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High School Sports

High School Sports

Area schools explore best safeguards for concussed athletes

Local coaches and trainers say they're increasingly wary of the dangers of potential brain injuries.

Local coaches and trainers say they're increasingly wary of the dangers of potential brain injuries.

July 18, 2012

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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.

ImPACT

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.”

Testing rundown

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.

Comments

Belinda Rehmer 2 years, 3 months ago

Lawrence Memorial Hospital has 2 local physicians (at this time) certified to conduct the imPact testing for student athletes. Daniel Dickerson, MD, Phd, Eudora Family Care was the first to become certified in this area and Thomas Marcellino, MD, Mt Oread Family Medicine soon followed.

Because LMH recognizes the importance of the baseline test in accurately predicting when an injured student's brain is ready to return to play, Daniel Dickerson and Adam Rolf, PT proposed they cover the additional cost of administering the test, resulting in both Lawrence and Eudora School Districts will begin providing the baseline test this fall to all high school athletes in association with their sports physicals.

In addition, this simple 30 minute computerized baseline test, is available for individuals by calling Mt. Oread Family Practice at 785.842.5070 or at Eudora Family Care 785.542.2345 for as little as $25.

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steve777 2 years, 3 months ago

Experts agree, Impact testing is effective in evaluating post injury. It does nothing to prevent minor events during play. Players hide injury. A corrective oral appliance may help those with Temporal Mandibular Joint Dysfunction or the boxers "Glass jaw". Have your team dentist certified in this procedure. www.mahercor.com has more info in this technology recognized by the U.S. Military.

Peer reviewed by Dr. Jeffery Shaefer Harvard/MGH

http://www.ncbi.nlm.nih.gov/pubmed/19614931

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Shelley Bock 2 years, 3 months ago

Referees working for KSHSAA were instructed in the 1990's to recognize the effects of concussions. If anyone lost consciousnesses as a result of any reason, they were deemed unfit to continue play and automatically disqualified.

It was clear that if the referee failed to take action and the player's health subsequently declined, the referee was as responsible as any coach would be for permitting the player to remain.

Good coaches protect their players' health, no matter what the consequence to the team. High school players aren't professionals. Sad if a team losses, but better to go down on the field of play than to the cemetery or the care facility for a fallen teammate.

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CheneyHawk 2 years, 3 months ago

Sounds like the KSHSAA should be chiming in on this matter and making an IMPACT statewide. Where are you KSHSAA????

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slider88 2 years, 3 months ago

Speaking from first hand experience. The only concern KSHSAA has is for it's own legal rear end. They are slow in adopting any type of accountability for itself or for the referres/umpires that represent the organization. Again, they view that the schools and coaches are the only entities that are liable and accountalbe for injured students. Frankly, I have had several student athletes go throught the KS school systems and the quality of officiating is declining. KSHSAA does not want to step up to the challange of keeping athletes safe. They claim to take thier direction from the National organization. KSHSAA has become the evil empire, unwilling to listen and learn.
Parents, insure your local coaching staff and AD recognize head injuries and how to treat them. KSHSAA will be of NO help.

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Lawrence Morgan 2 years, 3 months ago

I wonder if concussions result in not being able to drive (suspended license) - I think they may do this in some states.

If they were to take this into consideration (providing it is true in Kansas), many more players would consider not playing, for example, football.

The following is one example of the material available on the web:

http://www.brainline.org/content/2009/05/ask-the-expert-driving-after-a-sports-concussion.html

and there are many other sources of information on the web, as well.

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Clickker 2 years, 3 months ago

When I was a kid, they just rubbed a little dirt on your head, and sent you back into the game.

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