What is a concussion?

A concussion is a short term change in the brain’s ability to work which occurs after a blow to the head, neck or other part of the body. The blow causes the brain to move within head and may or may not result in loss of consciousness. After the injury, the brain needs time to rest and heal.

A concussion affects the way the brain works, which means that we can’t see changes or make a diagnosis on routine imaging.

What are the signs and symptoms of a concussion?

Symptoms reported by the patient:

  • headache
  • nausea or vomiting
  • dizziness or disturbance of balance
  • visual changes, such as blurry vision or double vision
  • sensitivity to light or noise
  • feeling foggy, slow or hazy
  • confusion

Signs a parent or poach might observe:

  • appears stunned or dazed
  • confusion about his or her assignment or position
  • forgets instructions
  • is unable to tell you the score of the game or the team he/she is playing
  • moves clumsily
  • answers questions slowly
  • loss of consciousness
  • behavior or personality changes
  • unable to recall events prior to and/or after hit or fall

What should you do if you think you child has sustained a concussion?

Seek immediate medical attention if any of the following symptoms occur:

  • loss of consciousness
  • 2 or more episodes of vomiting
  • seizure
  • headache which worsens with time
  • changes in the child’s behavior or mood
  • changes in coordination, such as stumbling or clumsiness
  • confusion
  • slurred speech
  • blood or fluid discharge from nose or ears

Call our office for an evaluation. It is best to be seen within 48-72 hours of injury. Keep your child out of play until seen by Washingtonville Pediatrics . No same day return to play. Your child needs to be evaluated by a health care professional to determine when it is safe for him or her to return to play. Repeat injuries during a concussion can lead to serious repercussions and even death.

How can you help your child avoid a concussion?

  • Educate your child regarding heads up play.
  • Ensure your child follows their coach’s rules for safety and the rules of the sport.
  • Ensure your child is wearing the appropriate protective equipment and that it is well maintained, fits well, and is worn consistently and properly.
  • Educate all athletes regarding the signs and symptoms of concussion.
  • Remind athletes that if they think they have a concussion to tell someone and stop playing immediately.
  • Obtain a baseline ImPACT test for all children ages 10 and older.

ImPACT (Immediate Post concussion Assessment and Cognitive Test) is a neurocognitive test which is used post injury to aid in the care of patients who have sustained a concussion. It is best to have a baseline assessment prior to sport season for any athlete. The test is 20-25 minutes in duration and evaluates four main aspects of the brain’s function including verbal memory, visual memory, processing speed and reaction time. It is offered for children age 10 and older. It should be repeated yearly for children ages 10-12 and every other year for children 13-19 due to changes in the brain’s development. The baseline test is not covered by insurance and there is a flat fee of $40 in the office. The baseline test will be reviewed by Dr. McKenna to ensure that it is a valid test. Please call our office to schedule a baseline ImPACT for your child. (Please note: some school districts are doing baseline ImPACT for varsity athletes.)

Post-injury ImPACT testing

If a concussion is suspected, we recommend that you call the office to schedule an appointment within 48-72 hours of injury. During the initial evaluation, ImPACT test may be performed to assess a patients neurocognitive functioning. If a valid baseline test is available, we can compare pre injury and post injury results which can help us assess any change in the brain’s ability to function post injury. The ImPACT test may be repeated during the recovery process to help aid in the decision of when it is safe to allow the patient to return to play.

Return to learn

During the initial evaluation post injury, as well as subsequent visits, we will work with the family and the school to determine when the patient is ready to return to school and if any academic accommodations need to be made to aid the patient in the recovery process.

Return to play

The return to play decision can be challenging to make. The physicians at Washingtonville Pediatrics will work with the family and patient to determine when it is appropriate and safe to allow the patient return to play. Once an athlete is able to tolerate full days of school or work, an exercise program can be started under the supervision of a coach, athletic trainer, or school nurse. The exercise program will gradually increase the intensity of physical activity while monitoring concussion symptoms. Once the patient is able to tolerate full mental activity and physical exertion, the family and patient will have a follow up evaluation and discussion regarding return to play.

Recommended Resources:
http://www.cdc.gov/concussion/HeadsUp/youth.html
http://www.Impacttest.com
Orange County Department of Health Brochure
Concussions and Our Kids by Robert Cantu, MD

Meet our concussion management specialist:

Maureen McKenna, M.D., F.A.A.P.
Maureen McKenna, MD, was born and raised in Dallas, Texas. She traveled to Massachusetts in the summers to visit family, which is where her love for the Boston Red Sox developed. She graduated cum laude from Boston College with a BS in Biology and a minor in Italian. She then returned to Dallas and worked for a year as a research assistant at Texas Scottish Rite Hospital for Children in their neurology department. In 2007, she graduated from the University of Texas Medical School in Houston. She returned to the Northeast to do her pediatric training at Hasbro Children’s Hospital in Providence, Rhode Island, where she completed her residency in June, 2010. She was board certified in Pediatrics by the American Board of Pediatrics in October, 2010. She is a Clinical Assistant Professor of Pediatrics, New York Medical College.

She joined Washingtonville Pediatrics in July, 2010, and begin her career in private practice. She enjoys all aspects of pediatrics, especially watching children grow and develop.

Dr. McKenna lives in Rock Tavern with her husband Ken. She has become active in the surrounding community and is getting to know Orange County better. In her spare time, she enjoys traveling, cooking and watching Ken’s softball games.