Dr. Elad Levy On Concussions

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Welcome back to another episode. Today we are going to discuss concussion and we are very fortunate to have an expert in that field. His name is Dr. Alad Levy and I really believe that the families and athletes should really educate themselves and know about concussions. And if anyone has any questions about Hartman Academy, that's our program. Have you go there, go to Hartman Academy. No.com check out our programs and for now enjoy Dr. Levy. He's going to give you a wealth of information. Enjoy the Show.

Hello, I'm Dr. Elad Levy, professor and chair of the Department of Neurosurgery at the Jacobs School of Medicine and Biomedical Sciences at the State University of New York right here in Buffalo. It is a pleasure and an honor to be here on the Mike Hartman Show. Today we're going to discuss what to look for when you think you your child may have suffered a concussion, especially a sports related concussion for context. In 2011 I spearheaded and helped found a local non profit organization called Pucks puccs which is the program for understanding childhood concussion and stroke which I currently serve as a president and founder with a wonderful team including a colleague, Dr. Renee Reynolds, who is a neurosurgeon at the Oshai Children's Hospital and also in the department of Neurosurgery. The purpose of this organization was to raise money which can fund concussion research locally and and educate players, parents, coaches right here in Western New York and most importantly prevent concussions in all sports. In my practice I focus on stroke as well as brain injury. I see many patients who come in with sports injuries, car accidents, work accidents or home related injuries who exhibit signs of concussion. So before we get into the signs and symptoms of concussion, let's start with the basic definition of what a concussion is. A concussion, also known as a mild traumatic brain injury or mild tbi, is a head injury that temporarily affects brain and brain functioning. As you know, the brain is surrounded by cerebrospinal fluid which protects it. As we have a concussion or we jostle that brain in our rigid skulls. Often that brain can slosh against the skull or turn at a severe rate and that can cause injury. Or these rotational forces can cause injury which result from Rapid acceleration followed by rapid deceleration. And often the brain is not cushioned enough to absorb these forces. Depending on where the injury occurs, different neurologic symptoms can occur. People can lose consciousness, though that's not necessary to diagnose a concussion. People can lose vision, people can have difficulty speaking, people can lose arm, leg and face function, and a whole host of other combination of signs and symptoms, depending again on how severe the impact is and where the impact occurs. Impact can result in as a direct impact, meaning when the head is struck by an object or a surface, or indirect impact, which is the forces of rapid acceleration, deceleration, or torsion from a rotational force. Going back to the symptoms of concussion specifically, they can include loss of consciousness. But again, please note, it's not necessary to lose consciousness to make the diagnosis of concussion. Memory loss, headaches, a fogginess or difficulty with thinking and concentration, balance problems, ringing in the ears, nausea, blurred vision, sleep disturbances, and mood changes also can result in a delayed fashion after the concussion. As one of the neurotrauma consultants for the NFL at the Buffalo Bills, these are many of the things that we test both professional athletes and collegiate athletes, as well as high school athletes for before allowing them to return to play. For example, we would assess in taking their history if they've had these symptoms, and then we put them through different drills or different testing, which tests of balance, potentially their thinking, their concentration, and basic motor skills. A hallmark of concussions is persistent confusion or fogginess. Sometimes you may have patients or athletes repeating the same question, or slow to respond, or unable to count backwards or say the Alphabet backwards normally. Cognitive functions that they could do easily are now more challenging for them after a concussion. As previously stated, it's key to note that a concussion can result in changes of mood, such as crankiness, loss of interest in a favorite activity, depression, tearfulness, emotional liability, where one time they may seem overly happy and then overly sad for no reason apparent reason. Common symptoms in children who are concussed include restlessness, lethargy, and irritability. Any of these symptoms may begin immediately right after the concussion, but sometimes they appear days after the injury. A concussion should be suspected if a person indirectly hits their head or experiences and then experiences any of these symptoms, as I mentioned before, just because they didn't lose consciousness or just because they seemed fine immediately after the event, it doesn't mean they didn't have a concussion. And sometimes these symptoms or signs can occur days after the concussion. While it's important to diagnose and effectively treat concussions, Prevention is imperative. And there is a whole industry and a whole science around concussion prevention and prevention of traumatic brain injuries. As many of you know, these general measures include things that we do every day, such as wearing a seatbelt to avoid head trauma in a car accident, using airbags, again to cushion any type of potential trauma, and protective equipment, and sports such as helmets. As I previously said, there is a massive industry around helmet and helmet technology in order to not only blunt the impact of direct trauma, but also to potentially protect the impact that may result from indirect forces such as rapid acceleration, deceleration forces or rotational forces. We also see in professional and youth sports that rules are changing. So for example, in different leagues in football, their tackling is restricted or prohibited until a certain age. As we see in hockey, body checking is limited or prohibited again until a certain age. So by reducing the amount of impact these youth players are seeing on a regular basis, as they're still developing in their bodies and their brains, we hope to mitigate not only the risk of concussion, but also the amount of concussive injuries they're subjected to as they're still understanding the sport, developing their size and developing their technique. Also, as kids grow, there's often a major size mismatch. Occasionally we'll see youth athletes at 12 that some have reached puberty early and some have not yet reached puberty. And there may be a 30 pound size difference and 3 to 4 inch difference between these athletes, which makes physical contact potentially very dangerous. Another reason that checking or tackling may be banned until a certain age is because once athlete suffers one concussion, they are at an increased risk of having another concussion. And repeated concussion may increase a person's risk for brain damage or mood disorders later in life. These include dementia, Parkinson's disease and depression. It is difficult in young athletes to often diagnose a concussion because they may not disclose their symptoms effectively to their parents or coaches. Additionally, there are many other factors. Parents may not want to disclose concussions in their children to coaches for fear that they may not be playing or they may have to sit out for a few weeks. So there are many emotions and forces and biases around not only the players, but players, families and coaches when it comes to concussion. And it's unfortunate because in the end we need to remember that these are developing athletes and our primary responsibility as coaches, as parents, is safety. And even in the professional realm, though, there may be tremendous amount of financial bias and financial forces placed on these athletes, on these coaches and on these teams in the end of the day, as a Physician I always return to the fact that safety is paramount. Let's talk quickly in the last few minutes about return to school and return to play. So the resumption of low risk school activities should begin as soon as a student feels ready and often can begin within the first 24 to 48 hours. Long absences are not suggested, but return to school in a safe, relatively quiet environment if possible is encouraged. Occasionally, returning to school where there's significant cognitive demands or potentially hectic and loud environments may worsen outcomes and therefore these cases need to be often assessed on a case by case basis and these decisions should be made in conjunction with your healthcare provider. Returning to sport has several guidelines and I think it's important to go over the series of graded steps that are suggested by the CDC as well as other governing organizations when it comes to return to play. So immediately after a concussion is suspected or diagnosed, one needs to see a healthcare provider in order to confirm was there a concussion or not so in the first stage. Truthfully, very gentle activities such as walking or potentially light schoolwork. Light schoolwork should be encouraged as long as these symptoms are not worse. Over the ensuing days up to a week, stage two can begin which includes light aerobic activity again such as walking or stationary biking. Now, if symptoms worsen or return, we need to back it down and go back to stage one. However, if the athlete is able to do this activity without a return or exacerbation of symptoms, one can move to stage three, which looks at sports specific activities such as skating or running. Again, if symptoms aren't returning, we can move on to stage four, which are non contact, more up tempo drills and after several days of this kind of exercise and conditioning, if there are no symptoms at this point, it may be safe to return the athlete to full contact practice which does require medical clearance, and after that point can return to full contact contests of their sport, also requiring medical clearance. Often it again cannot be emphasized enough that at any of these steps, if there's a return of the symptoms or if there's a return of symptoms or new symptoms, that the person cannot progress to the next stage and often should regress or go back down to the prior stage. On a final note, what we're optimistic about is that most concussions, if handled appropriately, do resolve and symptoms do resolve players patients can resume a relatively normal life. However, in up to 10, some studies say a few more, but around 10% of the patients do have post concussion syndrome, which lasts for more than a month and can last often for several months, rarely years, but several months. And again, fortunately, this doesn't happen often. Maybe around 10% of the population who suffers from concussion. These symptoms also include headache, dizziness, fatigue, anxiety, memory loss, attention problems, sleep problems, and irritability. In conclusion, the more we continue to educate our community and by community I mean our parents, our athletes, our coaches, our schools. Using handouts, videos, workshops, lectures and podcasts such as this one, we can improve not only the knowledge of concussions, but we can enhance the safety of the players in our community with strong concussion knowledge and recognition of these symptoms. By continuing to expand the knowledge base around concussion, we can continue to enhance the safety of the contact sports and of patients who suffer non sport concussions that are not related to sports. It is my sincere intention and hope that this podcast will help. Just do that. And again, I'd like to thank Mike Hartman and his team for allowing us to have this opportunity today. It was a pleasure speaking with all of you.

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