Concussion: Returning the Student Athlete Back to Life, with Dr. Gerard Gioia

Tonight at the Phillips Academy faculty meeting, we are talking with Dr. Gerard Gioia of the Children’s National Medical Center in Washington, DC. The purpose of this discussion is to ensure that we are adopting best practices to protect our students from traumatic brain injury (TBI), or concussions, and that we have sound policies and practices in place to help ensure that students get treatment and care for injuries they do sustain.  Dr. Gioia is a very clear and effective speaker with access to a great deal of relevant data and practical guidance for schools.

We are talking about the concussions that are most commonly seen in residential academic settings.  Research shows that about half of all concussions in these environments occur in the context of sports (hockey, lacrosse, football, and soccer are among the most common) and about half in everyday life.  After a student has a concussion, we, like many schools, have adopted accommodations for them on a case-by-case basis.

According to Dr. Gioia, the definition of traumatic brain injury, or concussion for short, is an injury to the brain due to a blow to the head or body that jerks the head forward and backward.  The damage is a “software” problem: that the brain’s electrochemical function changes as a result of the trauma.  Put a slightly different way by Dr. Gioia, it’s less of a “hardware” problem than a “software” problem.  Kids experience physical, psychological, cognitive, and socially-related symptoms that can last for hours, days, and much longer.  Concussions happen much more than we realize, among both kids and adults.  Injuries are one-off; there’s no one-size-fits-all in terms of the way to treat it and how quickly to bring kids back into their ordinary pattern of life.

The primary effect of TBI is to damage the working memory.  Students can experience slower reaction times, have trouble paying attention, or struggle with concentration.  Students can also experience greater irritability as a result of the injury.  Recovery time tends to be between 1 day to 140 days.  Our understanding and treatment modalities need to take into account this range and the variation within it.

Dr. Gioia suggests that best practices include ensuring that kids experience no additional forces to the head during recovery, by keeping them out of sports and other activities that might lead to re-injury.  Running, jumping, jogging the head; working too hard on homework; and emotional stress all can harm the brain further during the recovery period.  Students who have experienced a concussion especially need to rest their brain and get good sleep.  We need to help facilitate their physiological recovery.  The cognitive demands of school can slow recovery or exacerbate the negative impact of the injury.  (Studies show that math, it seems, is the hardest thing for students to do, by far, after a concussion.)  Dr. Gioia recommends a moderated approach to bringing kids back into their regular activities after a concussion.  The rest right after the injury is most important, with only a gradual increase in activity thereafter.  Dr. Gioia suggests setting up a team on campus that works with students after concussions, which is the approach that we’re taking at Phillips Academy.

Dr. Gioia ends with a positive message: these kids who get concussions will get better.