With summer activity comes injury. Among them, concussions. Left untreated, concussions can cause long-term discomfort or worse. Everyone should be aware of these damaging head-knocks and know what to do if they suspect they or their child may have one. We asked Dr. Audrey Paul, founder and director of Advanced Concussion Solutions in Westport and Garden City, LI, and author of Concussion: Your Game Plan for Recovery, for more information.
WLM: What, exactly, is a concussion and why is it dangerous? All I know is that it's a bad head injury (and, yes, I could Google it...)
Dr. Audrey Paul: Concussion originates from the Latin word concutere - to shake or clash together. Technically, a concussion is considered to be a type of mild traumatic brain injury; a functional not a structural brain injury. This means that concussions cannot be diagnosed by CT scan or MRI. Concussions result in cellular injury that slows down neuronal function. Appropriately diagnosing and treating a concussed patient can make the difference between rapid return to work, school, and athletics or months and even years of symptoms.
WLM: Did you have any personal experience that made you want to become a concussion expert?
AP: When my son turned 8, we joined the ranks of crazy hockey parents who wake up before dawn and drive hundreds of miles to freeze on ice rinks. The first year in CT, my son experienced a concussion while playing hockey. He slept for 15 hours a day and missed 2 weeks of school. The stress of not knowing when he would be better, and not knowing where to turn motivated me to open a concussion practice in Westport.
WLM: You have so many qualifications - you can do anything. Why concussions?
AP: I have been practicing pediatric emergency medicine for over 20 years. Emergency medicine speaks to the ADHD, immediate gratification side of my brain, and concussion management satisfies the part of me that still craves continuity of care.
WLM: What should we look for when we suspect our child has a concussion?
AP: The most common symptom is headache. Other symptoms include fogginess, excessive sleepiness, change in mood or behavior, visual complaints, difficulties with balance, blurry vision, double vision, nausea or vomiting. People can develop concussion symptoms 24-48 hours after the injury.
WLM: Until we're able to get him/her to a doctor, what should we do and why?
AP: Rest for the first 24-48 hours. I generally advise no video games or phone scrolling because it can exacerbate symptoms. But taking away a teenager's phone can result in isolation and depression. I recommend patients can text their friends but avoid scrolling and excessive computer screen time.
As long as an activity (like TV) doesn’t worsen symptoms it's fine. And no sports until your child is cleared by a physician!
WLM: What are the long-term effects of an untreated concussion AND a treated concussion?
AP: Post concussion symptoms last more than 3 weeks and persistent post concussion symptoms last over 3 months. Earlier proactive intervention decreases the likelihood of developing post concussion syndrome. In terms of long term effects of concussion, I think the biggest concern is CTE or chronic traumatic encephalopathy. CTE is thought to be due to an accumulation of sub-concussive blows that occur over a lifetime (which explains why we see this more in professional football players or hockey players).
WLM: Can you get a concussion for ways other than banging your head against something?
AP: Absolutely. Concussions can be caused by a direct or indirect blow to the head. I’ve seen concussions from athletes that were kicked in the jaw or punched in the nose. You can also experience concussion-like symptoms from a whiplash injury.
WLM: Are there any new methods available to diagnose concussion?
AP: In the past, ImPACT testing was widely used for baseline testing and concussion diagnosis. Unfortunately, there are validity issues with ImPACT testing such as test/retest variability in scores and the potential to sandbag the test. Current methods now include a multifaceted approach that evaluates eye tracking, balance, exertional tolerance, memory, and symptom scores. We’re now working with a cutting edge technology offered by Brainscope that provides objective diagnostic information - taking the mystery out of whether someone is concussed or not!
Audrey Paul M.D. Ph.D.
Founder and Director
Advanced Concussion Solutions LLC
Assistant Professor Pediatric Emergency Medicine, NYU Long Island
Author, Concussion: Your Game Plan for Recovery