The key to treating concussions in kids? Doing it very slowly. A new concussion handbook explains how to approach the healing process with youngsters.
It's difficult to type these words. Not because there's nothing to say, but because my brain is in my way.
Today, it's the pain. It's not a sharp pain – that comes some days, too, in the form of migraines – but more of a dull, steadily increasing pressure, like the inside of my skull is hosting a birthday party and some poor clown keeps trying to inflate balloons inside it.
It's been 11 years since my last serious concussion, with a couple car accidents sprinkled in since then, and I know my life will never be the same. I'm lucky to write about hockey for a living, as I can't play it anymore. I can do 30 minutes of cardio, once a week, and if I push my luck with a second session, the vertigo kicks in. Missing a step on a staircase or hitting a big wave on boat can do me in for a couple days, too. When a subway train pulls up, I have to look away until it comes to a stop.
After visiting the Holland Bloorview Kids Rehabilitation Hospital this past Wednesday, however, I realize my path could have been very different. Had I not returned to class, cracked the books hard and written my exams just days after my severe head trauma, and taken the time to recover properly, I might have no limitations today.
That was the message delivered by Dr. Nick Reed, Dr. Michelle Keightley, and a team of uniquely qualified hockey people at Holland Bloorview as they launched Concussion & You: A Handbook for Parents and Kids. The central tenet is ensuring no young person returns from a major head injury too soon.
"The brain, just like anything else in the body in a child, is developing," said Dr. Reed, an expert on pediatric concussions. "It's going through peaks and valleys of developmental processes. There are critical periods, and those are different for every child, and it's really hard to pinpoint what's happening. But, keeping in mind the brain is changing every day, we need to take a more conservative approach here."
We've seen the results of not being conservative enough, of trying to bounce back from a concussion too aggressively. A charismatic young man named Warren McNeil, 17, was on hand at Holland Bloorview to tell his upsetting story. By summer 2014, he'd sustained almost half a dozen concussions already. His latest came in box lacrosse, in which he was a goalie, when a shot hit him so flush, it knocked him out cold. Two months later, his hockey team was routing an opponent when he took a hit and fell awkwardly. His stick got tangled and blocked his arms from breaking his fall. He smashed into the boards head first.
McNeil missed several days of school and felt he was back to normal. About a week after the collision, he went on a bike ride with a friend. He felt mentally foggy upon returning home. The next day, when he woke up, he felt like he'd been hit by a bus. He had the worst headache he'd ever experienced in his life. He was very far from OK.
As the weeks progressed, McNeil said, he began suffering from dizziness, nausea and anxiety. Not being able to do anything made him extremely depressed. "It's the worst feeling ever," McNeil said. "You get to a point where you're like, 'I'd rather have broken both my femurs than gone through this. Because at least, when you break a bone, you can sit there and do something else. You can focus on something. But with a concussion, everything you do hurts your head. It's really frustrating."
McNeil's hockey career was over. He began to feel improvement in his symptoms in the New Year, however, and he says the key was attending information sessions at Holland Bloorview. The handbook didn't exist yet, but all the lessons found in it were being taught in live sessions, he said.
So what exactly does this handbook do?
It was developed by Dr. Reed and Christine Provvidenza, with research and clinical input from Dr. Keightley and many others. It starts by diagnosing the symptoms associated with concussions and dispelling myths. The symptoms are physical (headaches, nausea, etc.), but also emotional (anxiety, depression), mental (difficulty concentrating) and sleep-related.
The handbook divides the recovery process into six steps. The first involves conserving energy. At Wednesday's summit, Dr. Reed described the brain as a gas tank. When the brain is injured, he explained, it uses up a lot of energy simply trying to heal. Doing too much too soon after an injury burns that metaphorical gas and slows the recovery process. It also can create anxiety as the brain struggles to keep up with too many stimuli.
"We take for granted what our brain does," Dr. Keightley said. "It's not stressful for you to focus on me right now, to tune out background noise. But for your brain, that's actually work. And work translates into stress."
A stressed brain is more likely to manifest concussion-related symptoms such as headaches, making a patient feel like he or she has taken a massive step backward in recovery.
As Dr. Reed points out, some of the tips in the handbook apply not just to concussions but also to life in general for kids and adults. One example is the second step in the recovery process: getting proper sleep. That involves maintaining a proper daily pattern and setting up a comfortable, distraction-free sleep environment, like a dark room with no TV or computer. Just as that applies to, say, someone needing lots of shuteye before writing an exam, it applies to a concussion victim.
The handbook also covers nutrition, relaxation techniques, returning to school and, finally, returning to physical activity. The latter may feel like a pipe dream for certain concussion sufferers, but it's possible if the recovery process is treated respectfully. Jennifer Smith, the CWHL's director of marketing and communications, has a daughter, Sarah, who sustained two major concussions playing hockey. Luckily for the Smiths, they had been working with Dr. Reed during his years of concussion research. The team Jennifer coached even had its players outfitted with helmet sensors to track which types of impacts produced concussions. Understanding Dr. Reed's work helped Jennifer handle her daughter's injuries properly. For example, while the Smiths knew Sarah couldn't dive right back into physical activity, she could listen to e-books in the dark or play her guitar. After the second concussion, Jennifer decided to let Sarah have friends visit her. Jennifer was determined to help her daughter still feel like part of society as she recovered.
“You take a teenager and you remove them from their sports, their music, their friends, their school, and that’s devastating," Jennifer said. "Those are the most important things in a teenager’s life.”
Though Jennifer is quick to point out no two cases are the same, doing the research helped. She avoided overstimulating Sarah while still letting her do enough to fend off depression and anxiety. Today, Sarah plays rugby and goes white-water canoeing. She's living proof that following the handbook's teachings and recovering at the right pace can bring an athlete all the way back – even into the world of contact sports.
If you flip through Concussion and You, which can be downloaded here, it will seem simple enough. The teachings may even illicit the odd, "well, duh." But that's kinda the point. The content is meant to be accessible for kids and adults alike. And, as Dr. Keightley points out, the resources gives parents something immediate to grab onto in those moments of panic right after an injury, a one-stop shop for all the information they need. When kids, or adults, for that matter, rush back too quickly from concussions, it's usually because they lack education and a clear checklist.
The handbook can help change that – especially when we'll soon see it in many a minor hockey dressing room. One of the project's biggest supporters is Scott Oakman, executive director of the Greater Toronto League, the largest amateur hockey circuit on the planet. When back-to-back concussions threatened Sidney Crosby's career in 2011, it was a tipping point for Oakman, who has also been an OHL referee for 16 years. He realized that, if the education even at the league's highest level was poor enough that Crosby returned too soon, it must've been seriously lacking at the minor level. Now Oakman is determined to drill the handbook into the minds of every parent and coach out there.
"There's no question that it will be here before you know it," Oakman said. "You cannot give enough resources to people when it's an important issue like concussions. It's our responsibility to make sure it's in the hands of as many people as possible."
Here's hoping Oakman's right. It's too late for the teachings to save my brain, but if it protects countless other kids from returning too quickly after brain injuries, it'll be a huge victory.
Matt Larkin is an associate editor at The Hockey News and a regular contributor to the thn.com Post-To-Post blog. For more great profiles, news and views from the world of hockey, subscribe to The Hockey News magazine. Follow Matt Larkin on Twitter at @THNMattLarkin