Return To Play | Pediatric Concussion

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– Concussions are treatable injuries, especially in young athletes, if treatment is received early on by a concussion expert. Since opening it’s doors in 2000, the UPMC sports medicine concussion program has become a global leader in sports-related concussion testing, diagnosis treatment, and research. So, if a young athlete happens to sustain a concussion from sports or other activities, look no further than the experts right in your backyard. From pediatric baseline testing to individualized treatment programs for each type of concussion, they can help your athlete meet their return to play goals. Hi, I’m Charlie Batch. Yes, that Charlie Batch, if the name is familiar to you. And I’m here with Dr. Nate Kegel, a neuropsychologist specializing in pediatric concussions at the UPMC sports medicine concussion program. Doc, thank you for joining us here today. How would you describe a concussion to a young athlete?

– When I see a younger athlete, I think it’s important to be sure that I explain an injury like a concussion in an understandable way that’s appropriate for them. So, I try not to use a whole lot of technical terms. I like to be pretty simple and straightforward. So, I might say it’s a brain injury that’s caused, that will cause an energy issue that might result in headaches and fatigue. And you might feel a little slower than usual. And that’s one of my goals, initially, to educate them, but also reassure them that they’re gonna be okay. And that this injury is treatable and they’re gonna get better if we follow the right kind of steps.

– And how does a young athlete sustain a concussion?

– So, it’s all about force. force to your head, force your body that causes your brain to move inside your skull. And then it results in that energy crisis that causes some of those classic concussion symptoms. And it can occur in practices or games. Athletes can sustain them in high contact sports like football, and even sports that are lower contact or lower risk. You name a sport, I’ve probably seen a kid who’s had a concussion in that sport.

– Now, when we say young athletes, you say kid, what are some of the youngest ages that you’re seeing?

– Well, I see athletes as young as age four or five, and we can apply our model of management to those kids at that age. And we really focus on helping them stay on the routine and stay engaged in day-to-day activities, but maybe making a few modifications to their day-to-day activities to help them recover faster.

– And how can some of those younger athletes avoid a concussion?

– So, you have a great opportunity with younger athletes to teach them the right technique, especially in a sport like football or hockey, you’re teaching proper tackling but you’re also teaching them to not, you know, target another player’s head or take a cheap shot at another player. So, that’s a big part of, I think, you know, for younger athletes, we can reinforce those types of things. I think you can also, you’re never gonna completely eliminate concussion from some sports that involve, that have contact and collision, but to be able to recognize signs and symptoms and educate coaches and parents on signs and symptoms is important. And I think that can really help with reducing the risks and reducing the effects of concussion.

– Now, how do you identify but yet be able to treat a concussion?

– So, identification, of course, occurs on the field. Signs of a concussion are easy to pick up. Loss of consciousness, vomiting, balance issues, those types of things. Symptoms of concussion are gonna be reliant – You’re gonna be relying on the athlete to report those symptoms. So we take, you know, the injury that might’ve occurred, you know, when we diagnose a concussion, we rely upon that information, but then we bring them in the clinic, do a good interview, go over what happened and all of the symptoms they’ve been having. And then we have them go through some different types of evaluations. We might look at their eyes and see how their eyes work together. And we might look and see how they tolerate moving their head and see if that makes them dizzy or gives them any headache or nausea. We also complete neurocognitive testing. So, we’re looking at their memory, we’re looking at their processing speed, and we’re gonna put all those things together, come up with a diagnosis, and figure out what they need in order to get back on the right track.

– Now, you talked about baseline. How does pediatric and adult baseline testing differ?

– So, baselines are an important part of our evaluation and they provide a lot of information about how the athlete’s doing and when they’re safe to go back to play. A baseline would be a test of memory and processing speed that’s administered pre-season or before the injury occurs. The pediatric test is administered on a tablet. It’s more kid friendly. It’s shorter in administration time and it keeps the kids engaged and still gives us the information we need in terms of how their memory works and how quickly they’re processing information. And that helps us make decisions on return to play.

– Now, what does a concussion treatment plan look like?

– Once we have them in for an evaluation and we determine, you know, they have, they’ve had a concussion and here are some of their symptoms, we’ll tailor their treatment plan to those symptoms. The first thing in any case that we see is we’re gonna try to manage it behaviorally and we’re gonna try to apply some practical recommendations to the injury. So, we want them to stay on the routine. We want them to stay engaged in school. Maybe we make a few modifications to school, and then we’re gonna see if they need any formal treatment. There might be, there’s treatment for dizziness, there’s treatment for balance issues. If that’s the case, we send them to vestibular therapy. If they’re having some issues tolerating exercise and returning to play, we can do exertion therapy. So, there’s different types of therapy and treatment we can apply formally to the injury, but it all starts with getting them on the right routine and managing it behaviorally and getting them off on the right foot.

– Now, you mentioned “we” a few times. In there, who is part of that concussion treatment plan?

– So, when patients come to our clinic, the neuropsychologist serves kind of as a point guard. So, we come up with a treatment plan, we’ll get other disciplines involved if we need to. And that might include vestibular therapist or exertion therapist, but oftentimes the most important member of that treatment plan is the athlete, the young athlete’s parents. And we really rely on them a lot to help, you know, keep the patient on a good routine, make sure that they’re, you know, going to sleep at around the same time and keeping their sleep schedule consistent, making sure that they’re hydrating well, making sure that they’re staying on a good school routine. And I think that when we can educate the parents well, then that really, the outcomes are much better. And when we can do that early on, the outcomes are significantly better.

– Now, you do have parents and some family members who want to do their own research. What are some of the myths that you would like to clear up?

– So, I get asked quite frequently, “If my son or daughter sustains another injury, is it gonna be worse than the first one?” And the answer is no, it’s not necessarily gonna be worse. We don’t know for sure, but the assumption that the second injury is gonna be worse is not always true. The other question I get asked a lot is, “Is my child now more susceptible to concussion because they sustained one?” And it’s really a case-by-case basis on the injury, and that’s not always the case either that you’re, you’re not always more susceptible just because you’ve had one injury.

– In another myth, parents think that they should have their kids on strict rest. Is that true?

– Not at all. We take an active approach with our clinic. We like to get kids back to activity. We might need to modify that activity a little bit and have them take some breaks here and there if their symptoms become too severe, but we want them in school. We want them doing some level of physical activity. Usually, at least, we’ll have them do, you know, maybe 20, 30 minutes of light activity per day. We don’t want them napping. We want them to stay on a good routine. And I think keeping them active, and the research would show that keeping them active really facilitates recovery faster.

– How long does recovery usually take for young athletes?

– It can vary quite a bit. I’ve seen some of my patients get better in a week or even a little less than a week and I’ve had patients that take months to get better. I’d say, in general, most of the kids I see, the younger athletes I see, if we give them three weeks or so, they’re usually feeling better and getting back to play around that time frame.

– Now, getting back to play now, how do you know when a young athlete is ready to become clear to play?

– Right, so they have to meet a few criteria to get back to play. And it’s the same as, we would apply the same criteria to a younger athlete as we would to a high school athlete or a college athlete or a pro. They have to be symptom-free and they have to be able to tolerate physical activity. We make sure their vestibular system is working properly, so we make sure that they don’t have any dizziness with movement of their head and those kinds of things. And then we make sure that their neurocognitive testing is at a baseline, at baseline level if they have a baseline, and, or that it’s within a range where I would expect they should fall on that testing.

– Now, as you go through all of this and that player’s ready to return to play, is that one of the most rewarding factors of your job, when you have seen that athlete go from injury to now return to play?

– Yeah, for sure. And it’s especially rewarding in younger kids, ’cause I think you get a lot more of that emotion when you clear them, they’re gonna express that a lot more I think in a clinic situation than maybe an older kid might be a little more reserved. So, younger kids really express that a lot. Another thing I think that’s rewarding is if I go back to an initial appointment when I see a family, a lot of times they come in and they’re worried. They don’t know what to expect. And I think when we provide them with the right kind of education and the right information upfront, that we’re able to put them at ease and really make the injury a lot more manageable for them. And I’ve had numerous times where a parent just, they thanked me after the first visit because they feel so much better about the injury after we’ve kind of gone through everything and educated them. They were just, you know, nervous coming in and they feel much better after that first visit.

– And seeing those smiles, that’s what it’s all about.

– Right, exactly.

– Dr. Kegel, thank you for sharing that important information. We truly appreciate your time. Do you suspect your child has a concussion? Do you just want to know more about how concussions are diagnosed and treated here in Pittsburgh? From information about the types of concussion to education about active treatment plans, the UPMC sports medicine concussion program website has it all. To learn more about pediatric concussions and how to help ensure your child has a safe return to play, visit

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