Research is changing the way we view concussion
Over the past decade, the way medical professionals, coaches, parents and players regard “getting your bell rung” during a sporting event has changed dramatically. Schools are working with healthcare professionals to come up with good treatment plans, including baseline testing for athletes in sports where they are more likely to get concussions.By: Jana Peterson, Pine Journal
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Jamie Lund said she will never forget the time her daughter, Nicole Lund, got a concussion during a girls hockey game in 2008.
“She was like someone who had been drinking,” Jamie said. “Slowed speech, slowed reactions, wobbly … she couldn’t remember one of her best friend’s names. I can still see her, the look on her face, how she was struggling to talk, like you do when you’re trying to remember a word in a foreign language.
“The change in her – from getting the concussion – was creepy, that’s the only word I can think of. It was like she was trapped inside herself.”
Nicole Lund was definitely displaying a number of the common signs and symptoms of a concussion. She appeared to be dazed or stunned, she answered questions slowly and she was having memory problems.
As defined by the Centers for Disease Control (CDC), a concussion is as a type of traumatic brain injury caused by a bump, blow or jolt to the head that can change the way the brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even what seems to be a mild bump or blow to the head can be serious.
Over the past decade, the way medical professionals, coaches, parents and players regard “getting your bell rung” during a sporting event has changed dramatically. No longer are players encouraged to “shake it off” and get back on the field, no matter how vital they are to the team lineup.
In fact, once a player is even suspected of having a concussion, they are not allowed to return to play until they have permission from a health care provider, according to a Minnesota law that came into effect in June 2011.
Although Nicole’s concussion occurred before that law was passed, most of her treatment would be consistent with today’s guidelines. Once they suspected a concussion – later than her mother would have liked – she was not allowed to return to the game. In fact, she didn’t play again for at least two or three weeks, Jamie said.
“The on-call doctor told me she had a medium-grade concussion and she needed to let it heal completely,” Jamie said. “It really stuck in my head because he said if she didn’t let it heal completely and got hit again, she stood a good chance of dying. I didn’t need any more convincing after that.”
What is termed “second impact syndrome” occurs in athletes with prior concussion and can happen after a relatively minor second impact up to 14 days post-injury. According to the CDC, second impact syndrome causes “rapid brain swelling resulting in coma or death.”
Scary stuff.
Fortunately, every school in Minnesota now has a plan for dealing with concussion as required by state law and is mandated to follow that plan.
At Cloquet High School, for example, all coaches from grades 7-12 have been trained to recognize the signs of concussion. Once a possible concussion is recognized, the student athlete is referred to the certified athletic trainers the school works with. These certified trainers, provided by Park Avenue Therapies and Community Memorial Hospital (CMH) in Cloquet, are professionally trained to diagnose concussions through various physical tests and through use of the IMPACT computer program, which tests verbal and visual memory, motor speed, reaction time and impulse control, among other things.
Physical therapist and Park Avenue Therapies owner Rhonda Johnson explained that the IMPACT test, ideally, is given to a student at the start of his or her varsity or junior varsity career to establish a “baseline” reading. Then, should a student get a concussion, trainers have their previous performance to compare.
“IMPACT compares you to you, not to other people,” Johnson said. “A therapist or trainer will know if you’re back to your baseline. But a physician will still have to sign off [on the athlete’s return to play].
The IMPACT tests are free to Cloquet student athletes playing a varsity or junior varsity sport that has been determined to be at risk, including football, soccer, hockey and probably downhill skiing.
However, any area student athlete can take the test to get a baseline reading, Johnson said, adding that the service is available at Park Avenue Therapies for a $25 fee.
“The trouble with concussions is that you can’t see them,” Johnson said. “There’s no test like an MRI, an X-ray or a CT scan – concussions don’t show up on those. Those tests do rule out fracture, bleeding or swelling, but they cannot detect concussion. This neurocognitive [IMPACT] test is one way we can look at what’s happening inside the brain. We have to see if things are connecting. This test shows how different areas of the brain are working together … or not working together.”
“It’s the kind of test that it’s nearly impossible to cheat on without the test flagging that something doesn’t look right,” Johnson said, noting that, in addition to the “test,” students are also required to fill out background medical information including treatment for migraine headaches, substance abuse, as well as any speech therapy, learning disabilities and more because test results will be different.
According to the Cloquet High School concussion management plan, athletes are not cleared to return until they have met the following criteria:
+ No further physical or cognitive symptoms of concussion.
+ Passed physical and cognitive tests with training staff…including IMPACT test.
+ Have been cleared, in writing, to play by a medical professional.
Surprisingly enough, not all coaches are opposed to the changes.
“I think most football coaches are excited about the progress they’ve made regarding information about concussions,” said Tom Lenarz, Cloquet football coach and activities director, now in his 19th year of coaching. “In the past, it was up to the coach to decide whether or not a kid was OK. But kids lie all the time, they want to go back in. Now there are some physical and reaction-time things that they either pass or they don’t.”
Coaches, after all, are not medical professionals.
Cloquet’s Dr. Ken Ripp is the CMH emergency room and ambulance director as well as a youth soccer and ski jumping coach and sees several concussed student athletes a year.
He said athletes who are concussed need to rest both physically and mentally.
“I had a student, an A student, who took a math test after a concussion and got a 65 percent,” he said, adding that screen time should be kept below 30 minutes a day until the student recovers. “Teachers need to work with concussed students the same way a coach would.”
Female athletes can be more prone to concussion, Ripp said, because they have longer necks.
“It’s that whipping action that’s the problem,” he said, “because the brain sloshes. Girls soccer and hockey need to focus on neck strength.”
Wearing a mouth guard -- required in hockey but not in soccer -- would help, he said.
He noted that concussions can be especially troubling for younger people.
“For high school age and younger, a concussion takes more away from a kid and they are slower to recover,” Ripp said. “The brain is still forming. It’s not as durable as an adult brain. It might take a college-age kid a week to recover, but a high school kid maybe two or three weeks or longer.”
Jamie Lund said it took her daughter quite a while to get back to 100 percent.
“I told her, ‘You’re too young,’” she said, describing how her daughter wanted to get back on the ice before she was fully recovered.
“It’s just a game.”
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