Gerber, Tim. “Tracking Concussions Could Lead to Safer Sports for Texas Student Athletes.” KSAT. KSAT, 08 Oct. 2016. Web. 11 Oct. 2016.
Big hits are a big part of the action under the Friday night lights, but just how many of those violent collisions result in traumatic brain injuries?
The answer may be surprising: No one knows.
But the KSAT-12 Defenders have learned that the state of Texas could be the first in the nation to establish its own concussion research database to find out. In 2011, Texas legislators passed House Bill 2038, known as Natasha’s Law, which established a statewide concussion protocol to be followed by all schools.
“What that specific law did was require every school district to adopt a concussion oversight team. The concussion oversight team has one charge — to develop the return-to-play protocol for any student suspected of having a concussion.” said Jamey Harrison, deputy director of the University Interscholastic League, which oversees most high school sports in Texas. “If they suspect a student has suffered a concussion, the student must be removed from play and go through the return-to-play protocol before they can re-enter play.”
Clark High School football player Michael Oliver went through the protocol when he suffered a concussion during practice last year.
“I knew as soon as it happened, because I felt it,” Oliver said, recalling about the hit.
Oliver said he knew instantly something was wrong, so he went to the sideline and told a coach, who then sent him to see a team trainer. The trainer pulled Oliver from practice and told him he needed to see his personal physician to be evaluated for a concussion.
Oliver’s doctor, Evan Ratner, diagnosed him with a concussion and ordered him to rest his brain, removing him from school for a few days and ending his football season.
“I wasn’t allowed to use electronics or drive,” Oliver said. “It was constant pain. My head hurt all the time.”
According to numbers provided to the Defenders by several local districts, Oliver was just one of several hundred student athletes to suffer a concussion last year.
Northside ISD provided the most detailed numbers, offering up to two years worth of concussion injury data kept by district trainers.
The numbers revealed 527 concussions were logged by the district’s high school and middle school student athletes, 230 were suffered by football players, while girls soccer had the second most concussion injuries with 85.
The numbers may seem high but not when you consider how many student athletes participate in NISD’s sports programs.
“We’re around 1.6 percent to 2 percent out of 14,000 athletes, and that’s middle school and high school,” said Paul Rost, coordinator of NISD’s Athletic Trainers. “They (numbers) pretty well stay the same. We’ll have years just like any other injury or sport where you’ll see years that you have a lot of knee injuries or ankle injuries the next year, it goes up and down.”
Rost said any student suspected of having a concussion is immediately pulled from the game or practice and placed into the state mandated five-day concussion protocol established by Natasha’s Law.
“Once we are told that they have a concussion, we have to get the doctors note. We hand them the form and they have to go through our protocol before they can go back on the field,” Rost said.
Even if a doctor finds the student didn’t have a concussion, they must still wait five days to return to play.
NISD takes it a step further when it comes to middle school athletes, requiring those students to sit out at least eight days.
“Mainly because if you get a concussion and the symptoms reoccur during your evaluation period, you have to go back to the doctor. So we just wanted to give those middle school athletes a little more time. Younger brain, a little bit more time to heal up,” Rost said.
In addition to establishing the concussion protocols, the UIL was the first organization of its kind to also set limits on full contact practices to reduce concussions. Texas schools are limited to 90 minutes of full contact practice per player per week. Even with those measures in place, some feel the UIL could do more to reduce the impact of concussion injuries in the state.
Since 2011, the UIL has been collecting information on concussion injuries as part of its injury reporting system, but it only included a handful of schools and only for concussions that occurred on the football field.
“Right now, our injury reporting is only a sample of schools. It is not a scientific study. It was never intended to be a scientific study. It merely provides a snapshot of data,” Harrison said. “It sounds very easy in the general public to say you should collect concussion data, but just knowing that someone was concussed or suspected of having a concussion doesn’t do us much good. It has to be a scientifically based study and we’re not a medical research institution.”
That’s why the UIL is now partnering with the University of Texas Southwestern Medical Center and the Texas Institute for Brain Injury and Repair to launch the first comprehensive study of sports-related concussions called ConTex. For now, the study is a voluntary pilot program, but Harrison expects that to change.
“Our hope is that for as early as next school year, it would become mandatory for all schools to report suspected concussions to that registry through their module for every sport,” Harrison said. “That would include all sports, boys and girls, sub-varsity and varsity. So it would be a very comprehensive data collection and simply the most comprehensive model in the country. Concussions are a problem in every single sport, even swimming and diving,” he said. “Every sport we have, there is a concern about concussions. And how to go about addressing those concerns may differ from sport to sport, but we have to get that information so we know how to move forward.”
Harrison said the UIL hope the study will help them identify best practices that can be applied to reduce concussions. It could potentially identify what some Texas schools are already doing well that could be shared with other with schools in the state, such as teaching different techniques and identifying which schools are doing a better job of returning students to play after a concussion with less instances of reoccurrence.
“Ultimately, what we hope to do in getting the information back from those medical researchers is to make the games we provide as safe as they possibly can be,” Harrison said.
Ratner said one thing schools could start doing in the meantime is requiring student athletes to undergo baseline concussion testing prior to starting their sport each season.
The computer program Ratner uses puts the athletes through a series of tests and creates a score that can then be used to evaluate a student after suffering a concussion.
“Everybody’s baseline concussion testing is unique. It’s not an IQ test. It doesn’t tell me how smart the person is. It doesn’t tell me how good of a student they are. But different people think differently and their brains react differently and their reaction time is different,” Ratner said. “So what may be a normal baseline for someone, might represent an injured brain for someone else. I can compare someone not just to age and gender controls, but I can compare them to themselves.”
Ratner said having the baseline test can help determine when an athlete has recovered from a concussion, allowing a physician to clear them for return to play when their bodies are actually ready. He said the danger of returning a student to play too soon could have long term effects.
“Until a concussion is healed, the threshold for re-injury is much lower. So if they’re back to their routine activity and they’re taking big hits, every single one of them exceeds the threshold. Every single one of them is going to make things worse,” Ratner explained. “And by worse I mean more severe symptoms, symptoms that last longer even potentially permanently and in pretty rare conditions you can get something called second impact syndrome which is unfortunately even fatal.”
When it comes to creating a statewide concussion database and clinical study, Ratner believes the UIL is taking a big step in the right direction.
“We still don’t know exactly who’s going to have long-term effects and who’s not going to have long-term effects. So, by gathering the data and gathering this information it will really help us determine over the long-term who’s at higher risk for chronic injuries over many, many years,” Ratner said. “If we can keep track of concussions well it gives us an idea of really the scope of the problem and what we’ll come to realize is we’re not doing enough for them in San Antonio and we need to increase what we’re doing, including adding the baseline concussion studies.”
Interactive Map- https://www.thinglink.com/scene/834916583036944384
Dr. Evan Ratner- http://iuc.nextcare.com/plan-your-visit/services/concussion-care/
KSAT Digital Team Story on Concussion Helmets- http://www.ksat.com/sports/big-game-coverage/tmi-thinks-outside-helmet-to-soften-effects-of-football-injuries-concussions
10-year old Blaine Dyer is getting a checkup of his brain.
Gwinnett Medical Center pediatric neuropsychologist Dr. Adam Shunk wants to know how the Dacula fourth-grader is doing after Dyer took a hard hit during a youth football scrimmage game a couple of months ago.
“When I play football, I don’t cry unless I’m really hurt,” says the Gwinnett fourth-grader.
But, this time, Dyer did cry, for good reason.
“This kid grabbed my legs and then another kid came beside me and hit me right on my head,” he says. “It was hurting my head, because my helmet was squishing my head a little.”
Dyer was taken out of the game, suspected of having a concussion.
That hit may have jarred or shaken his brain inside his skull.
Sometimes there are symptoms, but sometimes not.
And while it’s dangerous to return to play too soon, before the brain has had time to heal, Dr. Shunk says many young athletes may be reluctant to admit they’re hurting.
“I mean every kid wants to get back on the field as quick as possible,” says Shunk. “So they’re not always going to tell you when they’re having symptoms.”
Dyer says he wanted back on the field.
“And I was kind of mad, because I really wanted to play my game, because I’d been waiting for it,” he says.
But a new screening tool could take the guesswork out of screening children as young as 5 for concussion.
It’s called ImPACT Pediatric.
“It evaluates areas that are sensitive to a concussion: such as speed of processing, their learning and memory abilities and general attention, that can be disrupted when you’re recovering from a concussion,” says Dr. Shunk.
Many high school and college athletes already get baseline ImPACT screenings before their season begins.
Then, they retake the test to look for changes in their performance after a suspected concussion.
Now, Dr Shunk says, they can do the same before and after screening for athletes between the ages of 5 and 11.
Blaine Dyer, who is now happily back in the game, recently scored his first touchdown of the season.
It’s really exciting,” he says. “When you first go out there, and you have a concussion. And then you go back on the field and score a touchdown, it’s really cool.”
Galvin, Beth. “New Tool Helps Screen Young Athletes for Concussion.” WAGA. FoxATL, 28 Sept. 2016. Web. 29 Sept. 2016.
At a time when athletes are bigger, stronger and faster than decades ago, precautions are being implemented to reduce the risks of concussions.
McCrabb, Rick. “Concussion Diagnoses in Children up 500 Percent.” News & Information for Hamilton, Middletown and Butler &… Journal News, 21 Sept. 2016. Web. 22 Sept. 2016
The US Food and Drug Administration (FDA) has given its first-ever clearance for marketing of devices designed to help clinicians assess cognitive function immediately after a suspected brain injury or concussion.
Called Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and ImPACT Pediatric, the tool was approved under a new FDA category titled “Computerized Cognitive Assessment Aid for Concussion.” The test battery is already used by more than 7,400 high schools, 1,000 colleges and universities, and 900 clinical centers as a way to test cognitive skills such as word memory, reaction time, and word recognition. ImPACT is designed for use on individuals aged 12 to 59, and operates on a desktop or laptop computer; ImPACT Pediatric is intended for children aged 5 to 11, and is run on an iPad.
While not intended as the sole tool for making a diagnosis or return-to-play decision, the ImPACT device can provide additional evaluative information though comparisons with age-matched databases or patient baseline scores, according to an FDA news release. Pittsburgh, Pennsylvania-based ImPACT Applications submitted more than 250 peer-reviewed articles—half of which were independent clinical research studies—supporting the safety and reliability of the devices.
Prior to the ImPACT approval, the FDA had cleared only devices that help determine the need for imaging after a head injury.
Football season has kicked off, and Friday night lights are shining for parents around the nation. Unfortunately, with football comes injuries, and the most common injuries discussed today are concussions. Even if your child doesn’t play football but is involved in another sport, you should know the definition of a concussion and what this means for your child.
A concussion is caused by a bump, blow or jolt to the body, with a force transmitted to the head, causing an injury to the brain. Because kids are not fully physically developed, having thinner skulls and weaker neck muscles, they are more susceptible to concussions.
Concussions have been estimated to account for 9 percent of all high school athletic injuries. However, it is estimated that 50 percent to 75 percent of concussions among high school athletes go unreported. What is most alarming in youth sports is that those 13 and younger are more likely to receive a concussion, and most of those are not reported.
Before your children get involved in sports, it’s important that you and your kids are properly educated and know what to do if a concussion is suspected. This should start with a checklist of the basics:
▪ Does your child know how to recognize and report a suspected head injury?
▪ Does your child know how to express a head injury to a coach, parent or teammate?
▪ Does your child’s team or league have a concussion protocol?
▪ What type of physician (neurologist, family medicine or pediatrician) would you take your child to for the evaluation and treatment of a concussion?
Once your child has started playing, become vigilant about head injuries. If you suspect your child has suffered a hit to the head, watch for these common symptoms of a concussion:
▪ Confusion or the feeling of being “in a fog.”
▪ Dizziness or balance problems.
▪ Fatigue or drowsiness.
▪ Nausea and/or vomiting.
▪ Sensitivity to light and noise.
▪ Irritability or nervousness.
▪ Trouble concentrating.
If you think your child or adolescent has a concussion, there are a number of dos and don’ts to follow:
▪ Do stop playing – immediately!
▪ Do tell a coach, trainer, teammate, friend or parent.
▪ Do consult a physician.
▪ Do keep hydrated.
▪ Do get some rest.
▪ Don’t continue playing.
▪ Don’t return to sports activities without medical clearance.
▪ Don’t consume alcohol.
▪ Don’t drive.
The nation’s growing awareness of concussions in the last decade has helped pass legislation to improve the treatment and management of concussions, especially in young athletes. State law requires parents, coaches, athletic trainers and, in some states, athletes to provide education about the symptoms and risks of a concussion. During athletic events, an athlete exhibiting concussive symptoms must be immediately taken out of play and is not allowed to return until they have received clearance from a medical professional.
As a result of legislation and research findings, the “6 Steps to Safe Play” were developed. Of particular significance are the tests now available to test your child’s brain function before and after injury. If your teen participates in a school sport, the following “6 Steps to Safe Play” are recommended:
1. Your child should have a preseason baseline, which is completed with ImPACT, a neurocognitive computerized test for kids 13 and older.
2. Sideline testing with SCAT 3, King Devick or BESS should be available.
3. If your child is injured while playing, he or she should be re-tested with ImPACT.
4. If concussion symptoms and ImPACT indicate a possible concussion, immediately seek medical treatment at a concussion clinic.
5. Once cleared by the doctor, your child can return to play and return to learn.
6. The team’s athletic trainers should have access to the Concussion Injury Surveillance System, a tool used to track concussions.
If a concussion is left untreated or an athlete sustains multiple concussions, your child could suffer permanent brain injury. The inherent competitive nature of sports and culture to win at all costs may sometimes overshadow the need to call attention to reporting injuries. As a coach, parent, athlete and even a fan, we must encourage the reporting of head injuries within the sports culture. An athlete’s awareness of the signs, symptoms, and effects of a concussion can only improve the safety of our athletes. Educating all parties, particularly our youth athletes, has shown to increase concussion awareness and reporting, making it a vital component of sports safety this school year.
For more information, visit UConcussion.com.
Gillian Hotz, Ph.D., is the director of the Kidz Neuroscience Center at UHealth – the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.
School is back in session and along with it the fall sports season. Youth sports promote physical activity and camaraderie, and the lessons of team sports can last a lifetime.
But injuries are a reality with youth sports, and kids are especially vulnerable to head injuries and concussions. There has been a lot written about sports-related head injuries in the last few years, yet kids and parents alike often downplay symptoms of concussions and rush too quickly to get back to the field or court.
There has been a lot written about sports-related head injuries in the last few years, yet kids and parents alike often downplay symptoms of concussions and rush too quickly to get back to the field or court.
A new study points out the risk involved with returning to sports too soon after a head injury. Researchers from Arkansas followed 70 young athletes who came to a medical facility for treatment of a sports related concussion. The average age was 15½. Half of the young men and women were removed immediately from play, while the other half were allowed to continue playing. Neurocognitive testing as well as assessment of symptoms such as headache were done a week later then again a few weeks after the first assesment.
The group that was allowed to continuing playing despite concussion symptoms took twice as long to recover compared to the group that was removed from play immediately (44 days versus 22 days). Kids who were allowed to continue playing were also more likely to have a long recovery from concussion symptoms (more than three weeks) including headache, dizziness, impaired cognition, academic, and psychosocial problems. The authors concluded that kids recover from concussions significantly faster if they are removed from participation immediately after their injury compared to those who were allowed to continue playing.
The findings from this study are not surprising. More than 3 million sports or recreation-related concussions occur in the U.S. annually. Adolescents are at the greatest risk for sports-related concussions and recover much more slowly than adults for unknown reasons, but possibly because their brains are still growing and developing.
Research has shown that the injured brain loses its ability to protect itself from a second injury, making the risk of a short-term second impact potentially catastrophic, and the risk is amplified is children and adolescents.
The danger period after a first concussion is unknown but it is likely at least 10 days. But even weeks later, kids can have subtle effects of a concussion, including emotional and mental symptoms including irritability and frustration. The psychological effects of a concussion may even start weeks after the physical effects have resolved.
In 2013, The American Academy of Neurology released guidelines on the evaluation and management of sports concussions. The first recommendation of the guideline is that an athlete suspected of having a concussion should immediately be removed from play and should not be allowed to return to play until evaluated by a trained health-care professional with training in both the diagnosis and management of concussions.
The guideline further recommends that high-school age or younger athletes should be treated much more “conservatively” than college or adult athletes, acknowledging that growing children and adolescents are at much higher risk of serious brain injury.
There is no evidence that any medications or other treatments hasten recovery over simple rest.
For boys, the risk of sports concussion is greatest with football and rugby, followed by hockey and soccer, while for girls the risk is highest with soccer and basketball.
Most sports injuries, such as a sprained ankle or broken wrist, are easily diagnosed and treated. But concussions may represent a far greater and longer-term risk. As a parent or coach, always put the player’s well being first and treat any head injury as a potentially serious injury.
Almost 2 million children could be suffering from concussions, according to a new study, and many of them may go untreated.
The good news is that there’s been a huge increase in the amount of attention concussions have gotten over that past several years, but there’s still a lot of progress that can be made when it comes to taking action, and that’s something coaches in Louisville are working on.
“We realize the importance of it. It’s a danger to the game itself, because a lot of parents will say if my kid’s at risk for suffering a concussion, I don’t want them to play,” said Larry Handley, the player safety coach for the St. Stephen’s Bulldogs.
“My responsibility is to make sure that all the coaches are trained,” explained Handley.
To do that, he put all his coaches through an hour and a half seminar, looking at the causes and signs of concussion, and what to do if someone gets one. “There’s a protocol we go through, it’s about a five-day thing to make sure that, that player has fully recovered. We do require a doctor’s signature saying that kid is clear before we can bring them back in.”
Handley say it’s important to talk with your players and keep a close on them. He says you should look to see “if a player is looking a little bit unsteady on his feet, like he’s a little dazed.” A player for getting a play, or a change in personality can also be symptoms that can be harder to notice.
Contact sports like football aren’t the only culprit leading to concussion. “It can occur on the setting of a playground. It can occur in a youngster that’s just out at the pool having fun during the summer,” explained Dr. Tad Seifert, the director of sports concussion program at Norton Healthcare.
“It’s a type of traumatic brain injury, more on the mild end of the spectrum and anytime someone is hit in the head, or even gets hit in the body, you have this movement of the head and neck and the movement of the brain within the skull it reverberates back and forth and moves back and forth and it’s that sudden movement of the brain within the skull that causes the injury of concussion,” said Seifert.
Studies show the force involved in a concussion are the same as if someone driving around 30 miles per hour ran into a solid wall. It’s a huge amount of force being put on the brain.
To help people recover, Seifert says, “the cornerstone of treatment is first and foremost to remove that individual from further contact risk to prevent them from further hurt and long term consequences from the injury.”
That’s exactly the plan Handley has to keep his players safe, making sure they don’t go back on the field before they’re ready. “Safety is more important than winning, safety is more important than the best player, it’s more important than anything,” said the coach.
To help prevent concussion before it happens Handley explains that they teach players “Heads Up Football.”
“It’s a method of tackling, and a method of blocking that teaches players when they block and tackle to always keep their head up and never lower their head, because that’s when you run the risk of not only concussions, but also neck injuries.”
Athletes at schools in Floyd County, Ind. have some new equipment to help prevent concussions this school year. With help from a grant and Norton Healthcare, the district will get more than 200 new football helmets, with some of the highest safety ratings available. Norton Healthcare did the same thing for JCPS last year.
A study released Wednesday states the number of people diagnosed with concussions is growing mostly in adolescents.
The study conducted by University of California San Francisco is advising adolescents to educate themselves about concussion diagnosis, prevention and treatment.
The research is in the Orthopaedic Journal of Sports Medicine online.
“Our study evaluated a large cross-section of the U.S. population,” said lead author Alan Zhang, MD, UCSF Health orthopaedic surgeon. “We were surprised to see that the increase in concussion cases over the past few years mainly were from adolescent patients aged 10 to 19.”
Zhang and other researchers looked at the health records of over eight million members of a huge, private payer insurance group called Humana Inc between 2007 and 2014. People under the age of 65 diagnosed with an concussion were classified by the year they were diagnosed, sex, concussion classification, age group and where they were diagnosed.
About 44,000 people were diagnosed with a concussion and 55 percent of them were men. The highest age group with this diagnosis were between the ages of 15 and 19 with 16.5 concussions for every 1,000 patients.
Fifty-six percent of those diagnosed in with a concussion found out in the emergency room while 29 percent found out in a doctor’s office.
During Daniel Longoria’s helicopter ride to UAB hospital, he wasn’t sure what was happening — but he felt he might be getting abducted by aliens.
The then-senior offensive lineman at Alexandria High School had just suffered a concussion during a preseason scrimmage. He was in and out of consciousness, had a tube put down his throat and had strangers prodding him.
Although he has since recovered, it was a scary time for the Longorias and the Alexandria football team. His twin brother, Joshua Longoria, couldn’t bring himself to go to the hospital at first.
“When this happened, you almost thought he was dead,” Joshua said. “He was barely breathing, he was unconscious, he wasn’t responding. We couldn’t get him to wake up no matter what he did.”
Concussions and how high school sports teams handle them have become a much more serious issue from the days when coaches simply said an athlete “got his bell rung” and allowed him to continue playing.
While the National Football League wrestles with how to diagnose and treat concussions, high school football teams are no different.
A concussion is defined by the Centers for Disease Control and Prevention as a traumatic brain injury that causes the head and brain to move back and forth, often because of a blow or bump.
According to figures provided by the National Federation of State High School Associations, high school football participation has dropped 2.6 percent from 2009 to 2015, which is the most recent year figures are available.
While the statistics don’t include a reason for the drop, Roger Blake, executive director of the California Interscholastic Federation, told Sports Illustrated, “Think of how far we have come in the last 20 to 30 years when it comes to concussion awareness, tackling techniques, equipment. And yet we’re still having these discussions about declining participation and safety concerns.”
Daniel’s injury was not the first experience the Longorias had with concussions. Joshua sustained one in Alexandria’s jamboree game in 2014. He remembers the exact play.
“I was pulling around to make a block,” Joshua said. “It happened so fast. It was a guy about my size, and instead of raising my arms … I reared back and head butted him in the chest. It was kind of a stupid move, and it rung my bell.”
He felt like everything was moving slower and spinning, but he didn’t tell anyone until the third quarter. His coaches didn’t notice at first because he didn’t seem to have any symptoms.
But when he finally sat down, his symptoms hit. Everything was really loud and bright and an intense headache set in. His teammates thought he might have a concussion when he started acting strange. By the time the trainer came over, he couldn’t stand. Five minutes later, he was losing strength, and his mom, Rebekah Longoria, drove him to the hospital. At Anniston RMC, light caused him to shake.
“They asked me who the president was, and I said Nixon. I don’t know where that came from,” Joshua said. “They asked me what my name was … I told them my name was Big Longo.”
The next morning, he could remember football, but he couldn’t recognize his family or remember his name.
After more than 30 years coaching, Michael Shortt, head football coach at Cleburne County High School since 1998, has seen gradual changes in how concussions are assessed and treated — changes for the better, in his opinion.
“Anything safety-wise that can enhance our game and make it safer for kids, I’m all for that,” Shortt said. “We’re going to do that here.”
Shortt remembers sustaining concussions during his playing days.
“My coaches took care of me then,” Shortt, a 1980 graduate of Cleburne County, said. “They knew something wasn’t right.”
Last year, the state limited the number of hours of live contact in which football teams could participate, according to the AHSAA.
Ron Ingram, an AHSAA official, said a school ignoring the state’s concussion protocol is rare. The protocol was adopted by the state Legislature in 2011 to apply to all youth associations. If a doctor, trainer or coach suspects an athlete is suffering from concussion signs or symptoms, such as dizziness or confusion, that athlete is removed from play and cannot return until he or she is cleared by a medical doctor.
“There’s three things the AHSAA puts most importantly,” Ingram said. “One is health and safety. Second, fair play and the third thing is sportsmanship.”
State regulations serve as a baseline for schools’ concussion protocols, according to Randy Beason, athletic trainer at Cleburne County and Alexandria high schools.
Beason uses the Standardized Assessment of Concussion, which measures orientation, immediate memory and concentration among others. He also uses the Balance Error Screening System, to assess potential concussions. An athlete is assessed a day later. After Beason observes concussion-like symptoms, he takes the athlete out of practice and informs the parents and coach. A physician then takes over and determines the next steps. Beason typically will enact the concussion protocol if he observes more than two symptoms.
“I treat them like my own child,” Beason said. “If I’m not going to let my child play, I’m sure not going to let anybody else play.”
At Cleburne County, Shortt will keep a player with a concussion out for at least seven days.
Athletes who suffer a concussion need brain rest, which extends beyond the football field, according to Michael Herndon, who served as team doctor at Jacksonville State University for 10 years and Alexandria’s team doctor for 17.
“Our typical protocol is if you get a concussion … shut it down, do nothing, no exercise, no contact, no nothing, until all neuro symptoms abate,” Herndon said. “That may be days to weeks, depending on the kids.”
After symptoms abate, Herndon looks at how long symptoms lasted and determine when athletes can be eased into play. If there are no symptoms after days of exercise, the athlete can return.
“Everybody wants that crystal ball answer, when can I go back,” Herndon said. “Well, when you quit having neuro symptoms. And that’s different for every individual and that’s even different for every concussion.”
Issues with self-reporting
Ingram said coaches and trainers are taught to recognize symptoms because athletes won’t self-report.
Beason said athletes not self-reporting concussions are only hurting themselves.
“Football’s never worth dying over,” Beason said. “I don’t care who thinks it. I would prefer them to self-report it. That way it’s less damaging to everyone, team included.”
Shortt said that is why it is important for coaches to know their players and be able to spot the signs of injury.
“The athlete that really wants to be there … they’re not going to report an injury,” Shortt said. “That’s why it’s important for coaches to know your kids.”
Beason has had parents try to go over his head, but he typically is able to talk to them.
“They may only play sports in high school,” Beason said. “They’ve got the rest of their life to live, including a family.”
According to Ingram, the AHSAA member schools came up with the rules, and the AHSAA simply enforces them. Coaches are required to receive training to recognize concussion symptoms because he said most injuries happen in practice.
Though Daniel’s injury looked worse, Joshua had the worse concussion because he stayed in the game.
“(Joshua) scared us in the long run; Daniel scared us in the short run,” Gary said.
Both brothers received outpatient treatment at the concussion clinic at UAB. Rebekah said this helped them understand more of what was happening with Daniel’s concussion.
“They actually got our names mixed up a couple times,” Joshua said. “Because they thought it was me coming back for more appointments when it was actually Daniel.”
Joshua’s injury had lasting effects. Most of his childhood memories come from photographs and others’ accounts. He experienced some personality changes, too. He called himself a “book nerd” in the past, but is more impulsive now.
He suffered another concussion in a car wreck and was diagnosed with post-concussion syndrome. He had concentration issues and sometimes his vision would go black and white.
“Basically, it was like my head resetting itself,” Joshua said.
The whole experience was overwhelming, especially the depression that can come with head injuries, according to Daniel. School was especially difficult for Joshua because of all the people he didn’t recognize talking to him. Not being on the field hurt for the brothers. However, they had a support system of friends to help them through. Without his group, Joshua thinks he might have had a “meltdown.”
“I actually had my buddies, they would walk with me around to every class, and if I started getting a look on my face, they knew I was starting to go into panic mode because I was scared,” Joshua said.
Daniel added that the group of offensive linemen jokes around a lot. Said Joshua: “They really helped us become strong again.”
More than preps
Concussions affect more than just football, according to Ingram, who cited examples of people getting concussions from using their heads in soccer.
“The whole purpose is to make the game safer,” Ingram said. “It’s not just football, it’s all sports.”
Concussions are diagnosed more often now because people know what to look for, according to Beason. Diagnosing concussions is much different now than as recent as a decade ago, according to Beason, who called it a “night and day” difference.
“Back then, you could get your ‘bell rung’ and when symptoms subsided, hey, we may let you go back in,” Beason said. “That’s not the case now.”
Shortt said bigger and stronger athletes are affecting the game. He stressed the importance of teaching proper tackling and using safe equipment.
“Any coach that doesn’t spend his money on good equipment is crazy,” Shortt said.
And that extends beyond concussion protocols, Ingram said. Coaches must also take a class on heat safety and learn the signs of someone going into cardiac arrest. They also must have a current certification to perform CPR and use an Automated External Defibrillator.
Beason believes concussion safety extends beyond high school. He said parks and recreation coaches must receive concussion safety training now.
“You’ve got some parents out there, old-school dads, that remember, ‘Hey, I got hit like that before, and I’m fine,’” Beason said. “Well, just how fine are you? At the same time, the education is there, we’ve just got to utilize that education.”
Love of the game
Through his sons’ experiences, Gary has learned a lot about concussions. He now thinks concussion patients should stay out longer. As Daniel and Joshua were preparing to return to football, many of the tests assessed reaction time. Joshua was held out even after he had no physical symptoms for a while because his reaction time was still slower than normal.
“These tests they do pick up on subtle things,” Rebekah said. “They know your brain’s not completely healed yet.”
Rebekah, who is a registered nurse, had a hard time relaxing at the Valley Cubs’ football games after the concussions. Gary and Joshua said Rebekah was always calm during crises.
“I told the doctor, ‘I live to watch them play ball,’” Gary said. “If the doctor told us, ‘It’s over. He can’t play any more.’ it was going to be a hard decision, but we were going to accept that.”
Despite the risks, they still love football.
“To tell you the truth, I wish I had another year to play,” Daniel said. “I kind of miss all the summer workouts and stuff.”
Added Joshua: “The game outweighs the risk. You can get hurt just riding a bike down the road, you can get hurt walking out to get your mail out of your box. If you’re going to get hurt doing something, you might as well be doing something you love.”
We often hear concussion is a worry for parents whose tween or teen participates in sports. What usually gets less attention is that younger children also suffer from concussions and that their symptoms may not have a typical manifestation.
Is there concern if your younger child has suffered a concussion and you missed it? Here is some information to help you answer these questions.
1. We depend on the child’s complaints, performance and behaviors to diagnose a concussion. Concussion is a brain injury caused by a forceful bump, blow, or shaking of the head. The head does not need to be hit for the brain to be injured as some concussions occur only with head shaking, especially if the shaking is sudden and forceful. The brain injury cannot be detected by taking CT or MRI pictures of the brain.
What causes the brain injury in concussion is a change in the way brain cells use energy, communicate with each other as well as leaking of blood chemicals into the brain rather than physical changes in the brain. The doctor will know if a child has suffered a concussion based on the child’s complaints, level of functioning, and behaviors that imply that the brain is not functioning normally.
Credit: JAMA Pediatrics
2. Concussions are becoming more common in younger children. A recent article describing 8,000 concussions occurring in the Children’s Hospital of Philadelphia health system between 2010 and 2014 reported thatone-third of all concussions occurred in children under the age of 12. Many of these concussions were first treated by the primary care provider and not the emergency room showing that pediatricians are the ones that handle most concussions in younger children. While this is anecdotal, I can say that as a pediatrician, I have noticed in my practice that I am seeing more concussions and those occurring at an earlier age than perhaps 10 years ago.
3. The child’s complaints, performance, and behaviors that doctors use to diagnose concussion differ with the child’s age. Typically, concussion in a child 12 years or older is spotted by the coach or parent after a sports injury when he or she shows typical symptoms of fainting, nausea, headache, memory or concentration problems, balance problems or vision problems immediately following the injury. This is often suspected after a positive “sideline” assessment using a standard concussion questionnaire. In a younger child, the symptoms may be different.
A younger child might injure his or her head at home, playground, school or day care. The parent might not be aware of the circumstances or even that the injury occurred. A child may underreport symptoms to avoid getting in trouble or to go back to play. A child may also over report symptoms to skip school. A younger child should be suspected of having a concussion if there is a head injury AND the child has symptoms such as irritability, sudden mood changes, appetite change or sleep problems. These symptoms may be alone or in addition to the typical symptoms of loss of consciousness, nausea and vomiting, headaches, balance problems, and concentration difficulty seen in older children.
What if I missed a concussion in my child? Are there future consequences? We know that head injuries cause worse concussion symptoms if the child has had a previous concussion. Children having multiple concussion are at increased risk for prolonged recovery. Here is what you can do to avoid missing a concussion and to prevent long term consequences:
Read up on signs and symptoms of concussion. Then you will be less likely to miss one. One of the best places to read about concussion in children is the Centers for Disease Control and Prevention website called HEADSUP.
When in doubt, see the doctor. If you suspect a concussion, then go to your child’s doctor as soon as possible. An emergency room visit is warranted if your child has any of these symptoms: progressively worsening headache, vomiting, difficulty waking up or paying attention, seizures, slurred speech or balance problem on standing up.
Rest is always the first step. If you suspect a concussion, having your child rest physically and mentally, and removing her from sports is always a safe bet until you can see or talk to your doctor. This is important since treatment of concussion starts with this kind of rest. Your doctor will recommend the ultimate duration of this rest and if any additional treatment is needed.