New state concussion guidelines in place this fall
Concussion awareness has become a focal point at every level of athletics in recent years.
Now it is becoming mandatory for Massachusetts high schools.
Many schools in the area are following the guidelines of the Massachusetts Executive Office of Heath and Human Services this fall, which includes a section that requires all parents and athletes to list a concussion history and gives them websites to learn more about head injuries. Trainers, coaches and officials must also take an online course on how to identify and react to possible concussions.
The impending state law on head trauma is meant to protect athletes from concussions that for years went undiagnosed or not taken seriously enough.
Locally, Janna Berger – an athletic trainer at Dana Hall Prep School in Wellesley – has become an expert on the subject. Entering her 20th year at the prep school, Berger recently took a sabbatical in which she was given a chance to research concussions and was able to work with many people and doctors regarding the issue.
She worked with doctors at the Children’s Hospital Boston Sports Concussion Clinic, The Sports Concussion New England and Chris Nowinski of the Sports Legacy Institute. She did baseline neurocognitive concussion testing for more than 100 players in the Wellesley Youth Hockey program.
Berger defined the official diagnosis of a concussion as a “complex psychophysiology process affecting the brain, induced by traumatic biomechanics forces,” as described by the International Conference on Concussions in 2008.
Concussions can result from a direct blow to the head, face or neck and usually results in “the rapid onset of short-lived impairment of neurological function that resolves spontaneously,” according to the concussion conference.
“I think to think of a concussion as a ship that is sinking,” said Berger. “The brain is acting like the people trying to bail out all the water, and righting the ship, but it just can’t keep up.”
With football season right around the corner, the rate of concussions suffered by high school athletes is expected to rise. Even though Dana Hall is an all-girls school, Berger has plenty of experience with football players and football-related concussions.
“The most recent study in the American Journal of Sports Medicine on January 29, 2011 shows that football has the highest incidence of concussion with a rate of .60 per 1000 athlete exposures, each time you are at practice or a game counts as an exposure,” said Berger.
As for the girls, soccer has the highest rate of concussions suffered with an incident rate of .35 per 1,000 exposures, according to the American Journal of Sports Medicine study. In the 11 years in which the study took place, there was a 15.5 percent annual increase in the concussion rate.
“I see the most concussions in soccer, lacrosse and riding (equestrian),” noted Berger. “Most clinical studies do not look at girls lacrosse and riding as they are not considered contact collision sports. I would consider a fall off a horse both collision and contact.”
Berger explained her process of diagnosing a concussion but stressed the importance of having a medical doctor officially diagnose any potential concussion. Needham High does have a full and part-time trainer on staff this year, as well as Director of Health Services for the Needham Public Schools Mimi Stamer.
“All concussions should be diagnosed by a medical doctor with experience in concussions,” said Berger. “All of my concussion diagnosis’ are done with the collaboration of doctors from Children’s Hospital Boston Sports Concussion Clinic, and Sports Concussion New England.
“There are many different aspects that need to be taken into consideration when diagnosing a concussion, how did the injury occur, was the a blow to the head or body, etc., once a concussion is suspected and a standard protocol has been done and the injury is not considered life threatening, the athlete would be observed for signs and symptoms using graded checklists for the variety, severity and duration of symptoms.”
Afterwards, they would undergo physical balance and strength tests, as well as cognitive stress tests for memory. Berger also said that the knowledge of previous concussion history is important to look at for all concussion cases.
Symptoms of a concussion include amnesia, retrograde or antegrade, disorientation, appearing dazed, acting confused, forgetting game rules or play assignments, inability to recall score or opponent, inappropriate emotionality, physical in-coordination, imbalance, seizure, slow verbal responses, personality changes, headache, dizziness, nausea or vomiting, difficulty balancing, vision changes, photophobia, phonophobia, feeling “out of it,” difficulty concentrating, tinnitus, drowsiness and sadness.
If a trainer, coach or official judges that an athlete has a concussion, the athlete must immediately come out of the practice or game and see a physician or nurse practitioner for an initial examination. The athlete must then remain symptom-free for seven days and see the physician or nurse practitioner again to begin the process of getting back on the field. From there, the athlete must go through an “exertion test” in which the heart rate is raised without a recurrence of symptoms. The athlete then must go through four more steps of gradually increasing participation in their sport over a series of days before they are cleared to return.
The process lasts about two weeks. If at any time they experience concussion symptoms, the entire process starts over.
Even though the medical knowledge of concussions has increased greatly over the years, doctors are still unable to fully prevent them from occurring.
“Unfortunately, concussions in sport cannot be completely prevented, we can however better prepare for them,” said Berger. “I call it the concussion toolbox. All athletes should have properly fitted up to date protective equipment, they should be physically strong and ready to endure their sport, be educated about the signs and symptoms of concussion, have preseason baseline neurocognitive testing done once a year if possible, have medical reference numbers on hand. Beware of ‘concussion proof’ equipment. Nothing can fully prevent a concussion, if anything these labels can give you a false sense of security and an empty wallet.”
Berger has some advice for all football players, as well as parents and coaches who may suspect that a player may be suffering from a concussion:
“I would tell them to tell the athletic trainer or medical doctor or personnel covering the event,” she said. “If they cannot tell them have a friend speak for them. If there is not a medical person available they should then tell their coach. Have them evaluated by a medical person experienced with the diagnosis and management of concussion immediately.”
Berger stresses the importance of having all potential concussion cases fully examined and clear before any athlete can return to their respective sport.
“If a concussion is not treated properly it can be deadly,” she said. “This is called Second Impact Syndrome. This is why we stress that all concussions need to be properly diagnosed, treated and healed fully before returning to play.”