Head, brain trauma

Concussions real concern of athletes, coaches, health officials

State law forces schools to have policies in place Jan. 1
By Mark Haskell | Dec 28, 2012
Photo by: Mark Haskell Oceanside High School senior Drew Townsend, front, is driven off the field by Ed Hastings after Townsend suffered a concussion during an early-season soccer game against Medomak Valley in Thomaston.

Less than 40 minutes into his final high school soccer season, Oceanside senior Drew Townsend lay on the field for several minutes being evaluated by school trainer Mike Zemrak.

On that play in the first game of the 2012 campaign, Townsend was forced from the field, diagnosed with a concussion, which sidelined him for 11 games.

Forty-three days later, the Mariner student-athlete returned to the same field he was concussed on and helped lead the Mariners to a 2-1 win over previously-unbeaten Camden Hills.

It likely was the most satisfying day of the fall for Townsend. And it may not have been possible had it not been for the school's new concussion policy.

Months earlier, in Augusta, then-Windjammer sophomore Chandler Crans, who had received a concussion in the fall of 2011 and was forced to miss much of that football sesaon, accompanied then-senator Chris Rector and former New England Patriot and current team executive director of community affairs Andre Tippett to discuss the importance of the proposed bill LD 98, a bill set in place to adopt a policy regarding management of head injuries, notably concussions, in high school sports.

While that bill was killed in the Senate, with it spawned LD 1873, which was signed into law by Governor Paul LePage on May 21, 2012.

The law states that beginning Jan. 1, 2013 all public schools and the governing body of each private school enrolling more than 60 percent of its students at public expense have a policy in place for a plan of action for student-athletes suffering from concussions.

Rector said the act of killing a sponsored bill and replacing it with a similar committee bill is "not uncommon at all."

LD 98 was sponsored by Rep. Don Pilon (Saco) and co-sponsored by Rep. and Senator-elect Ed Mazurek (Rockland).

"Obviously, I'm very pleased that it was able to get worked out and we were able to get a law in place," said Mazurek. "It's something that has to be done to ensure safety in sports. I don't know if it goes far enough, to be honest, but it’s the beginning."

With the law passing in May, many schools have taken the proactive approach and already have head injury policies in place.

Prior to the new law, the only statewide requirement on concussions came from the Maine Principals' Association, the governing body for al high school varsity sports in the state, which was for all coaches to take a course on concussions in the form of an online video.

However, with the recent upheaval of concussions from the youth ranks to professional sports in recent years, state legislators felt it was time to implement guidelines.

The Maine School Management Association, a statewide, non-profit federation of local school boards and superintendents, came up with the policy that most school districts have adopted, though each district can follow their own unique course of action.

The framework for the MSMA's policy, which the majority of high schools across the state have adopted, includes starting the high school season with all student-athletes taking part in a baseline test, also known as ImPACT testing, which determines their pre-injury level of cognitive function.

Camden Hills athletic trainer Chris Audet explained the inner workings of the ImPACT test. "It measures reaction time, visual acuity, tracking, memory, lots of cognitive stuff," he said. "I took it when we first got it just to see what we were getting out kids into, and it's kind of like a complicated Sudoku game."

Should a student-athlete receive a concussion from that point, they begin the recuperation process, which Belfast athletic director Mark Babin said both parents and players are becoming more educated on by the day.

"No longer do you get dinged up and go back out there and play," Babin said. "If you get your bell rung, you're sitting out. And there's a process you have to go through."

That process is known as the Zurich Guidelines, a six-step re-entry process that is the basis for the student-athletes' return to the field/court/etc. after having received clearance from a licensed healthcare provider trained in concussion management.

First, the student-athletes take part in the same ImPACT test again to see how their results measure up to their previous test.

If the student-athlete passes the ImPACT test, the second step is light aerobic exercise, while step three is more sport-specific cardiovascular exercise.

The fourth step entails non-contact training in practice and resistance training, while step five is returning to full contact practice.

The sixth and final step is the student-athlete's full-time return to the team and its regular competitive schedule.

The policy MSMA drafted essentially is what came from legislation and, while most school district adopt it as is, schools are free to draft their own policies.

"We took that [policy] and went through it paragraph by paragraph [and] made changes," said Medomak Valley athletic director Matt Lash. "Just because Maine School Management comes out with a policy doesn't mean we have to adopt it as is."

Lash said the greatest sticking point is that with MSMA's policy, it reads that each athlete can only be cleared to play by a licensed healthcare provider that is trained in concussion management.

Due largely to the shortage of licensed healthcare providers trained in concussion management in the Midcoast, both Lash and Oceanside athletic director Jim Leonard updated their respective policies so the student-athlete's primary care physician can make the call to get young athletes back in the game.

The lone person in that capacity in the Midcoast is Kendra Bryant, who works for Neuropsychology and Concussion Management Associates in Rockland. Bryant works with student-athletes at many area high schools, including Camden Hills Regional High School, Belfast Area High School, Oceanside High School and Medomak Valley High School.

Bryant said the best advice she can give to student-athletes is not to fight the urge to report symptoms.

"I try to tell athletes that I work with, 'If this happens, you really want to report it,' " said Bryant. "Even if you're not sure you've had a concussion you want to tell your coach or you want to tell your trainer. Because if you go back in and something else happens, you're much more likely to lose your entire season."

"If they do that, they're risking potentially losing a whole lot more when it might just be a couple of days."

Leonard said he expects that protocols for dealing with concussions to evolve over the next few years.

"It's on the fast track and it's going to change high school sports forever," he said. "People that get their bell [head] rung aren't coming back next week [anymore]. They just aren't."

"Back in the day, you'd get your bell rung and you'd go back out there," said Mount View athletic director Chuck Karter. "We didn't know any better. A coach would say, 'Toughen up, rub some dirt on it, go out there you're all set.' But the landscape has changed."

Bryant and area athletic trainers agree they do not feel concussions are happening more as much as the science and technology has become more advanced, given athletes access to more information from the onset.

"I doubt we're having more [concussions than in the past]," said Bryant. "I think we're just recognizing them better and appreciating more that they can have long-term consequences and they can have very serious consequences if they're not identified."

"Things in the past like, 'Oh he just got his bell rung' [is not acceptable anymore]," said Audet. "Now we're realizing the cumulative effects of multiple sub-concussive hits. Plus, there are more layers. Concussions are not a black-and-white thing."

"The rates of diagnosed concussions at all levels of sport are seeing an increase," said Mount View athletic trainer Casey Holmes. "I feel this is again because of improved awareness of concussions, their mechanisms, signs and symptoms, and a sense that we have a new respect for the damage that concussions cause and the very real risks that exist if they are not recognized and cared for properly."

While every concussion, much like every student-athlete, is different, the protocol for how they are handled remains the same.

"With concussions you just want them to be still, not engage in much [activity]," said Zemrak. "So depending on how the athlete is feeling [immediately following the on-site diagnosis], I may just send them home if they're around here, get them home and into a dark place with not much going on. Because if they're still on the sidelines watching the game, sometimes that can aggravate symptoms."

Zemrak said sending student-athletes to the hospital following a concussion is not necessary unless they show more severe symptoms, such as numbness and tingling, seizures, slurred speech and loss of consciousness.

"I tell the parents that if symptoms get substantially worse to go get them checked out," Zemak said.

Dealing with concussions properly from the onset can lessen the probability of second-impact syndrome, which is defined as rapid swelling of the brain after a person suffers a second concussion, without having fully recovered, knowingly or unknowingly, from the first concussion.

"If it's not recognized or they don't report it or it's not handled well and they go back to playing even if it's a minor hit, it can result in severe or permanent impairment," said Bryant of second-impact syndrome. "It can result in death. It's not common, but it can happen."

"Like many other injuries, initial care given is the most effective tool to decrease risk of long-term symptoms or re- injury," said Holmes. "This care often includes some duration of rest, whether it be use of a sling for a shoulder injury or crutches for an ankle sprain."

"There could be long-term neurological damage, balance issues and ultimately [the student-athlete] could not play sports again," said Zemrak. "The best case scenario is that it would just delay their symptoms and have them out longer."

The landscape for treating concussions likely will continue to evolve over the next few years, and some of those advancements already appear to have begun at Camden Hills.

"Not only do we have an athletic return-to-play policy, but we have an academic return-to-play policy too, so to speak," said Audet. "The modifications [for the academic return-to-play policy] may be anything from as drastic as missing school to half days at school to being able to wear sunglasses [due to sensitivity to light], just making modifications so that the student isn't having their symptoms re-exasperated."

Audet said, in many ways, cognitive rest is just as important, if not more so, than physical rest.

"Anything that is going to cause your brain to function can bring symptoms back or at least slow the healing down," Audet said.

Townsend, who still only remembers bits and pieces of what happened prior to his injury in Oceanside's season opener against Medomak Valley in September, had a tough time with his recovery process.

"The next few weeks were miserable," he said. "I just sat in my dark room by myself. Luckily, I had the support of my friends and my family to help me through it. I had a cold washcloth on my head and I couldn't do anything. I couldn't read, I couldn't look at my phone to text. I think I honestly sat there doing nothing for about a week."

The senior forward said he was cleared to begin the Zurich Guidelines a week before the team's game against the Windjammers and was cleared to play the day before.

"I remember wearing a pinnie [during the fourth stage] and all the coaches out there just said, 'No one touch Drew,' " said Townsend. "That was how practice went for me."

Townsend still gets headaches even months after the incident.

"I think it'll be a long time before it's totally gone," he said. "I hear a loud noise or I read for too long and I get a headache."

Zemrak, who is the athletic trainer for both Oceanside and Medomak Valley, has seen numerous concussions between the two schools in only his second year in that capacity.

"You just want to comfort [the athlete] and let them take their time and get them off the field," he said when a concussion occurs in any sporting realm. "Then you can further evaluate them on the sideline and that's when I'm looking for [other things]."

Noticeable concussion symptoms vary from headaches, dizziness, fatigue, anxiety, blurred vision, memory and attention problems, sleep problems and irritability.

Concussions can take days, weeks or even months, in some cases, to subside and leave student-athletes free of symptoms.

When treated properly, the long-term effect of concussions is minimal to non-existent. But, if gone untreated or ignored, it can cause a lifetime of consequences.

"I've seen videos right now about second impact, and it's something you don't want to mess with," said Townsend. "It could ruin the rest of your life."

"As a teenager you always think you're going to be fine," said Bryant. "You never think about the long-term consequences, but they're taking the risk of losing a lot more if they don't report it."

Fall concussion numbers for Midcoast high schools

Belfast Area High School — 12

Camden Hills Regional High School — 7

Medomak Valley High School — 4

Mount View High School — 5

Oceanside High School — 5

Searsport District High School — 2

Courier Publications Associate Sports Director Mark Haskell can be reached at 207-594-4401 or by email at mhaskell@courierpublicationsllc.com.

Comments (2)
Posted by: Alison Wholey | Dec 31, 2012 10:09

 

 

Hurray for Village Soup making the important point that concussion symptoms are not always obvious. It is so important to accept that your child doesn't  need to be knocked unconscious or "have your bell rung" to sustain a concussion. Even a seemingly, minor impact can cause a brain injury. Symptoms of a concussion to watch for can include:

• Headaches or a feeling of pressure in the head
• Nausea or vomiting
• Dizziness or balance problems
• Feeling sluggish, hazy, foggy, groggy
• Double or blurry vision
• Confusion
• Does not "feel right" after a trauma to the head

Mark Haskell's article points out the real point of tension in all this: Teenagers find it hard to accept how long it takes for concussions to heal. They feel great, and wonder "why can't I go back on the field?" However, it's up to coaches, parents and healthcare workers to make sure the student understands that concussions can cause cumulative damage and receiving multiple concussions can cause permanent brain damage.

Thanks for bringing this into the forefront.

Alison Wholey, RN, Esq.

Briggs & Wholey, LLC



Posted by: Catherine Cooper | Dec 28, 2012 12:37

Concussions real concern of athletes, coaches, health officials

and a real concern for Secretary of States set to testify in Benghazi! LOL!!




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