New tech, early diagnosis, focused therapy & close recovery tracking yields promising results
By Kim Chiomento, Staff Writer, The Times
You probably know someone with a concussion or perhaps, like me, are a parent of children who have had concussions. Concussions are never good news, but with nearly five million diagnosed annually, it seems like they really are everywhere. They can and do happen during any sport or activity; and result when a person’ head is bumped or jarred and the brain’s normal function is disrupted. Concussions are categorized as mild, moderate and severe.
We all hit our heads as kids and very rarely heard of anyone being in bad shape or suffering much as a result. It is amazing what we did not know. And yes, I have had my moments of cynicism in recent years; questioning whether we are all over reacting to what used to be called “getting your bell rung.” My recent experience and becoming educated has certainly erased that cynicism.
I’ve learned a lot since my son suffered a concussion in August, specifically, how much the diagnostic and post-concussive therapy protocol has changed in the three years since my daughter had one. At that time, she was briefly evaluated, observed to rule out brain bleeding, sent home with rest, no “screen time” and quiet environment until she “felt better“ and had one follow-up doctor’s visit about two weeks later.
So much more is known today about the brain’s healing response time that cannot be accurately assessed by “feeling better” and looking “normal.” The real danger occurs when someone who is still suffering a concussion reinjures their brain which can result in permanent irreversible damage, paralysis and even death.
A few days after my son’s concussion, I sent an email to a hand full of my mom friends sharing what I had learned, some local medical resources and signed-off with the hope that none of them ever needed to put the information to use. I was floored when in less than a week, two very worried moms texted me and needed me to resend the information ASAP as both of their boys were believed to have concussions. This need for information got me thinking that perhaps it may be helpful to share what I’ve learned with an even larger audience.
So, please know that this article is not my endorsement of a particular physician, diagnostic test, business or therapist. My intent is to share some basic information about what parents should know, questions to ask, and what types of resources are out there when seeking care for a child suspected of suffering a concussion. As with all medical concerns, each case is unique and as parent we must seek what we believe most appropriate for our own children.
ImPact Testing: I had heard of the baseline ImPact concussion testing, but unless you have athletes in middle school or high school, the likelihood that you’ve had one done for your child is pretty small. This computer test is about 30 minutes in length, is administered at certified ImPact clinics (including school athletic departments) locally; and provides a baseline on your child’s neurological reactive response time, memory and visual reflexes. There are other similar tests on the market; but I am not familiar with them and can only speak to what my family has experienced. The ImPact test is very common and used by many Chester County schools and emergency clinics.
After taking the test, your child is then assigned an ID number from which you can log-in and share their test results with any physician. If in the unfortunate case your child is suspected of being concussed, they will re-take the ImPact test and have the results compared with their original baseline.
A fascinating part of this test, which was developed by renowned neuroscientists, is in the way it is structured – it can specifically identify what part of the brain has been bruised, to what extent it is damaged; and on the reverse; will also track each region of the brain’s healing process.
For a list of ImPact test clinics and certified physicians visit, www.impacttest.com – you can search easily by state and zip code from their website.
Expertise: I have friends whose concussed children are under the care of a general practitioner or their pediatricians, and are receiving fine care. However, I would ask to be evaluated by a physician who is a concussion specialist. We worked with Dr. Vincent Schaller at Premier Urgent Care in Kennett Square. Dr. Schaller is a concussion specialist, ImPact Test certified physician and also Medical Director of the Mid Atlantic Concussion Alliance. The exam my son received was extremely thorough and very different from the one administered to my daughter just three years ago.
During my son’s initial exam, Dr. Schaller ran a series of physical vestibular tests that involved tracking repetitive eye, neck and head movements and balance. This was really tough for me to watch. Even my untrained eyes could see my son was struggling; and these test results directly correlated with the findings of his ImPact testing. During future visits the news was better, and; it was a huge relief to see all of his movements improving. These findings also went hand-in-hand with subsequent ImPact tests that were tracking steady brain healing.
The importance of seeing a specialist, in my opinion, is two-fold: not only will they most accurately diagnose your child’s injury and have the latest training to do so, but a specialist will understand the post-concussive physical/vestibular therapy required to best suit your child’s needs and recovery process. And yes, there are physical therapists who are specialists in post-concussive vestibular therapy. We are working with ATI Physical Therapy in Kennett Square. It took a few phone calls to find therapists who knew what I was talking about, but they are out there.
Communication: Seek a physician who will actively communicate updates with your child’s school as there is very often an academic restriction component to most school-age concussion recoveries. In our case, Kennett Middle School’s (KMS) nurse works closely with Dr. Schaller. She promptly sends-out regular doctors reports to his teachers on his academic and physical restrictions; all of whom have been most supportive with his post-concussion “re-entry” protocol.
It has been reassuring to know that the support on the academic side of this equation is there too. My son initially was very stressed-out about school work and tests piling up. For him, seeing the support first-hand really helped him relax and heal; “turning off your brain” is big part of that process. He is steadily catching up on all of those items now without being penalized.
Education: This concussion resulted from a fall during football practice while tackling a “dummy” bag (yes, thank you, we have heard ALL the jokes) and banged the front part of his helmet on the ground. He describes it as not that hard of a hit, and nothing in comparison to some of the collisions he’s had previously playing lacrosse, football and even basketball. But this time, it just “felt different” and he knew something wasn’t right. He describes feeling “off” and had mild nausea –both textbook concussion symptoms.
That is the crazy thing about concussions – it’s not necessarily about the velocity of the hit to the head but more about torque and how the head was hit.
“Severe concussions can have no significant symptoms like passing out or vomiting,” Dr. Schaller said. “Likewise, a mild or moderate concussion can show prolonged nausea, headaches, dizziness, etc.”
Also, be aware that some concussion symptoms can present themselves a few days after the traumatic incident; however, for both my daughter and son, their symptoms were nearly immediate.
“Concussions occur in all age groups and in so many different environments and situations,” Dr. Schaller said. “In the concussion clinic we have seen and treated patients with concussions from age 6 to age 94. Although the ImPACT testing we use is accurate for ages 10 – 60, utilizing a thorough vestibular exam can be used to follow patients with concussions younger than 10 and older than 60.”
My son was brave to speak up and I am very proud of him. He knew exactly what it meant for him as an athlete: he would likely sit out for a good portion, if not the entire season. But, even more importantly, he was made aware of the severe consequences of NOT speaking-up, the irreversible damage that playing with a concussion can cause by all of his coaches; and as a result he didn’t hesitate to approach them to seek help.
In this instance, I credit the KMS coaching staff for the clear message of safety first, speak-up immediately and having awesome resources field-side. And thankfully, I have gotten that very same message from each of the various sports teams and clubs he has played for.
Encourage your kids to know what feels right and what does not, know what concussion symptoms are and ensure that they are playing for teams whose coaches have received the latest concussion training. Tolerate nothing less than an environment of safety first.
Resources: My son was taken off the practice field and sent to the athletic trainer who administered the ImPact test with poor results, confirming a moderate concussion. We knew he needed medical attention without any guesswork, what a blessing. We were able to walk into a physician’s office, with the test results in hand within about an hour of him taking the fall, further expediting his good care.
Even if your child has not taken a baseline concussion test (ironically, my son’s was scheduled for the next morning) there are over five million baseline tests in the ImPact database. If your child is suspected of suffering a concussion they can still take the ImPact test and have their results compared to their peers’ baselines within a very good margin of error.
Don’t Judge: Yes, my kids play contact sports (and I can already hear some tongues out there “clucking”); but there are so many children we know who have concussions from everyday falls, running into swing sets, banging their head on a tables, baseball, cheerleading, field hockey, soccer, swimming, and one mom I know just shared that her daughter simply shooting hoops in her driveway and the basketball landed on her head, enough to jar her head and cause a concussion.
“Athletes make up about 50-60% of the concussion clinic patients, but almost half are non-athletes. I see non-athlete students encountering concussions on the playground, in gym class or just getting to and from school,” says Schaller, “Concussion cases come from automobile accidents, work injuries, slips on ice, wet surfaces, etc. The key to concussion safety is to increase education and awareness.” Again, it is not always about the velocity of the hit, but exactly how your head was hit that affects this type of injury.
Looking Forward: Dr. Schaller is optimistic. “With the new technology available to diagnose concussions and track recovery, along with focused physical therapy, successful outcomes for concussion recovery are now possible. The future is bright.”
Short of wrapping our kids in bubble wrap, it’s my opinion that we can just do our best to educate, support each other as parents and work together to ensure those playing on teams and our schools have the latest technology, gear and resources available, while placing safety first at all times.
Do I worry? Sure, everyday about lots of things related to my children. And yes, any type of serious injury, illness and their safety are always at the top of that list. For my kids, so much joy, self-confidence, good physical condition, appreciating their healthy bodies, self-motivation, effective time management, ability to work with others, great grades and very special friendships have come out of all the teams we’ve been involved with; organized sports have become a part of who we are.
On a lighter note, I am happy to close with some good news: My son is nearly 100% healed much to the credit of him staying disciplined, early diagnosis, following doctor’s orders (not always easy for an active, very social 12 year old!) and the support of his coaches, school and friends. It has all paid off.
My sincere hope is that you never need to use this information; but if need be, I hope it helps you get the care your child, friend or family member may need. Wishing everyone a safe fall season! And, by the way, where’s that bubble wrap???!!!
Kim Chiomento covers news for The Times in the Kennett Square area and is a parent of children in the Kennett Consolidated School District.
