A diagram of the forces on the brain in concussion (Photo credit: Wikipedia)
By: Anne Forline
Gloucester City News
In 2010, Governor Chris Christie enacted legislation that required school districts to implement policies and procedures regarding sports related concussions.
At Gloucester City Junior-City High School, Athletic Director, Leon Harris and Athletic Trainer, Bill McLaughlin, work hard to stay ahead of the curve.
Prior to the 2010 legislation, the district already had a concussion policy in place, Harris said.
However, he credited McLaughlin, along with School Nurse, Linda Stewart and Team Physician, Dr. Carl Vitola, for comprising a specialized team that keeps abreast of current medical policies for the district, coaches, athletes and their parents.
Concussion education and treatment are critical since there are many misconceptions regarding treatment and diagnosis.
Namely, that an athlete must “blackout” or experience seizure-like symptoms in order to be diagnosed as having sustained a concussion.
McLaughlin defines a concussion as a “brain bruise,” which can manifest symptoms ranging from simple to complex.
Simple symptoms include headache and nausea whereas complex symptoms may cause an athlete to experience seizures and slurred speech.
Because the brain is affected when an athlete suffers from a concussion, it is not always easy to diagnose and monitor as compared to a sprained ankle or knee. McLaughlin said the brain is the most complicated, multifaceted organ.
“With other sports related injuries, as in a knee or an ankle, you may see swelling and deformity. You can visually monitor healing and compare it to the uninjured extremity,” McLaughlin explained.
Also, he said that with a concussion, symptoms may not appear for a few days.
In the past, he said athletic trainers had no concrete tool to rely on other than the injured athlete’s feedback, which would include dizziness, nausea or light sensitivity.
The old way of diagnosing a suspected concussion was to send the student athlete to the emergency room for a CT scan.
McLaughlin said almost 99.9 percent of the time the CT scan results would come back normal, unless there was bleeding on the brain. However, for the most part that does not show up, he added.
Another problem with using CT scans as a form of diagnosis, McLaughlin stated: “They are on their way out. That’s because we’re trying to keep kids away from needless and unnecessary exposure to radiation.”
In 2011, the GCSD received a grant to begin administering the ImPACT Test to student athletes who participate in contact and collision sports, which include football, baseball, soccer, field hockey, wrestling, basketball and softball.
ImPACT is an acronym for “Immediate Post-Concussion Assessment and Cognitive Testing” and is a computer-based test that is a relatively new tool that aids in the diagnosis and treatment of concussions.
The ImPACT test was developed in the 1990s by Drs. Mark Lovell and Joseph Maroon. According to ImPACT’s website, the “20 minute test has become a standard tool used in comprehensive clinical management of concussions for athletes from age 10 through adulthood.” t is also the “the first, most-widely used, and most scientifically validated computerized concussion evaluation system and was developed to provide useful information to assist qualified practitioners in making sound return to play decisions following concussions.”
McLaughlin said that all high school students who participate in collision and contact sports in the New Jersey State Interscholastic Athletic Association (NJSIAA) in grades 9-12 must take the ImPACT test to ascertain a baseline score.
As an assessment tool, McLaughlin stated that the ImPACT test is definitely useful. “Prior to ImPACT, we had no test to measure cognitive functions. With the ImPACT test, we can measure three different responses in mathematical graph form: recall, reaction time and visual memory,” he explained.
Although, the ImPACT test is a valuable assessment tool, McLaughlin empathically stressed that the physical examination still remains the most critical piece.
When taking the 20 minute computer based ImPACT test, a student athlete should take it in a quiet room, free of distracting factors.
McLaughlin likens the test to playing a video game that measures multiple aspects of cognitive functioning, including attention span and non-verbal problem solving. Responses are gauged from different testing modules including symbol and color matching.
The baseline results are stored in a cloud where they can be assessed for comparison purposes in the event the student-athlete faces a concussion situation.
In the instance of a suspected concussion and following the physical examination, McLaughlin explained that another ImPACT test is administered to compare it with the initial baseline results.
Once the results are compared, a course of treatment is determined, which may include brain rest. Brain rest treatment essentially calls for a student athlete’s brain to relax. That means cell phones, computers, TV and homework are off-limits.
As per the Gloucester City School District (GCSD) concussion policy, it is mandatory that the student-athlete must be asymptomatic for 48 hours. After that 48 hour period, the student athlete can begin a graduated return to play protocol, but is still carefully monitored during this time for any reoccurrence of concussion symptoms.
McLaughlin also stressed the importance of avoiding “second impact syndrome.” This syndrome is dangerous in that it could lead to long term problems. If a student-athlete suffers from a second impact from another serious hit and the initial swelling was not resolved, this can lead to future severe brain problems, injury or death, he cautioned.
In addition to the GCSD, ImPACT Applications, Inc. counts the NFL, NHL, NBA and MLB, among other professional and college sports teams, as clients. For more information about the ImPACT test visit http://impacttest.com/.
For more in-depth district related information regarding concussions, visit Gloucester City High School’s home page at http://www.gcsd.k12.nj.us/ghs/default.htm, click the Athletics tab and then “Concussion Policy” and “Concussion Info.”
Anne Forline blogs at: http://anneforline.blogspot.com.