After-effects of a concussion continue to wrack the brains of young hockey players long after they appear ready to return to play, new research finds.
MRI scans of concussed teen hockey players revealed brain changes persist for at least three months -- weeks after other symptoms resolve and skaters are cleared to hit the ice, a Canadian research team found.
Scores on thinking and memory tests -- two current measures of recovery -- returned to normal about 24 days (on average) following a concussion, the study findings showed.
These results indicate that current clinical tests used to judge an athlete's recovery could be improved, said senior researcher Ravi Menon. He's a professor and chair of functional and molecular imaging with the University of Western Ontario's Schulich School of Medicine and Dentistry.
"Clearly those tests are not very sensitive," Menon said. "Basically, the standard concussion guidelines would indicate it's OK to go back to play, but the MRI changes show the brain is still damaged and still trying to compensate."
The study involved 17 Canadian boys, aged 11 to 14, who sustained a concussion while playing in Bantam hockey leagues.
Each player underwent standard thinking, memory and balance testing following his concussion. The boys also had MRI brain scans -- most had one right after the concussion and another three months later.
All the players' scores on thinking and memory tests returned to normal before the three-month mark, ranging from 10 to 46 days.
But the three-month MRIs showed they still had signs of widespread damage to their white matter. The white matter serves as the wiring that allows different regions of the brain to communicate, Menon noted.
"We see damage to the wiring, and as a consequence of that we see a reduction in the communication between the areas that those wires connect," Menon said.
The researchers also found other areas of the brain trying to create new connections, apparently in an attempt to re-establish communication impeded by the white matter damage, Menon explained.
According to lead researcher Kathryn Manning, a doctoral student at the University of Western Ontario, "Those underlying white matter changes persist."
Menon said that the results call for better clinical tests that reveal whether the damaged white matter has fully re-established communications.
In the meantime, parents should consider keeping their kid out of play a little longer following a concussion, he suggested. There's some concern that brain damage can stack up in a youngster who receives additional knocks to the head while recovering from concussion.
"Probably the more pragmatic approach is to not rush a kid who is 12 years old back into a game the minute their clinical score is normalized," Menon said. "There's no multimillion-dollar athletic contract on the line at this point. Give them a chance to rest and recover, and then ease them back in."
That stance is a little too conservative for Dr. Anthony Alessi, a Norwich, Conn., neurologist and fellow of the American Academy of Neurology.
"The best clinical tools right now are the tests we have," Alessi said. "If your child feels they're back to normal, they're functioning well at school, neuropsychometric testing is normal, they've seen a physician and all clinical indications are that they're normal, I'd let them go back and play."
The best way parents can protect their child is to interview coaches to make sure they can recognize a concussion and place proper concern on removing injured children from play, Alessi said.
It also helps if there's medical expertise on site.
Studies have shown it's advantageous to have a certified athletic trainer working with the team, Alessi said. "Typically, a concussion will be recognized sooner and there will be intervention sooner," he added.
The study was published online Oct. 25 in the journal Neurology.
For more on sports-related concussion, visit the American Academy of Pediatrics.
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