Concussion care evolving as providers seek ‘sweet spot’

Photo: Pia Christensen/AHCJNeurologist Dr. Glynnis Zieman, of the Barrow Neurological Institute, answers a question from a Health Journalism 2018 attendee about brain injuries. Mayo Clinic neurologist Dr. Amaal Starling (left) and NPR science correspondent Jon Hamilton (right) also were featured on the panel moderated by NPR’s Scott Hensley.

Doctors and researchers are adapting treatments for brain injuries to recognize individuals’ needs, but still are searching for the right balance of care for a diverse set of patients who have suffered blows to the head, panelists told attendees at one panel during Health Journalism 2018 in Phoenix.

Treating people with possible concussions means providers must assess and manage a wide range of patients, from young athletes and military personnel to domestic violence victims and the elderly, the experts said during the Friday session, “Concussion and brain health: New angles on diagnosis and treatment,” which was moderated by National Public Radio editor Scott Hensley.

“The key is … knowing where that sweet spot is,” said Dr. Amaal Starling, a Phoenix neurologist for the Mayo Clinic, adding that patients must be identified quickly and treated with a multipronged approach to ease them back into regular activities.

For athletes, especially youth, Starling said providers are shifting to a more blended approach rather than strict, long-term rest regimen that can leave patients feeling isolated and negatively impact overall well-being. Attitudes are changing to recognize the need to immediately remove athletes from play, for as long as necessary, so they can continue to be active long term, she added.

Still, there is still no clear-cut way to diagnose a concussion, Starling said, cautioning journalists away from simple headlines that can mislead readers.

“There is not a test that rules in or rules out a concussion,” she said.

Dr. Glynnis Zieman, a neurologist at Barrow Neurological Institute’s Concussion and Brain Injury Center in Phoenix, discussed the differences between men and women when it comes to head injuries and potential brain trauma. Zieman said hormones, neck size, athletic style of play and other factors can impact the risk of concussion and their effects.

Photo: Susan HeaveyBarrow Neurological Institute neurologist Dr. Glynnis Zieman discusses the differences between male and female patients with head injuries, as well as the challenges of diagnosing and treating victims of domestic violence.

She also discussed the challenge of treating head injuries for victims of domestic violence. Unlike athletes, these patients usually are not immediately removed from their source of risk, often may not report such injuries or seek care, and can be more frequently injured over a more extended period, she pointed out.

“Unlike athletes, they don’t get the luxury of recovering until they’re exposed to the next one. They just keep getting hit,” said Zieman, adding that emergency responders, police and doctors should rethink how they engage with such patients.

A reporter’s coverage of concussions and other brain injuries similarly requires an individualized approach, said NPR science correspondent Jon Hamilton.

Hamilton said he looks for stories beyond the commonly heard tales of injuries to teenage soccer players or professional football stars, recalling one story that featured mixed martial artist star Gina Mazany. Another piece featured a former service member-turned-scientist’s quest to examine traumatic brain injury (TBI) after reconnecting with an old Army buddy.

Hamilton also has explored the effect of multiple smaller blasts on the brain, known as subconcussions. He encouraged health reporters to find unique ways to cover this issue, look for unusual patients who don’t fit the mold and delve into the people behind ongoing research. He acknowledged the challenge of reporting on such a complex subject, especially in a conversational way for a radio audience.

It is, after all, covering, “the most complicated thing in the known universe” – the brain, he said.

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