Sports Medicine Concussion Q&A with Dr. Erin Reynolds By Sports Medicine, December 23, 2016 Erin Reynolds, PsyD, with the UPMC Sports Medicine Concussion Program, and Gail Donlan, whose daughter has suffered multiple concussions, answer your questions about concussions during a Facebook Open Wall chat. Question: What are some of the symptoms of concussions? Are there any that aren’t as obvious? Dr. Reynolds: The most common symptoms of concussion include headache, dizziness, nausea, sensitivity to light and noise, difficulty concentrating, and the inability to sleep or sleeping too much. Less obvious signs can include subtle changes in mood, mild increase in irritability, and being more tearful. Sometimes symptoms are worse riding in cars or being in busy places. Change in behavior including taking naps or avoiding social engagements are also some of the less obvious signs of a concussion. Gail: My daughter’s initial symptoms were very severe. She didn’t lose consciousness but she couldn’t put thoughts together and suffered from confusion. She was also showing abnormal neurological signs. Question: Gail, how long did it take your daughter to recover from her concussion? Gail: My daughter was back in school approximately one week after the injury. She attended vestibular therapy sessions for four weeks before she was cleared. I understand that this time frame differs between patients, though. Question: Gail, is there anything you learned from your experience with your daughter’s concussion that would be helpful for other parents to know? Gail: My daughter actually suffered three concussions between the ages of 12 and 15, so I’m pretty well-versed in the process at this point! The first two were treated by doctors at a different facility. When she was concussed a third time, we ended up at the UPMC Sports Medicine Concussion Program. I quickly learned that the treatment protocol here is very different compared to other programs. For example, I learned that my daughter didn’t have to sit in a dark room, that she was actually able to use her brain, and that she didn’t need to sleep all day. Once my daughter learned that she didn’t have to “do nothing” per past treatment programs, I think it helped her recovery time decrease due to a lack of depression. She was more motivated to do the treatment and get moving again, which really kept her spirits up. Question: Dr. Reynolds, do concussions always involve a loss of consciousness? My sister collided with another player but wasn’t knocked out. Dr. Reynolds: Good question. Loss of consciousness doesn’t always occur with a concussion. In fact, 90 percent of concussions do not involve loss of consciousness. If you do lose consciousness, it’s important to receive immediate medical care. You should proceed to the nearest emergency room or call 911. Question: How many concussions are too many, Dr. Reynolds? Is there a number, or does it depend on severity? Dr. Reynolds: There’s no magic number. It depends on a number of factors including severity of injury, the time it takes someone to recover from a concussion, how complicated the recovery process is, and what risk factors someone has prior to the concussion. For example, someone with a history of migraine headaches and motion sickness who is getting concussed more frequently could experience increasing complexities in his or her recovery. Question: Dr. Reynolds, I’ve read a lot about special helmets and headbands for various sports. Is there really a way to prevent concussions? Dr. Reynolds: Unfortunately there’s no way to prevent concussion. Helmets are designed to prevent skull fracture and they do a good job at that. A concussion occurs when the brain shakes inside the skull. Until we develop technology that prevents that from occurring, helmets are insufficient in preventing concussions. The same goes for any protective headgear, including soccer headbands. Question: Does my child need to give up sports if he suffers a concussion? My husband and I have differing opinions. Dr. Reynolds: We believe that concussions are treatable. Our understanding of the injury has evolved dramatically over the last decade. We continue to better understand the intricacies of the injury. We are now able to identify clinical profiles and develop individualized treatment plans based on the patient’s symptoms. There are some exceptions in which return to contact sports may be cautioned against, but that is definitely a rare occurrence. Gail: My husband and I believed our daughter shouldn’t be allowed to play again after her injury in soccer, but after going through the program at UPMC, we felt very reassured that it was okay and safe for her to continue playing. Question: My mom wants to know about getting my younger brother baseline tested. How can she schedule a test for him, Dr. Reynolds? Dr. Reynolds: The UPMC Sports Medicine Concussion Program offers ImPACT® baseline testing for children ages 5 and older. We recommend having children baseline tested once a year until they reach high school, at which time testing can decrease to every other year. Question: Dr. Reynolds, do you accept out-of-town patients? If so, how often do patients need to travel for appointments? Dr. Reynolds: Absolutely. We see patients from all over the United States, and even other countries, regularly. Learn more about concussion symptoms and signs. Out-of-town patients receive an itinerary prior to their first visit. Appointments are typically scheduled for the same day, and almost always in the same building to make the treatment process as manageable as possible. Depending on your recovery, out-of-town patients are typically asked to do one to two follow up appointments. If you’re interested in making an appointment, you should call our office at 412-432-3681. Question: Two questions: No. 1: Dr. Reynolds, why do females have a higher risk for concussion? No. 2: Gail, as a parent, what kind of resources/education did you find helpful when your child had a concussion? Dr. Reynolds: There are a few theories about why females tend to be more prone to concussion than males. The first one has to do with neck strength. We know that adolescent males grow at a faster rate than females and their necks are stronger, therefore they can better protect themselves. The second theory involves hormones. Due to hormones, females are more susceptible to migraine headaches, which are very similar to concussion in the way they affect the brain. Women of child-bearing years are more likely to have migraine headaches and therefore may also be more susceptible to concussion. Gail: There are a lot of resources online but I found the information to be very conflicting. So, I relied on my daughter’s clinicians at UPMC Sports Medicine Concussion Program to provide the best information for her care, and later they told me about their website ReThinkConcussions.com. A lot of people aren’t familiar with the latest treatment options for concussion so it was refreshing to know we could rely on UPMC. I knew my daughter was in good hands. Question: Dr. Reynolds, my daughter had a couple of concussions in high school and was treated by UPMC. Is there any risk for her adult years? To schedule an ImPACT® baseline test, please visit the registration outreach program website or call 1-855-937-7678. Dr. Reynolds: It’s somewhat hard to say what the future will hold in terms of long term risk, but the research to suggest long-term effects is minimal at best. Unfortunately, there has been more media attention to this issue than solid research, so we don’t have good data to rely on. That being said, we have evolved significantly in our treatment and incorporate a number of assessment tools to determine when someone has recovered from a concussion. We believe that, once full resolution of injury has occurred, that person should not be more at risk for future concussions. I would be more worried about potential long-term effects when multiple concussions are sustained with no treatment. There could be more significant neurologic damage in repetitive, layered injuries. If your daughter was treated in our program at UPMC, then you can rest assured that she received comprehensive treatment and was not returned back to play until full resolution of injury was met.