Better Concussion Care
A strategic gift brings together the expertise needed to better understand, prevent and treat concussions in kids and teens.
Published in Connection magazine, Fall 2017
Amit Perlin is now a junior in college, and his interest in medicine was spurred, in part, by his experience with persistent concussion symptoms. Dealing
with ongoing symptoms was really tough, recalls Perlin. “There’s no cast or physical scar that shows you’ve been injured, so people can’t always understand
that you’re hurting. But you use your brain for everything and the symptoms can limit your life in almost every way.”
Each year, somewhere between 1.1 million and 1.7 million kids
sustain a sports- or recreation-related concussion.
The good news is that most feel better within 10 to 14
days. But some – between 10% and 20% – remain
symptomatic for weeks or months afterward.
Amit Perlin was one of those kids. His first concussion
resolved within a couple of weeks, as expected. But the
second one, sustained during his junior year in high school,
resulted in severe headaches, fatigue and nausea that lasted
for nearly a year. The standout basketball player at Seattle
Academy of Arts and Sciences suddenly couldn’t tolerate
noise or light, and his limited ability to concentrate or work
at a computer took a toll on his school work. Over time, the
usually outgoing teen found himself retreating from friends
and social situations.
“It was like my life was taken away from me. I couldn’t do
things I was used to doing, and I became solitary and sad,”
recalls Perlin, who recently started his junior year at Tulane
University in New Orleans.
What made it worse was that no one could tell his family
what to expect, how long the symptoms would continue, or
what would help.
“It was shocking how
little concrete information
there was for such a
“We know medicine isn’t an exact science, but it was
shocking how little concrete information there was for such
a common injury,” says his mom, Sharon Perlin. “It’s hard to
see your kid in a dark space and not know how to help.”
Filling in the gaps
A $5 million gift from the Satterberg Foundation in 2014
established the Seattle Pediatric Concussion Research Collaborative, propelling efforts to fill in these knowledge gaps by investigating the mechanisms of concussion, how
the injury impacts functioning, and how it can be treated
The group brings together experts from the wide range
of specialties involved in the treatment and study of youth
concussion (including pediatrics, rehabilitation medicine,
sports medicine, neurosurgery, psychology and radiology)
to generate creative ways to address the issue. It also funds
pilot studies to test out these new ideas. The goal is to
produce results that are compelling enough to attract
support needed from external funders like the National
Institutes of Health (NIH) to test these on a larger scale –
an essential step to establishing better care for kids.
Caring for mind and body
Kids with concussions do get better, and the goal of the research
collaborative headed by Dr. Fred Rivara is to help them get better faster.
“We don’t want to scare folks from having their kids play sports. Kids need
to be active throughout their childhood – and their lives – to be healthy.”
One of the first studies tested a new model of care for
adolescents, like Perlin, whose symptoms continue beyond
“Persistent symptoms are important because kids can be
quite incapacitated and we don’t yet have good, evidencedbased
treatments,” says Dr. Fred Rivara, Seattle Children’s
Guild Endowed Chair in Pediatrics, who spearheads the
collaborative. “We want to find ways to get them back to
full functioning as quickly as possible.”
Dr. Cari McCarty, a psychologist and researcher at Seattle
Children’s, and University of Washington psychiatrist Dr. Doug
Zatzick designed a care model that features a care manager
to coordinate between the family, the specialists, the primary
care doctor and (if necessary) the school. It also includes
cognitive behavioral therapy (CBT) to help kids cope with
what they are going through.
“CBT involves changing behaviors and thinking patterns.
Our study included teaching relaxation techniques and
coping skills, and offering pain management,” says McCarty.
The small pilot study found that those who received
collaborative care got better more quickly than those who received the usual care. Thanks to these results, Rivara,
McCarty and Zatzick secured a $2.5 million grant from the
NIH to lead a four-year study of the collaborative care model
with a larger group of patients.
Freedom to try
The collaborative care model developed by Dr. Cari McCarty of Seattle
Children’s and University of Washington psychiatrist Dr. Doug Zatzick
adapts treatments known to be effective for issues that affect people
with ongoing concussion symptoms like pain, headache and depression.
“The Satterberg Foundation gave us the freedom to pursue
the areas of greatest need within the broader theme of
concussion. It allows us to create a mini-model of something
new and test these ideas and concepts on a small scale
before taking them to a larger setting,” says McCarty. “It’s
like that first stage of building a snowman where you create
the base. From there you can build something wonderful and
new. That’s been the real gift to us.”