Concussion Care: Cocooning Is Out

Audrey Paul’s son is a hockey goalie. He’s had 2 concussions.

The first occurred 4 years ago, soon after the family moved to Westport. She felt “completely in the dark.” Doctors did not offer a clear treatment strategy. Paul had a tough time finding up-to-date information.

The second — last June — was different. The 14-year-old was treated at a concussion center. His recovery — spurred by new evidence that forgoes “cocooning” in favor of targeted therapy — went much more smoothly.

That could be a typical Westport story, except for one thing:

Dr. Audrey Paul

Paul is a doctor, trained in pediatric emergency medicine. She teaches at Mt. Sinai Medical Center. And she’s the founder of Heads Up Westport Concussion Center on Imperial Avenue.

Paul did not treat her own son after either concussion. She prefers having an objective professional take charge. But the difference in protocols over those 4 years was striking.

After her initial experience, Paul asked 7 Mt. Sinai doctors for their treatment plans. She got 7 different answers.

Paul went to work. She got a grant to study more than 600 emergency centers nationwide, looking at discharge instructions for patients. They were “all over the place.”

In Westport, she says, pediatricians advised everything from “go back to school tomorrow” to “rest inside for 3 weeks.”

She wanted to create a central space for information. The goal of Heads Up is to provide comprehensive baseline testing, and personalized recommendations for concussion management.

“Targeted therapy is important,” Paul says. “Every concussion is different.” Some primarily affect the eyes; others, balance, or the spine.

While practitioners still recommend 2 to 3 days of strict rest, they’re now moving toward “a more proactive approach” to concussion management, she adds.

It’s empowering to learn “you can do something about concussions,” beyond sitting in a dark room without a TV, computer or phone screen, Paul notes.

Despite — or perhaps because of — her focus on concussions, she does not advocate banning youth contact sports.

“You can’t live your life hiding under a bed,” Paul says. “Kids should be active.”

But, she warns, “if you do get injured, it’s important to be treated appropriately.”

FUN FACT: March was Brain Injury Awareness Month!

11 responses to “Concussion Care: Cocooning Is Out

  1. “You can’t live your life hiding under a bed,” Paul says. “Kids should be active.”

    The above is certainly true but your children can avoid certain sports and still not live under a bed. Football is especially egregious.
    See for example this book
    http://againstfootball.org/

    A. David W Staples 1956

  2. Bill Boyd (Staples 1966)

    Frightening commentary on the ignorance that exists in the medical community….even in 2017!
    AND….Great job Dr !

  3. Bill Boyd (Staples 1966)

    GREAT JOB BY DR. PAUL!

  4. Dave Feliciano

    Concussions are cumulative, and debilitating, those that cause unconsciousness can take years even decades to heal. Wear your bicycle helmets every time and every where, I have lost several friends to bike crashes, the kinetic forces involved in a high speed far exceeds any other non-motor powered sport. In a highly competitive town, where winning at all costs predominates some risks truly outweigh the benefits.

  5. Pippa Bell Ader

    Connecticut has a history of dangerously weak concussion laws, which have been implemented in all 50 states to protect youth athletes. In 2014 we successfully facilitated the passage of an updated law for high school students and we are now working to legislate the same basic standards of care for all youth sports. This would include education for athletes, parents and coaches on the signs/symptoms/treatment of a concussion and remove from play/return to play protocols. These simple provisions can prevent life-long brain injuries.

    Many individuals in Westport–whose priority was always the health of kids—have worked hard for this change. Jim Marpe and Jen Fava facilitated the implementation of a concussion protocol for town sports in Westport 1-1/2 years ago. Jonathon Steinberg is leading the state legislative effort. And Elliott Landon helped implement changes at SHS 4 years ago and encouraged us to update the state law.

    We are proud of Westport’s leadership in providing much needed concussion protections to all of CT’s youth athletes.
    Pippa Bell Ader, Parents Concussion Coalition

  6. Diana Coyne, Parents Concussion Coalition

    We encourage parents to do their homework and ask sports organizations what they are doing to minimize the risk of brain injuries. Ask questions such as: 1) Are the coaches required to take a concussion training class; 2) does the league have access to a healthcare professional trained in concussion management (if involved in contact sports).

    Parents should especially understand the team policy for limits on contact practices. The science is now documenting that CTE is better correlated to total brain trauma exposure – the number of hits to the head – rather than concussions.

    We did an audit of all 50 state high school associations compliance with football contact practice guidelines and the state of Connecticut did very poorly: http://concussionfoundation.org/media/press-releases/high-school-football-players-concussion-risk

  7. Dale Nordling

    The focus on sport-related concussions is all good, and we certainly need to protect children and athletes, pro and not. Dr. Paul’s Concussion Center is timely, and I hope it will be replicated in other towns. However, sports are not the only culprit.
    There is another relatively hidden segment of our people who are also getting concussions at alarming rates. Battered women can be concussed repeatedly by their abuser, some without even realizing what is happening to their brains. The violence they endure can include being thrown against a wall or other hard surface with great force, and these repeated head-poundings (without helmets!) are cumulative, and more damaging with each incident. In addition to sport-related concussion, I think we must look at other areas where prevention and protection from brain injury will save a person’s quality of life.

  8. My son had a very bad concussion in his junior year at Staples (he was playing around in the gym and fell back on the gym floor and smacked his head). We kept hoping that time and rest would heal him, but after two months he still suffered with headaches, inability to concentrate, anxiety, fatigue and could not do his school work or even spend the whole day at school. We were very scared and desperate. We decided to try a treatment that our naturopath in Fairfield recommended and utilized at his clinic–hyperbaric oxygen therapy. After three hour-long sessions, he was dramatically better and we knew we had found our miracle. He completed 12 sessions in all over the course of 3 weeks, and was completely cured. We strongly suggest that anyone suffering from TBI or post concussion syndrome consider hyperbaric oxygen therapy (HBOT). It uses pressurized oxygen to flood all the cells of the body with pure oxygen that heals physical trauma (as well as a number of other ailments). My brother-in-law who is Chairman of the neurology department at Dartmouth Hitchcock Medical Center called it a “cure in search of a disease”. Unfortunately HBOT is not recognized right now as a treatment for concussion by the medical establishment, so insurance won’t pay for it and it’s very expensive. You also can’t use the hyperbaric tanks that sit idly by in all the hospitals. Those are reserved for medically approved uses. So you need to find an independent clinic that allows public use. There are extremely few of these, but we are extremely lucky to have someone who offers it in Fairfield. Just also be aware that the chambers that are sold on the internet are not sufficient pressure to cure TBI–you need the medical grade tanks with the higher pressure. The clinic in Fairfield has a full time MD who supervises the process continually. If interested in their clinic go to wholebodymed.com.

    • I understand how desperate people are to alleviate concussive symptoms, but please do your homework before seeking care. The results of a study funded by the Department of Defense concludes “Hyperbaric Oxygen No Better Than Sham After Concussion”.

      http://www.medscape.com/viewarticle/835490

      • I was already aware of the study, thank you very much. As a mom, I do a ton of research, so I take offense at your statement that I don’t do any. I also know of a new FDA approved clinical trial at Jupiter Medical Center in FL to test HBOT on TBI patients, spearheaded by Joe Namath. He was so impressed by his own outcome from HBOT (which he’d recently undertaken), after decades of suffering, that he helped to initiate the study there. I understand that the DOD didn’t find any significant improvement in their study, but many people have gotten improvement. My son certainly did. I suspect he’d still be suffering had he not done the treatment. I also
        don’t believe all studies as it seems every time one comes out, another one comes along to refute it.

  9. Andra, my sincerest apology to you and I am very pleased that your son recovered from his symptoms. My only intent was to provide the pros/cons and information regarding the booming concussion industry.

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