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As brain injury researchers strike blow after blow against contact sport, parents are faced with difficult choices about what they will allow their children to play. (Taylor Callery For The Globe and Mail)

As brain injury researchers strike blow after blow against contact sport, parents are faced with difficult choices about what they will allow their children to play.

(Taylor Callery For The Globe and Mail)

Parents struggle to keep their heads in the game Add to ...

The study, co-authored by Monica Maher, a neuroscience master’s student, pointed to the long-term effects – verbal and visual memory loss – for soccer players who suffered more than one concussion or had “sub-concussive” head injuries. Those involve repeated blows to the head without the athlete presenting concussive symptoms such as headaches, dizziness and nausea.

Also in February, Boston University made a discovery that stunned the soccer world. Doctors found chronic traumatic encephalopathy (CTE) in a 29-year-old soccer player who had died in 2012 from amyotrophic lateral sclerosis (ALS). Researchers admitted they need more information before they could say conclusively that heading a soccer ball results in CTE, and that CTE contributed to development of ALS.

Van Donkelaar says soccer could take a page from the playbook of other sports to lower concussion risk for kids.

“In baseball, if you’re under a certain age, you’re only allowed to pitch a certain number of throws or innings. That stops them and it saves the arms of young kids so they’re not used up by 15,” he said. “In soccer, there is an inkling to limit the number of times a player heads the ball. It would only be allowed at a certain age, like hitting in hockey.”

The cost of concussion is high. “A developing brain with a major injury is far reaching,” he added.

The undeveloped brain: Why treat kids like adults?

When adults suffer a concussion, they’re told to rest at least seven days. When kids suffer a concussion they’re told the same thing.

Dr. Michelle Keightley disagrees with that identical treatment plan.

The clinical neuropsychologist at the Holland Bloorview Kids Rehabilitation Hospital in Toronto is convinced the current concussion protocol designed for adults is inappropriate for children.

“Before, it was all about the adults. They were told it was a seven to 10-day recovery so kids were told that, too,” Keightley said. “[But] we found their brains take longer to recover because they are still developing.”

The Greater Toronto Hockey League has been working with Holland Bloorview. After suffering a head injury, players may require weeks to months of rest, along with an MRI so that doctors have a better understanding of the neural impact.

Dr. Blaine Hoshizaki, a professor at the University of Ottawa’s Faculty of Health Sciences, says there’s still much to learn.

“I think there are more concussions involving children than reported, likely much higher than in adults,” he said. “I would agree with Dr. Keightley that we should be treating children more conservatively until we have more research involving children.”

At Mind Matters, a University of Toronto symposium on concussion and sport, researchers noted that younger athletes report longer recovery times: about 10 days for professional athletes, 20 days for university athletes and 45 days for high-school students. But that doesn’t necessarily mean that recovery time would be longer for even younger athletes.

Dr. Doug Richards, chief medical officer of the Canadian Sport Institute Ontario, said younger athletes may be telling the truth about ongoing symptoms, where professional athletes may lie to get back into play sooner. The Canadian Paediatric Society recommends “conservative, cautious and individualized” return-to-play decisions for athletes.

Researchers simply don’t know if a younger brain takes longer to recover. “There may be issues that we don’t understand,” Richards said. But, he noted, when it comes to getting accurate information from young athletes, a real challenge is “hovering parents” – kids simply aren’t comfortable answering questions about sexual activity and substance use in front of mom and dad.

New research points to the importance of understanding emotional changes during the recovery stage as well. Tension, depression, anger, fatigue and confusion levels rise post-concussion – and not simply because athletes aren’t able to play the games they love.

Athletes, concludes Dr. Lynda Mainwaring, professor at the University of Toronto, often don’t report emotional disturbance because they don’t realize it’s a symptom related to their injury. “Assessment of post-injury emotional functioning could help to inform return-to-play decisions so that athletes do not return to play with emotional disturbance, which might create a risk for further injuries,” she writes.

With files from Sarah MacWhirter

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