Concussion saw Macy lose her ‘spark’, but a new trial helped her recover

Source : ABC NEWS

It wasn’t until three months after Macy Watson’s concussion that she found the help she needed.

Normally an extrovert, mum Jo remembers 15-year-old Macy losing her ‘spark’.

“I was so worried she wasn’t going to come back,” Jo said through tears.

“School was such a struggle, relationships were such a struggle, and they weren’t normally. I just didn’t want her to suffer that much.”

Macy sustained a concussion on a school trip to the Victorian beachside suburb of Torquay, hitting her head on the bottom of the ocean after falling off a surfboard.

Her initial symptoms were dizziness and a headache, but over time, psychological issues appeared too.

“I was getting really anxious at school, and overwhelmed in situations where I normally wouldn’t,” Macy said.

“I was also really teary and irritable at home.”

Jo took her daughter to the local GP, who told Macy to rest. But after several weeks without improvement, Macy was referred to a sports doctor, who in turn referred her to a neuro-physiotherapist.

Facing increasing wait times, and anxious for Macy to improve, Jo stumbled across a flyer for a trial concussion clinic being run by Murdoch Children’s Research Institute (MCRI) at The Royal Children’s Hospital.

Despite the duration and severity of her symptoms, Macy would go on to become one of 94 per cent of participants whose symptoms improved within the eight-week duration of the program.

The program consisted of a total of 158 participants aged between 8-18 years, with just over half of those male.

67 per cent were considered to have ‘fully’ recovered, compared to 37 per cent of those receiving ‘usual’ or routine concussion care.

Lead researcher professor Vicki Anderson, and principal physiotherapist Katie Davies said the success of the program proved that concussion, while serious, is treatable under the right circumstances.

30 per cent of children have ‘persistent’ symptoms

Concussion in kids is relatively common, with some studies suggesting one in five children sustain one by the age of 10.

But as with adult concussion, it is notoriously difficult to diagnose.

MRI scans of the brains of kids with concussion look no different to ‘normal’ brains, and there is no established blood test to diagnose it.

The main symptoms include headache, dizziness, balance problems, sensitivity to noise and light, and cognitive or emotional problems such as poor memory, brain fog, sadness and irritability.

Contrary to what many parents think, it does not necessarily involve a loss of consciousness.

Half of concussion hospitalisations are caused by falls, while sport is involved in approximately one in five cases.

Cycling, either as sport or a mode of transport, is associated with the largest number of sport-related concussion hospitalisations.

Nonetheless, Dr Anderson said many parents were worried about their children participating in contact sports such as Australian Rules and rugby league or union.

“Over the years I’ve been practising, I’ve seen a lot more fear in parents and families,” Dr Anderson said.

As Dr Anderson explains, international data suggests 70 per cent of kids who sustain a concussion will go on to recover ‘normally’ (and be symptom-free) by three weeks.

MCRI’s randomised control trial was designed to pick up the 30 per cent who have persistent symptoms and require further intervention — like Macy.

Similar programs have been trialled across the country, including Australia’s first multidisciplinary concussion service at the Royal North Shore Hospital in Sydney, which launched in 2022. 

The Brain Injury Rehabilitation Service in Brisbane, at Princess Alexandra Hospital, also sees patients aged 16 and over with persistent concussion symptoms. 

‘Gradual’ return to activity required

Families attended the MCRI clinic for one hour per week, and could choose between physio, psychology or educational sessions about concussion.

Davies said families most often wanted education, because they wanted detailed guidance about how to get their child back into school or sport.

While not so long ago concussion patients were told to rest, Davies and Dr Anderson explain that a “gradual” return to activity is encouraged.

“So really after the first 48 hours, we want kids to start getting active,” Dr Anderson said.

“Even if they’ve got headaches, we really want them to gently push through their symptoms … firstly with some light activity, then a little bit of homework.”

Ideally, Dr Anderson argued, children can return to school within the first couple of weeks and be back to contact sport by 12 weeks (so long as they are symptom free, and cleared by a doctor).

In line with Australia’s ‘conservative’ approach to concussion management, kids are also required to sit out contact sport for a minimum of 21 days.

But principal physiotherapist Kate Davies emphasised that pacing is key.

“We know a lot of people stop activity when they have a concussion, and do nothing,” she said.

“You need to do a little bit, you just can’t do too much, so you’ve got to be in that perfect sort of wedge [in between].”

Education key to minimising parental anxiety

The program also considered factors that contribute to some children having prolonged symptoms of concussion.

While 94 per cent showed improvement within eight weeks, six per cent had persistent symptoms, and generally fell into one of three categories: those with existing mental health issues, chronic migraines and/or autonomic nervous system dysfunction.

Another factor associated with prolonged symptoms was parent anxiety, with Dr Anderson explaining that if parents are “frequently checking in on [children’s] symptoms”, it can increase anxiety in their child, which can in turn delay recovery.

She believes this makes the message that concussion is treatable more important than ever:

Dr Anderson argued this is critical given rising rates of obesity and ‘screen addiction’.

“The more you take kids away from being active, the more likely those problems are going to increase,” she said.

Moving forward, MCRI has received funding for a national rollout of the program, which will be available via telehealth.

She said the funding offers hope to families around Australia who do not have access to major urban centres like Melbourne.

“There is so much momentum in concussion research, and we want as many patients as possible to benefit from the latest findings,” she said.

“Ultimately we want to alleviate concussion symptoms faster, accelerate early recovery and provide free, accessible resources to families so children can be safely managed at home and feel like themselves again.”