Concussions are traumatic brain injuries that occur when a blow or jolt to the head or body causes the brain to bounce off of the bony surface of the skull. These are serious injuries that can affect how the brain functions.
Many concussions heal on their own with plenty of rest and limited physical activity. However, depending on the extent of the damage to your young athlete’s brain, they may need physical, speech, or occupational therapy. If the concussion is severe, we may perform brain surgery to repair or remove bruised brain tissue or ruptured blood vessels.
At the Sports Medicine program at Children’s Nebraska, we diagnose and manage post-concussion recovery for adolescents and teenagers. Since the brain is still developing, concussion management in a young person is much different than in an adult. That’s why our board-certified sports medicine physicians have specialized training and the necessary experience and use an age-appropriate approach.
Concussions typically require a minimum of two visits — one for diagnosis and initial treament, the other for follow-up on progress and management. The initial examination is made up of several components, including a complete history and symptom review along with a physical exam.
Concussion Signs And Symptoms
A concussion is usually suspected when any one of these signs or symptoms are present after a blow to the head:
| Physical Symptoms | Cognitive Symptoms | Sleep-Related Symptoms | Emotional Symptoms |
|---|---|---|---|
| Headache or “pressure” in the head | Difficulty concentrating | Feeling slowed down | Feeling more emotional |
| Nausea/Vomiting | Confusion | Low energy | Irritability |
| Dizziness | Memory problems | Drowsiness | Sadness |
| Balance problems | Feels as though they are “in a fog” | Trouble falling asleep | Nervousness or anxiousness |
| Double or blurred vision | Difficulty remembering | Trouble staying asleep | |
| Sensitivity to light or noise | |||
| General feeling of “not feeling right” | |||
| Neck Pain |
Sports Medicine Concussion Care: Safely Returning Young Athletes to Sports & School
Physical Exam
The physical exam will assess:
- Cognitive function and memory
- Neurological impairment
- Compromised balance
When Is A Concussion A Medical Emergency?
Call 911 or go to the Emergency Department if your adolescent has any of the following signs or symptoms:
- Seizures (twitching or jerking movement of parts of the body)
- Weakness or tingling in the arms or legs
- Cannot recognize people or places
- Agitated
- Impaired consciousness
- Difficult to arouse or unable to awaken
- Repeated vomiting
- Slurred speech
- Bloody or clear fluid from the nose or ears
Concussion Care
We know concussions affect your young athlete during play, on the field, and in the classroom. That’s why we have developed comprehensive concussion care services not only to address the physical symptoms, but also to get your teen back to the classroom faster.
The majority of concussions in adolescents and teenagers — about 80 to 90% — resolve in 2 to 3 weeks. The remaining 10% to 20% can benefit from specialized therapy to address the areas that take longer to heal.
Our Concussion Care Services is equipped with licensed, board-certified physical therapists, licensed speech-language pathologists and licensed athletic trainers, to help return the athlete to the classroom and field of play.
When referred for care, our concussion experts will provide you with the tools your young athlete needs to make a complete and safe recovery.
Our care involves a three-part approach:
Part One
This is an exercise-based program using various forms of exercise, including:
- Activity modification
- Cardiovascular
- Strength
- Vision
- Vestibular
- Balance
- Return to sport
Part Two
They will work with our academic liaison and licensed athletic trainer, who will:
- Meet with your teen and systematically go through their academic schedule.
- Take note of classes your teen is struggling with and outline accommodations for those specific deficits.
- Reach out to the school to ensure staff there are able to provide these accommodations.
Part Three
They may work with our licensed speech-language pathologist to address:
- Difficulties understanding or using spoken and written language
- Difficulties understanding the subtleties of language such as using or identifying emotions, facial expressions, gestures, or body language
- Difficulties carrying on conversations
- Inabilities or difficulty paying attention or staying on-task
- Difficulties with memory and information processing
Concussion Legislation
Return To Play
If your young athlete gets a concussion, they are at an increased risk of getting a second one. If a second concussion occurs before the first concussion has finished healing, it can be life-threatening. Because of this, every state in the US has now enacted concussion legislation to protect young athletes from returning to play too soon following a concussion.
The Nebraska Concussion Awareness Act took effect on July 1, 2012. Now by law, after suffering a concussion, your young athlete will not be allowed to participate in any recreational or school supervised activities (games or practices) until:
- They have been evaluated by a licensed healthcare professional
- They have received written, signed clearance from their healthcare professional and written permission from their parents or guardians
- They have submitted that material to the appropriate personnel
Licensed health care professionals include physicians and athletic trainers, who are specially trained in concussion recognition and management and can guide your young athlete back to play and school safely.
There are certain stages of activities that must be completed in order, without symptoms, prior to returning to play
- No return to play same day of incident for young athletes
- Must be asymptomatic without the use of medicines before they are allowed to progress to sports
- A minimum of 24 hours should be spent at each stage. Younger athletes or those with a complicated concussion history will often spend more than 24 hours at each stage
| STEP | ACTIVITY | GOAL |
|---|---|---|
| 1 – Symptom limited activity | Daily activities that do not provoke symptoms | Recovery |
| 2 – Light aerobic activity | Walking, swimming or stationary bike keeping intensity <70% of max HR; no resistance training | Increase Heart Rate |
| 3 – Sport-Specific exercise | Skating drills in ice hockey, running drills in soccer; no head impact activities | Add Movement |
| 4 – Non-contact training drills | Progression to more complex training drill (e.g., passing drills in football and ice hockey); may start progressive resistance training | Exercise, coordination, and cognitive load |
| 5 – Full contact practice | Following medical clearance, participate in normal training activities | Restore full confidence and assess functional skills |
| 6 – Return to play | Normal game play |
Return To Learn
Since concussions can affect any part of the brain, they may lead to learning or concentration problems. This can impact the quality of your young athlete’s academic performance. However, with the right accommodations, this might not have to be a significant impact.
Appropriate management of the “Return to Learn” process is a critical part of concussion recovery. At the Sports Medicine Program at Children’s, we will customize a “Return to Learn” plan for your adolescent or teen.
They will move through the plan at their pace, typically graduating from complete cognitive rest, to light cognitive activity, to a gradual increase of school-specific activity, culminating in a return to full academic activities.
| STAGE | AIM | ACTIVITY | GOAL |
|---|---|---|---|
| 1 | Daily activities at home that do not provoke symptoms | Typical activities of the day that do not increase symptoms (e.g., reading, texting, screen time). Start with 5-15 min. and gradually build up time | Gradual return to typical activities |
| 2 | School activities | Homework, reading, or other cognitive activities outside of the classroom | Increase tolerance to cognitive work |
| 3 | Return to school part-time | Gradual introduction of schoolwork. May need to start with a partial school day or increase breaks during the day | Increase academic activities |
| 4 | Return to school full-time | Gradually progress school activities until a full day can be tolerated |
Return to full academic activities and catch up on missed work |
These accommodations may be in place for the duration of the healing process and should stay in place for post-injury complications that affect their ability to perform at their highest potential.
Concussion Resources
- World Herald Article 11/13/18 Kids with concussions can text, but ‘Fortnite’ should wait, says Children’s doc in new report
- Suggested Guidelines for Management of Concussion in Sports – April 2017 (National Federation of High Schools – NFHS)
- Soft Headgear in Non-Helmeted Sports Position Statement – April 2017 (National Federation of High Schools – NFHS)
- Heads up for Parents (Centers for Disease Control – CDC 2017)
- Heads up for Middle School Athletes (Centers for Disease Control – CDC 2017)
- Heads up for High School Athletes (Centers for Disease Control – CDC 2017)
- World Herald Article 10/16/16 Is it safe to play? Without definitive data on brain injuries, parents must weigh pros and cons of kids’ contact sports.
- World Herald Article 11/3/16 In Omaha area, doctor portrayed in movie ‘Concussion’ stands by conclusion that kids under 18 shouldn’t play football.
- WOWT Interview with Dr. Kody Moffatt “The Concussion Discussion”
For more detailed information, please see the following links:
- Brain Injury Alliance of Nebraska
- Centers for Disease Control
- National Athletic Trainers’ Association (NATA)
- Nebraska Brain Injury Advisory Council
- Nebraska Department of Education
- Nebraska State Athletic Trainers’ Association (NSATA)
- R.E.A.P Manual (Remove/Reduce, Educate, Adjust/Accommodate, Pace)
What To Do Next
If your young athlete has a concussion, call 402-955-PLAY (7529) to schedule an appointment with one of our sports medicine physicians at the Sports Medicine Program.