By Patti Singer
Democrat and Chronicle
Matt Grady, M.D., a pediatric sports medicine specialist at Children's Hospital in Philadelphia, held up his right hand as though he were cradling a fresh egg between his index finger and thumb.
"The shell is the skull," he said. "The egg is the brain."
Then he shook his hand as if to say, "This is your brain getting a concussion."
Any questions?
Grady, Jack Jallo, M.D., Ph.D., director of the Division of Neurotrauma and Critical Care at Thomas Jefferson University Hospitals, and Margot Putukian, M.D., team physician and director of athletic medicine at Princeton University, explained the symptoms, diagnosis and recovery from concussion in "From pee wee to pro: Head injuries in sports."
The doctors said that many people think that concussions are caused only by a direct blow to the head. But a concussion is any force applied to the brain, and the reverberation from a blast or the quick rotation of the head and neck can cause an injury that impairs the person's ability to function.
The physicians centered the discussion on concussions, and not second-impact syndrome or chronic traumatic encephalopathy, which can be related to repeated brain injury.
Putukian said there is variability with the effects of concussions, which are graded as mild, moderate or severe.
Symptoms can develop over time, so it is important to keep an eye on anyone with a head injury. The athlete could experience nausea, have difficulty with vision, feel off balance or have trouble remembering or identifying their surroundings.
Concussions are a concern for all age groups, the experts said. But children, either at play or in organized sports, are at high risk. Grady said that emergency room data showed that 65 percent of concussions occurred in people younger than 18, and most happened in the 11- to 14-year-old age group.
Considering the data, it seemed surprising to many in the audience that concussions have not been extensively studied among pediatric patients.
"Studies have focused on adults," said Grady, a pediatric sports medicine specialist. "We know that pediatric patients are not little adults."
He said that children take longer than adults to recover from the injury and they can have difficulty with new learning. For a child who has sustained a concussion, "you're not really talking about returning to sports, you're talking about a return to function."
Neurophysiological testing is becoming popular as a way to gauge an athlete's baseline cognitive and physical status. But the experts saw some problems with those tests, including the need for a qualified person to interpret the findings and the calculated efforts of some athletes to flunk the test to gain leeway in case they did sustain a concussion.
Sports organizations and the Centers for Disease Control and Prevention have started programs to raise the awareness of concussion as a serious injury. That treatment includes rules that govern return to play.
But that message can get lost when athletes of any age are pushed to excel. Jallo and Grady discussed the role of the doctor protecting the athlete from him or herself.
For professionals and children, the injury can have long-term consequences. While a professional has a career on the line and must provide for a family, the youngster also has a future to consider – one that may never have led to the pros.
Grady said that because concussions impair a person, doctors have to look at how a child was doing before a concussion and how they are doing afterward.
"I have this conversation a lot with parents," Grady said. "Your child used to be an A student and now they're a B student. How much stupider are they allowed to get. If you put it that way … ."
