Ahead of the Game: The Parents' Guide to Youth Sports Concussion

Rosemarie Scolaro Moser's  book, Ahead of the Game: The Parent's Guide to Youth Sports Concussion (University Press of New England) is just what it says it is: a practical, no-nonsense guide for parents about sport concussions.

Moser brings to the subject matter a unique background: As a clinician who has treated hundreds if not thousands of concussed student-athletes at the Sports Concussion Center of New Jersey, she brings real world experience to the subject, not just as a neuropsychologist with specialized expertise on baseline and post-concussion neurocognitive testing but in the management and treatment of concussions, including the academic accommodations that are often needed during the sometimes long road to recovery.

As the author of several landmark studies on the often subtle and long-lasting effects of concussion (particularly multiple concussions), neurocognitive testing, and, most recently, on the importance of cognitive and physical rest in recovery, she is also working on the cutting edge of science, helping to expand the frontiers of our knowledge in this rapidly evolving field.

And, finally, she is, like I have been, a tireless advocate for increased concussion education for all of the stakeholders in youth sports, and, above all, for a careful, balanced, and conservative approach to the management of concussions in youth athletes, one that, in my view, is pitch perfect: avoiding on the one hand the view of the doomsayers predicting - or, indeed, calling for - the elimination of contact and collision sports at the youth level, and on the other hand, the position taken by some that there is little, if anything, we can do to protect young athletes from the risks inherent in participating in such sports.

To be sure, for someone as steeped as I am in the subject of youth sports concussion, much of AHEAD OF THE GAME plows familiar ground. It covers all the bases, from concussion definition and symptoms to post-concussion evaluation and treatment, from a list of questions for parents to ask coaches, certified athletic trainers, school nurses, and a child's physician, to an eight-step plan for parents to follow in safely returning an athlete to the playing field after a concussive injury.

Moser does a very good job of tracing the history of our understanding of concussion, giving credit where credit is due to such pioneers as neuropathologist Bennett Omalu, for example, for being the first to link concussions among former NFL players with the development of chronic traumatic encephalopathy (CTE).

Like fellow MomsTEAM expert Bill Meehan's excellent book, Kids, Sports, and Concussion, Moser draws on her experience as a clinician to provide parents with helpful and informative case histories, including the story of Heidi Taggart, whose concussion journey her mom, Dorothy Bedford, chronicled in depth for MomsTEAM readers in her cautionary tale, Unmarked Detour. Each chapter ends with a helpful summary, and the book concludes with several very helpful appendices listing resources (including MomsTEAM); a sports concussion card listing concussion signs and symptoms, steps to take in the event of a suspected concussion, and tips to remember; the academic phases of concussion recovery; and a state-by-state guide to new and pending concussion legislation. Ahead of the Game is meticulously researched and copiously footnoted, and as current as a book on a rapidly evolving field such as concussions can be.

But there is also much in Moser's book that parents - even those with concussion experience - may be learning for the first time and find not only informative but perhaps surprising. For example, not only does she remind parents of the importance of monitoring their children for symptoms of concussion that may not appear for hours, if not days, after a concussion injury, but she explains why delayed symptoms are so typical in children and adolescents.

For parents who may not understand just why cognitive and physical rest after a concussive injury are so important (the benefits of which are reported in Moser's soon-to-be-released study), Moser provides a detailed - but not too detailed - explanation of the way the brain functions (including the fact that the brain uses 20-25% of the body's energy), the effect of a concussion on that function, and why it is so important not to "stress a brain when it's down."

As a clinician with concentrated experience in administering and interpreting the results of the ImPACT neurocognitive test, she provides parents with extremely valuable, practical advice about the use of such tests, including the need for periodic re-testing to establish a new baseline to reflect a child's developing brain and cognitive skills.

But of all of her advice to parents of concussed athletes, there is one recommendation that I hope they will listen to and follow above all: that concussed youth athletes not return to contact sports for at least three weeks after all symptoms have subsided. While she concedes that some parents may view three weeks as "an excessively long break," her recommendation, which I share, is backed up not just by science (recent studies, for instance, showing that cerebral blood flow in youth may remain suppressed even 30 days after concussion, and another finding that 85% of concussions take at least three weeks to resolve, and many take longer), but by Moser's  vast clinical experience: "In my experience, by the time an athlete has completed an initial course of rest, submitted to post-concussion testing, and passed physical exertion testing, and a graduated return to exercise, three weeks or so have already passed anyway. Better not to rush the recovery process; returning to sports too soon only sets the athlete up for further, potentially devastating injuries."

To that I say, bravo, Dr. Moser, bravo!

Brooke de Lench is Executive Director of the non-profit MomsTEAM Institute of Youth Sports Safety, Founder and Publisher of MomsTEAM.com, Producer of the PBS documentary, The Smartest Team: Making High School Football Safer,  the author of Home Team Advantage: The Critical Role of Mothers in Youth Sports (HarperCollins), now available as an e-book on Amazon.com.

 Updated November 10, 2015