In a split second, the 13-year-old figure skater knew something was wrong.
Failing to complete a difficult double axel, she sat on the ice overcome by a headache, nausea, dizziness, and blurred vision, the result of a serious blow to the back of her head.
Five days later, the seventh-grader was still coping with symptoms when she arrived at the office of Cynthia LaBella, a pediatric researcher and the medical director of the Institute for Sports Medicine at the Ann & Robert H. Lurie Children’s Hospital of Chicago.
An estimated 30 to 40 million children participate in organized sports every year, according to the Centers for Disease Control. While the overall sports-injury rate among young kids is lower compared to adolescents and adults, concussion rates tend to be higher and children often take longer to recover because their brains are still developing. Unfortunately, very little research has been done to determine the short- and long-term effects of concussions on this youngest group of athletes.
Although there’s been a groundswell of interest in concussions in collegiate and professional football players, “they represent such a small subset of the at-risk population,” LaBella says. “You can’t extrapolate data from NFL players to 10-year-olds playing soccer.”
LaBella’s larger research focus is on identifying risk factors for injuries in youth sports and investigating strategies to prevent them. Her earlier work demonstrated that a 15-minute, coach-led warm-up with neuromuscular exercises could significantly reduce knee and ankle injuries in female soccer and basketball players at Chicago public high schools.
She’s also investigated the injury risk associated with early sports specialization — playing a single sport year-round. A collaborative study with Neeru Jayanthi from Loyola University showed that specialization was an independent risk factor for overall injuries and for injuries due to overuse.
LaBella’s ongoing concussion investigation seeks to identify age-appropriate clinical evaluation tools and treatment and prevention strategies for young children and teens.
“The goal is to fill in this research gap,” she says. “One question I hear all the time from parents is, what does this concussion mean for my child’s future? Right now we don’t have enough data to predict who may be at risk for long-term difficulties post-concussion.”
As a pediatric sports medicine specialist, LaBella identified an opportunity in the growing number of young patients she was seeing with concussions. For the past two years, every concussion patient seen by Lurie Children’s sports medicine physicians has been invited to participate in a longitudinal study that LaBella plans to extend for years to come. To date, nearly 400 patients have been enrolled, and data is collected every six months about their symptoms, sports participation, emotional wellbeing, academic performance, lifestyle changes, and any subsequent concussions.
Because concussions are currently a clinical diagnosis — based on patient history and a physical examination by a healthcare provider, rather than
by a diagnostic test — how doctors assess patients is of great importance.
“In the simplest sense, a concussion represents a type of brain injury that affects how the brain functions,” LaBella says. “But how this manifests is highly individual. No two brains are the same, so no two concussions are the same. And the still-developing brain is much different than the mature brain, so one of the things we need to do is validate a set of age-appropriate testing and treatment measures for younger patients.”
Initial information from people who have suffered a head injury is typically obtained from a symptom checklist filled out by the patient. Physicians then administer tests of cognitive function, visual skills, and balance.
“One of the challenges in designing age-appropriate testing is to be able to diagnose 12-year-olds who aren’t necessarily worried about their health — they just want to get back to playing,” LaBella says. “When a patient who doesn’t report any symptoms fails a balance or visual skills test, we know their brain is still recovering, so we have them continue to rest from contact sports until these test results have returned to baseline.”
Groundbreaking research by Labella and Nina Kraus, the Hugh Knowles Professor in the School of Communication, recently identified a biological marker in the auditory system that could take the ambiguity and controversy out of diagnosing concussions and tracking recovery.
By observing research subjects’ brain activity as they were exposed to auditory stimuli, the research team discovered a distinct pattern in the auditory response of children who suffered concussions compared to children who had not.
“This is something patients cannot misreport, you cannot fake it or will your brain to perform better or worse,” says Kraus, who describes the initial findings as a major first step in developing a tool to better diagnose concussions.