Summer 2013

Managing Sports Concussions As If Each Child Were a Million-Dollar Athlete

After head injuries suffered over three-plus years, a teen athlete suffered from significant headaches, sleep problems, mental "fogginess," anxiety, depression and school difficulties. Multiple specialists had viewed her "normal" scans, prescribed medication regimens and repeatedly allowed her to return to activities.

Dr. Mitul Kapadia

Dr. Mitul Kapadia

That’s the point when Mitul Kapadia, MD, and an interdisciplinary team conducted a complete diagnosis at the Bay Area Concussion and Brain Injury Program, located at UC San Francisco’s Mission Bay campus. They concluded that in addition to symptom management, the girl needed comprehensive cognitive and physical rest following evidence-based protocols. Kapadia helped the family understand what that means.

"When I saw her last a month later, she was about 80 percent back to normal," he says. He still follows her progress carefully.

Meeting an Unmet Need

According to the Centers for Disease Control and Prevention, at least 1.7 million Americans seek medical help every year for concussions. While many don’t suffer lasting damage, far more do than was previously believed.

Yet approximately 90 percent of patients who follow up-to-date, evidence-based protocols will enjoy a full recovery, usually within a month or two, says Kapadia, who directs the Physical Medicine and Rehabilitation program at UCSF Benioff Children’s Hospital. The catch is that the protocols demand precise diagnoses, as well as the ability to manage symptoms while guiding patients through a challenging recovery period of cognitive and physical rest.

"Most physicians don’t have the means to do a comprehensive evaluation, which can include computerized ImPACT testing, 3T MRI imaging, vestibular therapy and a variety of tests for spatial and visual awareness and memory," says Kapadia.

Drs. Carlin Senter and Gary Abrams

Doctors consult over
a patient image.

He also cites the need for interdisciplinary expertise. At UCSF, the monthly clinic includes a team of nationally recognized experts in sports medicine, physical medicine and rehabilitation, neuropsychology, neuroradiology, neurology and neurosurgery. The program also works closely with schools to guide re-entry.

Patient Education and Training

As in the case of the teen above, patient and family education is especially challenging because the intense restrictions on activity can be difficult to maintain. "But cognitive and physical rest with appropriate medical management is the only evidence-based approach," says Kapadia.

Children who have had multiple injuries are most in need of restricted activity. "Brain injuries are additive, and these kids are more likely to get reinjured, because balance, spatial-visual awareness and their ability to respond to stimuli are among the last things to come back," says Kapadia. If they’re not properly managed, they risk lifelong deficits, which is why Kapadia prefers to see patients as early as possible.

"My patients have their whole lives ahead of them," he says. "We manage concussions in our young patients in the same manner as we do in a million-dollar athlete."

For more information, call the Bay Area Concussion and Brain Injury Program at UCSF at (415) 353-1915.

When to Refer

Consider referring your patient to the Bay Area Concussion and Brain Injury Program if he or she has suffered a blow to the head, neck or body and is experiencing one or more of the following:

  • Confusion
  • Difficulty concentrating or remembering things
  • Dizziness
  • Headaches
  • Insomnia or excessive sleepiness
  • Problems with balance and coordination


Summer 2013 Table of Contents

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