Head injuries still on minds: Area schools explore safeguards for athletes
The words themselves are jarring: traumatic brain injury.
That phrase is the simplest definition of a concussion. No wonder the affliction has become a growing concern in the realm of sports, particularly in football.
Just last month more than 2,000 former NFL players filed a lawsuit accusing the league of covering up information linking football-related injuries to long-term brain damage.
Everything from memory loss to drastic behavioral changes and dementia has been linked to the aftermath of concussions in reports over the past few years.
In July 2011, the School Sports Head Injury Prevention Act went into effect in Kansas, establishing a statewide protocol for how athletes playing for their schools should be handled if suspected of suffering a concussion or head injury during a competition or practice.
The athlete in question has to be removed from competing or practicing and can’t return until a health care provider (defined by KSHSAA as a medical doctor or a doctor of osteopathic medicine) has conducted an evaluation and provided written clearance — which should not be on the same day as the injury.
There are no specific rules, however, about how a student-athlete should be tested for a concussion. That can vary case by case, depending on what doctor an athlete sees or where the athlete goes to school.
One of the tools high school and college programs nationwide have adopted in their concussion management programs has included a computerized system widely used in the college and professional ranks called ImPACT (immediate post-concussion assessment and cognitive testing).
The test establishes a measurement of how an athlete’s brain operates in its normal state. Using that information, it is easier to track any changes in the brain’s functionality and determine when an athlete truly is ready to return to action.
ImPACT is just one of the tools used at Kansas University when doctors and trainers are evaluating concussed athletes.
Certified trainer Matt Kuehl said the KU staff uses a battery of assessments, including a paper cognitive test called the Sideline Assessment of Concussion.
Plus, the staff is implementing the Balance Assessment Scoring System to capture lingering post-concussion balance issues.
KU athletes, who are removed from participation until cleared by the KU medical staff, take the ImPACT test the day of their injury, are asked to rate their symptoms daily as part of the process and take the ImPACT test again when they report they feel normal.
Kuehl said once athletes have returned to their baseline levels, they begin a graded return to activity and contact after being cleared by a team physician.
Uneven playing field
But such tests aren’t available to every high school student in Kansas. As Tonganoxie High athletic trainer Mark Padfield sees it, that lack of continuity could be to the detriment of some young athletes. Padfield, who also is public relations officer for the Kansas Athletic Trainers Society, said the best way to improve overall player safety is to increase athletic trainer coverage or increase the availability of baseline neurocognitive testing, such as ImPACT.
“That really takes a lot of the guesswork out of it if you have that tool in your arsenal,” Padfield said.
Without a baseline option, the THS trainer said testing becomes more subjective, “because you’re relying more on the skills of your medical staff, whoever that may be.”
At the high school level, Padfield said, baseline tests make it a lot harder for athletes to hide their concussion symptoms.
While some larger schools have ImPACT or something like it, many smaller ones, such as Tonganoxie and Baldwin high schools, don’t currently have that luxury. Gary Stevanus, athletic director and trainer at Baldwin, said he and other district officials have looked into ImPACT, but they didn’t think it had become mainstream enough to be a viable option locally.
Stevanus said they needed to know the data would be interpreted by someone with a proficient level of expertise.
“Yeah, it’s another tool,” Stevanus said, “but are you really getting the full force of the program?”
That question is echoed by Basehor-Linwood football coach Steve Hopkins, who said that while ImPACT is one tool, it is not a “cure-all,” and that there may be additional tests his program needs to consider.
Still, Hopkins said the school and its trainer, Rob Hojnacki, has access to a possible grant for 300 students across all sports to take the test.
For the last three years, Basehor-Linwood has used a protocol that removed athletes who exhibited signs of concussions, and followed strict medical guidelines before allowing them to return to practice or competition.
“We will always err on the side of caution,” Hopkins said, “and we hope to continue to improve our coaching techniques to cut back on concussions.”
Hopkins said both coaches and players are getting better at noticing concussion symptoms. Better still, he said, is that the athletes are becoming more honest and aware.
Bonner Springs football coach Lucas Aslin said his program hadn’t yet adopted the ImPACT testing system either. Aslin said mandated concussion awareness forms, videos shown during parent meetings and teaching players to avoid initiating contact with their helmets has been among the program’s main modifications.
“This issue has changed a lot since I got into coaching, and has really changed the last three to five years,” Aslin said.
The Braves also require mouthpieces at all time, be it practice or a game, and also purchased 75 new helmets in the last two seasons to ensure players have access to the most updated helmet technology.
Terri Brandley, Kansas University Hospital concussion coordinator, said when injured athletes visit the facility, they receive a comprehensive physician exam post-injury, then another one at least 72 hours later. After that, Brandley added, periodic exams including ImPACT evaluations are done before beginning a supervised gradual return to play, as well as school or work.
The following are other guidelines employed at KU Hospital:
• Concussion patients, particularly adolescents, should be followed very closely medically to avoid any complications.
• Concussion patients should be gradually returned to play/competition in 24-hour increments; if symptoms return, then go back a step until symptom-free under medical supervision.
• Gradual return to school/work is also recommended until the patient is symptom-free. KU physicians provide academic/work accommodation modifications according to the patient’s needs.
• The KU nurse clinical coordinator makes contact with patients between appointments, provides ongoing concussion education and helps the patient to navigate the healthcare system.
Dr. Randy Goldstein, director of youth and adolescent sports medicine at KU Hospital, said ImPACT testing has been used on athletes as young as 5 years old.
Various doctors, he said, are comfortable down to a certain age for their exams, and pediatric ages can be evaluated with slightly different tools than adolescents and adults.
Stephen Montemayor contributed reporting on this story.
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