Wednesday, September 15, 2010

Keeping ahead of the concussion curve

Education the key to preventing, treating head injuries

Express Staff Writer

Wood River High School athletic trainer David Allred, shown here along the sidelines during Fridayís Wood Riverís football game, is a constant presence at Blaine County School District athletic events and also keeps tabs on the athletes off the field. Photo by Willy Cook

The Idaho High School Activities Association (IHSAA) has a new motto for dealing with concussions, "When in doubt, sit them out."

"Don't even take a chance with these types of injuries," said John Billetz, IHSAA president. "That is what we have been preaching to our schools."

Recent legislation has brought more attention to a problem that affects nearly every sport, from football to soccer to skiing. Billetz said the push for concussion education began last year when the Idaho Legislature passed Bill 676.

Known as Idaho Code 33-1620, the provision mandates the Idaho State Board of Education provide concussion guidelines for its youth athletes. They include education for coaches, officials and parents, and strict standards under which an injured athlete can return to the playing field.

"We started considering concussion education last year when the bill was floating through the legislature and approved it in August," Billetz said. "We knew we needed to do a bit more as far as coaches' education and this was an opportune time. The state education board along with IHSAA will develop materials for parents, coaches and athletes in relation to concussion management."

An estimated 300,000 sports-related concussions occur annually in the U.S. with high school football players suffering nearly one-quarter of those injuries, according to Caroline Faure, an assistant professor of Sports Science at Idaho State University. She helped develop the state's management strategies and titled her report, "Identification and Management Strategies for Coaches, Parents, Athletes and Others."

Also, the Center for Disease Control and Prevention estimates an average 1.7 million people per year suffer traumatic brain injuries in the U.S., resulting in 52,000 deaths, 275,000 hospitalizations and 1,365,000 emergency room visits.

The CDC defines a concussion as "a type of traumatic brain injury, caused by a bump, blow, or jolt to the head that can change the way your brain normally works.

"Concussions can occur from a blow to the body that causes the head to move rapidly back and forth," the report continues. They can change the athlete's behavior, thinking, or physical functioning.

Symptoms can range from the mild—headache or nausea—to more serious complications ranging from depression to loss of balance. There may also be an even greater vulnerability to further injury, or post-concussion syndrome.

The recognition of the severity of concussions and the myriad of ill effects has spilled over to a cautionary reaction on all level of sports from professional football teams to Peewee hockey leagues.

And that's a good thing for all involved, said Billetz. "The days of holding up two fingers and asking a kid how many fingers he sees are over," he said.

John Rade, Wood River High athletic director and a former defensive captain of the Atlanta Falcons in the National Football League, agreed.

"I know there would be times when I was concussed, heck, we didn't even call them concussions, we would say it was a ding or we got our bell rung, but it was a non-event. But there is an awareness about it now and it is good for the athletes," said Rade.

Testing in Idaho

Out of 156 high schools in Idaho, Wood River and Carey are part of a small group that now perform baseline testing on all athletes who participate in contact sports, including football, soccer, volleyball, cheerleading, wrestling, basketball, baseball and softball.

The neurocognitive assessment is run on a computer software program called ImPACT. It measures learning and memory skills, the ability to pay attention or concentrate and how quickly a person can think and solve problems. Rade said the test takes 25-30 minutes.

"What it does is give a cognitive baseline which gives us an objective measure that takes the decision process out of athletic trainers, coaches and parents hands. Kids won't be able to play until they pass the test and are released by a doctor. I look at it as a tool that helps protect our kids," Rade said.

In establishing the new guidelines, the Idaho Legislature points to the CDC's following statement, reading, "Catastrophic injury or death is significant when a concussion or head injury is not properly evaluated and managed."

There is evidence that athletes who suffer a second concussion before the symptoms of the first have healed are susceptible to a phenomenon called Second Impact Syndrome, Faure's report said.

It stated, "Though rare, SIS is characterized by rapid swelling of the brain. Surgery does not help and there is little hope for recovery. Most die and those who survive are often severely disabled. SIS is most often associated with athletes under the age of 19, perhaps because of the sensitivity of their developing brain and perhaps because the seriousness of the first concussion is often overlooked."

Rade said, "Coaches and parents have their own reasons for getting kids back on the field. But the thing is this—with concussions, athletes don't have a physical injury that anyone can observe. It is not like you are on crutches or you are banged up.

"This establishes a baseline that kids have to return to before they can play again. It is something I agree with. You can't be too careful and we are going to error of the conservative side."

All varsity head coaches and game officials are now required to take and pass an online course on concussions developed by the National Federation of State High School Associations and the CDC, which is administered by the IHSAA.

The course consists of four units. They are concussion overview, the problem, your responsibility and a review. "As long as it is good quality education, it is beneficial to everyone involved," Rade said.

As well, game officials now have at their discretion the ability to remove a player from a game if they think the athlete has suffered a concussion. Once diagnosed, no player can return to the field until they cleared by a health care professional. Coaches also have a checklist to follow if they think an athlete has suffered an injury in a game or practice.

"I have a symptoms checklist that a carry around with me," Carey head football coach Lane Kirkland said. "It's a 2x3 card and it goes on my wristband under my plays. We try to be as cautious as we can."

With new measures in place, Billetz said he thinks the state governing organizations are doing everything they can to protect Idaho's prep athletes against concussions and help them safety return to the playing field should they occur.

"I feel like we are as good as any state in the union when it comes to concussion management," he said.

Rade agreed, "Of course the knowledge you have today might not be as good tomorrow. It is a continual learning process. But it is a good start."

The ImPACT baseline testing software is also used by the Sun Valley Ski Education Foundation. Its executive director Don Wiseman said, "Several of our athletes have relied on the baseline testing to get diagnosed. My feeling is the baseline is of great value and a great tool to use."

Signs Observed by Coaching Staff

Appears dazed or stunned

Is confused about assignment or position

Forgets an instruction

Is unsure of game, score, or opponent

Moves clumsily

Answers questions slowly

Loses consciousness (even briefly)

Shows mood, behavior, or personality changes

Can't recall events prior to hit or fall

Can't recall events after hit or fall

Symptoms Reported by Athlete

Headache or "pressure" in head

Nausea or vomiting

Balance problems or dizziness

Double or blurry vision

Sensitivity to light

Sensitivity to noise

Feeling sluggish, hazy, foggy, or groggy

Concentration or memory problems


Does not "feel right" or is "feeling down"

General Tips to Help Aid in Recovery

Get lots of rest. Don't rush back to daily activities such as work or school.

Avoid doing anything that could cause another blow or jolt to the head.

Ask your health care professional when it's safe to drive a car, ride a bike, or use heavy equipment, because your ability to react may be slower after a brain injury.

Take only the drugs your health care professional has approved.

Write things down if you have a hard time remembering.

You may need help to re-learn skills that were lost. Your health care professional can help arrange for these services.

Provided by the Centers for Disease Control and Prevention

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