As kids across the Tampa Bay area prepare to return to school, physicians are gearing up for the start of the fall sports season and the head injuries that inevitably follow.
Concussion diagnoses are on the rise, especially in youth sports in Florida, said Dr. Patrick Mularoni with AllSports Medicine, a program at Johns Hopkins All Children’s Hospital that serves youth athletes from Sarasota to Pasco counties. Over the last five years, the program has diagnosed and treated at least 3,000 concussions in children, he said.
"There are more school-aged kids participating in sports these days than before, and in Florida they play year-round. So naturally, their exposure to injury increases," Mularoni said. "But children, their parents and the coaches are more knowledgeable about concussions than, say, 20 years ago, when head injuries weren’t being reported as frequently. And because they are aware of it, head injuries are being diagnosed more often."
But other physicians say the concern goes well beyond children. Dr. Byron Moran at the USF Health Concussion Center, worries more about the care that adults are receiving after a head trauma, like in a car accident. A recent study published in the Journal of the American Medical Association showed that many adult patients who suffer a traumatic brain injury rarely receive follow-up care after being discharged from a hospital emergency room.
"We see a lot of people who come in here three months, six months, 12 months after a car accident and are struggling to function," Moran said. "The non-sport concussion diagnoses are a neglected community."
There’s still a lot that physicians don’t know about brain injuries and concussions. They can alter mood, balance and affect cognitive abilities. Sometimes symptoms can last for years or become permanent.
But Mularoni and Moran agree that the way to treat concussions is evolving. Techniques used years ago for recovery aren’t the same as today.
"There is still some hysteria and confusion of what to do, even though the training in emergency rooms and general awareness is improving," Moran said.
He and Mularoni sought to debunk some of the myths about the diagnosis and treatment of concussions. Among the most common ones:
• Myth 1: Recovery requires a lot of time in a dark room.
For years, patients were told to avoid bright lights and screens as their head recovered from an injury. Moran and Mularoni agree that this is no longer a recommended strategy.
"That can actually be counterproductive to recovery," Moran said.
He said the protocol now is to try to get patients back into a normal routine sooner rather than later. While some may need to rest longer than others, many could start going back to school or to work for a few hours a day or a week much sooner than previously thought.
"To tell some of these kids that they can’t be on their phones for weeks, that’s asking for emotional problems," Moran said. "That’s their social connection to the world. They don’t have to be completely isolated. But if they’re symptoms get worse because they’re looking at a screen too much, that’s when it’s time to stop or dial it down."
Mularoni agrees, and warns that parents should still be cognizant of screen time.
"The tools we use every day, like our phones, do make concussion symptoms worse," he said. "They are eye movement-based. In school they spend their day looking at phones and computers, and that rapid eye movement can make it more severe."
• Myth 2: Repeated hits to the head don’t have long-term impacts on the brain.
Physicians and researchers say it’s unclear how or when concussions can lead to long-term or permanent brain damage. Some data suggest there are long-term risks for professional athletes, like NFL players, but there’s not much evidence on high school athletes or other groups.
Mularoni and his team at Johns Hopkins All Children’s Hospital are collecting research on football, soccer and hockey youth athletes around Tampa Bay to study the impact of collisions in play and the long-term affects they can have.
Thirty-one local male and female athletes will wear mouth guards or headbands with sensors on them that track their movement and any collisions they sustain. The idea is to follow them through the season and monitor the "sub-concussive" hits that don’t cause a concussion to see how they affect the brain over time.
"We’re now in the third year of the study, and we will analyze the data at the end of this season," Mularoni said. "We hope it helps us understand how many impacts they’re having, and whether we can use impact data to determine if they face the risk of any cognitive dysfunction even if they don’t get a concussion."
• Myth 3: There’s no need for a brain checkup until you injure your head.
Physicians recommend that athletes come in for cognitive baseline testing before the season starts. This way, doctors have data they can use from when a patient is healthy and performing normally to guide them during treatment in the case of a concussion.
Some sports groups, including U.S. Soccer, require baseline testing to play in the league.
The tests collect information on memory, mood, balance, cognitive delay and other aspects, Moran said.
"Even if the test hasn’t been done before, it’s so important to follow up if they think they might have suffered a concussion," he said. "The recovery time could double if they don’t sit out the rest of the game and see a doctor as soon as possible. The best option is to never wait."
Contact Justine Griffin at [email protected] or (727) 893-8467. Follow @SunBizGriffin.