Concussions in teen athletes: Making sure the brain is OK before getting cleared to play

Even though concussions are in the news frequently, researchers are just beginning to understand what actually happens to the brain of a concussed individual. There may be several different conditions that cause a variety of symptoms and may require different treatment.

Current assessments used in concussion diagnosis focus heavily on athlete-reported symptoms and observed performance on balance and coordination tasks. These methods can be valuable in diagnosis, but they can also be highly subjective. There is the possibility of mistaking unrelated symptoms with those of a concussion. Researcher Kristy Arbogast points out a similarity between concussion symptoms and normal teenage behavior. "I have a 15-year-old son in my house... He's tired and irritable often. I don't think he's concussed." With this concept in mind, researchers at Children's Hospital of Philadelphia (CHOP), are using balance sensing and eye-tracking technology to better understand concussion. These efforts may eventually help clinicians step away from subjective self-report tools and use objective measures to make better return-to-play decision.

In addition to researching new technology for diagnosis, clinicians at CHOP and many other sites are beginning to change their philosophy on brain rest after a concussion. Previous concussion treatment methodology supported the idea of "cognitive rest," which discouraged complex cognitive tasks such as texting, reading and video games until symptoms abated. Newer research indicates that this approach may have been too extreme. Now, 'brain-training' exercises and light aerobic activity are a common treatment approach soon after concussion, though much research is needed to determine when exercise can begin and which symptom clusters respond best to different treatment approaches.