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When a minor concussion is a major injury

Posted on Apr. 1, 2015 ( comments)

Maddie is a club volleyball player missing a season with her team due to a minor concussion.

A concussion is high on the list of worst nightmares for parents of young athletes. 

For Erin Summa, that nightmare became reality when a ball hit her 14-year-old daughter Maddie in the head during PE.

"It was random," Summa says. "She's an athlete, competed in the junior national volleyball championships the last two years. But the injury didn't happen while she was playing with her club volleyball team. At first we just thought she had a headache."

Maddie has a history of chronic headaches, but this headache didn't go away. For a few days following the accident, she also had trouble focusing and her headache was getting worse.  

Summa, a health educator at Mary Bridge Children's Hospital, knew something wasn't right and made an appointment with Maddie's pediatrician. 

A diagnosis with complications

Maddie's doctor diagnosed her with a mild concussion. 

A concussion is a blow to the head that causes symptoms such as fatigue, short-term memory loss and headaches. Most young athletes recover from concussions after limiting physical and cognitive activity. 

Maddie's doctor recommended rest, reduced school work and no sports or screen time. After several weeks she was cleared to return to full activities, including volleyball.  

Then, during a warm-up exercise on Maddie's first day back at practice, she lost her balance and hit her head on the gym floor. 

"It was back to square one," Summa says. 

Back at the beginning meant familiar symptoms and a referral to MultiCare Health System sports medicine specialist Joshua Purses, DO.

Dr. Purses says it isn't common for a hit to the head from a fly ball to cause a concussion. Maddie's ongoing history with headaches likely caused a minor accident to become a major injury. 

"Anyone recovering from a concussion is susceptible to be reinjured from blows to the head," Dr. Purses says. "This is not a typical injury and her previous condition with headaches complicates her recovery."

Therapy through setbacks

Maddie's complicated case needed the right kind of therapy to help her recover. Dr. Purses referred Maddie to Charlene Guardia, occupational therapist at the MultiCare Gig Harbor North clinic at the Tom Taylor Family YMCA.

"We were impressed to be referred so quickly to a specialist in our system that could help," Summa says. "Dr. Purses didn’t just refer us for therapy. He referred us for therapy with Char."

Guardia, fondly known as Char to her patients and their families, has experience working with post-concussion and mild traumatic brain injury patients. She's worked with Maddie twice per week since January. 

On Maddie's first therapy session, basic movements such as walking and turning her head side to side made her headache worse and caused nausea. 

After a few weeks of therapy, Dr. Purses told Maddie she could go to practice to watch, but not to play.

Maddie was excited to be a part of the team again until a volleyball hit her in the head while standing on the sidelines—her third injury. 

A few weeks later, Maddie was injured a fourth time when a soccer ball hit her in the head while she was eating lunch at school. 

After the fourth hit, Purses recommended Maddie sit out for the rest of the season. 

Maddie makes progress

Guardia worked with Maddie through each setback. In her latest therapy sessions, Maddie is progressing to exercises that incorporate balance, movement and cognitive processing.

"We're teaching her body how to handle activities that cause symptoms," Guardia says.

A large part of Maddie's therapy focuses on symptoms associated with her eyes. Maddie was sensitive to light when she began therapy and struggled to shift her focus from objects nearby and far away. 

Guardia says these are common symptoms associated with concussions—and important skills for young athletes to regain.

"We move our eyes all the time to negotiate our environment, to walk around the grocery store for example," Guardia says. "These skills she’s working on in therapy will hopefully translate to the classroom."

The tricky thing about concussions

Concussions affect the functions of the brain. As Dr. Purses points out, there isn't a one size fits all approach. 

"Imaging doesn’t show us anything with a concussion," Dr. Purses says. "It isn't a structural injury; it's a temporary chemical imbalance that is typically completely reversible."

Guardia calls concussions a puzzle because physicians and therapists have to rely on the symptoms to help them understand how to treat each patient's individual needs. 

"These injuries are tricky because CT scans are normal but the patients have symptoms," Guardia says. "Sometimes the symptoms can resolve naturally and sometimes therapy is necessary."

Dr. Purses works with each patient to find a plan that works for them. He urges the importance of paying attention to symptoms instead of ignoring them. 

"Sports injuries are simple if you address them early," Dr. Purses says. "If you wait it can be more of a challenge. Never ignore ongoing worsening pain."

In Maddie's case, catching the concussion early on is helping her work her way back to her volleyball team next season. She is getting better each week.  

"She's a rock star," Guardia says. "She is definitely going to recover from this concussion."

After a recent therapy session, Maddie's mom thanks Char and smiles at her daughter as they walk out of the clinic and into the Gig Harbor North YMCA.

"I'm so grateful Dr. Purses referred us here," Summa says. "Nothing else has given us this bump in improvement."

Maddie agrees.

"It's definitely helping with my headache recovery."

Concerned about concussions? 

MultiCare Health System is home to the South Sound’s only youth sports concussion program. Get sports safety tips and learn more about local care for young athletes with concussions.

About The Author

Jen Rittenhouse Jen Rittenhouse
Jen Rittenhouse is the social media manager for MultiCare and Mary Bridge Children's Hospital. She writes stories that connect people with hospitals, health care and each other. You can reach her at [email protected].
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