Dr. Mirus and Dr. Featherstone on concussions
Alex: A hot topic that was trending about two weeks ago and is now less relevant but still important is concussions (I guess this is how you sign it), especially in contact sports like football. Recently NFL quarterback named Tua Tagovailoa had two serious concussions in two straight games. The first time he was unsteady but the second time he passed out and was hospitalized. So I’m wondering what you are seeing in your hospital in cases with children, young people, or those in college with concussions in contact sports. It is not only football but maybe hockey or some other sport. I wonder if you’re seeing a lot of cases? Are you concerned? What can families and children do to prevent brain injuries?
Dr. IV Mirus: What is a concussion? It is a type of traumatic brain injury. It happens when there is a jolt to your head. Your brain lives inside the skull. So the brain moves against the skull when it is jolted. It causes swelling of your brain and chemical changes. It may cause problems in the future and also causes symptoms. We see a lot of it in football because it is very popular. The NFL was criticized for what happened because the Dolphins quarterback, Tua, was wobbly on his feet after the first hit. That was a clear effect of some kind of brain injury. A part of his brain was not running properly. He should have left the game. The reason why it’s important to pull the player from the game is something called the second impact syndrome. It means that when you are healing from your first concussion — which may take one or two weeks for your brain to return to normal — if you get another concussion while your brain is still healing, it will cause much worse swelling, worse symptoms and worse problems in the future.
Dr. Zach Featherstone: I’m good with post-concussion care. Dr. Mirus is an expert on the immediate traumatic effects since he works in the ER, while I deal with the aftermath. ERs typically refer cases to me after the incident and tests to make sure the patient is okay. I will then use a tool called SCAT 5. SCAT 5 stands for Sports — I can’t remember what C stands for — Assessment Tool 5. There are a lot of written questions that the patient must answer to help us score if they are still suffering from a concussion or if they have made a full recovery and resumed playing. It is a good tool to help us figure this out. We test their cognitive functions, their vision and balance, and their body and brains. For example, if they are high school or college students, we would look at their grades. If they typically get A’s and B’s and then after a concussion starts getting C’s or D’s, it means there’s something still lingering and they’re not ready. When they are back getting A’s and B’s on tests, it is a good indication that they can come back. Then there’s a “return to sports” policy. There are five different levels where you have to meet each criterion before you can start playing again. One criterion is rest. The next is doing light exercises. And so forth until the last one: full contact in sports practices. If all is good, they can resume playing. Each of the criteria requires a minimum of 24 hours. But many experts recommend a minimum of 48 hours each, so that amounts to almost two weeks in total. So that’s why we like to see a two-week minimum for them to recover.
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Alex: In the U.S., it is very popular for high schoolers or middle schoolers to play football. We even have a few Deaf schools doing very well in 8-man or 6-man football. What can schools, coaches, and parents do to make sure that their kids stay as safe as possible? If they’re not going to stop playing football, how can it be as safe as possible?
Dr. Mirus: There are safe ways to change the game itself. For example, you can do “air contact” or “air practice.” You don’t have to have full contact in practice. You don’t have to bang your head against your teammates. Practices are for learning the game, techniques, perfecting plays, and when it’s game time, you can go ahead with full contact. There are some ways to modify it. You can teach coaches how to recognize early symptoms and pull players from games. There are ways to make the game safer, but will the risk be reduced to zero? That’s impossible.
Dr. Featherstone: It’s all about education. If we all educate parents and coaches on the pros and the cons… that’s the best answer I can give. But I am grateful to see new policies being implemented in different states. For example, with youth football, they used to allow hitting, but now you can’t. It depends on the state as some don’t allow contact until age 12 or until age 14. It varies. I think that’s appropriate. These types of policies are helpful in reducing risk. Some studies show that when kids are younger, you should be more careful and help them to be safer, while older kids can understand the risks and decide for themselves if they want to play. They shouldn’t have parents pressuring them to go and play football. Let the kids decide. That way they can accept the risks.
Dr. Mirus: I think we have two different populations. You have to be careful with children and protect them. We need policies and guidelines to protect this vulnerable population. But NFL players know the risk. It is their livelihood and they make money that way. They’re famous and it’s their dream. They can’t imagine doing anything else. So they accept the risk on their own and they’re also adults so it’s fine. But with children, we have to be careful. We have to study and do research and follow the data on what is safe.