The words themselves are jarring: traumatic brain injury.
That phrase is the simplest definition of a concussion. No wonder the affliction has become a growing concern in the realm of sports, particularly in football.
Just last month more than 2,000 former NFL players filed a lawsuit accusing the league of covering up information linking football-related injuries to long-term brain damage. Everything from memory loss to drastic behavioral changes and dementia has been linked to the aftermath of concussions in reports over the past few years.
In July, 2011, the School Sports Head Injury Prevention Act went into effect in Kansas, establishing a statewide protocol for how athletes playing for their schools should be handled if suspected of suffering a concussion or head injury during a competition or practice. The athlete in question has to be removed from competing or practicing and can’t return until a health care provider (defined by KSHSAA as a medical doctor or a doctor of osteopathic medicine) has conducted an evaluation and provided written clearance — which should not be on the same day as the injury.
There are no specific rules, however, about how a student-athlete should be tested for a concussion. That can vary case by case, depending on what doctor an athlete sees or where the athlete goes to school.
In the Lawrence school district, concussed students might soon have the option to utilize a computerized system widely used in the college and professional ranks called ImPACT (immediate post-concussion assessment and cognitive testing). Free State High athletic director Mike Hill said he and Lawrence High athletic director Ron Commons were approached by Lawrence Memorial Hospital about implementing the baseline test in the district.
ImPACT and other baseline tests measure how an individual’s brain works in its normal state. Using that information, it is easier to track any changes in the brain’s functionality and determine when an athlete truly is ready to return to action.
“Obviously, there has been a lot more attention paid to concussions the last few years, and rightfully so,” Hill said, noting local doctors are educating school athletic directors on the importance of baseline testing. “It seems like a very important step for us to take.”
Hill said it is possible LHS and FSHS athletes could have the option of using ImPACT when the new school year begins.
ImPACT is just one of the tools used at Kansas University when doctors and trainers are evaluating concussed athletes. Certified trainer Matt Kuehl said the KU staff uses a battery of assessments, including a paper cognitive test called the Sideline Assessment of Concussion. Plus, the staff is implementing the Balance Assessment Scoring System to capture lingering post-concussion balance issues.
KU athletes, who are removed from participation until cleared by the KU medical staff, take the ImPACT test the day of their injury, are asked to rate their symptoms daily as part of the process and take the ImPACT test again when they report they feel normal. Kuehl said once athletes have returned to their baseline levels, they begin a graded return to activity and contact after being cleared by a team physician.
Uneven playing field
But such tests aren’t available to every high school student in the Sunflower State. As Tonganoxie High athletic trainer Mark Padfield sees it, that lack of continuity could be to the detriment of some young athletes. Public relations officer for the Kansas Athletic Trainers Society, Padfield said the best way to improve overall player safety is to increase athletic trainer coverage or increase the availability of baseline neurocognitive testing, such as ImPACT.
“That really takes a lot of the guesswork out of it if you have that tool in your arsenal,” Padfield said.
Without a baseline option, the THS trainer said testing becomes more subjective, “because you’re relying more on the skills of your medical staff, whoever that may be.”
At the high school level, Padfield said baseline tests make it a lot harder for athletes to hide their concussion symptoms. While some larger schools have ImPACT or something like it, many smaller ones such as Tonganoxie and Baldwin high schools don’t currently have that luxury.
Gary Stevanus, athletic director and trainer at Baldwin, said he and other district officials have looked into ImPACT, but they didn’t think it had become mainstream enough to be a viable option locally. Stevanus said they needed to know the data would be interpreted by someone with a proficient level of expertise.
“Yeah, it’s another tool,” Stevanus said, “but are you really getting the full force of the program?”
At the very least, Padfield said schools that have a full-time athletic trainer on staff have a step up on other athletic departments in the state that don’t.
“They’re relying on a coach that has a minimal part of training on concussion awareness,” Padfield said, adding it is hard for coaches to recognize every head injury when they’re busy with other parts of a practice or game.
Free State football coach Bob Lisher is grateful to have a training staff handy. “We see anybody who’s been dinged or not acting right, we immediately send them to the trainer,” he said.
LHS football coach Dirk Wedd agreed: “It takes it completely out of the coaches’ hands.”
Terri Brandley, Kansas University Hospital concussion coordinator, said when injured athletes visit the facility, they receive a comprehensive physician exam post-injury, then another one at least 72 hours later. After that, Brandley added, periodic exams including ImPACT evaluations are done before beginning a supervised gradual return to play, as well as school or work.
The following are other guidelines employed at KU Hospital:
n Concussion patients, particularly adolescents, should be followed very closely medically to avoid any complications.
n Concussion patients should be gradually returned to play/competition in 24-hour increments; if symptoms return, then go back a step until symptom-free under medical supervision.
n Gradual return to school/work is also recommended until the patient is symptom-free. KU physicians provide academic/work accommodation modifications according to the patient’s needs.
n The KU nurse clinical coordinator makes contact with patients between appointments, provides ongoing concussion education and helps the patient to navigate the healthcare system.
Dr. Randy Goldstein, director of youth and adolescent sports medicine at KU Hospital, said ImPACT testing has been used on athletes as young as 5 years old. Various doctors, he said, are comfortable down to a certain age for their exams, and pediatric ages can be evaluated with slightly different tools than adolescents and adults.