Q&A: Concussions in Youth Sports

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by Tom Pedulla – 

With youth and high school sports in full swing, Dr. Mark Herceg, a neuropsychologist at Phelps Hospital, participated in a question-and-answer session with The Hudson Independent for the benefit of young athletes and their parents.

Dr. Mark Herceg
Dr. Mark Herceg

Before Dr. Herceg joined Phelps, he served as Westchester County’s Commissioner of Mental Health from 2015-2017. He chaired a 28-member County task force that explored best practices for concussion management. Dr. Herceg grew up in Dobbs Ferry and lives in Irvington with his wife and their three daughters.

Q: How significant is the concussion issue in youth sports?

A: Youth sports remain what we kind of refer to as a black hole. In many youth sports or modified sports or pre-high school, there aren’t protocols in place in a lot of these organizations. There aren’t particular requirements. However, in youth hockey, USA Hockey for this coming season is actually the first one, I believe, to say that a youth who has a suspected concussion cannot come back to play without a doctor’s clearance, which is very different than the past.

Q: What is baseline testing?

A: Basically, it’s a 20-minute test that looks at attention, concentration, memory, processing speed. It’s to get the temperature of how the brain’s cognitive state is.

Q: How important is it for a young athlete to have a baseline test?

A: I always tell parents if you are going to get your kid baselined, have them tested by someone who really understands the brain and brain injury.

Q: What typically causes a concussion?

A: For most cases, it’s a direct blow to the head or it can be a whiplash injury where the head is snapped either back and forth forward or sideways.

Q: Can the severity of a concussion be measured?

A: No. A concussion is a concussion. We used to do that. We used to say Grade 1, Grade 2, Grade 3 concussions. We’ve done away with that for almost 10 years now. The symptoms can have varying degrees of severity, but we diagnose it as a concussion.

Q: Once a concussion occurs, is there a greater risk for more?

A: Yes. With each concussion, the risk increases. What is most important is to do everything you can not to have a second injury within the first 10 days of the first injury. We call that the cerebral window of vulnerability. You don’t want to have another injury as your brain is in an acute stage of healing.

 Q: Are there symptoms that young athletes and their parents or guardians should watch for?

A: The number one symptom is headaches. It’s visual and balance issues. Those are the three main ones.

 Q: Why is it that concussions did not seem so prevalent years ago? Were they going undiagnosed?

A: As much as we knew about the impact of a blow to the brain, I don’t think we knew the nuances, how the nuances linger, how they can play a role in the child and high school and college player’s academic life and the impact there.

 Q: Do you believe that the rewards associated with high-contact sports outweigh the risks?

A: That’s the million-dollar question. My daughter (Nina) plays high-level competitive travel hockey. She has had two concussions in the past three years. One was she was checked head-first into the boards. Another was she was checked by another girl this past summer and the body hit caused her to move her head in a violent manner. She recovered both times thankfully, and I made sure that we have people here who checked her out to make sure nothing was lingering. I think we need more data. For those who have no history of concussions, I think the benefits outweigh the risks. If a child has had a number of concussions or if a child has a history of learning disability,
I think we have to be careful about putting them at risk. We have to look at it

 Q: Is Nina continuing to play hockey?

A: Yes, she is continuing to play. She loves the sport. She loves the camaraderie of it.

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