Lancaster Physician Winter 2018 - 12

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Best Practices

Concussions
Football players, ice hockey players,
cheerleaders, and soccer players are the
most likely athletes to suffer from concussions. Treatment for concussions has
evolved and changed in recent years, as
physicians better understand the recovery
from a bump or blow to the head or body
that causes the brain to move rapidly
inside the skull.
One of the biggest changes is in the
basic approach to treating concussions. The
"old school" method prescribed complete
rest and quiet.
"We very much are going away from
that," Stein says.
A concussion sufferer may need a short
period of rest, but most kids should
resume cognitive activity fairly soon
after the concussion even if they are still
experiencing symptoms. To help alleviate
discomfort, some accommodations such as
wearing sunglasses or taking breaks may
be recommended. Stein sometimes sends
concussion sufferers to physical therapy, to
get them started on a regimen of recovery.
Stein, who did training in sports neurology during his residency in pediatric
neurology at the University of Michigan,
says appropriate stimulation of the brain
helps to repair it and get it used to doing
what it was doing before the concussion.
"If you tell a 15-year-old athlete to do
nothing, sit in a dark room, don't talk and
don't play sports, they can get depressed
from doing that," he says. "And the
symptoms of depression overlap with the
symptoms of concussions."
Stein follows the BRAIN protocol,
prescribing these five, progressive steps:
Biking (stationary); Running; Agility; In
red (limited contact in sports for a time);
and No restrictions.
A Mayo Clinic study of men who played
high school football from 1946 to 1956
found that after following the participants
for 50 years there was no increased risk

for degenerative brain disease, such as
dementia or Parkinson's disease. Stein
a longtime ice hockey goalie, has had
personal experience with concussions,
suffering one when he was 15; he recovered
and expects to have no long-term damage
from the injury.
Today's athlete enjoys better protection
(such as high-grade helmets) and monitoring by coaches and school athletic
trainers, who remove kids from the field
of play when appropriate and refer them
for treatment. Stein encourages parents
not to be afraid of organized sports.
"I think contact sports are safe and
have great benefits, such as camaraderie,
teamwork, and physical exercise," he says.
"The benefits outweigh the risks."
Headaches
WellSpan Neurology has treated children
as young as 5 years old for headaches.
Migraines are the most common type of
headache among children and often have
a genetic component.
Treatment is both behavioral and medical. Stein tells patients to follow good
headache hygiene, urging them to stay
hydrated (and avoid caffeine), get proper
sleep (8 to 10 hours a night), and exercise
(three times a week). Medications are
sometimes prescribed to prevent and to
get rid of headaches. Physical therapy can
be helpful in some circumstances, as well.
Stein also does two types of nerve blocks,
including one that numbs the back of the
head and another that involves inserting
pain medication into the nasal passage.
Seizures
WellSpan Neurology sees children who
have seizures that can range from a 5- to
10-second staring spell to uncontrollable
shaking all over the body that makes a
child fall to the ground.
Treatments for epilepsy, which causes
seizures, have evolved. There are many
medications that can help control seizures
and doctors have a better understanding
of what causes the disease, which is one of

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12

PHYSICIAN

the common brain disorders. In addition
to prescribing medications, Stein also
refers children for vagal nerve stimulation
at WellSpan Pediatric Neurology in York.

It's important for
parents to know how
to act when their
child has a seizure.
DO'S INCLUDE:
* Position the child on his side.
* Move dangerous objects from the
range of the child.
* Be prepared to call an ambulance
if the child stops breathing, looks
blue, or if the seizure lasts more than
5 minutes.
DON'T'S INCLUDE:
* Lift or shake the child.
* Put anything in the child's mouth.
* Restrain the child.
Stein encourages giving kids with
epilepsy the opportunity to still be kids
but urges parents to observe some precautions-such as not allowing children
to swim alone, be alone in a bathtub, or
climb on high objects.



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