Specialized care needed for post-concussion syndrome
John-Peter Temple, MD
Collision sports such as football, hockey and soccer carry a higher level of risk for brain concussion and post-concussion syndrome in children and adolescents. But frequently, non-collision activities like track, volleyball, gymnastics and cheerleading share that danger, too.
"All concussions or suspected concussions should be evaluated medically, ideally by those with specialized training in concussions and traumatic brain injuries (TBI)," reports John-Peter Temple, MD, the region's only board-certified pediatric neurologist. "Proper treatment requires awareness of what young patients need to make sure their brains recover. This is especially true in the acute phase immediately after the event which can pose the greatest risks."
According to Dr. Temple, it's also important to remember the following about concussion:
- There does not need to be a loss of consciousness.
- It doesn't require a direct blow to the head—it can be caused by a whiplash action.
- The degree of post-concussion syndrome is not always proportionate to the severity of the concussion.
- Symptoms of impairment may not appear for several hours or even days after the event.
"Post-concussion syndrome can last for weeks or even month after the initial concussive injury. Symptoms are often variable in patients including headaches, dizziness, coordination problems, loss of concentration, mental fogginess, light and sound sensitivity, mood and personality changes, irritability and sleep disturbances," Dr. Temple explains. "Some may not be obvious."
Dr. Temple stresses, "It's better to over-refer than to under-refer if you have a pediatric patient with symptoms that may indicate concussion. That's because if someone has had a previous concussion or any degree of impairment, delayed treatment may slow recovery.
Student athletic programs in our area perform baseline neurocognitive testing called ImPACTÒ (Immediate Post-Concussion Assessment and Cognitive Testing). It is used with participants in collision sports to evaluate a student athlete who may have suffered a concussion.
If a concussion occurs, a healthcare provider can perform a follow-up ImPACT test comparing it to the data from the baseline test. This is a way for the provider to objectively evaluate an athlete's post-injury condition, track recovery and determine fitness to safely return to play.
"An athlete should not return to sports or full activities until his or her score is at or near the baseline score," reports Dr. Temple. "Continued full participation in academics and sports after a concussion can prolong recovery. Return to activities should be a gradual and monitored process."
For a referral to Gundersen's Pediatric TBI Clinic or a consultation with Dr. Temple call Pediatric Neurology via MedLink at (800) 336-5465. In La Crosse, call (608) 775-5465. Gundersen Neurosciences also has an Adult TBI Clinic, staffed by Physical Medicine and Rehabilitation and Neuropsychology which can be reached via MedLink as well.