HEADS UP!

By Jennifer Marcus
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Treating concussion in children and adolescents

Your son goes helmet to helmet with a linebacker in a school football game. Your daughter heads a soccer ball. What impact will these incidents have on each child’s developing brain? Researchers at Children’s Hospital Los Angeles want to find out—and help kids recover more quickly.

Between 1.6 million and 3.8 million sports- and recreation-related head injuries occur each year in the United States. While most concussions in adults resolve within seven to 10 days, children and adolescents often have longer recovery times, likely because of differences between mature brains and developing ones.

 

Tracy Zaslow, MD
“Our comprehensive sports concussion team provides immediate access to state-of-the-art care, making CHLA the sports medicine home for student athletes.”

– Tracy Zaslow, MD

 

In response to the increasing prevalence of families seeking care for these injuries, CHLA has developed the only pediatric concussion program in Los Angeles. This multidisciplinary program incorporates research and clinical care to provide the latest evidence-based assessments and treatment plans specific to the needs of school-aged patients.

Although concussion is a fairly common injury in children and adolescents, treatment guidelines have been based mostly on experience with college athletes and other adults. But because their brains are still developing, children and adolescents may be at increased risk for long-term effects. Also, this age group may manifest symptoms of injury differently than adults.

Kids are different from adults
Kenneth Hartline, PsyD
Kenneth Hartline, PsyD

“Our comprehensive sports concussion team provides immediate access to state-of-the-art care, making CHLA the sports medicine home for student athletes,” says Tracy Zaslow, MD, director of the Children’s Orthopaedic Center Sports Concussion Program and assistant professor of Orthopaedic Surgery at the Keck School of Medicine of the University of Southern California (USC). “With the increased awareness of sports-related concussions, we see a lot of adolescents with this injury—both athletes and non-athletes—and we feel a responsibility to study more age-specific ways of diagnosing and treating our young patients.”

Emotional aspects of concussion are the focus of a pilot study directed by Kenneth Hartline, PsyD, a pediatric neuropsychology fellow at CHLA. The study found a correlation between mood and recovery time, with mood—especially sadness during the initial visit—associated with a more prolonged recovery. While this assessment is preliminary, it guides CHLA’s concussion team to intervene with psychological support sooner when needed.

Kenneth Hartline, PsyD
Anita Hamilton, PhD

Pediatric neuropsychologist Anita Hamilton, PhD, is principal investigator of the concussion registry at CHLA, an effort to track the wide-ranging ways concussion can impact brain maturation, learning and psychosocial functioning. Hamilton studies neurocognitive and neuroimaging outcomes related to traumatic brain injury in children and adolescents. So far, the registry details nearly 250 patients. By collecting information about age, method of diagnosis, treatment and outcome, the research team can develop personalized, evidence-based care for future patients.

“While concussion is common among children and adolescents, there is still a lot we need to understand about the factors that impact recovery time and outcome,” says Hamilton, who is also an assistant professor of Orthopaedic Surgery at the Keck School of Medicine of USC.

 
Kids are different from each other
ResearCHLA 2017 - Heads Up

“One of our clinical hypotheses was that high-achieving students would take longer to recover from concussion,” says Zaslow. “But when we reviewed data from the registry, we found that wasn’t the case.” They found that children and adolescents identified as academically elite actually demonstrated an accelerated recovery course. These students also tended to seek treatment sooner and reported more anxiety-related symptoms than their peers.

The research team speculates that high-functioning students, who assume additional pressure to deliver stellar performance on and off the field, may possess internal factors such as greater cognitive reserves and resilience. These qualities may work in their favor to accelerate recovery and promote healthier outcomes following concussion.

 
 
What’s next?
Bianca Edison, MD, MS
Bianca Edison, MD, MS

The Sports Medicine Program at CHLA is gearing up to begin a large-scale longitudinal study in partnership with the Harvard-Westlake School—a private high school in Los Angeles with approximately 1,600 students. The project, anticipated to begin in fall 2017, will follow participating students starting in seventh grade and continuing over a five-year period.

Led by Principal Investigator Bianca Edison, MD, MS, the project joins together multidisciplinary research workgroups at both institutions to better understand different factors that influence a student’s academic and athletic performance, including nutrition, social activities, sleep habits and sleep disturbance.

“Surveying student athletes throughout the span of their middle and high school years will teach us a lot about typically developing adolescents and the many aspects that impact their development and what helps drive success in the classroom and on the field,” says Edison, an attending physician in CHLA’s Children’s Orthopaedic Center and an assistant clinical professor of Orthopaedics at the Keck School of Medicine of USC. “Knowing about typically developing students in such detail will help us identify very subtle differences in young people with concussions so that we can intervene early and effectively.”

Read more about our sports concussion clinic: CHLA.org/CONCUSSION

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