We need a plan for addressing concussion

Seriously. When it comes to handling concussion and mild traumatic brain injury, especially among student athletes, we desperately need a plan of action to address the injury when it happens.

Because it can — and does — happen. And it will continue to happen so long as we are doing more than sitting passively in a chair watching the game. Provided you never move from that chair, you’ll be safe… until obesity and all the health issues that accompany sedentary life catch up with you.

Personally, I’d rather run the risk of concussion.

And so would a lot of other people.

So, given that there are individuals out and about who are engaged in activities which carry a danger of head injury, how shall we address it when it happens?

I say, we come up with a plan for this. Especially among athletic trainers and other healthcare professionals and those who have been down the road of mild TBI and lived to tell about it.

People who are in a position to respond — response-Able individuals — need to step up and put some thought into not just prevention and immediate response, but also concussion recovery. Because if we just say, “You got hurt, but we really don’t know what to do to get you back on your feet. Every brain is different, so we really don’t know what to tell you, other than rest,” I will bet you any amount of money that the under-reporting and symptom concealment and unsafe return to play will continue, even escalate.

At the same time, you don’t want to set unrealistic expectations with the Plan and set people up for disabling disappointment. It’s true that every brain is different, so we have to be careful about making ‘guarantees’. There are none in life, especially with brain injury.

I think there’s definitely a fine line between providing hope and supporting health, and getting yourself into a professionally untenable position. The last thing you want, as a professional healthcare provider, is to have angry athletes and parents showing up at your doorstep shouting, “But you PROMISED my kid would be okay in three months!” I won’t even go into the lawsuit stuff.

Still and all, we need to do something. All of us, not just a select few. And outside the realm of commercial enterprise. Commerce and Concussion should never mix, but unfortunately, they increasingly do. We need to seize the moment and step up, as this concussion business is getting a lot of press – and heaven forbid we squander the opportunity to rise to the occasion.

How about this? Say, we craft a “crowd-sourced” response to concussion which draws on the collective intelligence and training and insight of experts of many kinds all over the place. And we do it for free. Online. As a community.

I envision the following Concussion Response Plan (CRP) for responding to concussion:

This would be an approach which, after a mild traumatic brain injury:

  • Leverages expertise in conditioning and protection and prevention, which comes from the Athletic Trainer camp. We need this to educate players (and others, like parents and coaches) about the source of their injury, to show them how and why their concussion happened.
  • Incorporates knowledge about the physical nature of mild traumatic brain injury, which comes from the Medical camp. We need this to educate folks about the nature of brain injury, to explain the inner workings of it and how physical changes in the brain affect its functioning. We need to stop being so squeamish and start calling concussion what it is — a mild traumatic brain injury.
  • Incorporates knowledge about the potential physical, mental, and emotional impacts of mild traumatic brain injury, which comes from the Neuropsychological/rehabilitation camp. We need this to educate everyone affected about the potential issues that may come up, help them craft intelligent coping mechanisms, AND to show that healing and recovery are possible… and where recovery is not 100% complete, there are indeed coping mechanisms that can be used to offset the effects of the injury, or other options available in life to the impacted individual.
  • Has a firm foundation in physical and cognitive-behavioral conditioning and fitness — in Action. We need to not just sit around and think about “this concussion stuff”. We need to put what we learn into action. This is especially important for concussed athletes, because the agitation that can come from TBI can be a huge issue, and the energy needs to be directed in some productive and constructive direction.

This CRP needs to be clearly defined and articulated from the start, even before athletes are concussed. The uncertainty of sitting out for an indeterminate amount of time, with no structured activity and now outlet for this crazy agitation that comes up — and stays — is no way to spend your days, especially as a student athlete with a concussion. If there’s no planned response to concussion in place, and athletes are left hanging with no structure or direction, the experience is HELL, and it’s all the more reason to hide your symptoms or pretend you’re all better before you are.

And that can — quite literally — get you killed.

But when you’re 16 years old, and the only way you’ve found to be the popular, successful person you always wanted to be, has just been yanked out from under you, it’s easy to choose to risk your life instead of honest disclosure. When your whole identity and sense of self hinges on being able to play — and play well — having that taken away from you might as well be death.

Yes, we need a Plan — a cohesive, coherent, well-thought-out program of action to address Concussion in youth sports across the full spectrum of experience, after the injury as well as before it happens. We need to chart a course that offers some level of structure and predictability to kids and parents alike after the concussion, and gives them some assurance in the midst of a situation which is chronically devoid of predictability.

Even if it’s the assurance of knowing what has happened and that there are specifiic, orderly steps they can take to take to address it — without any specific guarantee that it will all work 100% as they hope/expect — at least that would be something.

We need a Plan for addressing Concussion — how to prevent them, how to appropriately respond to them, and what to do during the time period required to recover. Without such a Plan, athletes — at all levels — are going to continue to avoid this issue and not address it directly or modify their behavior. Because sometimes uncertainty is the scariest thing of all. And nobody likes to be scared.

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Do all the concussions need to wreck us?

Source: diamondduste

I’ve been giving a bit of thought to all the reports of concussions in the news, lately. Football players, ice hockey players, soccer players… not to mention all the reports of kids heading to the ER. Conflicting as those reports may be — some say more pre-teens are being treated, some say more high-school age teens are being treated — the picture is still pretty significant. And the concern is increasingly palpable.

The message, like in a recent blog post of the Chicago Times Union, frames the issue from a concerned parent’s point of view. This isn’t an isolated case, either. Soccer/hockey moms/dads are becoming increasingly vocal about concussion risks in youth sports, and plenty of times there’s an accompanying dismay at the apparent cluelessness of the coaches regarding the risks of unsafe return to play.

Here’s the thing, from where I’m sitting — as a multiple concussion survivor and a former student athlete myself: If we funnel all our energy into fear and avoidance and attempted prevention of injuries like concussions, aren’t we possibly missing a big lesson that sports can teach us, in the first place — namely, that it’s part of human experience to get hurt… and it’s vital that we learn to pick ourselves up, dust ourselves off, and head back into the fray, facing our fears and dealing with what is.

Getting bent out of shape over concussions is understandable, but does it need to derail the very important process of learning from screwing up that often comes from childhood and youth? Since when did we start believing that all the lessons we can learn should be framed in positive terms, with no harm or danger involved? I would argue that by avoiding and trying to prevent risks, we are depriving the next generation of really critical lessons they need to learn, in order to deal effectively in the world.

If they don’t learn how to handle injury and adversity now, when they are relatively safe within the fold of their parents’ house, how will they handle it when the shit really hits the fan?

It inevitably does, you know. No parent can prevent that, hard as they  may try.

Now, I’m sure that there are plenty of parents who will take issue with this attitude. And coming from a multiple mild traumatic brain injury survivor, I realize that credibility is an issue. How can someone who’s gotten clunked on the head as often as I have be a trusted source for judgment about how to deal with sports concussions? I’ve talked about my judgment around risk being a bit impaired in the past, so why listen to me now?

Here’s the thing — it’s not that I’m advocating that we put our kids in harm’s way and not give a damn about their safety. Far from it. But at some point, the helicoptering starts to genuinely prevent the most valuable part about childhood and youth — the learning gained from trying and failing and trying again. That includes the learning gained from falling down, getting hurt, getting up and assessing the severity of your injury, letting yourself heal, and then getting back into the game when it is genuinely safe to do so.

Granted, with concussion, the threshold of safe return to play is often elusive and unpredictable.  But the opportunity — indeed, the teachable moments — that healing from an injury provides, can be invaluable in later life.

Concussions happen. They happen a lot. And I suspect they’ve been happening since the beginning of time — we just haven’t always had emergency departments at the ready to accept the steady stream of kids whose parents have good enough insurance and the level of understanding and concern to get them there.  I’m not sure there are more concussions happening today than before — we’re just more keenly aware of them. And this increased awareness means we’ve got a shining opportunity to learn all about the injury — as well as how to heal.

And learn we must. It’s not enough to wring our hands over all those mild traumatic brain injuries. It’s not enough to rush the kids to the ER and lecture the coach about their insensitivity and putting our kids in danger. It’s not enough to turn our heads away from danger and injury and/or do everything in our power to prevent it. We must learn to deal directly with this in a way that actually works, so that it doesn’t get the best of us. We need to learn to face up to the danger, the risk, the harm, the inevitable hurt, and master our skills in overcoming it.

After all, if concussions are endemic to the human experience and people have been experiencing them since the beginning of time (which I believe is accurate), and we’re all still here (more or less) and we haven’t all died off due to chronic traumatic encephalopathy and our societies haven’t completely disintegrated into a dust cloud of demented violence (or maybe we have?), isn’t that at least some evidence that concussions can and do heal — and that we can probably find a better, more effective way to heal than we’ve seen in the past 50 years or so?

Rest alone won’t always do it.  Concussion and TBI experts tend to agree that resting (and doing nothing else) doesn’t always fix the problems that come from post-concussive syndrome. Exercise, on the other hand, has been shown to clear issues with people with remarkable success — as SUNY’s University at Buffalo Concussion Clinic has found. Even professional ice hockey players are turning to them for help, and it appears to be helping. After decades of partial solutions, we’re getting to a point where we’re learning new ways of dealing with the somewhat staggering numbers of head injuries, and we should use them.

Let’s use them. Let’s deal with the issues around concussion — both the prevention of needless injury, and the healing from the hurt. Short-term recovery should be actively evolved and pursued and talked about in every public forum, from youth/amateur sports to professional circles. And long-term recovery should be addressed as well. Nobody who’s sustained a concussion (or more) should have to live under the dark cloud of the depression, the mood disorders, the behavioral issues, and the cognitive problems… not to mention the public stigma that comes from being considered “brain damaged”.

Concussions happen. But they shouldn’t have the last word.

At least, that’s what I think.