Karen Schlossmacher Smith, an RN, was working on the critical care floor at Children’s Hospitals and Clinics of Minnesota when she got a phone call. Her daughter, Adrianna, was in the Emergency Department with a concussion. She had gone in for a lay-up at a basketball tournament when she fell to the ground and a fellow player stepped on her head.

It was 13-year-old Adrianna’s second concussion. She was treated and scheduled for a visit at Children’s Concussion Clinic for follow-up care.

Twenty-four hours later, Schlossmacher Smith got another call while at work. This time, it was for her daughter Michelle, Adrianna’s twin. Michelle had suffered a concussion during the same weekend basketball tournament. She took a block, hit her head and momentarily blacked out.

“It wasn’t even funny. I think I was in a little bit of shock and disbelief after the second call came,” she said.

Twin girls. Two concussions. One day apart. Unlikely? One might think so. But, this wasn’t their first experience with back-to-back injuries. They once broke their hands 18 hours apart and ended up with casts on opposite hands, Schlossmacher Smith said.

A concussion is a type of brain injury that changes the way the brain normally works, according to the Centers for Disease Control and Prevention. It can be the result of a bump, blow, jolt to the head, or from a blow to the body that causes the head and brain to move rapidly back and forth.

Concussions can have a more serious effect on a young, developing brain and need to be addressed correctly and quickly.

“It takes a child or teenager three to four times longer to recover than an adult due to the rapid brain growth and development,” said Mary Dentz, a nurse practitioner who helped treat Adrianna and Michelle. “If the brain is not given sufficient time to heal from the injury before a child returns to regular activities, the recovery time becomes even more prolonged. Children and teens also experience more severe symptoms and neurological disturbances compared to adults.”

Symptoms from a concussion include having headaches, being sensitive to light and noise, feeling dazed, and being forgetful – to name a few. Adrianna experienced difficulties with vision and balance; Michelle had sensitivity to light and sound, Schlossmacher Smith said.

At Children’s Concussion Clinic, where Adrianna and Michelle were treated, patients receive a medical evaluation as soon as possible after the injury, which is usually within a week. The clinic, which has a multidisciplinary team, offers physical therapy, audiology, pediatric neurology, neuropsychology, advanced imaging capabilities and an active research program.

Between their Emergency Department visits and continued care, Adrianna and Michelle were seen a total of 15 times between them at Children’s, Schlossmacher Smith said. Physical therapy played a significant role in their recovery.

Children’s physical therapists see every concussion patient as early as 10 days post injury to help the patient return to sports safely, said Elaine Walin, a physical therapist who worked with the twins. An occupational therapist may see a patient if he or she has challenges more than a month after the injury. Therapy aids patients with their visual acuity, balance and tolerance to exertion, Walin said.

Patients return to school and regular activity only when they get an all-clear from a trained health provider. In Minnesota, young athletes who show signs of a concussion must be sidelined until they get a medical all-clear.

That law is important, Dentz said.  “Doing too much too quickly after a concussion can make the concussion symptoms worse and prolong recovery time,” she said.

Contact activities place a child or teen with active concussion symptoms at risk for a second concussion, she said. Having a second concussion before fully recovering from the first one is dangerous and can result in prolonged recovery time, lifelong problems with thinking, memory, processing or balance, and, while rare, death from second-impact syndrome (SIS).

Sports and recreation-related activities account for a majority of concussions. At Children’s clinic, 43 percent of the patients seen suffered concussions while playing hockey.

Sports play a big role in Adrianna and Michelle’s lives. With Adrianna so young and having already suffered two concussions, Smith worries about what will happen if she receives a third concussion.

“I think we will need to call it quits for contact sports,” Schlossmacher Smith said.

There’s not a lot of data on outcomes for children and teens after multiple concussions, but this is currently being studied, Dentz said.  Prolonged recovery time and more severe symptoms occur with each subsequent concussion, but the long-term effects aren’t clear yet.

Adrianna and Michelle continued going to school, but they took a break from physical education classes, music and testing, Schlossmacher Smith said. They took naps in the nurse’s office during gym and music classes, which was what allowed them to continue going to school. At home, screen time, such as watching TV and texting friends, was limited.

“The goal is to allow the brains to rest,” Schlossmacher Smith said. “They look fine on the outside, but definitely felt the effects in different ways.”

Adrianna and Michelle, who are also varsity divers and swimmers, only returned to play in their final state basketball game this past weekend.

The family appreciates the care they received from Dentz and Walin, who kept the girls positive and accountable for their own recovery, Schlossmacher Smith said. The girls’ Roseville coaches, teammates and other families supported them, knowing the importance of a slow recovery even when it impacted the team and resulted in having to pull out of games.

“They understand the long-term consequences,” Schlossmacher Smith said.