March 2012 : The Role of a Neuropsychologist Specializing in Concussion-gathering still more information
The Big Picture IV
“I will never forget when we were hit. All I remember is seeing the car driving through the red light at the intersection. I knew we were going to be hit. I was worried about my daughter. I was fine. However, Ella was taken by ambulance to the hospital and was admitted for two days. She had headaches, nausea, and dizziness for about four weeks after the accident. It appeared as though she had trouble with attention and seemed rather anxious and irritable. I know all eight-year-old kids can be irritable but Ella seemed more irritable than usual. My daughter had problems with attention before the accident. She needed lots of direction and reminders in kindergarten. I guess I wonder whether her current problems with attention are due, in some part, to the accident. Did the accident make her focusing troubles worse? Ella is now 10 years old.”
Ella's mother should be concerned. She is wondering whether her daughter's behaviors are related to the accident. Weaknesses in attention and concentration can affect a child's learning, social skills, and confidence.
A neuropsychologist who understands the complexities of concussions (also known as mild traumatic brain injury) plays a critical role in the assessment of cognitive and psychological functioning following traumatic brain injury. Neuropsychologists can also provide early intervention in the form of support and education. In addition, they can treat emotional problems that the student may encounter as they recover.
I asked pediatric/young adult neuropsychologist, Claudia Kernan, Ph.D. from the David Geffen School of Medicine at UCLA, to educate you about concussions that result from an accident and sports-related events.
Karen Schiltz, Ph.D.: “Thank you, Dr. Kernan, for joining this educational blog. First, what is a concussion?”
Claudia Kernan, Ph.D.: “Hello Karen. Thank you for inviting me to participate in your blog. A concussion is a type of brain injury that changes the way your brain normally functions. Concussions are caused by a bump, blow, or jolt to the head. A blow to the body or any other traumatic event that causes the head to move quickly back and forth can also cause a concussion.
It is important to remember that even what seems to be a mild bump to the head, or what is often referred to in sports as a “ding”, can cause a concussion and have serious consequences. Bottom line, there are two things that parents, coaches, and other adults should look out for to recognize a concussion in a child: 1) A forceful bump, blow, or jolt to the head or body that results in rapid movement of the head and 2) Any change in the child's behavior, thinking, or physical functioning. If these two things are present, you should seek medical attention right away.”
Dr. S.: “What types of symptoms may a student exhibit after a concussion?”
Dr. Kernan: “The Center for Disease Control and Prevention (CDC) has great fact sheets that can be downloaded by parents, coaches, and school professionals to help them identify the signs and symptoms of concussions. You can find the fact sheets at www.cdc.gov/concussion. I encourage anyone who works with student athletes to download this information and share it with others. In fact, everyone who works with children should learn the signs and symptoms of concussions because prompt intervention is important and lowers the risk of prolonged recovery and other negative consequences.
To help you remember the types of symptoms to look out for, the CDC divides concussion symptoms into four categories: 1) problems with thinking and remembering, 2) physical problems, 3) emotional or mood problems, and 4) problems with sleep. Problems with thinking and remembering include symptoms such as difficulty thinking clearly, slowed thinking, feeling “foggy”, difficulty concentrating, and difficulty remembering new information. Physical symptoms include headache, problems with vision, nausea or vomiting, dizziness, balance problems, sensitivity to light and sound, and fatigue. Emotional or mood problems can include irritability, sadness, unusual moodiness, and nervousness or anxiety. Finally, after sustaining a concussion, your child may be drowsy, sleep more or less than usual, or have trouble falling asleep.”
Dr. S.: “Ella's symptoms resolved in four weeks after the accident. Is this to be expected? Can you please educate the reader about the recovery period for those students diagnosed with a concussion?”
Dr. Kernan: “The recovery period for students diagnosed with concussion varies widely. Symptoms may last a few minutes, days, weeks, or even months or longer in some cases. Most students will not have prolonged recovery periods. One study found that about 90 to 95% of young athletes recovered within 7 to 10 days  . Researchers are still investigating the reasons why some young people recover faster than others. Some factors that have been found to be related to prolonged recovery times include history of prior concussion s, prolonged loss of consciousness, prior history of headaches, and a prior history of learning disabilities or problems with thinking and attention  .”
Dr. S.: “How can parents help their child during this recovery period?”
Dr. Kernan: “Parents play a vital role in monitoring their child's symptoms after a concussion and protecting their child from further injury. It is important to follow the instructions of your health care provider in the days and weeks after injury. Don't let your child return to playing sports or other activities that carry a risk of re-injury until a health care professional qualified in the management of concussions says it is safe to do so. Also, your doctor may recommend that your child rest from both physical and mental activity. Too much activity engaged in too early may delay recovery. Talk to your doctor and get a clear idea of what types of activities are safe while your child is recovering. If a physical or mental activity appears to be making your child's symptoms worse, stop the activity and contact your doctor.
If your child has a concussion, you should share this information with others involved in his or her care, such as teachers, counselors, babysitters, and coaches. You should also be sure to talk with your child about the symptoms they are experiencing and the dangers of returning too soon to normal activities. Again, I urge parents to download the fact sheets on concussions from the CDC. You can use them to learn about concussions together with your child and to reinforce your medical professional's plan for supporting your child's recovery.”
Dr. S.: “How about the school? How can teachers help the student as he/she recovers during this period?”
Dr. Kernan: “It is important that teachers, school nurses, and other school professionals monitor children after they suffer a concussion. Teachers should watch for increased problems with attention, concentration, and learning new material. Students may be less organized and take longer to finish tasks. School professionals can do a great deal to support a child's recovery if they understand concussions and implement accommodations and modifications to support the child. For example, children may need to take more rest breaks during school, spend fewer hours at school, and be given extended time to take tests or complete assignments.”
Dr. S.: “There has been a lot of press about sports-related concussion. Why is this recognized as a major public health issue in the USA?”
Dr. Kernan: “Yes, researchers have identified sports concussions as a major public health concern. It is estimated that between 300,000 to 3.8 million sports-related concussions occur annually in the United States  . Many cases never come to the attention of health care professionals for various reasons. Sometimes people do not recognize the signs and symptoms of concussions and other times athletes may minimize their symptoms in an effort to stay in the game  . One reason that concussions have received so much attention in the media is that more and more research has demonstrated that these injuries can have devastating long-term effects, particularly when certain risk factors are present. To keep things in perspective, however, I'd like to note that most children recover quickly and fully from concussions. This said, it is important to be aware of the signs and symptoms, give our children prompt medical attention, and follow the advice of medical professionals to minimize the likelihood of serious or long-term consequences.”
Dr. S.: “What role do neuropsychologists play in the evaluation and management of the injured athlete?”
Dr. Kernan: “Neuropsychologists play an important role in concussion management. The decision to return an athlete to play following a concussion is complex and requires analyses of several sources of information. In order to clear an athlete for play, neuropsychologists work together with other members of the concussion management team such as sports medicine physicians, neurologists, neurosurgeons, and athletic trainers. The neuropsychologist will conduct testing of the athlete's attention, memory, and speed of thinking, which are functions that are often affected by concussions. Performance on neuropsychological tests can be one indicator that the brain is not working properly. This information is critical in deciding whether or not the athlete has recovered fully and whether or not it is safe to engage in sports and other physical activities.
A neuropsychologist can also help to support a student athlete in domains other than sports. Many student athletes have difficulties in school after a concussion due to ongoing symptoms. They may also have problems in daily life activities at home and other contexts. A well-qualified neuropsychologist will conduct a comprehensive evaluation of the student's cognitive, emotional, and behavioral functioning and help construct an individualized plan for the student. The plan will include recommendations for any needed accommodations, modifications, and treatments to help the concussed child keep up in school as much as possible without being overwhelmed or running the risk of delaying recovery. The neuropsychologist will look at the “whole child” and help address any problems with thinking or emotions that result from the concussion.”
Dr. S.: “Thank you, Dr. Kernan, for your time in addressing these important issues. Can you please tell us about your research at UCLA and private practice?”
Dr. Kernan: “It was my pleasure to participate. Your blog is a valuable source of information for parents and others who are invested in helping children optimize their potential in school and in life.
I am a licensed clinical psychologist with a private practice specializing in the neuropsychological assessment of children, adolescents, and adults. I work with individuals with learning disabilities, attention problems, emotional and behavioral issues, developmental disabilities, head injuries, and other neuropsychological conditions. A major area of focus for me has been the neuropsychological assessment of sports-related concussions and I have experience working with athletes across the lifespan, including high school, collegiate, and professional level players.
I also hold an academic appointment at the David Geffen School of Medicine at UCLA, where I conduct research and teach students. I have received funding from the National Institute of Health to conduct research in the field of traumatic brain injury. I have conducted research with children with moderate to severe head injuries and with retired NFL players with concussions. I have also consulted in the development of a multi-disciplinary sports concussion clinic at UCLA, scheduled to open in 2012. Part of our clinic's mission is to educate the public about concussions and I have been asked to do outreach in schools to help with concussion awareness and the development of programs for the management of concussions on campus.”
Dr. S.: I will be interviewing Advocate and Educational Consultant, Gwen Campbell, M.S., LMFT on Ella's rights within the public school system because this student is clearly exhibiting problems within the classroom and when taking tests. Ella's mother reports that her daughter forgets to turn her homework in on time and also fails to remember when tests are scheduled. Ella is frustrated because she just can't “get it together.” Her friends are now noticing because the teachers are constantly redirecting Ella on a daily basis. Ella's mother wants to know how she can help her daughter in the public school system.
Copyright Karen L. Schiltz 2001