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Concussions policy fuzzy for student athletes

An estimated 92,000 high school athletes suffer concussions each year in the United States — yet in Colorado, more than a quarter of high schools surveyed have no written policy governing how sports-related head injuries will be treated or when injured athletes may return to play.

And among those that do have a policy, 18 percent said it’s the coach who determines when an athlete is ready to return and 15 percent said it’s the parents who decide.

That scares Chris Mathewson, the head athletic trainer at Ponderosa High School in Parker, who helped organize the survey in January. Just over half the state’s high schools – 167 – responded.

“Of course, both the coaches and the parents are critical in the decision-making, but none of them are likely to have medical training,” Mathewson said. “A lot of people are involved when an athlete suffers a concussion – parents, coaches, physicians, the students – and they all bring different skill sets to the table. I had a parent come to me once bringing in an article on concussions from Popular Mechanics. Concussions are not like ankle injuries. They don’t fit in a box. Each concussion should be treated individually, and it’s crucial that you get objective data.”

A study released by the Center for Injury Research and Policy at Nationwide Children’s Hospital last year showed that between 2005 and 2008, about 40% of athletes who suffered concussions were allowed to return to play too soon. The study found that in the 2007-08 season alone, 15.8 percent of football players who sustained a concussion and lost consciousness returned to play the same day.

Douglas County schools have developed one of the most comprehensive policies in the state regarding concussions in student athletes. On Saturday, the district hosted a seminar drawing dozens of coaches, athletic trainers and health care providers from around the metro area to share what they’ve learned. Even Steve Antonopulos, head trainer for the Denver Broncos, was there.

Scroll down to the end of the story to see a short video from the seminar.

Around the country, concussions are a hot topic among athletes, from Little Leaguers to the National Football League. Last year, Washington and Oregon passed laws requiring all high school coaches be educated about the danger of concussions, and requiring any student athlete suspected of sustaining a concussion be immediately removed from play. In January, the Colorado High School Athletic Association ruled that beginning this fall, no student athlete who sustains a concussion can return to action without a doctor’s written permission.

The days of dismissing such head injuries as “a ding” and encouraging young athletes to shake it off and return to the field of play are gone, Mathewson said. “We now know that every concussion is a brain injury and it can be serious. We’re trying not to be dismissive any longer.”

“Concussions” are any disturbance to the brain function that occurs following a blow to the head or violent shaking of the head. They can occur in any sport, though football accounts for nearly half of the concussions diagnosed among high school athletes. That’s followed by girls’ soccer, boys’ soccer, girls’ basketball and wrestling.

Symptoms vary, so diagnosis can be tricky, but in general the signs of concussion may include confusion, forgetfulness, clumsy movement, slow verbal response to questions, amnesia, loss of consciousness or change in personality or behavior. Those who’ve experienced a concussion may report having a headache, nausea, double vision, a sensitivity to light, sluggishness, changes in their sleep patterns or concentration and memory problems.

Most people who sustain a concussion recover fully, but 15 percent experience ongoing symptoms for a year or longer, Mathewson said. Allowing athletes to resume playing too soon after suffering a concussion can lead to lingering neurological problems or catastrophic injury.

In 2004, Jake Snakenberg, a freshman football player at Aurora’s Grandview High School, collapsed on the practice field and never regained consciousness. His cause of death was later determined to be “Second Impact Syndrome.” He had likely sustained a concussion the week before, but his symptoms were mild and had never been treated.

“The recognition and management of a mild head injury is one of the most challenging problems faced by athletic trainers, team physicians and other medical professionals,” Mathewson said. Concussions are difficult to assess without objective measurements. Symptoms can be subtle and athletes may be tempted to mask their symptoms so they can return to the game more quickly.

In Douglas County, athletes who appear to sustain even a minor head injury are quickly given a standardized assessment to test their ability to concentrate, to commit things to short-term memory and neurological reaction. A perfect score on the test is 30. If they score 24 or less, they’re removed from the activity, and their parents are contacted and advised to have the child see a physician.

The next day, they’re given a more extensive neurological evaluation, called an ImPACT test, short for Immediate Post-concussion Assessment and Cognitive Testing. It was developed by a group of doctors at the University of Pittsburgh Medical Center, and has been adopted by a number of professional sports organizations, including Major League Baseball, the National Hockey League an the National Football League.

“It assesses memory, reaction time, other symptoms,” says Peter Thompson, Douglas County School District psychologist. “It’s actually similar to what I do as a school psychologist.” Thompson says he has encountered parents, anxious for their children to return to sports, who try to convince him to dismiss the results of the ImPACT test, but he’s found it to be highly reliable.

In Douglas County, athletes – including cheerleaders – are given a baseline ImPACT test before they start playing sports. If their ImPACT score following an injury is significantly different from their baseline score, they’ll be sidelined for at least seven days, says David Whitelock, head athletic trainer for ThunderRidge High School in Highlands Ranch.

But seven days may not be long enough, says Mathewson. So athletes are led through a gradual return to activity. The steps include:

* Rest until the athlete no longer exhibits any symptoms.

* That’s followed by a return to light aerobic exercise

* Then sport-specific training.

* Then non-contact drills.

* Then contact drills.

* And finally a return to game play.

If the symptoms of concussion recur at any point, the athlete drops back to the previous level.

“This is one of the things we’re trying our hardest to convey to the medical community,” says Mathewson. “Sometimes we get notes from doctors saying ‘Athlete may return in seven days.’ That’s the old-school ways of doing it. I’m not saying that’s wrong but science has evolved past that. One kid might need seven days, another might need 21. But if they’re holding a note from a doctor saying the kid can return in seven days, that handcuffs us. Some kids might be ready, but others might not be anywhere near their baseline.”

Thompson said that children react differently to concussions than adults do. “It’s better to have a concussion when you’re an adult than when you’re a child,” he said. “Children’s injuries take more time to come back, and they’re more susceptible to later damage. So you can’t apply conclusions from adult studies of concussions. That’s why we feel it’s better to be more conservative.”

Mathewson said that, in Douglas County, the athletic trainer has the final say on who can or cannot play. “We’ve had a couple of instances where parents were pounding on our door, wanting their kids to return to play, but we always have the final say.”

For more information:

An excellent resource for schools, families and health care providers on dealing with concussions is “The Benefits of Good Concussion Management,” a toolkit produced by the REAP Project, a partnership between Rocky Mountain Hospital for Children at Skyridge Medical Center, Swedish Medical Center and several local school districts.

The March 2010 issue of the Journal of School Health includes an evaluation of the Center for Disease Control’s “Heads Up: Concussion in High School Sports”

The CDC website also offers a variety of materials dealing with sports-related concussions.

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