Busy Concussion Clinic Combines Management and Research

Categories: Orthopedics Now
Busy Concussion Clinic Combines Management and Research
Busy Concussion Clinic Combines Management and Research

Jacey Clarke of East Haddam knows all too well what a concussion feels like.

As a basketball player for Nathan Hale-Ray High School, Jacey, 16, was scrimmaging with her team last winter when she took a severe blow to the head.

“I was running down to get in front of the Center and she side-checked me,” Jacey explained. It was with just enough force to send the high school sophomore into the concrete wall, head first.

“I was on the ground for about 30 seconds and when I got up, I was instantly nauseous,” she said. “I felt completely unlike myself. My depth perception was off, and I couldn’t even catch the ball.”

“The coach recommended I go to the doctor because she knew it could be a concussion,” Jacey said.

And she was right.

Busy Concussion Clinic

Each year, hundreds of teenage athletes, like Jacey, are referred to Connecticut Children’s Elite Sports Medicine in Farmington, which offers a comprehensive sports-related concussion program for adolescent and young adult athletes.

“Concussion alone makes up one-third of our patient population,” said Concussion Program Coordinator Regina Kostyun, MSEd, ATC. “We were seeing between 400 and 500 patients a year between 2013 and 2015. Our main demographic is athletes between 10 and 20 years of age.”

One of the first concussion clinics in the state, its services include concussion management, baseline and post-injury neurocognitive testing, physical therapy, vestibular therapy and more.

Concussion 101

Jacey Clarke Orthopedics Now (Summer 2017)
Jacey Clarke is part of a balance study conducted by the Concussion Clinic at Connecticut Children’s Elite Sports Medicine. She is pictured here with lead research engineer Matthew Solomito, PhD.

A concussion is a traumatic brain injury, resulting from a blow to the head, face, neck or body. It commonly occurs in sports but can also result from whiplash or other injuries.

“On the outside, the patient may look normal,” Kostyun said. On the inside, other things are going on at the cellular level.

When an athlete takes a hard blow to the head, calcium floods into the cells, triggering an increased need for glucose from the brain to allow healing to take place. But while the brain needs glucose to heal, the cells are leaking potassium, which results in a surge of events that lead to constriction of blood vessels and a decrease in the amount of blood delivered to the brain.

Recovery can take four to six weeks, or even longer.

Traditionally, concussions were seen most often in football, hockey and lacrosse, Kostyun said. Today, a higher concussion rate is being seen in female soccer players, but basketball players, swimmers and even cross-country runners are not exempt. “It can, unfortunately, happen in any sport,” she said.

Concussion Research

At Connecticut Children’s Concussion Clinic, staff are not only treating concussion, they are studying it — from multiple angles.

“We have a number of different projects underway,” said Matthew Solomito, PhD, lead research engineer in the Division of Orthopedics. One of the current studies is looking at balance.

“Everybody’s balance is different,” Dr. Solomito said. But software he developed will help the researchers determine if a patient is still experiencing concussion symptoms at follow-up visits by mapping postural sway (horizontal and backwards and forward movement) and shift in weight to maintain postural balance after concussion.

Patients who agree to participate in the balance study begin by completing a survey on their first visit. Subsequent visits involve patients answering a series of questions with their eyes open and closed while using a specialized balance board.

“We currently have 30 concussed adolescents participating, along with 18 healthy adolescents who are not concussed,” Dr. Solomito said. Collegiate athletes have also been recruited for the study.

What the findings seem to suggest thus far is that patients who have lower scores on certain questions answered with their eyes closed are still experiencing concussion symptoms.

“Postural balance and dynamic balance (balance while in motion) both seem to be affected by concussion,” Dr. Solomito explained. “What we’ve learned is that many patients will try to mask their symptoms, saying they feel OK when, in fact, they are still experiencing symptoms.”

Much More to Learn

While the balance board has been useful in helping determine whether a patient is physically ready to return to sport, the researchers are also collecting data on the psychological impact on athletes returning to sports after concussion recovery.

“The knowledge we have gained from studying concussions has exploded in the last decade,” Kostyun said. “But we are still going to be learning more about this condition 30 or 40 years from now. We’re still early in the spectrum.”

To learn more about concussion, view the online video, “Know the Signs: The Concussion Anthem,” written by David Wang, MD, Medical Director of Connecticut Children’s Elite Sports Medicine Division.