Michael, a 14 year old 9th grader from Philadelphia has suffered 13 documented concussions. His history of repeat concussions coupled with cognitive testing and a neurological exam showed Michael should refrain from doing something he loves: playing ice hockey. Dr. Mijail D. Serruya, M.D., Ph.D. Co-Medical Director at the Jefferson Comprehensive Concussion Center (JCCC) explains the risks of sustaining multiple concussions, and gives some guidelines for patients to move forward after their diagnosis.
“We already know that the biggest risk factor for having a concussion is having had one,” says Dr. Serruya. “It is the medical opinion of [Michael’s] providers that the risks of him playing contact sports again are unacceptably high and hence we advise he avoid them.”
However, this does not mean Michael and others who suffer concussions should not continue to lead an active lifestyle. Instead, it means quite the opposite. “It is VERY important for every child, especially 12 and up, to be doing aerobic exercise regularly fairly soon after a concussion; maybe not the next day, but certainly at some point soon in the weeks thereafter,” says Dr. Serruya.
Michael is now looking to focus on track and field in the coming spring. His parents hope this will give him an outlet to continue staying active.
According to Dr. Serruya, “the physical therapist and athletic trainer can be crucial members of the care team in guiding a child and family on what physical activities can be done when.”
Dr. Serruya also stresses that no two concussions are the same. “As one of the neurologists lecturing at the American Academy of Neurology last spring said, ‘if you’ve seen one concussion, you’ve seen one concussion.’ The long-term prognosis is extremely variable across people with the same diagnosis.”
Today’s technology-driven society presents interesting challenges for those with concussions – “I presume human beings have been getting concussions since our species differentiated and walked upright,” says Dr. Serruya. “Most post-concussion symptoms are logical from an evolutionary perspective because they coax a person to hide in a cave and rest and recover. These phylogenetically ancient reflex behaviors are really put to the test in our modern computer-age world where there are glowing mobile phones and tablets every corner and every second of our lives.”
He advises those with concussions should rest in a “screen-free” environment for a few days, but getting back to everyday activities is important, suggesting half-days for a few days can also help one ease back into a normal schedule.
If, like Michael, your “normal schedule” includes contact sports, it’s advisable to find some alternative activities. “In the long term, every additional concussion would further increase [Michael’s] risk of developing chronic traumatic encephalopathy, a progressive neurodegenerative condition that could lead to early dementia, possibly in his fifties or even forties.”
Dr. Serruya concludes that while there is still much to learn about the science of concussions, clinicians must help guide patients and their families through the journey.
“We don’t want to make concussions and their consequences any worse…than what they are,” he says. “We want to keep kids like Michael out of harm’s way as much as we were able, achieve and sustain the gains of recovery and keep living a healthy, meaningful life.”
If you or a loved one has suffered a concussion, make an appointment with the Jefferson Comprehensive Concussion Center.