Pediatric Concussion Clinic helps heal young brains

Katherine Holmes, APRN, checks Grace Arneson's balance and coordination during a follow-up visit to the Pediatric Concussion Clinic. Holmes told her young patient she was doing well.
Katherine Holmes, APRN, checks Grace Arneson's balance and coordination during a follow-up visit to the Pediatric Concussion Clinic. Holmes told her young patient she was doing well.

Concussions are in the news lately, with healthcare providers, retired sports stars and parents of young athletes sharing their concerns about the frequency and effects of this common traumatic brain injury.

Due in part to the media attention, patient volume in Yale-New Haven Children's Hospital's Pediatric Concussion Clinic has increased dramatically in the past several months, from one or two patients a week to eight to 10.

YNHCH has been treating children with concussions for many years, but the increasing number of patients requiring follow-up symptom management prompted the section of Pediatric Neurosurgery at the hospital to establish the clinic. YNHCH officially opened the concussion clinic last September in the Pediatric Specialty Center on West Pavilion 2 with Katherine Holmes, APRN, as the primary provider.

"Clearly there is a growing need for the specialized evaluation and care that we can provide through the clinic," said Michael DiLuna, MD, chief of Pediatric Neurosurgery at YNHCH and assistant professor of Neurosurgery and Pediatrics at Yale School of Medicine. "A concussion is rarely life-threatening, but it is a brain injury, and it can affect a person's ability to function and quality of life. Children might have difficulty with school work and be forced to limit other activities until their brains have healed."

Concussions occur when sudden movement — such as a hard bump, blow or fall — causes the brain to hit the inside of the skull. Concussions can temporarily alter brain function, producing symptoms like headaches, fatigue, emotional changes, nausea and difficulty with concentration, sleeping and balance.

Most Pediatric Concussion Clinic patients are referred from YNHCH's Emergency Department, community pediatricians and coaches. Holmes performs a thorough neurological evaluation and, based on symptoms, may refer patients to neurologists or neuropsychologists, depending on patients' clinical needs. Many patients also require vestibular therapy for balance and coordination problems.

In most cases, patients' symptoms resolve in one to two weeks, but can sometimes last longer, Dr. DiLuna said.

Even after symptoms resolve, children might need further evaluation and symptom management, so Holmes works closely with school nurses, coaches and families to ensure her young patients are following their care plans and improving. Most clinic patients have had just one concussion, but Holmes doesn't hesitate to tell those who have had more to reduce or eliminate activities that are causing the concussions.

"I want kids to do what they're passionate about, but the child's brain is my first priority," she said. "My goal is to help kids get better and stay healthy. Most of them do. It just takes the appropriate amount of time and medical clearance to get them there."