Le Bonheur neurosurgeon leads concussion study, clinic

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What does a concussion look like and when can an athlete go back to the game? The answer varies from clinician to clinician. Paul Klimo, MD, MPH, is working to learn more about pediatric brain injuries and educate coaches and local health care providers on the best way to care for these kids.

What does a concussion look like and when can an athlete go back to the game? The answer varies from clinician to clinician. Paul Klimo, MD, MPH, a neurosurgeon with Le Bonheur Children’s Neuroscience Institute and Semmes-Murphey Neurologic & Spine Institute, is working to learn more about pediatric brain injuries and educate coaches and local health care providers on the best way to care for these kids.

“We don’t know the long-term effects on a developing brain that’s experienced two or three concussions,” said Klimo. “It’s a form of traumatic brain injury.”

The lasting harm associated with repeated concussions is gaining national attention, especially as it relates to high school athletes. More than three dozen states have passed legislation that sets stricter rules on when a student exhibiting concussion symptoms can return to play. The state of Tennessee is expected to take up the issue in 2013. Klimo and Le Bonheur Trauma Director Trey Eubanks, MD, are currently working with other medical professionals in the state to craft this legislation.

Despite the publicity around this topic, Klimo says the research lags far behind. Second Impact Syndrome, though rare, has now been documented in teen athletes who experience rapid deterioration after a second impact or concussion.

Scientists also have discovered cumulative brain trauma, or Chronic Traumatic Encephalopathy (CTE), in NFL players after their deaths. CTE leads to erratic behavior and speech, Parkinson-type symptoms, gait difficulties and eventually dementia years after the concussion(s).

To learn more, Klimo, Semmes-Murphey and The University of Memphis faculty are performing impact and balancing testing on high school and college athletes at the beginning and the end of the season, as well as post injury.

Subjects for the study include Memphis’ Central High School football team and athletes from The University of Memphis’ football, women’s soccer, volleyball and basketball teams. The study has been funded by a $25,000 FedEx Institute Corporate Engagement grant.

Because of so many risks and unknowns, Klimo says it is important to be vigilant, especially with children and teens whose brains are developing. Coaches and trainers should recognize when a child has concussed and make sure he or she is appropriately evaluated, Klimo says.

The signs and symptoms of a concussion are evolving. While concussions were once diagnosed with a brief loss of consciousness, scientists now cite more symptoms to watch for — including difficulty in school and loss of sleep.

Semmes-Murphey is creating a multi-disciplinary concussion clinic designed to follow high school and college athletes who develop concussion symptoms. The clinic will be staffed by neurosurgeons, neurologists, neuropsychologists, physical therapists and radiologists. The staff will also organize educational seminars for coaches, trainers and others involved in athletes’ care.

“I approach the question of when to allow the child to return to play in a conservative way. When in doubt, keep the child out of the game and get them evaluated by an appropriately trained medical professional. In my opinion, the child or athlete must be virtually symptom free before they return to play, and the return should be gradual,” Klimo said. “If I was a parent of child who had suffered multiple concussions, I would strongly encourage them to pick a non-contact sport. I haven’t heard of concussion occurring in golf or tennis.”