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Concussion Considerations for Athletes with Neurologic Conditions


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.