A New Way to Care for Young Brains
Charlie Mahoney for The New York Times
Brian Lilja is a patient at
the Boston Children’s Hospital youth sports concussion clinic. His
mother, Jennifer, said his injuries caused a “scary” personality change.
By BILL PENNINGTON
Published: May 5, 2013 85 Comments
BOSTON — The drumbeat of alarming stories linking concussions among
football players and other athletes to brain disease has led to a new
and mushrooming American phenomenon: the specialized youth sports
concussion clinic, which one day may be as common as a mall at the edge
of town.
Charlie Mahoney for The New York Times
Isabelle Kindle, center, a hockey player at Wellesley
High School in Massachusetts, recently returned to the ice after two
concussions. There is no standard recommended recovery time for young
athletes who have had a concussion. Doctors may consider genetic,
biomedical or anatomical characteristics in addition to the severity of
the injury.
In the last three years, dozens of youth concussion clinics have opened
in nearly 35 states — outpatient centers often connected to large
hospitals that are now filled with young athletes complaining of
headaches, amnesia, dizziness or problems concentrating. The
proliferation of clinics, however, comes at a time when there is still
no agreed-upon, established formula for treating the injuries.
“It is inexact, a science in its infancy,” said Dr. Michael O’Brien of
the sports concussion clinic at Boston Children’s Hospital. “We know
much more than we once did, but there are lots of layers we still need
to figure out.”
Deep concern among parents about the effects of concussions is colliding
with the imprecise understanding of the injury. To families whose
anxiety has been stoked by reports of former N.F.L. players with
degenerative brain disease, the new facilities are seen as the most
expert care available. That has parents parading to the clinic waiting
rooms.
The trend is playing out vividly in Boston, where the phone hardly stops ringing at the youth sports concussion clinic at Massachusetts General Hospital.
“Parents call saying, ‘I saw a scary report about concussions on Oprah
or on the ‘Doctors’ show or Katie Couric’s show,’ ” Dr. Barbara Semakula
said, describing a typical day at the clinic. “Their child just hurt
his head, and they’ve already leapt to the worst possible scenarios.
It’s a little bit of a frenzy out there.”
About three miles away, at Boston Children’s Hospital, patient visits
per month to its sports concussion clinic have increased more than
fifteenfold in the last five years, to 400 from 25. The clinic, which
once consisted of two consultation rooms, now employs nine doctors at
four locations and operates six days a week.
“It used to be a completely different scene, with a child’s father
walking in reluctantly to tell us, ‘He’s fine; this concussion stuff is
nonsense,’ ” said Dr. William Meehan, a clinic co-founder. “It’s totally
the opposite now. A kid has one concussion, and the parents are very
worried about how he’ll be functioning at 50 years old.”
Doctors nationwide say the new focus on the dangers of concussions is
long overdue. Concerned parents are properly seeking better care, which
has saved and improved lives. But a confluence of outside forces has
also spawned a mania of sorts that has turned the once-ignored
concussion into the paramount medical fear of young athletes across the
country.
Most prominent have been news media reports about scores of relatively
young former professional athletes reporting serious cognitive problems
and other later-life illnesses. Several ex-N.F.L. players who have
committed suicide, most notably Junior Seau, a former San Diego Chargers
and New England Patriots star, have been found posthumously to have had
a degenerative brain disease linked to repeated head trauma.
State legislatures have commanded the attention of families as well,
with 43 states passing laws requiring school-age athletes who have
sustained a concussion to have written authorization from a medical
professional, often one trained in concussion management, before they
can return to their sport.
The two Boston clinics, one started in 2007 and the other in 2011, are
typical examples of the concussion clinic phenomenon, busy centers of a
new branch of American health care and windows into the crux of a
mounting youth sports fixation.
“We are really in the trenches of a new medical experience,” said
Richard Ginsburg, the director of psychological services at
Massachusetts General Hospital’s youth sports concussion clinic. “First
of all, there’s some hysteria, so a big part of our job is to educate
people that 90 percent of concussions are resolved in a month, if not
sooner. As for the other 10 percent of patients, they need somewhere to
go.
“So we see them. We see it all.”