More study urged on concussions in young athletes
WASHINGTON — No one knows how often the youngest athletes suffer concussions. It’s not clear if better headgear is the answer, and it’s not just a risk in football.
A new report reveals big gaps in what is known about the risk of concussion in youth sports, especially for athletes who suit up before high school.
The Institute of Medicine and National Research Council on Wednesday called for a national system to track sports-related concussions and start answering those questions.
Despite a decade of increasing awareness of the seriousness of concussions, the panel found young athletes still face a “culture of resistance” to reporting the injury and staying on the sidelines until it’s healed.
“Concussion is an injury that needs to be taken seriously. If an athlete has a torn ACL on the field, you don’t expect him to tape it up and play,” said IOM committee chairman Dr. Robert Graham, who directs the Aligning Forces for Quality national program office at George Washington University.
“We’re moving in the right direction,” Graham added.
But the panel found evidence, including testimony from a player accused by teammates of wimping out, that athletic programs’ attention to concussions varies.
Reports of sports concussions are on the rise, amid headlines about former professional players who suffered long-term impairment after repeated blows. Recent guidelines make clear that anyone suspected of having a concussion should be taken out of play immediately and not allowed back until cleared by a trained professional.
Although millions of U.S. children and teens play school or community sports, it’s not clear how many suffer concussions, in part because many go undiagnosed.
But Wednesday’s report said among people 19 and younger, 250,000 were treated in emergency rooms for concussions and other sports- or recreation-related brain injuries in 2009, up from 150,000 in 2001.
Rates vary by sport.
For male athletes in high school and college, concussion rates are highest for football, ice hockey, lacrosse and wrestling. For females, soccer, lacrosse and basketball head the list. Women’s ice hockey has one of the highest reported concussion rates at the college level.
College and high school sports injuries are tracked, but there’s no similar data to know how often younger children get concussions, whether on school teams or in community leagues, the IOM panel said.
“One thing that parents question is, `Well, should I let my son or daughter play this sport they’re asking me to play?”’ said sports injury specialist Dawn Comstock of the University of Colorado, who reviewed the report. “If we don’t have that type of data on the national level, it’s very difficult” to know.
Could safety gear prevent kids’ concussions?
Some equipment ads make that claim. But there’s little scientific evidence that current sports helmet designs or other gear, such as face masks or headbands for soccer, really reduce the risk, the panel cautioned.
Still, it stressed that youngsters should wear helmets and other sport-appropriate safety gear, because they guard against other injuries, including skull fractures and face injuries.
“Parents deserve to know how safe their children’s safety equipment really is,” said Sen. Tom Udall, D-N.M., who is pushing legislation to curb false advertising and encourage improvements to sports equipment standards.
“While we can’t reduce every risk, we should do everything we can to stop misleading advertising that gives parents a false sense of security.”
The report found that every state except Mississippi has passed a concussion law since Washington started the trend in 2009, prompted by a 13-year-old who suffered permanent disability after returning to a football game despite a concussion.
The laws address such things as criteria for removal from play and standards for return-to-play decisions, but the report said most are in the early stages of being implemented.
It’s not always easy to spot a concussion — symptoms might not be obvious right away — yet most young athletes practice and play without routine access to a professional trained to check them, the panel said. That can leave the decision to bench players up to coaches and parents.
That’s especially true before high school and in community leagues, said Tamara Valovich McLeod with the National Athletic Trainers’ Association, which long has pushed for concussion education.
Without training, people may not realize you can have a concussion without losing consciousness, or that you can still have symptoms despite a clean CT scan, she said.
Typically, youth athletes recover from a concussion within two weeks. But in 10 percent to 20 percent of cases, symptoms can persist for weeks, months, occasionally even longer, the report found. A second blow before full recovery is especially dangerous.
Nor is the concern only about physical activity.
The American Academy of Pediatrics this week said teachers may need to ease students back into learning after a concussion.
There’s increasing evidence that too much mental activity can prolong recovery, too. Sensitivity to light, headaches or memory difficulties may require breaks or extra time on assignments when the student returns to class, the pediatricians’ policy says.
The IOM report also said:
—Youths who’ve already had a concussion are at higher risk for subsequent ones.
—Calls for a “hit count” to limit the number of head impacts in a week or a season make sense, but there’s no evidence to say what that number should be.
—Sports officials should examine if there are age-specific rules to make play safer, such as Canadian youth hockey’s no-checking rule for the youngest players.
But the report shouldn’t scare parents into pulling their kids out of sports, injury expert Comstock stressed.
“The positives of sports as a physical activity still far outweigh the negatives,” she said. “We just need to make it as safe as possible.”
Utafiti wa hivi karibuni unaonyesha kuwa vijana wengi wanajikuta na mshtuko wa ubongo, lakini hakuna mtu anayejua ni mara ngapi wanariadha wadogo hupata mshtuko wa ubongo. Haijulikani wazi kama vifuniko bora vya kichwa ni jibu, na si hatari tu katika mpira wa miguu. Ripoti mpya ya utafiti wa utafiti wa afya ya vijana inaonyesha kuna mapungufu makubwa katika kile kinachojulikana kuhusu hatari ya mshtuko wa ubongo katika michezo ya vijana, hasa kwa wanariadha ambao hujipamba kabla ya shule ya sekondari. Taasisi ya Tiba na Baraza la Utafiti la Kitaifa (IOM) limetoa wito kwa mfumo wa kitaifa kufuatilia mshtuko wa ubongo unaohusiana na michezo na kuanza kujibu maswali hayo. Licha ya mwongo wa kuongezeka kwa ufahamu wa uzito wa mshtuko wa ubongo, jopo hilo liligundua wanariadha wachanga bado wanakabiliwa na "utamaduni wa upinzani" wa kuripoti jeraha na kukaa kando hadi litakapopona. <unk> Mshtuko wa ubongo ni jeraha linalopaswa kuchukuliwa kwa uzito. "Ikiwa mwanariadha ana mlipuko wa ACL kwenye uwanja, hutarajia yeye kuufunga na kucheza, ""alisema mwenyekiti wa kamati ya IOM Dk Robert Graham, ambaye anaongoza ofisi ya programu ya kitaifa ya Aligning Forces for Quality katika Chuo Kikuu cha George Washington." "Tunaelekea katika mwelekeo sahihi", Graham aliongeza. Lakini jopo hilo lilipata ushahidi, ikiwa ni pamoja na ushuhuda kutoka kwa mchezaji aliyeshtakiwa na wenzake wa timu ya wimping out, kwamba programu za riadha za kuzingatia mshtuko wa ubongo hutofautiana. Ripoti za mshtuko wa ubongo katika michezo zinaongezeka, huku vichwa vya habari vikielezea wachezaji wa zamani wa kitaalamu ambao wamepatwa na matatizo ya muda mrefu baada ya kupigwa mara kwa mara. """Miongozo ya hivi karibuni inaonyesha wazi kwamba mtu yeyote anayedhaniwa kuwa na mshtuko wa ubongo anapaswa kuondolewa kwenye mchezo mara moja na asiruhusiwe kurudi mpaka apate ruhusa kutoka kwa mtaalamu aliyezoezwa." Ingawa mamilioni ya watoto na matineja wa Marekani hucheza michezo shuleni au katika jumuiya, haijulikani ni wangapi wanaugua mshtuko wa ubongo, kwa sababu wengi hawajulikani. Kulingana na ripoti ya Jumatano, kati ya watu wenye umri wa miaka 19 na chini, 250,000 walitibiwa katika vyumba vya dharura kwa mshtuko wa ubongo na majeraha mengine ya ubongo yanayohusiana na michezo au burudani mnamo 2009, kutoka 150,000 mnamo 2001. Viwango hutofautiana kulingana na mchezo. Kwa wanariadha wa kiume katika shule ya sekondari na chuo kikuu, viwango vya mshtuko wa ubongo ni vya juu zaidi kwa mpira wa miguu, mpira wa magongo, lacrosse na mapigano. Kwa wanawake, mpira wa miguu, lacrosse na mpira wa kikapu ndizo zinaongoza orodha hiyo. Hockey ya barafu ya wanawake ina moja ya viwango vya juu zaidi vya mshtuko wa ubongo katika ngazi ya chuo kikuu. "Uharibifu wa michezo ya chuo kikuu na shule ya sekondari unafuatwa, lakini hakuna data kama hiyo kujua ni mara ngapi watoto wadogo hupata mshtuko wa ubongo, iwe katika timu za shule au katika ligi za jamii, ""jopo la IOM lilisema." "Jambo moja ambalo wazazi wanauliza ni, ""Je, ni lazima nimruhusu mwana wangu au binti yangu kucheza mchezo huu wanaoniomba niucheze?"" alisema mtaalamu wa majeraha ya michezo Dawn Comstock wa Chuo Kikuu cha Colorado, ambaye alikagua ripoti hiyo." <unk>Ikiwa hatuna aina hiyo ya data katika ngazi ya kitaifa, ni <unk> vigumu sana<unk> kujua. Je, vifaa vya usalama vinaweza kuzuia watoto wasipate mshtuko wa ubongo? Matangazo fulani ya vifaa husema hivyo. Lakini kuna ushahidi mdogo wa kisayansi kwamba miundo ya sasa ya kofia za michezo au vifaa vingine, kama vile vinyago vya uso au vifungo vya kichwa kwa mpira wa miguu, kwa kweli hupunguza hatari, jopo hilo lilionya. Hata hivyo, ilisisitiza kwamba vijana wanapaswa kuvaa kofia za chuma na vifaa vingine vya usalama vinavyolingana na michezo, kwa sababu vinalinda dhidi ya majeraha mengine, ikiwa ni pamoja na kuvunjika kwa fuvu la kichwa na majeraha ya uso. "Wazazi wanastahili kujua jinsi vifaa vya usalama vya watoto wao vinavyo salama kweli", alisema Seneta Tom Udall, D-N.M., ambaye anaendeleza sheria ya kuzuia matangazo ya uwongo na kuhamasisha maboresho ya viwango vya vifaa vya michezo. "Wakati wa kutangaza, ""Tunapaswa kufanya kila kitu tunachoweza kuzuia matangazo ya udanganyifu ambayo huwapa wazazi hisia bandia ya usalama,"" ripoti hiyo iligundua kuwa kila jimbo isipokuwa Mississippi limepitisha sheria ya mshtuko wa ubongo tangu Washington ilianzisha mwenendo huo mnamo 2009, ikichochewa na kijana wa miaka 13 ambaye alipatwa na ulemavu wa kudumu baada ya kurudi kwenye mchezo wa mpira wa miguu licha ya mshtuko wa ubongo." Sheria hizo zinazungumzia mambo kama vile vigezo vya kuondolewa kwenye mchezo na viwango vya kurudi kwenye mchezo, lakini ripoti hiyo inasema kwamba nyingi ziko katika hatua za mwanzo za kutekelezwa. "Si rahisi wakati wote kutambua mshtuko wa ubongo - dalili zinaweza kuwa wazi mara moja - lakini wanariadha wengi wachanga hufanya mazoezi na kucheza bila upatikanaji wa kawaida kwa mtaalamu aliyezoezwa kuwachunguza, ""alisema jopo hilo." Hiyo inaweza kuacha uamuzi wa kuweka wachezaji benchi kwa makocha na wazazi. Hiyo ni kweli hasa kabla ya shule ya sekondari na katika ligi za jamii, alisema Tamara Valovich McLeod na Chama cha Taifa cha Wafundishaji wa Michezo, ambayo kwa muda mrefu imesukuma elimu ya mshtuko wa ubongo. """Bila mafunzo, watu wanaweza kutotambua kwamba unaweza kupata mshtuko wa ubongo bila kupoteza fahamu, au kwamba bado unaweza kuwa na dalili licha ya CT scan safi." Kwa kawaida, wanariadha wachanga hupona baada ya kuathiriwa na mshtuko wa ubongo ndani ya majuma mawili. Katika asilimia 10 hadi 20 ya visa, dalili za ugonjwa huo zinaweza kuendelea kwa wiki kadhaa, miezi kadhaa, na mara kwa mara hata zaidi. Pigo la pili kabla ya kupona kikamili ni hatari hasa. Wala hangaiko si kuhusu utendaji wa kimwili tu. Chuo cha Marekani cha Pediatrics (AAP) kimesema kuwa wanafunzi wa shule ya sekondari wanaweza kupewa nafasi ya kujifunza baada ya kuathiriwa na mshtuko wa ubongo. Kuna uthibitisho unaozidi kuongezeka kwamba utendaji mwingi sana wa kiakili waweza kurefusha uponyaji, pia. Uwezo wa kuona mwanga, maumivu ya kichwa, au matatizo ya kumbukumbu yanaweza kuhitaji mapumziko au muda wa ziada wa kazi wakati mwanafunzi anarudi darasani, sera ya madaktari wa watoto inasema. Ripoti ya IOM pia ilisema: "Vijana ambao tayari wamepata mshtuko wa ubongo wako katika hatari kubwa ya kushikwa na mshtuko wa ubongo baadaye. <unk>Wito wa <unk> hit count<unk> kupunguza idadi ya athari za kichwa katika wiki au msimu una maana, lakini hakuna ushahidi wa kusema ni nini idadi hiyo inapaswa kuwa. <unk>Maafisa wa michezo wanapaswa kuchunguza kama kuna sheria maalum za umri ili kufanya kucheza salama zaidi, kama vile sheria ya Hockey ya vijana ya Canada ya kutokuwa na kuangalia kwa wachezaji wadogo zaidi. Lakini ripoti hiyo haipaswi kuwaogopesha wazazi ili kuwaondoa watoto wao kwenye michezo, mtaalamu wa majeraha Comstock alisisitiza. "Mavutio ya michezo kama shughuli ya kimwili bado yanazidi sana mambo mabaya", alisema. "Tunahitaji tu kufanya hivyo kwa usalama iwezekanavyo".