An expert talks about concussions


Kevin Walter, a sports medicine and concussion expert at Children’s Hospital of Wisconsin, wants to make parents, coaches and young athletes educated and aware of head injuries and the best way to treat concussions.

Dr. Walter has been a member of the Wisconsin Interscholastic Athletic Association (WIAA) Sports Medicine Advisory Committee since 2006, where he has helped to create guidelines for the safe participation of Wisconsin’s high school athletes.

He also has followed the progress of the NFL’s concussion protocol. Here are excerpts from his interview with the Journal Sentinel’s Lori Nickel for the Packers story on concussions.

Q: Do you see more awareness and recognition of concussion treatment overall in sports now?

Walter: Yes. It’s about reduction, awareness, recognition and education. If athletes report right away, they’re less likely to run into problems with prolonged recovery and bad outcome. When they report and fess up right away, concussions become less problematic. But there’s still a ton of misunderstanding. I still get pushback from families about puling kids out, and saying this is not a big deal.

Q: What are your long-term medical concerns for concussions?

Walter: That’s tough because when you look at CTE – Chronic Traumatic Encephalopathy – and all the post-concussive problems, there’s no clear scientific pathway on how you go from injured athlete to someone who suffers from CTE. Its more than just repetitive head impact. There’s got to be a genetic component, there’s got to be a psychosocial component, etc. But the biggest thing I worry about long term is memory, focus and mental health. If you don’t treat it right, those are the problems you have eventually if you have too many injuries or you don’t let your injury recover.

Q: The course of treatment for someone with a concussion is plain and simply rest?

Walter: It is, but it’s not strict bed rest. I’ve moved away from, ‘sit in a dark room and do nothing,’ and moved toward the idea of decreasing your mental stimulation. You still want physical rest; you just don’t want to do things that make you feel worse. So is texting or watching TV going to prolong your recovery? Probably not, because there’s not much more mindless than those two things. But if you do too much of it, it will. It still boils down to giving your brain a rest and decreasing that stress, be it school, work, physical exertion, visual stimulus – and making sure you get good sleep. A lot of young adults have real bad sleep habits.

Q: A concussion is a concern, but what about multiple concussions? Some NFL players have had one in high school, in college and then in the pros. Isn’t that a red flag to consider?

Walter: Number of concussions is only one piece to the puzzle of when to consider dialing back. If you have three concussions and they’re spaced three years apart and they all recover within one to two weeks, that’s probably not that bad of a history, because the brain is going to bounce back with a full recovery. If you have three concussions and the first one is two weeks and the next one is two months and the next one is six months to recover, and those all happen within a couple of years, that’s a much worse history. Then you start looking at how they get injured: big hit, medium hit, light hit. Is it decreasing force. I tell my high school kids that they don’t want to be treated like a professional athlete, because professional athletes are doing this for a lot of money, and they’re willing to take more risks that a high school kid should never be exposed to. The nice thing about all the battery of tests is that you can get a good baseline for when they started. And if you’re starting to see a decline from baseline, those are people I would argue shouldn’t come back.

Q: Current players for Green Bay say they’re not worried about getting a concussion. When you’re in a contact sport, is that just naïve?

Walter: Yes and no. What I would be more unhappy about is a professional football player that says, ‘Every time I go out and play, I’m scared of getting a concussion.’ Then you shouldn’t be out there. That’s someone who’s going to be slowing down, changing how they approach the game – and you could argue that that person would be more likely to get injured. If they truly and honestly believe ‘I’m a safe player, I’m never going to get concussed,’ of course that is naïve and silly also. But what I hope is that by saying they’re not worried about getting a concussion, they’ll also say, ‘But if I do, I’m going to do the right thing, I’m going to manage it, I’m going to treat it. And I will look at short term health and long term health and make a decision that is best for me.’

Dr. Walter was appointed to the National Academy of Sciences Institute of Medicine committee on Sport-related Concussion in Youth. He has authored many articles on sports injuries in children and concussions in the young athlete. Dr. Walter has helped create The Sports Concussion Program in collaboration with Children’s Hospital of Wisconsin, the Medical College of Wisconsin, and Froedtert Hospital.

For more information, he recommended

“Changing the Culture” by the CDC

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