Long-term Effects of Concussions in Children

In some cases, the effects of concussions can last for decades following an injury. Many of these long-term effects can have serious repercussions.

There can be abnormal brain wave activity for years following a concussion leading to attention problems. Those who return to active sports, school or play too quickly following an injury are more likely to sustain a second concussion. And repeated concussions will increase the risk for later developing dementia, Parkinsons and/or depression, headaches, a feeling of being in a fog, behaviourial changes and slowed reaction times.

Some studies indicate that even one concussion can result in long-term structural damage or brain atrophy. Children, particularly those between ten and seventeen years of age, who have sustained concussions may be more susceptible to long-term effects. An already vulnerable brain can be further injured if there is not rest both physically and mentally following a concussion. A child's brain continues to develop until they are twenty-five years old.

When I was sixteen years old, I sustained a concussion and a broken nose, while in an automobile accident. I was unconscious for a few minutes. I did not suffer any memory problems or any of the other symptoms except for a very bad headache and the feeling of being somewhat foggy for a short period of time. The headache, however, lasted for several years. I did not rest either mentally or physically following the concussion and my doctor's idea of treating my headaches was to attempt to hypnotize me.

About twenty years later, I began having mild seizures which, periodically over the years, became more frequent. I was eventually put on medication which cured my seizures and my headaches. Because of my experience, I can certainly attest to the importance of having proper care following a concussion.

At that time neither my parents or my doctor placed much importance on a 'bang on the head'. I think my parents felt a broken nose and a knock on the head were relatively minor; at least I was still alive. Over the years I have spent a lot of time working on keeping my brain sharp and my memory in good condition and in fact, I have an excellent memory. But there are many who, like me, did not receive the necessary follow-up treatment after a mild head injury and are not aware of the necessity of keeping their brains sharp as they age. Are they doomed to suffer from dementia?

It is for this reason that we need to protect our children, as much as possible, from receiving concussions and if they do, to ensure that they rest both physically and mentally until it is deemed that they are well enough to return to school and sports. If this is not done, the long-term consequences of concussions can affect their whole lives particularly as they age.

How the Brain Can Change Itself

It is believed that the brain can change itself, with determination, perseverance and hard work, during both healthy development as well as following a brain injury. The reason for this is because of its plasticity.

Even as we age, our brains can change. The old saying, 'you can't teach an old dog new tricks' simply isn't true. As people age they can still learn something as difficult as a new language or learn to play an instrument. This has to do with neuroplasticity. It's true that we don't learn as quickly when we are older and we have to work harder at it but with determination and hard work, it definitely can be done. This is because the brain is making new connections between brain cells similar to that of a pathway. And like a pathway that is often used, the way is clear and easy to follow. But a pathway that is rarely used will become overgrown and difficult to find. The expression, 'use it or lose it', is not just a cute cliche.

Neuroplasticity plays an important role not only in healthy development but also when recovering from a brain injury or the results of a stroke. Simply put, other areas that are close to the damaged area of the brain, will take over. Following brain injuries or strokes, it has been proven that our brains will adapt and compensate by creating new connections.,p> Genetic factors, our environment and how we think and behave all have a bearing on neuroplasticity as well. Things like using your opposite hand to do everyday functions such as peeling vegetables, using your mouse and brushing your teeth will eventually create new connections between brain cells, if done often enough. Also, keeping your eyes closed when you do such things as getting up in the middle of the night to use the washroom, (if you are in a familiar area), choosing clothes from your closet based on the feel and texture of the fabric or setting the table.

The power of positive thinking uses the ability of the brain to be plastic. We are what we think just as much as we are what we eat. If we think we are inferior to others, our brain will tell us we are but if we think we are worthwhile, we will behave as if we are. By continually thinking we are worthwhile, we will be remapping our brains and creating new neural connections. It is the power of visualization. Athletes often use this technique to help them prepare for various sports events even when they are not actually physically able to practice.

Also, according to Norman Doidge, Psychiatrist and Psychoanalyst and a specialist in neuroplasticity, it is believed that intelligence is not fixed; it can be changed. For each new thing we learn, our ability to learn more increases.

Therefore, Dr. Doidge and many others like him, believe our brains can find new connections following head injuries and strokes. He also believes that we have the ability to increase our mental capabilities throughout our whole life and even well into our advanced years.

Concussions and Children - Important Things to Remember

It is important to protect our children against concussions and the effects of these injuries. In order to do this, we must know as much as possible.

The following are important things to remember:

- A sudden acceleration or deceleration of the brain within the skull can cause a concussion or brain injury.

- A person does not have to lose consciousness to have sustained a concussion.

- Being unable to recall recent events prior to or following a concussion is one of the symptoms of an injury.

- A child cannot return to playing the game after a concussion with only the approval of their parents. He or she should be immediately removed from the game, be evaluated by a physician and not be allowed to return until after he/she has received medical clearance to do so.

- The child should be monitored for at least two hours following a suspected concussion.

- A child should be kept awake for about two hours following a concussion; not the twenty-four hours that was originally considered to be necessary.

- Anyone suffering from a concussion should not read, text, play video games or go on the computer.

- They should wear sunglasses when outside in the bright light and if nouise is a problem, should wear earplugs.

- If they are a teenager or young adult, they should not drive following a concussion and should try to avoid all stimulation.

- Let a physician know if the child is more emotional than normal or if there is a sudden sleep problem. It is important to monitor all symptoms.

- Multiple concussions can increase the time it takes for someone to recover and can in all likelihood create long-term problems.

- Symptoms can appear immediately or not until a few hours or even days following the event.

- It will be important to avoid physically and mentally demanding activities following a concussion.

- If a teenager or young adult, he/she should avoid alcohol or drug use.

- All activities should be returned to gradually.

- It will be important to get plenty of sleep.

- Almost half of all concussions are not recognized or diagnosed by coaches or even physicians. Following a suspected concusion, there should be neurocognitive testing done to determine the extent of the injury and as a guide for follow-up monitoring.

- Each player suspected of sustaining a concussion must be diagnosed individually by a properly trained health care professional.

- All parents, coaches and officials should be familiar with concussion protocols.

The reason it is so important for a young child or teenager to rest both physically and mentally following a concussion is the brain's vulnerability to even minor jolts. For children who don't rest, the possibility of 'second impact syndrome' increases. This can possibly cause the brain to swell which may severely disable a child.

The more we understand concussions, the better able we are to protect our children against life-long problems as a result of them.

Brain Injuries and Their Treatment for Young Children

Brain injuries can be concussions, skull fractures or serious traumatic brain injuries. Those most at risk are the very young, because of tumbles and falls; and teens, often because of sports injuries or of thinking themselves to be invincible. Children's brains are very vulnerable.

If a young child has a suspected serious bump on the head and is dizzy or confused, has difficulty seeing, it will be important to consult your doctor. If the child appears unaffected, it will still be important to keep them awake for an hour or two before sleeping. Then check the child's skin colour and breathing pattern every couple of hours. If these are normal, allow them to continue sleeping. If either seems abnormal, gently rouse the child from sleep. If he fusses and wants to go back to sleep, he's fine but if he cannot be roused, or it is difficult to do so, it is important to call the doctor and probably place a 911 call.

Even when all seems normal, watch the child closely for the next twenty-four hours. If he/she vomits repeatedly, becomes confused, is listless or extremely irritable, complains of a headache, has slurred speech, neck pain, seizures, poor coordination, displays aggressive behaviour, has any discolouration or bruising around the eyes, blood or other discharge from the nose, enlarged pupils or loses consciousness, call your doctor or emergency services immediately. It is important to trust your instincts at this time.

Following any type of head injury, a child should be monitored. They should not return to playing sports or activities of any kind. Rest is important until the doctor advises that activities can be resumed again. It is a good idea for a child with a head injury to be examined by a doctor and if thought advisable that a CT scan be done.

Risks for future injuries should be minimized for sports related trauma as well as in other areas where children play and are active. Secondary injuries to the head can result in more longer lasting problems, i.e.: with neurocognitive problems, behaviours, learning skills, memory issues and depression.

Ways to minimize further injuries are:

- Banning body checking in the younger age groups.

- Reducing violence and defining acceptable behaviour.

- Changing the rules to protect children from getting concussions or more serious head injuries.

- Teaching correct tackling, contact procedures and collision techniques. Better training is important. Often it is parents who are doing the training and coaching and they may not have the necessary knowledge.

- Immediately replace damaged equipment. It is also important to remember that helmets, even when properly fitted and worn correctly, only protect against skull fractures. They do not protect against concussion because a bump on the head will still cause the brain to move around inside the skull.

- For children who are skateboarding, running or playing, it is important to do so in well-lit areas that are free of obstacles and holes or uneven ground.

- Follow the rules of the game and all other safety rules.

Now is the time to protect our children. Not when it is too late. If only, should have, and I wish I had, do not correct damage that has already been done.

Sports Related Childhood Brain Injuries

Through hockey, football and soccer, we are possibly placing our children in harm's way. There is the potential for brain injuries in all of these sports. But the dangers can be avoided if common sense is used and proper safety measures are considered.

More than half of the sports-related brain injuries that children suffer is while playing ice hockey, generally as a result of player contact, getting hit from behind or being hit into the boards. In football it is usually as a result of tackling and in soccer, it will result from head-to-head contact, collisions, high kicks or from hitting goal posts. Baseball injuries are usually the result of ball, bat or another player contact. This occurs more often in younger players, usually under ten, who stand too close to the swing of a bat or don't wear proper head gear when on the field. Other sports teams, where people can suffer head injuries, are lacrosse and basketball. Injuries in basketball have increased significantly in the past ten years from elbowing or by hitting a fixed structure.

Soccer and hockey are the most common sports played by children's leagues particularly for those in the five to fourteen age range. But other sports outside of leagues where there can be the potential for brain injuries are for skiers, snowboarders, cyclists, skateboarders, water skiers and for those who horseback ride.

There are, however, safeguards that can be adhered to in an attempt to protect our children against brain injuries while playing sports. They are:

- All children should wear protective gear, which includes properly fitted helmets that are worn correctly. And proper equipment should be used at all times - both in games and at practices.

- All rules and regulations for each sport should be strictly adhered to, i.e.: by following game regulations and making sure that all rules are enforced. (One rule that is not strictly enforced is hitting from behind in hockey which continues to happen in spite of the rule against it).

- All government officials, sports organizations, sports sponsors, schools, coaches, parents and players need to be aware of the dangers, and to change their behaviours and attitudes.

- Adult supervision should be mandatory in all children's sports.

- There should be programs available to educate the public on the dangers of children in sports and subsequent head injuries.

- There should be rules and incentives in place to encourage safety in sports.

- In soccer and football, padded goal posts should be on every field as both of these sports are highly physical games and children are at risk of injuries.

Although I no longer have young children playing sports, I do have grandchildren who play baseball and soccer. I see my seven year old grandson heading the ball, which is encouraged in soccer even with the very young, and wonder what that is doing to his brain. My son feels that the ball is not being kicked with any great force at that age so it's unlikely to do any damage.

I believe very strongly that attitudes have to change and people have to be educated. We have to protect our young people. They have no one else to do it for them but us.