Family Travels Long Road of Recovery – TCB Suggestion

Brooke de Lynch of Mom’s Team sent over this article and video about a family and their dealings with post-concussion syndrome and the long recovery after a very “innocent” looking hit.  It begins as most complex cases often do, with incorrect initial management;

On the evening of Friday, February 12, 2010, my then 15-year-old daughter Heidi was hit on the head by the stick of a teammate as she was warming up in goal before a hockey game.

It was not a catastrophic brain injury requiring a trip by ambulance to the hospital. But the blow did result in a concussion; one that turned out to be far more severe, complicated and long-lasting than initially thought.

Because multiple mistakes were made in the immediate aftermath of the injury by all parties – including by me, her mother – which exacerbated her symptoms, that cold winter’s night marked the beginning of what would turn out to be a fourteen-month long search for answers to the enigmatic riddle that is post-concussion syndrome.

Another great perspective from a mom, this time about a girls hockey player.

Listen, all cases are not as drawn out like this one, in fact stats tell us that some 75-90% of all cases of mTBI/concussion recover in 7-10 days.  Remember that the “recover” portion of that last sentence is from symptoms AT REST.  This brings me to my soap box moment of the day…

It seems that most people involved with and around concussions misinterpret the recovery of concussion.  Research has told us that the vast majority will recover on their own, only when combined with other circumstances (genetics, previous history, or mismanagement) do they seem to last longer than a typical injury.

When people read 7-10 days the competitive nature of people and general understanding of injuries in the sporting world they think that is the time frame to return to play.  Why wouldn’t they, it is the case of almost all injury prognosis but, we are missing the fact that the recovery time frame deals with symptoms at rest.

If we change how we look at the recovery then it would change our expectations on when someone can return to sport.

Using the graded return to activity outlined in the Zurich statement with one simple step added in to incorporate academia into the equation; our return to play time frame changes to 12-15 days.  Step one (rest) would last the 7-10 days then it would be another five, if all goes well, before there is a “safe” return to play.

I truly believe that concussions should be met with the expectation that they have a minimum recovery of 13 days, fits well into the football model (I know I will get hammered by my friends Irv Muchnick and Matt Chaney for that statement) but it should be expected that adolescents most likely will be longer.

In our limited data at the high school I work at when the protocol is followed to the “t” the average return to play is 17.3 days (n=8).  Meanwhile those kids that failed to follow the protocol (attending school too quickly, doing “side-work on their own, etc.) the return to play is over double the amount of time, 36.1 days (n=10).  There have been outliers on both ends that have been thrown out; one player returned in eight days (note from MD but did just fine) and on the long end we have an athlete that was out for ten months.

Regardless the moral of the story is to change how we view the recovery and return days from concussion and it will cause less consternation amongst the players, parents and coaches.

5 thoughts on “Family Travels Long Road of Recovery – TCB Suggestion

  1. A Concerned Mom February 28, 2012 / 14:03

    I followed this story on MomsTeam. Ms. Bedford has become a strong advocate for concussed students. I hope her daughter has no additional problems going forward (I know that is the greatest fear I have for my son).

    The linked article makes reference to short-term memory problems in teens lasting from 6 months to a year. If anything, it may be time for even more conservative management practices to be put into place.

  2. A Concerned Mom February 28, 2012 / 16:19

    Sorry for posting so many links, but 16-years-old and 6 concussions in 7 years!

    Based on her ImPACT scores, she’s going to be kept out of classes for a month (I’m sure not everyone will agree that ImPACT can be used to predict recovery times … but, on a 6th concussion, it’s probably good to be kept out a month).

  3. Jake Benford February 28, 2012 / 23:22

    I think this is a good idea. It comes down to communication and expectation. When the medical team hears 7-10 days, we know that means till we start the progression to RTP. Athletes/coaches/parents are expecting that means return to game level participation. Its our job to communicate the time line, but they are only going to hear the bottom line. We need to start setting the bar higher so they truely understand how long they are going to be out.

    I am also going to start using this as a jumping off point when I start talking to coaches about limiting contact in practice. Why risk having a kid be injured in practice when it means they are going to miss 2 games. This is the language they will be able to understand.

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