Give Concussions A Rest

By Dr. Kevin Higashigawa
Interviewed by Rasa Fournier
Wednesday - December 08, 2010
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Dr. Kevin Higashigawa
Orthopedic surgeon at Castle Medical Center

Where did you receive your schooling / training?

I received my medical school training at John A. Burns School of Medicine at the University of Hawaii and did my residency in orthopedic surgery at UH. I did my sports medicine fellowship training at UCLA.

What age group is most prone too concussions?

There are roughly 1.5 million head injuries in the United States every year. About 300,000 occur as a result of sports-related injuries, and the vast majority occur in adolescents, high school age or younger. Concussions in adolescents are a concern because the repercussions are more severe than in adults. Since 1945 more than 90 percent of the fatalities that occurred from sports-related head injuries occurred in adolescents.


What sport is thee most dangerous?

Football, by far. But concussions can occur in other sports such as soccer, lacrosse, rugby, etc.

Is thee injury severe in young people because their bodies are still developing, or because their sports are so dangerous?

The adolescent brain is still developing. The brain can still mature up to age 21, so it’s more prone to injury. Also, according to one study, about 50 percent of adolescents don’t report concussions to their coaches or to the training staff, and there are multiple reasons why. One reason is they don’t understand the severity of the injury. Another reason is they’re afraid that if they tell somebody they’re going to be pulled from the game. They’re under a lot of pressure from within themselves because they want to play, and from coaches and even their own teammates, especially if they’re really good players. And parents put a lot of pressure on their kids too.

Dr. Kevin Higashigawa checks on a patient

What is a concussion??

If you have a really severe concussion, you can have brain swelling, edema and hemorrhage. Most of the time concussions are relatively mild, and the injury occurs more on the cellular level and there is swelling in the cells, electrochemical changes, and changes in the metabolism of the cells and neurons. And there’s relative hypoxia, which means decreased oxygen availability. All of those things contribute to the symptoms of a concussion and they build upon each other, so it becomes a vicious cycle.

What are thee symptoms off a concussion?

There’s three signs of a really bad concussion. One is anterograde amnesia, which means that you can’t remember things after you get hit. The second is retrograde amnesia, which means you can’t remember things prior to the hit. The third is loss of consciousness, which was once believed to be the most ominous predictor of a poor outcome. But now others believe that amnesia is more important than loss of consciousness in predicting poor outcomes. Other symptoms are confusion, difficulty in concentration, headache, blurry vision, nausea, vomiting, balance problems, slow reaction time and decreased alertness.

Are there long-term m effects?

Yes. Studies suggest that after a concussion, the athlete has decreased neuropsychological functioning. They do more poorly in school. They don’t perform as well cognitively. But those are usually epidemiological studies, so it’s hard to prove causation.

How w do you treat a concussion?

The main treatment is rest. To prevent future complications, you have to manage it properly. One of the hardest decisions in sports medicine, especially when it pertains to an adolescent athlete, is deciding when an athlete can return to play. Concussions are difficult because there are no really good, objective measures of how well the brain is functioning. If someone tears the ACL or breaks a bone, there’s generally accepted guidelines as to when they can go back to play. But when someone has a concussion, there are no universal guidelines. It’s kind of an individualized thing, so it’s very difficult for physicians.


With head trauma,, at what point should a child see a doctor?

Any adolescent who has diagnosis of a possible concussion should see a doctor. Any adolescent who has a concussion in a game should not return to playing that same day. Even really mild concussions, what they call “bell ringers,” are probably not as benign as people used to think. Even with those, they recommend that adolescents don’t return to play in the same day.

Adolescents are unique in that there’s something called “second-impact syndrome.” It happens when an adolescent athlete suffers a head injury and within 14 days of the first injury, they suffer another head injury, even a mild one. For some reason, they suffer massive brain trauma, swelling and hemorrhage that could lead to paralysis and death. One study looked at cases from the 1980s to the early ‘90s, and there were 20-29 cases, and 50 percent resulted in death. Recently there was a case of second-impact syndrome in Washington. The athlete, Zachery Lystedt, was a 13-year-old in middle school and he played football. He suffered a concussion - after he got hit, he was holding his helmet in pain, and he sat out for 15-20 minutes. He went back in the game and he got hit again. As a result, he suffered massive brain trauma and now he’s paralyzed. Because of that incident, Washington state created a law that says that any adolescent who suffers a concussion cannot return to play in the same game. And adolescents and parents have to obtain informed consent saying that there are risks to playing football, including head injury. The third part, which is important, is that the coaches and the training staff and the players have to be educated about this type of injury. Washington was the first state to create a law about concussions. Because of that law, other states are slowly trying to adapt similar types of legislation.

With the holidays here,, are there gifts like Razors,, skateboards or shoes with wheels that parents should be wary of?

Related to concussions? Not that I can think of. But anytime someone rides a bicycle or uses Razors, they should use a helmet.

 

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