Ahead of the Pack

CHOP’s focus on concussion spans diagnosis, treatment, research

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One minute, 7-year-old Daniel Wanetick was buckled safely in his booster seat in the back seat of his dad’s car when it was stopped at a light; the next minute, BANG! The car was rear-ended, sending the Waneticks’ vehicle smashing into the car in front of it.

Initially, no one appeared to be injured because there was no visible trauma, not even a cut. However, when Daniel got home, he said his head hurt. He still had a headache the next day, so his mother, Neomi Barazani-Wanetick, took him to their local pediatrician.

“The doctor told us there was nothing abnormal, to continue on as usual,” Neomi recalls. Daniel went about his typical routine — school, playdates, soccer, synagogue — but the headaches continued. There were changes in his behavior, too. Normally a happy-go-lucky kid, Daniel burst into tears over little things. “He would tell me, ‘I’m just sad,’” Neomi says.

Days, then weeks, went by, with no improvement — in fact, things got worse. Daniel started to wobble when he walked. It was then Neomi requested a referral and was told: Take him to the Minds Matter Concussion Program at The Children’s Hospital of Philadelphia, one of the most comprehensive concussion programs in the world.

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What is a concussion? On impact, the brain moves inside the skull. The circuits stretch or break, causing the brain to not function normally.

Half of Concussions Aren’t Sports Related

CHOP’s Christina Master, M.D., F.A.A.P., C.A.Q.S.M., who co-leads Minds Matter, diagnosed Daniel with concussion. “People don’t recognize that motor vehicle accidents can cause a concussion,” Master says. “They think you have to be hit in the head, but all you need is for the brain to shake inside the skull. Whiplash from a crash is a huge unrecognized cause of concussion.” In fact, half of all concussions stem from non-sports injuries.

ahead-of-pack-master-860x483Minds Matter co-leader Christina Master (left) and CHOP President and COO Madeline Bell were invited to the White House for the Healthy Kids & Safe Sports Concussion Summit in May.

Younger children can be tricky to diagnose because they have trouble articulating their symptoms, and the typical mental symptoms seen in teenagers and adults, such as difficulty concentrating or remembering and feeling “foggy,” slow or confused, may not occur in younger children as they haven’t developed enough in those areas.

Master ordered total brain rest for Daniel: no school, no TV, no video games, no sports until symptoms improved. After two weeks, he was able to gradually resume activities. She referred him for vestibular therapy to work on balance and eye coordination. Swimming and yoga replaced soccer and baseball. It took a year of treatment before Daniel was released from care.

Spreading the Word

“This whole episode taught me that it’s very important to get information about concussions out to doctors and parents,” says Neomi. “Who knows? Maybe his symptoms would not have been so prolonged if we had shut down his activity those first few weeks after the accident.”

ahead-of-pack-walker-860x483Samantha, 11, has had four concussions. After passing various tests in the concussion clinic — including showing she can walk heel-toe-heel-toe down a line, backward and forward, eyes closed and eyes open — Christina Master, M.D., gave her the all-clear.

Minds Matter is busy addressing both those fronts — concussion education and research.

Its fact-packed website, chop.edu/concussion, lists symptoms and treatments and gives guidelines for reintroducing school and sports after a concussion. All 31 primary care practices in the CHOP Care Network feature at least one Concussion Champion who is specially trained in diagnosing and treating concussion. This gives families a convenient, familiar starting point if they suspect their child has suffered a concussion. Last year about 12,800 patients were treated for concussion by CHOP.

Multilevel Research

On the research front, a multilevel effort is striving to examine all aspects of concussion. Using CHOP’s integrated electronic medical record, the Minds Matter team is tracking thousands of patients, their symptoms, treatment and outcomes, allowing the team to verify best practices for recovery. This “registry” of pediatric patients drew the attention of the White House and a Clinical and Translational Science Award (CTSA) grant.

Minds Matter co-leader Kristy Arbogast, Ph.D., is testing the reliability of helmet sensors to detect the force of hits to the head.
In the lab, researcher Akiva Cohen, Ph.D., received a prestigious MERIT grant from the National Institutes of Health to advance his work using cellular nutrients to repair brain damage. Kristy Arbogast, Ph.D., co-scientific director of CHOP’s Center for Injury Research and Prevention, is working on testing the reliability of off-the-shelf sensors by using a crash dummy head in a helmet
outfitted with sensors and subjecting it to consistent g-force hits. Next step: Researchers will determine what force is likely to be “enough” to cause a concussion.

“Most of the concussion data out there concerns high-school-and-older patients with sports-related injuries,” Master says. “At CHOP, we see more kids with concussion than any other institution in the country — covering all ages and all types of injuries. That puts us in a leadership position to determine optimal diagnostic techniques and treatments, no matter how old the patient is. It’s a problem that isn’t going away. We’re ready to do what it takes to help children with concussion.”

CHOP is a non-profit charity, and depends on donors like you to continue to provide What’s Next for the patients and families we serve.
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