February 28, 2012

Teen Athletes Aren't Always Hard-Headed

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Joseph V. Madia, MD By:

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Concussions from sports appear to cause greater damage in teens than in adults or children

(dailyRx News) It may be tempting to knock your teen upside the head sometimes, but it turns out a head injury might cause more problems in adolescents than in adults.

New research reveals that teens are more susceptible to the short-term memory problems that a person suffers following a sport-related concussion.

"Protect your head in sports with headgear and proper playing form."

Neuropsychologist Dave Ellemberg, a professor in the Department of Kinesiology at the Université de Montréal, led the study, which is the first to compare the effects of a concussion across three different age groups.

Ellemberg's team worked with a total of 96 male athletes - half of whom had head injuries - who played amateur competitive soccer, hockey, rugby or football.

The researchers divided the athletes into three different age groups: one third were between ages 9 and 12, another third were aged 13 to 16, and the last third were adults.

Each athlete was evaluated using the neuropsychological tests used by the National Hockey League and then through electrophysiological measurements of their short-term memory, attention span and inhibition while they completed computerized tasks.

Although the neuro-tests used by NHL are helpful in pinpointing short-term effects of concussions, they cannot identify longer term effects as accurately .

"Electrophysiology allows us to see the response from the athlete and from his or her neurons which are sometimes independent from one another," Ellemberg said. "Therefore, certain participants showed weakness during certain electrophysiological tasks that the neuropsychological tests hadn't picked up on."

Ellemberg's research data showed that a person's first concussion will leave them with neurophysiological side effects for six months to a year, regardless of the person's age. These side effects include difficulty maintaining focus and trouble with short-term memory.

But teens' brains were more deeply affected than the adults or young children. The concussed teens had a 24 percent lower measurement in the brain on the electrophysiological test compared to the teens without a concussion.

The concussed adults' measurements were 13 percent lower than their control group and the children with concussions showed measurements 17 percent lower than their unconcussed counterparts.

The greatest amount of impairment for the teens occurred in their "working memory," the part of the brain that lets people process and store the short-term information necessary for mental calculation, reading and similar cognitive activities.

"The frontal regions of the brain are more vulnerable to concussions. These areas oversee executive functions responsible for planning, organizing and managing information," Ellemberg said. "During adolescence, these functions are developing rapidly which makes them more fragile to stress and trauma."

He said the commonly held wisdom that kids can bounce back more quickly from injury isn't borne up by the evidence - at least not where their heads are concerned.

"For a long time, we believed that the brain of a child was more plastic and could therefore better recover from an accident or stress," Ellemberg said. "In recent years, we've realized that quite to the contrary, a child's brain is more vulnerable. Our research shows that children are as afflicted as adults by a concussion."

According to Dr. Daniel Clearfield, D.O., a specialist in sports medicine, this study is valuable because so little is currently known about how to assess concussions and head injuries in children.

"This study is a step in developing a better way to assess these young athletes such that further harm is not done with continued competition," Clearfield said. "That said, ultimately the best thing we should continue to push is for prevention of these injuries as a whole."

Clearfield said it's important that children and teens avoid sports activities that can lead to a concussion or even a sub-concussive injury, where the head is injury but not to the point of a concussion.

"Such preventable things include avoiding tackling in football as well as heading the ball in soccer until at least adolescence has set in," Clearfield said. "The best way to treat an injury is to avoid it in the first place."

Another difference between children's and adults' head injuries that study author Ellemberg believes people take for granted is that the time required for a full recovery from a concussion can have additional consequences for children and teens that professional athletes don't have to worry about.

"Youngsters don't have a medical doctor and a protocol in place for becoming active again," he said, pointing out that professional athletes are financially and cognitively able to take off the months necessary for an effective recovery.

"After a concussion we impose cognitive rest, meaning no school, no television, no video games, and physical rest as well," he said. "This absence combined with the potentially chronic impact on the working memory can handicap a child's future

The research appeared online February 28 in the journal Brain Injury. Information was not available regarding funding, but the authors stated no conflicts of interest.

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Reviewed by: 
Joseph V. Madia, MD
Review Date: 
February 27, 2012

Last Updated:
February 29, 2012