This is your brain on contact sports – The NH Challenge

This is a reprint of an article I wrote for The New Hampshire Challenge – a publication covering disabilities from a family perspective.

I’m including it on this blog because the information is so vitally important. If you have a child playing a contact sport in High School, you absolutely need to know about this brain injury assessment program.

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This is your brain on contact sports
By: Wendy Thomas, New Hampshire Challenge Staff Writer

Brains are in the news. From the unfortunate death of actress Natasha Richardson from what seemed like a minor fall on a bunny ski hill to the horrific brain injury of Olympic snowboard hopeful Kevin Pearce when he crashed during a trick move (while wearing a helmet), we are realizing that injury to the brain can be more serious than simply getting “clocked.”

Studies are finding that trauma to the brain especially in children, if not recognized and managed properly, can result in significant and sometimes permanent damage. Although the majority of children who experience a concussion are likely to recover, an as yet unknown number of these individuals may experience chronic cognitive and neurobehavioral difficulties as a result of recurrent injury. With advancements in medicine and science, the days of clearing someone after a blow to the head if they can tell you what day of the week and who the president is are gone.

No one can predict when a concussion will occur but focus has recently been put on High School contact sports, like football, lacrosse, hockey, ski, and soccer where the rate of brain trauma from impact can run as high as 12%. Persistent symptoms, called “Post-Concussion Syndrome” from impact to the brain may include chronic headaches, fatigue, sleep difficulties, personality change (e.g. increased irritability, emotionality), sensitivity to light/noise, dizziness when standing quickly, and deficits in short-term memory, problem solving and general academic functioning.

In addition to Post-Concussion Syndrome, suffering a second blow to the head while recovering from an initial concussion can have catastrophic consequences as in the case of “Second Impact Syndrome,” which has led to permanent injury and even several deaths over the past decade.

The recognition and management of concussion in athletes can be particularly difficult for a number of reasons including:

 Athletes who have experienced a concussion often have a wide variety of symptoms. Although the classic symptoms of loss of consciousness, confusion, and/or memory loss may be present in some athletes with mild concussion, there may or may not be obvious signs that a concussion has occurred.

 Current management guidelines are not evidenced-based and little to no scientific data supports the arbitrary systems that are in place to manage concussion. As a result, there are currently 19 different management criteria available for concussion management.

 Traditional neurological and radiologic procedures, such as CT, MRI, and EEG, although helpful in identifying more serious concerns (e.g. skull fracture, hematoma, contusion), are not useful in identifying the effects of concussion.

 Student athletes may not understand the potential consequences of concussion and often minimize or deny symptoms so that they can return to play.

In an effort to protect their contact sport athletes some New Hampshire schools have started using tools like ImPACT 2005 which is a user-friendly, Windows-based computer program that can be administered by a team coach, athletic trainer or physician with minimal training.

The ImPACT testing takes approximately 20 minutes to complete and provides a baseline at the beginning of the sports season for each athlete. The computer program measures multiple aspects of cognitive functioning in athletes, including:

– Attention span

– Working memory

– Sustained and selective attention time

– Response variability

– Non-verbal Problem Solving

– Reaction time

The result of the testing provides a baseline. If an athlete then gets injured during the competitive season, retesting can be done to aid in the evaluation of any brain dysfunction.

“This program gives us one more piece to the puzzle for evaluation” said Stuart Glassman, M.D. of Granite Physiatry, who has been associated with the ImPACT program since 2009. “Treating a brain injury is not like treating an ankle or knee injury. There can be long term implications.”

“When we treat these athletes, we work with the athletic trainer, the school nurse, the athletic director, and the guidance counselors. It’s a whole package. Any athlete with a brain injury needs to have a graduated return to the sport. Once an athlete is symptom free, based on testing, only then can they begin a standardized return to exercise protocol.”

Recognizing that standardization of treatment is needed, the New Hampshire State Advisory Council on Sport・]Related Concussion, created to provide guidance on concussion management, issued a statement in 2010 to guide the creation and implementation of a best・]practice model for sport- related concussion management including safe return to sports and return to school.

The document aims to educate coaches, parents, athletes and physicians in the recognition of brain injury and subsequent treatment of their athletes. It outlines standardized procedures for: signs and symptoms of concussion, concussion grading scales, multiple concussions, second impact syndrome, and the role of baseline testing in the management of concussion.

Val Bucher the athletic trainer at Alvirne high school for the last 4 years was originally introduced to the ImPACT program while a student at University of Southern Maine where it is standard for all the high schools to have a program like this. When asked about success stories with the program she responded that “to be fair any child that participates in athletics and receives a concussion and is able to return safely is a success story.”

“I think that this program, since being fairly new to the primary care doctors in the area, has started to make the family physicians more aware of concussions in sports.” Bucher continued. “The NATA and neurologic standards for adolescents are that the athlete should not return to sports until they have been completely symptom free for 7 days. Here at Alvirne I also put them through a physical exertion test to see if their symptoms come back with stress. If they are cleared with the MD and my physical test they are then released slowly back to play.”

“More parents and athletes need to be aware of what a concussion is and how to take care of someone with one. The old standards are out, but many people/parents are unaware of the consequences if a concussion is not taken care of properly and their child is returned too early after having received one.” Said Bucher.

The Impact program costs about 2 dollars per athlete which provides 1000 baseline tests and 100 post injury tests. “Think of it as an insurance policy, said Glassman “It’s not effective until you need it, but when you need it, boy is it effective. Kids can be treated without a baseline but the more information you have before they get hurt, the more you have to work with in order to treat them correctly and to avoid future injury. It is amazing that any school system would not have a program like this. How could you ever stand behind a school that does not? ”

To find out more about the ImPACT program or to find a certified physician visit http://www.impacttest.com, the Concussion Council Consensus Statement Version 1.1-January 2010 document can be found at the NHIAA website http://www.nhiaa.org

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