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January 30, 2014

Concussion Up Close and Personal

Patricia A. Kelly

Two months ago my granddaughter, Rory Murphy McClain, fell off of a running horse. I didn’t see the fall, as the horse was between us, but I heard the thump as she hit the soft, sawdust covered ring floor.


She sat up immediately and cried like she normally would after a simple fall. She got back on the horse, trotted a little, and dismounted only a little before the end of the class, balking at the balance exercise. She insisted on doing her after-class grooming. She was wearing her helmet.


She told me on the way home that she fell spread-eagled onto her back, and I thought that was good, as her body was symmetrical, reducing the chance of injury. During the rest of the evening, at a family dinner, she seemed quite tired but in no other distress.


The next morning, she had a headache and was unable to turn her head due to discomfort in her neck.


Two months later, after three pediatric visits plus a specialist referral by her doctor, she is finally in a concussion clinic, diagnosed with complex concussion. That’s the third level. There is simple concussion, with symptoms usually gone in about a week, post concussive syndrome, with prolonged symptoms, complex concussion, with symptoms lasting months, and, recently studied in retired football players, chronic traumatic encephalopathy, or CTE.


Concussion in children happens quite frequently. Less than 10 percent of victims lose consciousness. During the symptomatic period, brain chemistry is altered. A second injury during the symptomatic period can cause CTE, or death. Complete brain and body rest can be necessary to help the brain heal.


The National Football League is helping to fund a program to prevent injury in young athletes, and the Center for Disease Control has concussion evaluation guidelines, along with recommended recovery guidelines.


Rory is blessed in a way. In spite of her extremely prolonged symptoms, she got a diagnosis. Her doctors think she will recover completely. The Parkway Elementary School staff created a learning and socialization plan for her, and obtained a grant providing her with an aide who helps her during the half day she is allowed in school.


She is moving on, some days even headache free. Right now moving on means wearing sunglasses outside, and avoiding crowds and noise, including friends’ birthday parties. It means avoiding television, reading, all electronics, and piano lessons. She can play board games and even pool, but she should put her hands over her ears when the balls break. It means her wonderful school aide, who helps her get through four hours of school by protecting her from noise, reading assignments to her, supervising her quiet lunch period with a few friends for company, and interpreting her computer work so she doesn’t have to look at the screen.


Rory requested and contributed to this column. She told me she could die if she falls again. She says that’s really scary. I don’t like her being scared. I don’t like not having known about this, even with pediatric emergency nursing experience. I don’t like her riding teachers not having a treatment algorithm for such falls. I don’t like her primary doctor not knowing exactly what to do for early concussion treatment, although I greatly appreciate their responsiveness to prolonged symptoms. I don’t like the possibility that many people out there might be unable to provide proper protection and care for their children.


Most children take many blows and falls without injury, which is the good news. There are, however, many children, along with adult football players, at serious risk due to lack of widespread information about the problem of head injuries.


Rory won’t be skiing or horseback riding any time soon. And that’s okay compared to the risk she would have faced had no one recognized her problem. There are many little football players out there, and they need some protection and proper care, too.


I’m a former emergency nurse, and I didn’t get it. Rory and I want everyone to know about the seriousness of childhood concussion, that loss of consciousness rarely occurs, that rest for the brain and body should be immediate and last a while, and that one should visit the emergency room after a potentially serious fall.


Spread the word, people. Hug your little ones, and keep a careful eye on them when they get hurt.


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