Concussion Specialists Debate Sports' Impact on Kids' Brains

— Recommendations expected Friday

MedpageToday

ROCKVILLE, Md. -- Researchers at a 2-day pediatric concussion workshop beginning Thursday morning jumped right into a controversial issue, debating how to address a youth sports culture that has often resisted change.

Speaking here at the National Institutes of Health Pediatric Concussion Workshop, panelists Dawn Comstock, PhD, and Susan Margulies, PhD, responded to a question about how much researchers know regarding the impacts of sports on the pediatric brain.

"Why don't we come out against these?" Margulies said, referring to contact sports such as football and hockey, which research shows are associated with higher incidences of concussion and more impacts to the head among young athletes than other sports are.

"We know these sports are probably not good for you," added Margulies, who said she encourages aggressive young athletes to try fencing, in part because of its low impact.

"It's an incredibly unpopular view," Comstock replied. When researchers try to intervene in youth sports programs, "they will laugh at us, because sports have their own culture. We have to respect it, and work within that culture."

Comstock questioned the notion that taking away aggressive, high-injury-rate sports would reduce the number of concussions and other injuries that kids suffer. Certain kids will always take risks, she said: "If we abolish football, these kids are the ones who are going to be doing tricks off of halfpipes in Colorado."

Thomas Talavage, PhD, then stood up in the back of the dim, packed conference room on the basement floor of a suburban Washington, D.C. hotel and challenged the room full of about 100 researchers to intervene in youth sports "now." He added: "Let's find a way to do this."

The researchers were speaking during the "What Is a Concussion?" session, one of four sessions held on Thursday. Three others are scheduled for Friday, as well as a patient advocacy perspective to be presented by Robert Gfeller, Jr., MBA.

Overall recommendations from various breakout groups are expected to be discussed at the end of the meeting, aiming to address the workshop's key goals regarding pediatric concussion:

  • Identify knowledge gaps
  • Identify high-priority research areas
  • Identify populations and study designs that "will prove most feasible for addressing knowledge gaps"

The workshop was organized by National Institute of Neurological Disorders and Stroke (NINDS) director Walter Koroshetz, MD, and Jonathan Mink, MD, PhD, of the University of Rochester in New York (an NIH spokeswoman noted that Koroshetz had skipped a conference with President Obama in Pittsburgh on the same day because of how important this issue is to him).

Other speakers and registrants included Ruben Echemendia, PhD, who co-directs the National Hockey League and Major League Soccer Concussion Committees, and Kevin Guskiewicz, PhD, chair of the National Football League's Subcommittee on Safety Equipment and Playing Rules.

Grant Iverson, PhD, addressed the difficulty for practitioners treating kids with suspected concussion. To gauge when they have recovered, "it's really difficult if you're not following them longitudinally," said Iverson, lead author of a study in December 2015 that tracked more than 30,000 high school athletes in Maine over 4 years. One obstacle, Iverson said, is that patients often show up in clinics months after they sustain the injury -- "so we don't know the underlying causes."

Conspicuously absent from the workshop, however, was Richard Ellenbogen, MD, who co-chairs the NFL's Head, Neck, and Spine Committee. ESPN and VICE have divulged e-mails showing Ellenbogen attempting to steer an NIH grant away from a Boston research group that has clashed with the NFL and to appoint NFL-approved researchers to a 2012 workshop. One Ellenbogen e-mail asked NIH to fire Koroshetz.