Concussion Concerns Remain

By Elizabeth M. Pieroth, PsyD, ABPP – The youth hockey community is appropriately focused on keeping players safe from COVID-19. However, when the players are back on the ice, concerns about concussions and other injuries also return. We want our players, coaches and parents to remain vigilant when it comes to player safety. Everyone involved in youth hockey should be aware of the signs (observable by others) and symptoms (reported by the athlete) of concussion. Click here for the Centers for Disease Control and Prevention Concussion Signs and Symptoms.

Symptoms of concussion can be subtle, particularly in younger athletes who may have a hard time expressing themselves. A parent or coach may notice behaviors that seem out of character or they may be slow to respond to questions. He/she may seem confused about directions from a coach or teammate. An athlete does not need to lose consciousness (be “knocked out”) to have suffered a concussion. In fact, most concussions do not result in a loss of consciousness.

It can be difficult to determine if an athlete has suffered a concussion, so the rule is “When in doubt, sit them out.” If any signs or symptoms of concussion are present, the player must be removed from play. Let an appropriately trained healthcare professional assess the athlete to determine if it is safe to continue to play. A coach or parent should never return a child with a possible concussion to the ice!

If there is concern that a player has a concussion, they should be evaluated as soon as possible. Most concussions do not need to be seen in the emergency department but there are “danger signs” that warrant immediate transportation to a local hospital. Click here to view the Centers for Disease Control and Prevention Concussion Danger Signs.

If the child is not taken to a hospital or urgent care center, a parent/guardian should contact a pediatrician or primary care physician for further guidance right away. Follow-up care with a concussion specialist is also recommended, as research has demonstrated that individuals seen by specialists recover more quickly because they are provided with appropriate accommodations and treatment recommendations.

What about prevention? Remember that helmets were designed to prevent skull fractures and more serious brain injuries, not concussions. There are no “concussion-proof” helmets but there are models that are better designed than others. I recommend that parents consult the Virginia Tech helmet rating guide to review the currently available hockey helmets. Regardless of the model the athlete wears, a proper fit is vital. A loose helmet affords less protection and one that comes off the player provides no protection at all. The use of mouthguards is important to protect teeth (especially those with expensive orthodontia!) but have not been shown to reduce the severity or frequency of concussions.

The consistent enforcement of rules against dangerous plays is one of the key factors in reducing concussions and other injuries. Is the coach creating an environment where safe play is encouraged? Are penalties being called and repeat offenders removed? Does your team/league have an emergency action plan (EAP) in case of emergencies and have all the coaches been trained? Additionally, have your coaches received education on concussions? As a parent, do you feel you have enough education on concussions? There are additional resources available to you on the Centers for Disease Control and Prevention website.

Finally, has your son or daughter completed a free baseline neurocognitive test through our A Step aHead program? This is the 10th year of the program that provides education on health and safety issues relevant to youth hockey players and free baseline testing. We thank the Chicago Blackhawks, AHAI, Athletico Physical Therapy and Midwest Orthopaedics at Rush/Rush University Medical Center for their continued support. Click here to register for the testing through November 30, 2020.

The next column will focus on treatment recommendations post-concussion. Feel free to send any questions to

Elizabeth M. Pieroth, PsyD, ABPP is a Board Certified Clinical Neuropsychologist and is the Director of the Concussion Program at Midwest Orthopaedics at Rush and Rush University Medical Center. She has been involved in the assessment of players in the National Hockey League since 1997 and is the Head Injury/Concussion specialist for the Chicago Bears, Blackhawks, White Sox, Fire, and the National Women’s Soccer League. Dr. Pieroth is the Co- Director of the NFL Neuropsychology Consulting Program. She is also on the Board of Directors of the Brain Injury Association of Illinois and is a member of the USA Football Heads Up Advisory Committee, the NFL Head, Neck and Spine Committee, the US Soccer Concussion Task Force, and the Amateur Hockey Association of Illinois Safety Committee. She has published on concussion management and neuropsychological assessment. Dr. Pieroth is currently working on her Masters in Public Health through the Medical College of Wisconsin.

Dr. Pieroth sees patients in Chicago, Naperville, Oak Brook and Oak Park and appointments can be scheduled by calling 877-632-6637. The orthopedic program at Rush University Medical Center continues its legacy of excellence with a 2020 ranking by U.S. News & World Report as No. 5 in the nation and as the top-ranked orthopedic program in Illinois and Indiana.

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