By Dev K. Mishra, M.D.
President, Sideline Sports Doc
It seems we are bombarded with new information about concussions on an almost daily basis, and here is even more information to cause us to stop and consider the best time to return a young athlete to play. A recently published study showed that cognitive and functional deficits persisted in young athletes after sport related concussion out to 2 months after the concussion. A group of concussed athletes were followed after concussion and tested at certain intervals. The concussed athletes were compared to a normal group of athletes also tested at the same time periods. The study showed statistically significant deficits in the concussed group compared to the control group in attention and task-switching at all time points tested, although the concussed group did improve over time.
Based on these study results as well other study data, the researchers suggest that adolescents may require an extended recuperation time to completely recover brain function following concussion, and that specific concussion tests can provide valuable information for physicians carrying out follow-up assessments and determining proper time points for return to play.
“If a person goes back to the playing field without a full recovery, that person is put into great danger of being re-injured,” emphasized study author Li-Shan Chou quoted here. “In any given season, if you suffer a concussion, the chances of your suffering a second one is three to six times higher and suffering a third is eight times higher. There are accumulations in this kind of injury. It doesn’t go away easily.”
“The differences we detected may be a matter of milliseconds between a concussed person and a control subject, but as far as brain time goes that difference for a linebacker returning to competition too soon could mean the difference between another injury or successfully preparing to safely tackle an oncoming running back,” said co-author David Howell.
What Can We Take Away From This Study?
This was a well-conducted study that adds to our knowledge base about concussion. Sophisticated testing can often find differences that are very subtle, even to a properly trained physician skilled in concussion management. The field of concussion testing is evolving and we don’t yet have a consensus on which of the various test methods is best. Most physicians at the college and professional team level use some form of the paper-based evaluation known as SCAT2. Ideally, the athlete has had preseason testing when he or she was functioning normally. That baseline is then used later to determine the amount of deficit when compared to the post-concussion tests. Ideally you want the player back to their normal baseline before returning to play.
The key takeaway for me is that young athletes may have deficits in brain function far longer than we would otherwise suspect from our standard office based exam. More reason to be cautious in return to play after concussion.