movement of the brain can cause stretching and tearing of brain cells, starting a “neurometabolic cascade of events,” Keane said.

The brain goes into a hypermetabolic state, where it’s metabolic activity speeds up, then into a hypometabolic state, where it slows down.

That causes decreased cerebral blood flow and decreased glucose, which contributes to the fatigued feeling a person feels after suffering a concussion.

The most obvious symptoms of a concussion are loss of consciousness or post-traumatic amnesia, forgetting about the play that caused the concussion or where they are, Keane said.

But the symptoms can also be less apparent — feelings of dizziness, lightheadedness, double vision or nausea.

It’s critical for athletes to be evaluated because studies show student athletes tend to minimize their symptoms in part because they want to continue playing, Keane said.

“When in doubt, sit them out,” she said.

An athletic trainer will be able to determine if an athlete needs to go to the emergency room, where doctors can decide if more specialized treatment from a concussion specialist like Keane.

For Haviland, the soccer player from Wall, the recovery was a longer process. She was initially “shut down” from all activity for a week, the last week of summer before school started.

Haviland returned for the first day of school, but soon realized her concussion had not fully recovered.

And for a second week, Haviland was limited to resting in her room with lights off. Slowly, once the headaches she described as stabbing and throbbing subsided, she was able to go out for walks, then build up to running and eventually light practice.

But if the headaches returned, Haviland had to return to the beginning of the rest.

After a month of recovery, Haviland once again was back on the field.

The experience has not changed how Haviland approaches soccer. But she does recommend other athletes take head injures, and potential concussions, seriously.

“I would say don’t hide it. Tell someone right away. It can only get worse from there (if athletes try to push through a concussion),” she said. “Looking back, I probably would have told my coach after the first hit that I wasn’t feeling good.”

Source: Cervenka, Susanne. “Concussions Require Medical Attention.”Concussions Require Medical Attention. N.p., 21 Sept. 2014. Web. 21 Sept. 2014.