Concussions can happen to anyone; but those with underlying conditions
may be at greater risk.
As a sports neurologist, I can say with confidence that the sports neurology
community knows much more about the phenomenon of concussion today than
we did even just a decade ago. However, I can also admit that we have
much more to learn. I understand that the unknown can be unnerving to
athletes or parents of youth athletes who play sports where a higher risk
of concussion exists. A new study calls to light some essential considerations
which individuals who play sports, or their parents, should take to help
understand that risk.
In short, the small and preliminary study recently published by the American
Academy of Neurology highlights the potential for concussion recovery
to take longer in specific individuals, namely those who have Attention
Deficit Hyperactivity Disorder, commonly referred to as ADHD. ADHD is
a neurological condition in the brain that impairs the ability to pay
focused attention and alters behavior in the individual who has it. The
researchers evaluated only 120 collegiate athletes. Eighty athletes had
not been diagnosed with ADHD; 20 were diagnosed and taking medication
for the condition; and another 20 were diagnosed and not taking medication.
What the study found was that the duration of concussion symptoms lasted
longest – an average of 12 days – in the group who had ADHD
and was taking medication for it. The non-medication group had concussion
symptoms for about 10 days, and the group that had not been diagnosed
with ADHD had symptoms for an average of 4 days. Though additional, more
extensive studies must be conducted to replicate and extract even more
meaningful findings from the data, even preliminarily, the study is important.
Are you wondering why this study merits a more in-depth look? After all,
it was about what happens AFTER a concussion has already occurred. Shouldn’t
we be in the business of PREVENTING brain injuries from occurring in the
first place? Yes, absolutely! And if we look deeper, we might see that
such a study offers us some helpful, though maybe uncomfortable, clues
as to which individuals may be at a higher risk of concussion symptom
duration, and possibly, of sustaining concussions altogether. That last
part warrants a deeper dive and further explanation. But it has to do
with a question I am frequently asked as a neurologist: “Knowing
what you know about concussions, would you let your son play football?”
I’ve been asked this question many times by reporters, colleagues,
and parents of youth athletes. My answer isn’t a one-size-fits-all
yes or no. One of the factors I would carefully consider in that answer
has to do with whether my child has been diagnosed with an underlying
neurological condition. In the case of football specifically, speed of
mental processing isn’t only a significant factor in an athlete’s
success on the field, it is also a necessary tool he must use in avoiding
a catastrophic collision. If I have a child who has a processing delay
or other condition that may impair his or her brain’s ability to
make a nano-second decision, I must consider this as a significant factor
in whether or not to allow his or her participation in that sport. It
may also result in my pursuit of brain training or other additional assessments
and therapies meant to improve speed of mental processing. As well, I
would pursue optimization of other factors that may help prevent concussive
injury and/or increase “physiologic reserve.” Sports vision
training, musculoskeletal activation exercises, and therapies to optimize
balance and vestibular function are examples.
Expressly, in the case of ADHD, to which the above-referenced study referred,
I would need to heavily consider the pros and cons of allowing my child
to play collision sports. I do believe that athletic participation is
essential, and I do think sports can be for everyone. But parents, as
well as adult athletes, must consider the TYPES of sports being played
and the position on the team that the athlete is playing. Perhaps as important
is to ensure that all the stakeholders associated with that team (coaches,
trainers, league officials, etc.) are on the same page relative to minimizing
concussion risk.
If a parent or athlete is unsure as to whether there might be an underlying
neurologic concern, this is where a pre-participation sports physical
is imperative. My personal recommendation these days is for a full and
comprehensive Neurological Screen and Assessment on a regular basis (pre/post
season and yearly) for athletes playing collision and contact sports.
There is a multitude of athletic opportunity in today’s world that
isn’t solely focused on sports where concussion risk may be higher.
And there are ways to mitigate against the risk in individuals with strong
interest and/or talent in contact and collision sports. Keep these things
in mind when choosing the “right” sport for yourself or your child.
Sources:
https://www.aan.com/PressRoom/Home/PressRelease/2735