Medical Breakthroughs 2013: The State Gets Serious About Concussion Prevention
One of the Hudson Valley’s top medical breakthroughs in 2013
Bumps and bruises are an everyday part of student athletics, from football to soccer. But when it comes to head injuries and concussions, more coaches, educators, and health experts are nowadays taking a red-light stance to the “tough-it-out-and-get-back-in-the-game” attitude that often prevailed in the past.
“There’s been more awareness about concussions lately because of media attention across the nation on the topic of head injuries, especially at the professional level,” says Todd Nelson, assistant director of the New York State Public High School Athletic Association, which is based in Latham.
And the American Association of Neurological Surgeons says more than 300,000 sports-related concussions occur annually in the U.S. — with the likelihood of suffering a concussion in a contact sport as high as 19 percent per year of play. More than 62,000 concussions are sustained each year nationwide in high school contact sports alone.
When it comes to protecting young athletes, New York isn’t sitting on the sidelines — it has joined at least 33 other states in issuing revamped regulations to help schools deal with prevention and treatment of sports-related concussions.
In July 2012, Governor Cuomo signed a state law containing several key provisions: Parents must sign permission slips before kids can practice or play in games, and schools must pull children from play immediately if they’re suspected of having suffered a concussion.
“In addition, student athletes are now required to be kept from play until they’ve been symptom-free for at least 24 hours following a possible concussion, and must have written medical clearance before resuming,” according to Nelson, who says the NYSPHSAA — which is affiliated with nearly 800 schools in the state — worked with Albany legislators to draft the new law, the Concussion Management and Awareness Act.
The mandate also requires certain school staff, such as coaches and trainers, physical education teachers, and nurses, to undergo concussion-management training; many schools are also offering more head-injury information on their Web sites, too.
“About one-third of the school districts we work with already had some kind of concussion-training program in place; this requires all school districts to have a program,” says Nelson, who says the new requirements apply to grades seven through 12 interscholastic programs in New York public and charter schools.
Experts say all this is a step in the right direction, because a concussion — a jarring of the brain or spinal cord — is no laughing matter. True, a conk on the head might cause nothing more than a few seconds of “seeing stars,” and kids — sometimes even parents and coaches — may downplay these accidents, allowing a child to return immediately to the playing field. But a bump to the head can sometimes trigger anything from temporary confusion to a brief spell of amnesia. In severe cases, unconsciousness can occur; if another blow to the head happens during recovery from a concussion, permanent brain injury — and even death — can result.
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There’s an app for that
Educators, parents, and kids themselves should be alert for suspicious signs — including dizziness, headaches, and the lack of ability to focus — after a child suffers a bump to the head. Some school districts are even turning to computers to monitor students’ conditions. One neurological software program, known as Immediate Post-Concussion Assessment and Cognitive Testing (or imPACT), offers a 20-minute battery of computerized questions and tests for student athletes.
“It’s a baseline test that measures things like memory, attention span, and reaction time,” says Nelson, adding that several local school districts are using it.
The kids can take the test prior to the sports season, and then, if a concussion is suspected, can retake it to compare their responses. It’s estimated to cost about $1,000 per year for a school to test 1,000 student athletes with the imPACT program.
At Yorktown High School in Westchester County, “We were ahead of the curve regarding concussion management,” says athletic trainer David Byrnes. “We’ve had a policy in place since 2010. Concussions aren’t new to athletic trainers. What is new is the advances in technology and information. A concussion can affect the body in many ways — physically, emotionally, cognitively.
“And now, it’s widely known that a condition known as second-impact syndrome — a second concussion on top of an existing one that hasn’t fully healed — can be catastrophic, even deadly in some cases. Our student athletes can’t return to sports until they’ve been cleared by the school’s medical director,” says Byrnes, who’s been with the district for 10 years. He estimates that last year, about 16 school athletes were treated for concussions. “This year, it’s already more than 20 — not because it’s happening more, but because everyone is so attentive,” he says.
In addition to assessing possible concussions, the school’s staff helps get young athletes back into their game after a head injury when the time is right. “It’s gradual, just like if a student had a physical injury to a muscle,” says Byrnes.“The program is actually for the whole school setting — not just athletes, but also kids in elementary school who might fall on the playground, students traveling as a team — any head injury.”
As a student athlete recovers from a concussion, he says, “We have them do non-contact, sports-specific activities as we monitor them. For instance, with basketball, they might practice running, dribbling, shooting — but no drills where they might collide with other players. Every concussion is different and treated individually,” he adds.
Among other computer options, the XLNTbrain-Sport program includes baseline testing, post-concussion assessment tools, plus smartphone based sideline assessment tools. And smartphone apps are now even available. One, the Concussion Recognition & Response app, was created by two neurology experts and guides users through a list of possible concussion symptoms in just a few minutes; results can then be e-mailed to health care providers for further assessment.
Another brand-new gizmo, unveiled by Reebok in 2013, is the Head Impact Indicator. The thin, black skullcap contains small, wearable sensors that activate a red or yellow light if a player is hit too hard. Verizon and Intel are among other companies also building concussion-detection systems.
“These types of tests can be useful tools, but they’re not a be-all and end-all,” says Nelson. “The important thing is concussion prevention and education.” And the best guidelines for student athletes suspected of having a concussion during a game? “When in doubt, sit it out,” he says.
Head injuries in the headlines — and the courts
Concern over sports-related head injuries has been in the national spotlight recently, with several high-profile former sports pros dealing with the effects of head trauma. Sadly, at least six former National Football League players (Jovan Belcher, Dave Duerson, Ray Easterling, Junior Seau, Kurt Crain and O.J. Murdock) have committed suicide since 2011; their deaths are possibly linked to after-affects of blows to the head.
More than 4,000 former pro football players have also united to file a class action lawsuit against the NFL, claiming the league downplayed or downright concealed information about the link between concussions and possible life-altering brain injuries. This complex case is likely to drag on; meantime, the NFL says it’s amping up rules and requirements for head-injury safety on the field, and concussion management off of it.
Worries aren’t just for pro players, either.
On the college front, the National Collegiate Athletic Association, like the NFL, has been criticized by some for how it handles concussions. In 2011, a class action suit was filed against the NCAA, alleging it was negligent in safeguarding student-athletes from the risks of concussions; the case is still wending its way through the legal system.
Even President Obama — a self-proclaimed football fan — tackled the subject of sports injuries. Last January, the president expressed concern over head injuries among college players, adding that he would hesitate to allow a son — if he had one — to play football. His worry, Obama said, was less about professional football players than students involved in college football, which has no union to protect participants.
The NCAA does require member universities to maintain and follow a concussion management plan, and offers safety guidelines, but leaves it up to each school to implement them.
The American Association of Neurological Surgeons lists these concussion symptoms:
- Prolonged headache
- Vision disturbances
- Nausea or vomiting
- Impaired balance
- Memory Loss
- Ringing ears
- Difficulty concentrating
- Sensitivity to light
- Loss of smell or taste
If any of these occur after a blow to the head, a health care professional should be consulted as soon as possible.