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CON C U SSION Aortic Valve Stenosis Open Continued from cover Parents Encouraged to Update Their Approach to Treating a Child with a Concussion Closed Aortic Valve and local anesthesia,” says UCLA Chief of Cardiac Surgery Richard J. Shemin, MD. This approach enables patients to avoid having to spend time in the intensive care unit. Patients generally are able to return home within one or two days. The FDA now has approved a clinical trial investigating whether or not TAVR is beneficial for low-risk patients compared to a surgically implanted valve. Based on the high volume of TAVR and surgical aortic cases with excellent outcomes, UCLA has been selected as a participating site for this expanded indication trial. “We are proud to be one of the sites for the new clinical trial and excited to be able to offer this minimally invasive treatment approach to low-risk patients to see whether or not this technology will be approved for use in an even larger population of patients requiring aortic-valve replacement,” Dr. Shemin says. To learn more abtout TAVR at UCLA, go to: heart.ucla.edu/tavr UCLA cardiologists and heart surgeons have been at the forefront of developing innovations to the procedure that have improved safety and outcomes while reducing the cost. overly conservative approach could be making their child’s symptoms worse. “In the past, there was often a tendency to downplay the significance of concussions,” says pediatric neurologist Christopher Giza, MD, director of the UCLA Steve Tisch BrainSPORT Program. “Now, some parents go too far in the other direction and, despite their best intentions, they can inadvertently complicate their child’s recovery.” A total of 569 parents nationwide were asked how they would care for a child whose concussion symptoms lasted for more than a week. Among the more surprising results, 77 percent of parents said they would likely wake their child up throughout the night to check on him or her. “We know that even on the same night as a concussion, once the child has been medically evaluated and the risk of a major problem in the brain has been ruled out, waking the child multiple times through the night tends to make the symptoms worse,” Dr. Giza says. “In fact, we encourage sleep very early on because that will help the brain heal faster.” An even higher percentage of parents — 84 percent — said they would make their child refrain from any physical activity if they still had symptoms a week after the concussion. While it’s true that children should avoid activities that would put them at risk for further injury, such as returning to a contact sport, they do not need to remain sedentary, Dr. Giza notes. “Walking the dog, riding a stationary bike or doing some other gentle aerobic exercise can actually be helpful in promoting faster healing, particularly for athletes,” he says. “Prolonged inactivity isn’t good for anyone. And when people are used to lots of exercising and you put them in a dark room and tell them not to do anything, it’s going to make them feel socially isolated as well as lead to deconditioning. Being active can help them improve their mood, take their mind off their symptoms and restore a sense of normalcy.” Similarly, most parents in the survey said they were unlikely to allow their child to engage in schoolwork for up to a week after the injury. “No one ever got a concussion from doing homework, and you don’t know what the child can do cognitively until you test him or her a little bit,” Dr. Giza says. “We advise symptom-limited cognitive activity so that the child doesn’t start falling too far behind on schoolwork, preferably sooner than a week after the concussion,” he says, noting that the peak period for symptoms following a concussion is within 24-to-48 hours. “As children begin to show improvement, they can be eased back into activity,” Dr. Giza says. As part of its outreach, and to spread the word on proper concussion care, the UCLA Steve Tisch BrainSPORT (Safety, Performance, Outreach and Treatment) Program is training primary-care physicians in the community through its Concussions Champions continuing medical education course. This training focuses on how to evaluate and manage acute concussions. Although every child is different, most concussion symptoms should subside within two-to-three weeks. If symptoms don’t subside, the child should be seen by a specialist. In addition, the UCLA Steve Tisch BrainSPORT Program works with schools and various youth sport leagues to provide targeted education and preseason concussion baseline testing for youth athletes. For more information about the UCLA Tisch BrainSPORT Program, go to: uclahealth.org/brainsport To view a video about treating concussion, go to: uclahealth.org/ concussion Vital Signs Winter 2017 Vol. 73 7