My Q&A with Being Brain Healthy author Ruth Curran

Will Smith's film CONCUSSION, based on the true story of one brave doctor's unrelenting efforts to enlighten the NFL about the effects of continual trauma to the brains of football players, has opened the eyes of many to the dangers of America's favorite sport. Concussions affect far more than just football players, though, and the movie has also opened the door for many important discussions about the effects of brain injuries of all sorts, suffered by all ages, regardless of the cause.

I have long been concerned about concussions in my rambunctious, active, sports-loving grandsons, so I turned to Ruth Curran, author of Being Brain Healthy, to assuage some of the worries and concerns I have as a grandmother. See, grandparents, unless they're in a situation where they serve as primary caretaker for their grandchildren, have little say in the day-to-day care of their beloved grandkids, can't restrict certain sports or activities. That doesn't mean we have no concerns.

Here, Curran addresses my concussion concerns as they relate to my grandsons and the possible damage to their little brains as they grow older and bolder, engage in rougher and tougher activities.

In CONCUSSION, it's mentioned that the hard hits in youth and high school sports contributed to the tally of head trauma in professional football players (Iron Mike, in particular, in the film). How concerned should grandparents be about hits to the head experienced by youngsters in youth sports as well as general play and toddlerhood?

Mindful, yes, but not overly concerned. These bonks and bangs happen and, honestly, worrying about them creates more long-term risk from stress for all concerned than the head bangs that come as part of growing up. Be aware and watch for signs of concussion after your grandson hits his head. Young brains repair well and quickly, even when concussed, if they are given time to heal. The good thing about all of this attention on the long-term damage from concussion is that everyone is now paying attention. That means more concussions will be identified in the moment and young players will not be put back in play until they heal.

What youth sports carry no concussion concerns for little players?

There really are no no-risk sports — even individual sports that we think of as safe like swimming and tennis carry some head trauma concerns that we just can’t control. The key is to focus on what we can control. Make sure that safety equipment is the best it can be and coaches and officials are paying attention and resting players if they hit their heads. That vigilance is especially critical in sports like gymnastics, cheerleading, and soccer where unprotected heads hit the ground, equipment, and the ball as a normal part of the sport.

In CONCUSSION, there's a line from Will Smith as Dr. Bennet Omalu that "God didn't intend for us to play football," due to the lack of protective "shock absorbers" like in head-banging animals such as rams and woodpeckers. As protective headgear seems to have gotten as protective as it can possibly be, what else can be done to prevent or limit damage to the noggins of little ones playing youth sports?

It seems that the real risk now is the back and forth motion that is inevitable with this kind of contact. I am not sure there is more equipment that will keep players safer. New rules will help in the long run — ones that continue to limit the types of contact and head-to-head or neck jarring hits — and keep players safer. The real interventions that will keep players, little and big, safe is consistently evaluating for concussion after every hit to the head and resting that brain and body if there are signs of concussion for as long as necessary to heal.

If a grandparent is concerned about damage to the brains of their grandkids due to rough-housing and sports, what behaviors should grandparents watch for when visiting with their grandkids that might signal there could be genuine concerns?

Here, taken from resources provided by the Mayo Clinic (with a few additions), are signs to look for after a child hits his or her protected or unprotected head, directly following the knock to the head:

• Headache / pressure in head
• Loss of consciousness
• Confusion or feeling as if in a fog
• Can’t remember the details of what happened (make sure to ask)
• Dizziness or "seeing stars"
• Ringing in the ears
• Nausea / vomiting
• Changes in speech
• Slower than normal response to questions
• Looking confused / dazed
• Difficulty concentrating or focusing
• Changes in personality including irritability or usual mood swings
• Sensitivity to sensory stimulation (lights, noise, smells, tastes, temperature)
• Sleep disturbances
• Psychological adjustment problems and depression

Continue to watch for these signs. Keep in mind you are looking for changes in normal behavior.

CONCUSSION touches on the symptoms of CTE, which include mood swings, depression, memory loss and suicides. How might grandparents (and parents) distinguish those behaviors from typical — albeit frightening — teen behavior (especially the depression and mood swings) in teens who have played sports for many years and may have even suffered concussions in the past?

This is the toughest question of all because honestly those typical teen behaviors show up in the same ways (manifest themselves) as signs of significant brain changes — all for a good reason. Brains regulate emotions and behaviors on a chemical and electrical level. Teenage brains are in chemical and electrical flux — changes in hormones (type and level) and new emotional experiences both change how the teenage brain operates at its most basic level. Conditions like CTE also change how the brain operates electrically and chemically. CTE has only been shown to be a factor after repeated head trauma. If a child has had multiple concussion absolutely watch closely in those teen years but know that much of what you can see on the outside may just be normal teen brain adjustments!

Grandparents and grandchildren enjoy playing games together. What types of game play and activities would be fun yet promote brain health in children (as well as the grandparents)?

Any interactive games are great for both grandparents and grandchildren. Not only are you practicing skills needed to play the game (thinking, fine motor, problem solving, decision making, strategic thinking, etc.) but you are also strengthening social skills and providing a safe place for your grandchild (and you) to try new things or try old things in new way. Interactive play is so valuable for both of you and the more laughter the better!

How can grandparents model brain healthy habits in hopes their grandchildren emulate the habits?

Brain health is as much about using your brain in challenging and interesting ways as it is about nutrition and exercise. Inspire your grandchild to wonder — ask questions, explore, experience — by modeling that behavior. Exploring the world with eyes wide open activates brain pathways in unique and complicated ways and that creates and strengths connections in the brain. Your grandchild’s brain starts making those connections before he is born and the process continues. By showing your grandchild how to actively wonder you are not only giving his brain a lifetime a competitive advantage, you are nourishing your own brain and keeping those connections alive and active.

You've mentioned in other places that the concussion discussion should be tackled from a place of information, not fear. What information is important for grandparents watching from the sidelines, with no real authority to make changes in a child's lifestyle or activities?

Figure out what you see as the value for your grandchild. Is he learning new skills? Is he getting some exercise? Is he learning to work with others? Is he smiling more/having fun? Try to put the focus on the positive elements — those great things that your grandchild is getting out of the experience and cheer for those. Parents, coaches, and little players will listen more when they see you get it that this activity has good points. When a child hits his head, offer to help evaluate for concussion and share your knowledge. Not all coaches (especially parent coaches) are trained to screen for concussion and those who are often, during the game, are pre-occupied with what is going on in the moment. That offer to help might let the coach know you are there to support and take some of the load while emphasizing the importance of paying attention to the little player’s status.

I think the biggest issue and the elephant in the room is this: You can’t put your grandchildren in a bubble (no matter how much you want to) so it is important to do your own weighing of risk versus reward when looking at what to say and what not to say about your grandchild’s participation in sports.

Where can grandparents find reliable information about concussions and how such relates to their grandkids?

The Center for Disease Control has great information about concussion here: http://www.cdc.gov/headsup/youthsports/. There are fact sheets that include what to look for, what to do, and how to react and other resources about safety.

What advice would you give grandparents concerned about their grandchild's brain health, whether related to sports or toddler-to-teen tumbles, bumps, and bonks?

All those things are going to happen. Period. The best defense is a great offense and that means helping your grandchild build brain resilience. The key is building new connections and letting your grandchild’s brain know it can look at the world in many ways. Play interactive games with them — especially ones where they have to make decisions. Challenge them to look at and think about what is in front of them in a different way.

For example, take a walk with your grandchild and ask them what they hear or smell or notice. Have them walk on the curb (balance beam style) or skip or dance or walk like a robot. Encourage singing, playing, and listening to music. Get them to act out stories. All those activities encourage new brain connections. The more brain connections the more quickly and seamlessly your grandchild will recover the bumps and thumps!

Is there anything else you'd like to add regarding brain health as it applies to grandchildren and the grandparents who love them?

Participating in sports in general and team sports in particular is good for children. Sports involvement lays the ground work for some critical life skills and from a brain development perspective, helps build connections that require critical thinking and problem solving while managing the complicated interactions of team work and coordination. Playing sports as a child gives little players a place to practice and refine those skills.

Here some facts to consider when you are doing your risk analysis:

• Playing sports builds self-esteem and confidence.
• Being part of a team exposes young people to mutual support and teamwork — more than just about any other activity in most schools in our country.
• We are facing an obesity epidemic in this country and team sports are a great way to get kids up and moving.

Ruth Curran MS is the author of "Being Brain Healthy: What my recovery from brain injury taught me... and how it can change your life" (available in paperback, Kindle, and audio on Amazon.com; from Rolling Mulligan Publishing). Curran writes about brain-healthy living and is founder of CraniumCrunches.com.

Click to read my review of CONCUSSION.