Hershey’s Harry Bramley Talks Concussions
In our July/August 2016 issue, “A Lasting Impact” raises some questions about the diagnosis and treatment of concussions. In that feature, we talked to pediatrician Harry Bramley ’99r (right), medical director of the Penn State Hershey Concussion Program, about the safety measures you can take after—or even before—a blow to the head. (You can find the original Q&A, “Off the Field,” on p. 42.) Below is an extended interview with Dr. Bramley offering more valuable advice for parents, players, and patients alike.
How often do you see patients? Depending on the season, I personally see 25 to 50 patients with mild brain injuries each week. But not all are from sport-related concussions: some are there because of motor vehicle accidents or diseases like meningitis. I also see patients on the whole spectrum of age, but focus mainly on children, adolescents, and young adults.
Any common concerns? A common question is the risk of early onset dementia or chronic traumatic encephalopathy following concussion. The likelihood is rare for most people. For the vast majority, they are fine and live a normal life.
What symptoms do you look at? The four major ones are: physical symptoms, such as headache, dizziness, or problems with balance; sleep, or, more specifically, trouble falling or staying asleep; emotional disturbance such as anger, depression, anxiety; and cognitive dysfunction including concentration, memory, and processing speed. We find out the ongoing issues that they deal with from month to month, then come up with a treatment plan starting with what symptoms tend to be the most troublesome for the patient.
Does age matter? It appears that the younger individual is more vulnerable when it comes to a concussion. They take longer to get better versus high school, versus college, versus professional athletes. The symptoms of a middle school kid seem to linger on longer, which might be because of a developing brain.
How do you feel about return-to-learn guidelines? We have a certified teacher in our clinic who meets with the families and is part of the team putting together a return-to-learn strategy. So maybe the patient goes from half days to full days, or maybe limited to one exam a day and reduced homework assignments. Return-to-learn, for us, is bigger or as big as a return-to-sport focus. That’s the first thing we have to do and move forward from there.
Amy Downey, senior editor