According to the Centers for Disease Control and Prevention (CDC), every year in the United States, hospitals treat approximately 174,000 kids 19 and younger for traumatic brain injuries (including concussions) sustained in sports and recreation activities. This number does not account for countless head injuries that go unreported. Because of alarming statistics such as these, concussions and mild traumatic brain injuries (mTBI) are sources of great concern for parents, health care providers, and schools alike.
Approaches to assessment and intervention of concussion and mTBI in youth vary widely from school to school, provider to provider, and state to state. It is no secret that in many schools the prevailing wisdom is to “sit and wait” to see if a child’s symptoms go away after he or she has sustained a head injury. This approach can have severe, long-term consequences. Behavioral and emotional issues, headaches, and learning disabilities are common after concussions and mTBI. Despite the dangers of head injuries among children, concussion screening programs have not been widely adopted by school systems. Several factors impact the ability of schools to provide access to quality care for head injuries including: funding, access to qualified providers, and adequate reporting of injuries by the students, parents, and coaches.
By far, the smartest and most cost effective method of screening for these injuries in the long run is to have baseline studies of various brain functions for all students. These findings can be recorded for future use and compared to assessments performed after a head injury has been sustained, or if one is suspected. Specific, reproducible deviations in scores on these re-tests would effectively detect the extent of the brain injury and help direct a course of action for the individual student and hopefully eliminate the “sit and wait” approach.
The CDC’s current recommendations for baseline screening by qualified professionals include medical history (noting important factors such as prior head injuries and learning and behavioral issues such as ADD/ADHD), symptom checklists, balance testing, and cognitive/neuropsychological testing (i.e. memory, attention, concentration, etc.). It should be noted that the majority of these screening procedures, aside from the cognitive and psychological testing, are largely sideline or bedside office tests (i.e. “follow my finger” or “stand with your eyes closed” types of tests).
To these recommendations I would emphatically add the need for advanced computerized testing of eye movements including videonystagmography (VNG) and saccadometry, advanced screening of balance and vestibular function with dynamic posturography, and quantitative EEG to assess brainwave activity, among others. These tests would allow for precise measurements of function typically impacted by head injuries that could be effectively scrutinized and compared post-injury.
While only a dream at this point for most schools in our nation, having effective screening programs in place for these injuries could eliminate a great deal of needless suffering. The following are 3 reasons we must strive to reach this dream:
- To ensure the safest, most timely return to school and sports possible. Children love sports, and many even love school too (I know mine do)! Too many of our kids are sidelined for extended periods (sometimes indefinitely) due to improper care after a head injury. Proper screening leading to proper intervention is critical for timely return to youth activities.
- To serve as a baseline for comparison when your child has been injured. There is no denying a child has suffered a mild traumatic brain injury when specific objective findings such as cognitive and eye movement testing show a decline after a blow to the head. The only way to determine the full extent of the injury is to have a baseline level of function established and recorded for comparison purposes.
- To prevent the chance of a potentially devastating recurrent injury. By far the most important item we will discuss here, recurrent injuries are the worst possible scenario for individuals that have sustained a head injury. And, it goes without saying that once someone has injured their brain, various systems involved in balance, attention, thinking, and more are impacted to a degree that the likelihood of a second injury increases dramatically. A condition known as chronic traumatic encephalopathy (CTE) has been strongly linked to recurrent head injury and can result severe, irreversible brain dysfunction and even death.
With a 60% increase in emergency department visits over the past 10 for children with head injuries, there is an ever-increasing need for proper assessment of these injuries. The CDC and other organizations have spawned efforts to educate health care providers primarily on the key aspects of detection, “return to play”, and prevention. While all noble efforts, there is, and always has been, an extremely large void in the intervention side of this equation. There are many effective therapeutic interventions that will specifically address and improve the cognitive, physical, and psychological components of head injuries in our youth – stay tuned for a future article addressing these progressive approaches.
About the Author:
Dr. Michael Trayford is a board certified Chiropractic Neurologist and founder of APEX Brain Centers. APEX Brain Centers use cutting edge techniques and technology to optimize brain function. Their program is safe, effective, research-backed and offers hope to people who are having neurological issues. Dr. Michael Trayford and his team offer help for people suffering from concussions, memory loss, Alzheimers and ADD Brain Training at APEX Brain Centers. Learn more about Brain Training at the APEX Brain Centers website.