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Students, coaches act pre-emptivey against concussions

posted by SK Brain Injury    |   August 15, 2011 19:10


Right before halftime several years ago, a Council Rock North football player approached athletic trainer Mike Horan with a strange complaint. He couldn’t remember the first quarter of the game.

When Horan performed a sideline evaluation for signs of a concussion, the player had no problems with balance, dizziness, headaches and his eyes were fine. He also remembered all the words that Horan asked him to repeat.

A few minutes later, Horan did the tests again, and the only problem was that the player did not remember the first quarter.

Not satisfied, the trainer involved a team doctor, who suspected a concussion and held the boy out the rest of the game. The next day, a computer test confirmed a mild concussion.

With head injuries, one symptom is one too many, trauma experts say. But the signs of a concussion can be subtle and sometimes take hours, days, even weeks to appear, increasing the risk of a second, life-threatening head blow because the player is not benched.

One tool for diagnosing a concussion is a computer-based neurocognitive test players take before a head injury that provides a baseline for memory, reaction time, speed and concentration. But not all area high schools use ImPACT testing, and those that do, may not use it consistently, though that could soon change.

Pending legislation in the Pennsylvania Assembly would create standards for managing concussions and trauma brain injuries involving student athletes, bench students who show symptoms of a concussion, require student athletes to undergo baseline testing and sport coaches to undergo concussion education training.

Meanwhile, for this upcoming school year, the Council Rock and Neshaminy school districts will require high school athletes who participate in contact sports to undergo ImPACT testing as part of a pilot project.

Student athletes will also be required to attend an educational program on concussions prior to testing. The coaches at participating schools will attend a training program on preventing concussions and recognizing their signs.

More than 700 fall athletes in the three high schools schools will be tested this month and another 600 will be tested throughout the school year, said Kim Everett, trauma prevention coordinator for St. Mary Medical Center in Middletown, which with the Bucks County Intermediate Unit’s Brain STEPS team and Princeton Brain and Spine Center brought the testing pilot to the districts.

Earlier this week, 466 athletes were tested including cheerleaders, football, soccer and field hockey players, Everett said. Another 75 to 100 kids at each school still needed to be tested as of Thursday. Monday is the first day of the fall sports season.

Only about 10 of the nearly 70 of Council Rock High School North football players failed to attend testing Tuesday, athletic trainer Mike Horan estimated. A makeup session will be held Monday, and students who miss it will be barred from practice until the test is administered.

“This is that important of an issue to us,” Horan added.


The human brain is a soft organ protected by a hard skull. Normally the fluid around the brain protects the organ from banging into the skull, but if the head or body is hit hard enough, the brain can shift, resulting in injury.

The Centers for Disease Control and Prevention estimates that U.S. emergency departments annually treat 135,000 sports- and recreation-related traumatic brain injuries, including concussions, among children ages 5 to 18.

Any sport involving a high rate of movement and sudden stops can result in a concussion, and most — 80 percent to 90 percent — are considered mild, meaning the person did not lose consciousness, according to the CDC.

But a mild concussion is a potentially serious injury that, if not treated properly, can result in brain damage, doctors emphasize.

Emerging research suggests that an athlete who has a concussion is more susceptible to a second one, and some studies have connected repeated concussion injuries with depression, Parkinson’s disease and amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease.

The greatest health risk is second-impact syndrome, which carries a high risk of death and permanent brain damage. It occurs when the brain has not adequately healed from an initial concussion and an athlete returns to play and has another concussion.

St. Mary Medical Center’s trauma unit is seeing an increase in the number of concussions among young athletes, Everett said. But too often the injuries are not immediately diagnosed or followed up on.

Kids today are physically larger than in previous generations, which creates a higher risk for concussions during contact sports and play, said Dr. Raymond Talucci, director of trauma services at St. Mary Medical Center.

“These hits can be quite violent at times,” he said.

A delay in diagnosis can occur because a diagnostic imaging scan may not show any immediate brain damage, though symptoms emerge later. This is the reason why observing how a person behaves and functions after a head blow is a better indicator of a concussion, Talucci said.

“If the CT is negative it does not mean the child is not injured,” Talucci emphasized. “If a kid has a bad enough injury to require a CT, he’s in trouble.”


The way that ImPACT testing works is, when a concussion is suspected, the original test results are compared with a post-injury retest. The test not only can help diagnose a concussion and its severity, but show when a player has recovered enough to return to play.

Many Bucks and eastern Montgomery county districts use ImPACT testing to some extent, but they’re not using it as effectively or widely as they could, Everett said. The main reason is a lack of staff to administer the test to all athletes participating in contact sports, Everett said.

Since 1999, Council Rock North has required ImPACT testing for its football team, which averages about two player concussions a year, Horan said. Six years ago, the school added mandatory testing for all other contact sports teams. Council Rock High School South added the student athlete testing last year.

For the last two years, Council Rock North students had been allowed to take on online version of the ImPACT test at home, and provide proof they took it. But a home environment doesn’t allow for the test control conditions necessary for a true baseline score, he said.

Neshaminy High School has offered ImPACT testing since 1999, but it has not been consistently used, athletic director Bryan Schendlinger said. Last school year, for example, only about one-quarter of football players were tested.

Neshaminy High School athletes had one or two serious concussions last year, but fewer minor concussions than the prior year, Schendlinger said. Where he is seeing more head injuries isn’t with football, it’s girl’s lacrosse.

Students typically will tell him or a coach if they are hit hard enough, but sometimes it can depend on the game situation, Schendlinger said.

“Some kids will turn other kids in,” he added.

Council Rock North senior Ferguson Amo, 18, plays football and runs track. Concussions are something he frequently thinks about.

He had one before, when he fractured his frontal sinus cavity after he was accidentally kneed in the head during gym class.

While coaches emphasize safer tackling techniques, head blows happen, the Upper Makefield teen added. That is why he thinks requiring the testing is a good idea.

“It’s going to be helpful. Nobody wants to end up like (the brain damaged football player) in the video we watched,” he said

Newtown Township resident A.J. Garboski, 17, plays football, hockey and baseball, all high-risk contact sports. He has been hit in the head, but doesn’t worry about concussions much.

About seven years ago he had a mild concussion after a head blow during a Pop Warner football game, but he hasn’t had a problem since, he said. But he agrees with the new testing requirement.

“It is good knowledge we all need to learn about,” he said. “It’s about our safety.”