Childhood Head Injuries

Your daughter collides with another player in a high-school soccer match, knocking her head hard. She doesn’t lose consciousness, but is briefly dazed. The team’s star forward, she grudgingly sits out the rest of the game. The next day she complains only of low-grade headache and begs to play in the championship tournament a day away. You’re apprehensive, but she really does seem fine. What’s the right thing to do?

If you’re unsure, you’re not alone. Currently, even team physicians and trainers have few quantifiably based, standardized guidelines to evaluate this type of mild head injury (MHI). Labeled the “silent epidemic” until recently, MHI’s severity is often difficult to determine, especially when there’s no loss of consciousness. And much of the MHI data currently available to clinicians are subjective, self-reported symptoms from the eager-to-play athletes themselves.

“It’s tough sometimes when the athlete’s saying ‘I’m ready to go, I don’t have a headache, I’m fine,’ and the coach really needs that player,” explains Kevin Guskiewicz, PhD, Assistant Professor in the Department of Physical Education, Exercise and Sport Science at the University of North Carolina at Chapel Hill. But if an athlete returns to play before his brain has fully recovered from trauma, he is susceptible to additional injuries. Disequilibrium or confusion during play could lead to sprains, breaks, or — if the head is hit hard again — even death.

“A head injury is no different from an ankle sprain or a knee sprain. There’s swelling that’s involved there,” Guskiewicz told Ivanhoe. “You wouldn’t go back running the next day on a sprained ankle, right? Well, you shouldn’t go back hitting people with your head the day after it’s been hit.” Guskiewicz, in fact, recommends at least a five-day rest for athletes still experiencing trauma symptoms the day after injury – symptoms like memory loss, dizziness, altered vision, cloudy thinking, or your daughter’s headache.

His recommendation is based in part on his ongoing research to develop MHI clinical assessment guidelines. With co-investigator David Perrin, PhD, at the University of Virginia, he is measuring two common results of MHI: cognitive deficit and balance impairment. With test question responses and computer-assisted balance measurements gathered from volunteer college athletes before and after MHI, Guskiewicz is measuring, for the first time, the extent of MHI-induced cognition and balance impairment.

And he hopes this information will ultimately take some of the guesswork out of return-to-play decisions. “If you’re throwing a person right back out there to play – like a lot of people are – then you’re really putting them at risk,” he contends. For athletes like your daughter, and the estimated 350,000 high-school football players suffering concussions each year, it’s a risk they shouldn’t have to face.

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