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THIS MONTH DR. JACQUES DOUECK INTERVIEWS NOTED NEUROPSYCHOLOGIST DR. GAD KLEIN

By: Dr. Jacques Doueck



Dr. Klein is a fellowship-trained clinical neuropsychologist. He evaluates children, adolescents, and adults with a wide range of disorders and injuries, including concussions, learning disabilities, and ADHD. He can be reached at 516-642-0191.

Is it a Concussion or Just a Bump on the Head?

What is a concussion and is it something to worry about?

Concussions in general and sports-related concussions specifically have generated a lot of interest in the media lately. A concussion is a type of traumatic brain injury that is caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull. The injury may or may not involve a loss of consciousness and standard brain imaging techniques such as CT and MRI typically appear normal after a concussion has set in.

What are the symptoms of a concussion?

Although symptoms vary widely from person to person, they usually fall into three categories: physical symptoms (e.g. headache, fatigue), cognitive symptoms (e.g. memory loss, difficulty concentrating), and affective symptoms (e.g. irritability, anxiety, depression).

How long does it take to get over a concussion?

Most resolve in approximately three to seven days, but the symptoms can last significantly longer if they are not managed correctly in the early stages.

When can a person return to normal activity?

A returnto strenuous physical activity or organized athletics before all symptoms have resolved may lead to another blow to the head. This can be extremely dangerous due to the rare, but real possibility of Second Impact Syndrome (SIS). SIS can occur when a child or adolescent experiences a second blow to the head soon after suffering a concussion, and often results in severe brain injury or death. Luckily this is very uncommon, but is a critical reason to have a child removed from the field of play and evaluated if there is any suspicion that they have suffered a concussion. Even when SIS is not a concern, repeat concussions can lead to longer recovery times and increased susceptibility to further concussive injury.

What is the role of the specialist?

An evaluation by a neuropsychologist trained in concussive injury can assist in providing appropriate management guidelines and school accommodations such as extra class breaks, limited home assignments, and extra time on tests if necessary. We use a range of tools including clinical examinations of balance and vision, neuropsychological testing, and symptom questionnaires to diagnose concussions and treat them appropriately. These methods are also used to determine whether young athletes are ready to return to play and to evaluate their cognitive and academic abilities before and after returning to school. While clinical specialists help to manage and treat concussions, parents, athletic personnel, and teachers are often the first line of defense and should be taught how to recognize these injuries and how to react in order to ensure the safety of the children in their care.

So how do you “treat” a concussion?

Likely, the most critical component of concussion management is rest, rest, and more rest. Obviously physical rest and sleep are incredibly important following a concussion. However, cognitive rest is also critical because the brain needs to heal. In order for the brain to “rest,” concussion patients need to limit involvement in activities that require significant cognitive exertion. These include long periods of exposure to TV and computers, exposure to graphics-intensive video games, and intensive academic work in school or at home. Because this type of “rest” is less intuitive to most people than sitting on the couch with the legs propped up, it is important that post-concussion rest guidelines be explained both to the parents and to the concussed child.

Medication is not typically the first method of treatment following concussive injury. However, if the post-concussion symptoms persist for a prolonged period of time and are not resolving with conservative management, there are medications utilized by experts in this field that may be of help.