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Keeping all eyes on the head

Area high schools carefully track athletes before and after concussions

When Sara Downs returned to school after suffering a concussion during a soccer game, her day was flipped upside-down. Her focus in class was affected by a massive headache, and she found it hard to sit down during class.

She got dizzy and disoriented when things moved quickly, making the halls of Durango High School difficult to navigate during passing period. Even though Downs normally is a high-achieving student, she found she had to take things easy and not worry about turning work in on time.

As the impacts of concussions become better known, high schools are working with students and doctors to develop better ways of testing for concussions and setting new measures to ensure students receive the proper treatment and don’t return to the game too soon. The hope is that with better diagnosis and treatments, students can get back on the field or court safer and healthier.

To this end, Ignacio, Bayfield and Durango high schools implemented the Immediate Post-Concussion Assessment and Cognitive Testing, or ImPACT, baseline test in 2010 to help with diagnoses. At all three schools, every athlete is required to take the test every two years as well as after a possible concussion. A comparison to the baseline test will help coaches and trainers determine the extent of the head injury.

“Every student takes a baseline test at the beginning of their first season. If they are suspected of having a concussion, they take the test again,” said Roxanne Perrin, Durango High School’s athletic director.

Baseline concussion tests measure athletes’ attention span, nonverbal problem solving, reaction time and working memory, among other things, to determine their normal brain function. The ImPACT test initially was developed to help the National Football League determine when athletes could be cleared to play after a concussion and has expanded into school sports as concussions in youths have come more into the public’s awareness.

Studies of former NFL players have shown alarming evidence of brain damage.

And a recent study by the National Academy of Sciences also was newsworthy: It measured instances of concussions per “athletic exposures,” each exposure being a practice or game. For high school football players, the rate of concussions per 10,000 exposures was 11.2. For girls basketball it was 5.6. Furthermore, the study showed that 10 to 20 percent of the time, those suffering concussions had symptoms weeks to months later.

Defining concussions

A concussion is a traumatic brain injury that alters the way a person’s brain works. It most often is caused by a blow or jolt to the head. It sometimes results in unconsciousness. When it doesn’t, a concussion can go unnoticed or undiagnosed.

Typical symptoms of a concussion include headache, amnesia and confusion. Some symptoms, such as light and noise sensitivity and sleep disturbances, are not initially apparent but occur a day or two after the incident. Athletic trainers and doctors recommend that athletes who have experienced a concussion should be monitored for a few hours afterward to ensure emergency care is not needed.

On Jan. 6, 2012, Gov. John Hickenlooper signed the Jake Snakenberg Youth Concussion Act into law, requiring all coaches of youths 11 to 18 to have concussion recognition training. If a concussion is suspected, the athletes must sit out until they have medical clearance to return. The Colorado High School Activities Association, or CHSAA, and the National Federation of State High School Associations have strict policies regulating the return of concussed athletes to sports.

The CHSAA policy regarding concussions states that students with signs of a concussion cannot resume participation in their sport until they are cleared by a licensed health-care practitioner. Returning to a sport too soon could result in second impact syndrome – an increased risk of a more severe concussion, dangerous for a growing brain.

“If a student is suspected of a concussion in practice or in a game, they are taken out until it is confirmed.” Perrin said. “When in doubt, sit them out.”

Many concussions are diagnosed through self-reporting. But relying on the athlete means many instances are not reported to the coach. So all coaches at BHS, DHS and IHS are required to undergo concussion education courses to learn how to identify symptoms and how to proceed if an athlete has a suspected concussion.

Day-to-day effects

Student-athletes, who are expected to keep in good academic standing during their sport’s season, often face difficulties when suffering from a concussion, especially when it affects their day-to-day actions. Many concussed students said they have found that most teachers are understanding of their condition and will cut them a little bit of slack. Of course, the athlete is expected to make up work missed during a concussion, just as with any other illness.

“We modify and accommodate them with extended time, people reading aloud to them,” said Melanie Taylor, principal at IHS and a former athletic director and volleyball coach. “We want to help the kids be successful.”

DHS follows its same policy for sick days while keeping the lines of communication among coaches, teachers and athletes open until the athlete has recovered.

When students have a concussion, they often have difficulty focusing on the task at hand, especially when they haven’t gotten much sleep the night before and have an intense headache. Staring at printed words in a book or trying to take notes off a screen image often prove to be difficult tasks for these students because they can’t focus on the text and the harsh light from a computer screen attacks their sensitive eyes.

“The hardest part about having a concussion at school is just handling the environment,” said Downs, who has had concussions from soccer and theater. “With my concussions, it was really easy to overstimulate my mind.”

Both Downs and fellow student Danica Dudley, a sophomore, found that teachers were very good about making sure they both stayed caught up in class by extending deadlines and giving extra help when needed. Although they went back to school shortly after having a concussion, their advice to other students is to stay home and take it easy – give their brains time to recover.

“I’ve been told so many times a concussion really is your brain on the line,” said Dudley, who has suffered concussions while playing basketball and softball. “ ... My brain was more important than worrying about falling behind in school.”

“They shouldn’t be watching TV, listening to their iPods. ... We’re worried about the cognitive stuff,” said Rocky Cundiff, IHS athletic director, explaining some of the things he recommends concussed students avoid until 48 hours after their last symptom disappears.

Helmets in football, hockey and lacrosse and headgear in soccer and basketball often are seen as a way to prevent concussions. Most evidence supporting such claims comes from bicycle helmet studies, which looks only at single-use helmets, not multiple-use helmets.

“Helmets have to be certified every year by national high school standards and checked and recertified at the end of every season,” said Gary Heide, BHS head football coach.

There are no concussion-proof helmets, mouth guards or headgear, but there is evidence that properly maintained equipment can help reduce an impact to the head, reducing the frequency of a concussion, high school officials said. However, some athletes who have protective headgear take more risks because they feel they have more protection, raising the rate of concussions. Coaches and trainers can help reduce concussions by ensuring that athletes know headgear is not fool-proof and by teaching safe practices in sports.

“We are pushing (students) to be more aware of concussions and what causes them and practicing safer techniques,” Cundiff said.

Higher awareness of concussions has allowed schools to more accurately detect and diagnose them, although schools still are a long way from creating a concussion-free environment.

Concussions can greatly disrupt a student’s life while the symptoms last. And while technology will never stop all concussions, increased awareness among coaches, athletes and trainers can at least lower the risk of concussions and allow student-athletes a greater chance of a full recovery.

Hannah Robertson is a Durango High School senior who is spending several hours a week studying media in the Herald newsroom.

CHSAA Concussion policy (PDF)

Inside the ImPACT brain test

At the beginning of their first sports season, students take the ImPACT test, a computerized baseline test with three sections.

The first part is a basic health questionnaire, gathering information about the test-taker’s height, weight, sport, position, concussion and learning disability history, and other important information.

Next is the neurocognitive section, which is divided into six parts. “Word discrimination” tests verbal recognition memory and attention spans using a word discrimination pattern. “Design memory” evaluates attention span and visual recognition memory using a design discrimination pattern. “X’s and O’s” measures visual working memory and visual processing speed using a visual memory paradigm to measure response speed. “Symbol matching” evaluates visual processing speed, learning and memory. “Color match” measures choice reaction time, impulse control and response inhibition. “Three-letter memory” measures working memory and visual-motor response speed.

The six tests are combined into five composite scores: verbal memory, visual memory, processing speed, reaction time and impulse control. All the scores are averaged and presented in a graphic display at the end of the test.

The third section asks students about the most recent concussion they’ve had, how much they slept the night before and what medication they currently are taking. Then students are asked to rate the current severity of 22 concussion symptoms ranging from headaches to concentration to emotions using a seven-point scale. If the student does not have a concussion, this section simply provides another data point for trainers and coaches.

When a suspected concussion occurs and there is no computer around or if the school does not have a computerized baseline test in place, a sideline concussion test usually is used. Coaches or trainers check for physical signs of a concussion, such as loss of consciousness and/or balance problems, and then run a Glasgow Coma Scale test.

The person administering the Glasgow test asks questions testing the athlete’s memory, concentration and delayed recall. A balance-and-coordination examination involves athletes balancing on their nondominant foot as well as moving one finger from an outstretched position to their nose and back again.

If the score is outside the normal range, the trainer or coach gives the athlete a concussion diagnosis, and the athlete then has to be checked by a doctor and be declared symptom-free before returning to the game.

On the Net

ImPACT Test link: www.impacttest.com/about/?The-ImPACT-Test-4

SCAT test link: www.nj.gov/education/aps/cccs/chpe/concussions/SCAT2.pdf

For your headTypes of equipment to prevent concussions

Mouthguards can help reduce impact caused by the jaw shutting quickly during a head impact, although they are less successful in preventing concussions than originally thought.

Helmets in football, lacrosse, biking and other activities help prevent concussions by providing an extra layer between the person’s head and whatever they are about to hit.

Headgear for sports such as soccer, volleyball and wrestling help prevent concussions by diffusing the impact of the force over a larger area, thus lessening the initial impact of the hit.

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