Second Impact Syndrome in TBI

Question

Answer

 I had intended to talk a little bit about second impact syndrome specific to individuals who participate in sports, because currently there is so much talk in the media about concussive events.  I thought it would be only right here to just pause to talk about the idea of children returning to play.  Sometimes speech pathologists are asked, because of their knowledge about traumatic brain injury, in the event of a child that is participating in a sports activity in school, when are they able to return to play?  Certainly that is a discussion for the child's physician to have with the family.  But the concern of course is that coaches receive training specific to this individual's traumatic brain injury.

Mild concussion is a form of brain injury, even if it is temporary and resolved very quickly.  The concern is that if there is an initial concussive injury, if the child returns to play immediately, there can be a second impact syndrome where there is a great increase in cranial pressure even with just a mild hit.  A child has received a mild TBI or a concussive event.  They say, “Get me back in the game, coach.  I need to get back in there.”  The coach says, “You don't have any double vision.  You're not slurring your words.  Sounds good.  Get back in the game.”  There is this concern of second impact syndrome that another event, even if it is a very mild blow to the head, will cause this catastrophic increase in intracranial pressure. This can happen in athletes that have prior concussion with a mild second impact.  There is the potential for one more small injury to cascade into a larger traumatic brain injury.  It is imperative, even if it has been a mild strike to the head, blow to the head, or concussive event, that the child be pulled out of play immediately and not return until their physician recommends it. 

I certainly don't want to be giving recommendations about when people return back to play.  It is entirely something that should be consulted about with their physician. There's a lot of work that is being done on that at the University of Virginia.  They have an elaborate model where all their student athletes are given baseline neurocognitive testing when they first come in, and they use that to determine when they can go back to play after an injury.  They do that testing again every day until they see that the kid is returning to cognitive baseline in terms of their rate and accuracy of response, and they make that the determining factor in when a child should go back to play.  I think that over time, probably within the next five to seven years, we'll see that children even in middle school are going to be required to have neurocognitive testing delivered either through a computer-based model or by OTs or by other individuals, if they're going to participate in an athletic sport in school.  Then there will be a baseline that will tell the coaches and families when it is safe for that child to return back to play.