Elizabeth Pieroth, PsyD, ABPP, MPH, Director of the Concussion Program at Midwest Orthopaedics at Rush talks about a rise in concussions in kids involved in sports.
Interview conducted by Ivanhoe Broadcast News in 2024.
What’s significant about concussions in 2019?
Pieroth: So the reason I thought it was a great question is that 2019 is before the pandemic, and so, when we think about 2020, we automatically start thinking about the pandemic and in the pandemic in most states, certainly here in Illinois, we stopped playing youth sports and what we found was that there was significant benefit to kids playing these sports they love from their exercise, from being involved with other kids and social lives, just being outside, just being engaged. And parents understood that there was a significant cost to their children not playing these sports. And so, while everyone still remains very concerned about concussions, that hasn’t changed, certainly since the pandemic, there’s a little bit more of a balance. We understand that there is a risk associated with these sports, but we see the benefit much clearer. And so I think there’s sort of a balancing of people looking at, do they want to have their kids engaged in these sports.
I guess what you’re saying is because of that, they’re a little bit less worried about their kid getting a concussion playing football, is that what you’re saying?
Pieroth: No, I’m not saying that they’re less worried. And certainly those of us do this work are not less worried. We are still very dedicated to reducing concussion in sports. But prior to the pandemic, I think people had this fear that it wasn’t worth letting their child play a sport, particularly a contact sport like football or hockey or soccer. And when the kids were out of those sports, they saw very clearly what they were missing and all the benefits of sports to kids and so they could make a better decision about balancing the risk of concussion, which remains the same and the benefit of those kids being involved in those sports.
There hasn’t been any new diagnosis, new treatment, new technology that has done anything to reduce parents’ concerns? There really hasn’t been anything that’s happened in those five years?
Pieroth: So our understanding of concussion prevention, recognition and treatment have evolved constantly, which is one of the great things about this field is that our understanding is always changing. And so there have been new technologies for reducing concussions as an example. So there has been great improvements in the helmets that are used across sports that the technology that we’re using is improving that. There have been new technology to help us recognize concussion because one of the big problems with concussion is under reporting is that athletes don’t report their symptoms, don’t tell us when they’re having a symptoms that may be a concussion and so we need better tools to figure out if somebody has a concussion or not. And our understanding of how to effectively treat these concussions is always improving. So even how we did things five years ago has changed dramatically.
There was a lot of press around this blood test that was helping healthcare professionals diagnose concussion. Did you agree? What do you think about that?
Pieroth: No, because the headlines were misleading. And so it’s not a blood test to diagnose concussion. There’s different types of blood tests in this realm. And one is what was letter press about was a blood test that would be given to say that, does that person need a CT scan? Is there any evidence of any bleeding that would suggest something more serious? And so then they would go and get a neuro imaging study. Other blood tests are looking at, is there a marker, what we call blood serum marker, that would tell us did a concussion occur at all? And unfortunately, we are nowhere near having a test that is available for the public at this point. We just don’t have the data to suggest that there’s any one particular blood serum marker that will tell us, did this concussion just happen 10 minutes ago? You’re taking them off the field, or five hours ago, five days ago, etc. So unfortunately, that’s stay tuned for that.
Do you think that was really overrated?
Pieroth: It got a lot of press. And as you can imagine, people come in asking about this blood test and the problem too, is from the ER standpoint, if an ER physician is concerned that there may be something more serious, they’re going to send off that person for a CT scan regardless. They’re not going to take a blood test, wait a few hours for their results and then send them. So it hasn’t dramatically changed the way concussions are assessed in the emergency room.
Who developed that blood test? Do you know?
Pieroth: I don’t. There’s so many of them, I can’t keep track.
It’s a bunch? It does seem like a field where there’s constantly, somebody’s coming up with something new. Just my perception.
Pieroth: No, it’s not your perception. As someone who works in this field, as you can imagine, I get deluged with information and information that’s sent to me about new products, new treatments, and part of that’s really exciting. Things that we use now that we know are well validated and well studied. At some point we thought we’re crazy. So things do change. The problem that we have is that a lot of people make claims that are not actually supported by science. And we have to be really careful that we’re not trying to give people false hope. We don’t want athletes to use a product that they falsely believe is protective when it’s not. We don’t want people spending a lot of time and money on products that are unsafe that may have adverse effects. So these products really have to be studied very closely. Just unfortunately love that manufacturers push them out to the public before that proper research is done.
Because I remember one of the pushbacks on a new helmet, this is when my son was playing football, because they have this super duper helmet now they can go do a head to head tackle and then they end up with a broken neck or something like that. I mean, it almost gives a false sense of, probably, a mouth guard wouldn’t do that, but it almost gives them a false sense of they’re a avengers.
Pieroth: It’s true. There’s been studies looking at particular soccer head gear that found exactly that result is that people felt like now I have this protection, I can behave, I can play in a more aggressive way, which is problematic. There is good football helmet technology, there is good hockey helmet technology that is showing a reduction in the amount of force applied to the head, but there will never be a concussion proof helmet. You cannot stop the brain from moving inside the skull. So we can improve the technology, we can improve the materials, we can do all these things that help reduce concussions. But we always have to be careful that we’re not misleading the athlete or the parents that any of these technologies are full profit.
The Holy Grail of protecting your kid’s brain. How do you feel about the guardian caps? I know they’re using them at Stale Central. I walk past practice and I see them and the little kids.
Pieroth: So there’s a couple of issues of guardian caps. So a lot of schools are not buying them because the NFL is using them. The problem is you’re looking at data that’s based on 300 pounds, six men with rather large necks and just different physiques. It’s not apples to apples when you’re talking about putting that on a kid. Even a high school kid. And so, and the guardian caps that were used, the NFL were specifically designed for NFL players, so we have to be really careful about that. In addition, there’s just one year of data. So the NFL certainly has not made any statement that this is some panacea, it’s the answer to concussions. They did see a reduction in concussions in the positions that wore the guarding cap and they have increased the number of players that are wearing it this year in practice. So there’s this leap to assume that the guarding cap is the answer. There are a couple of problems with not just the guarding cap, but any of these helmet add ons. One is it adds weight. Helmets are already heavy and then you add weight on top of that. And so we’re concerned about how you’re going to increase neck injuries. We did not see that in the NFL, but like I said, the default player necks are significantly larger than our little guys. Two is causing issues with heat. If you add some on top of a helmet, does it not dissipate the heat away from it? Again, in the NFL, we did not see problems with increased heat illness. But they have lots and lots of people to be watching them, which is not always the case in our little ones. Third, helmets are meant to slide off each other. That helps reduce the amount of force applied. If you’re adding something that makes it sticky, or the viscosity at all, does that increase the amount of force applied to the head, does it increase the rate of neck injuries? These things need to be studied. And the last thing that I worn, appearance is if you put anything on a helmet. If you alter a helmet in any way, you have avoided the liability of the manufacturer. So if something tragic were to happen and you believed it was the helmet that was the problem, you have no liability. You’ve erased the liability of the manufacturer by doing so. All of these things should be considered before we run out and, try to use this new technology.
Is anything coming that you think is interesting, that is being researched, that you’re feeling hopeful about?
Pieroth: I do, I think the most exciting line of research is on what’s called pupillometry, and so there’s technology where it’s a machine that can actually look at the reaction of pupils that we see. There’s lots of ocular changes post concussion, and so I think this is probably the most fruitful line of research currently. There’s lots of research again, on prevention recognition and treatment of concussion. One of the things that we struggle with most is that recognition and I think that pupillometry, a really exciting technology.
END OF INTERVIEW
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