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Childhood Concussions

Next Step Therapy - Wednesday, November 11, 2015

“There’s nothing wrong with him….. He looks normal to me.”

As Zachery made his way down the hall to class, he felt like he was in a fog. The commotion, bright lights and chaos of the hall made him feel like his head was spinning. His head started to pound and his heart raced. He finally made it to his first class feeling dazed and confused. Class started and he felt like he was in another world. He wasn’t able to focus; every sound echoed in his ears.  He couldn’t follow directions and the lecture seemed like a foreign language to him. He thought “What is wrong with me… everyone keeps telling me how great I look, but on the inside I know something is wrong… Am I going crazy?” He felt fine while he was at home the last few days, but shortly after his day began he knew things weren’t better.

Zachary suffered a concussion less than a week ago during a football game. He was taken to the emergency room where he was diagnosed with a concussion. He was sent home and instructed to rest for a couple days and follow up with his physician. He started to feel better and went back to school, but this is when he realized something wasn’t quite right. He was sensitive to light and noise. He often had headaches and noticed that school was much harder for him. He was unable to concentrate and was having difficulty remembering things that used to be easy for him. He was often late for class and his grades started to slip. He even received detention for being late to class on several occasions. This was not him. He had always been a great student.

He followed up with the physician. During the visit he and his mother explained the problems he was having. His doctor reassured him that he wasn’t stupid or going crazy. These are all common problems after a concussion. He explained that it is best to start back into mental activity slowly, despite previous thoughts that complete mental rest was needed. He referred him for an evaluation by a speech therapist. Zachary was confused because he wasn’t having difficulty speaking. His doctor told him that speech therapy focuses on more than speech. Speech therapists also work on improving cognition. Exercises can be completed to retrain the brain. Patients can also be taught compensatory strategies to help cope with deficits.

Zachary underwent an evaluation by a speech therapist. Therapy was recommended 2 times per week for 4 weeks and would focus on improving memory, thought organization, attention and problem solving. Sessions would last from 30-60 minutes depending on the severity of symptoms. His speech therapist also referred him to a program which helps students transition back into school. They work with school staff to make accommodations needed for the student to succeed during the healing process. Zachary felt a sense of relief knowing that he wasn’t going crazy and that there was help out there for him. After a month of therapy, Zachary started to notice improvements. His therapist taught him strategies to help him compensate for some of his deficits. He was able to manage his time better with the use of a journal and schedule. He was able to recall information he read and realized the importance of small breaks when completing school work.

There is more and more news about concussions. The old school of thought used to be “he just got his bell rung,” but research has shown that the long term effects of concussion, if not treated property, can lead to lifelong disability and even death. Sometimes physical symptoms only last a few days, but cognitive deficits don’t show up until a student is back into their normal routine. Sometimes these issues seem to resolve, but down the road can return when a student is presented with more complex tasks. Unlike students with physical injuries, concussed students look “normal.” These students experience deficits in memory/recall, attention, problem solving and thought organization. Along with cognitive deficits, students can experience visual disturbances and dizziness, which can be treated with vestibular rehab. These students are often misunderstood and appear to just be “different” or have behavior problems. It’s so important for these students to undergo a cognitive evaluation, so treatment and accommodations can be implemented.

As more and more research is completed in this area, we are learning the problems these students face, not only with their symptoms, but also with others reactions to them because unlike a broken bone, a concussion cannot be “seen.” These students appear to be normal, when in actuality they are truly struggling. My hope is that as awareness of the effects of concussion improves, fewer students will have to suffer unnecessarily.

 

Heidi Underwood, MS CCC-SLP

 

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