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Brain Injury Community Outreach Council says concussion safety a no-brainer

September 21, 2012|By MARIE GILBERT | marieg@herald-mail.com
  • Smithsburg High School student athlete Morgan Thorhauer, front, takes her computer-based memory test while certified athletic trainer Ryann Frye, left, looks on. At rear, is fellow student athlete Samantha Tilden.
By Joe Crocetta/Staff Photographer

Friday night lights. Gridiron glory.

With the start of a new school year comes another fall ritual — the return of football.

But as teams step onto the field, coaches are chalking more than Xs and Os. Concussions are now part of their play books.

There was a time when head traumas were called dingers and playing with injury was a sign of toughness. You got your bell rung, you sat out a play and then went right back into the huddle.

But with former National Football League players bringing more public attention to the topic, the affects of concussions are being addressed at all levels of athletics, including youth programs.

And the need for changes in dealing with head injuries is supported by a vast number of studies and reports.

The Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio, for instance, noted in a recent study that younger, less-developed brains are at greater risk of second-impact syndrome. Submitted to a scientific journal for peer review, the study examined more than 1,300 concussion incidents reported by athletic trainers and found that in girls' volleyball and boys' football, basketball and baseball, more than half of concussed players returned to their sport too soon.

The repercussions included memory loss, difficulty in concentration, speech impediments and headaches.

A 2007 study conducted by the University of North Carolina found that many young athletes suffered from depression following concussions and had difficulties in the classroom, both academically and emotionally.

And a study in 2008 by the American Academy of Neurology (AAN) found that 41 percent of concussed athletes in 100 high schools across the United States returned to play too soon under guidelines set out by the AAN. The guidelines say, for example, that if an athlete's concussion symptoms, such as dizziness or nausea, last longer than 15 minutes, he should be not be allowed to play until he's symptom-free — which could be several weeks.

The most alarming data, uncovered by the same researcher, showed that 16 percent of high school football players who lost consciousness during a concussion returned to the field the same day.

The consequences of returning to a sport too soon after a concussion can be dire, said Debra Wagner.

That's why she and a group of volunteers are working to safeguard local young athletes from such dangers.

Wagner is chairwoman of the local Brain Injury Community Outreach Council, an organization dedicated to providing public awareness, increasing prevention efforts and improving services and support for those living with brain injury.

The council was once part of the Brain Injury Association of Maryland, which, through grant money, established outreach branches across the state.

"But when the grant funding dried up, we decided to continue the program, operating as a group of volunteers," said Wagner, who has been with the council since 2007.

Wagner said the council, which continues to partner with the state association, consists of medical personnel, teachers, trainers and parents — all dedicated to educating the community about protecting children from head trauma.

The group represents Washington County and provides resource to Allegany, Frederick and Garrett counties.

Daniel Sullivan, a council member who practices physical medicine and rehabilitation with Parkway Professional Center in Hagerstown, said the whole discussion of head injury begins with the question, what is a concussion?

"It's an injury to the brain caused by a jolting of the head," Sullivan said. "It doesn't have to be a direct blow to the head.  It can be a violent shaking of the body — such as Shaken Baby Syndrome.  And it doesn't have to involve a loss of consciousness."

Concussions are very common among children, Sullivan said. In fact, each year, more than one million children sustain a traumatic brain injury — 80 to 90 percent of which are mild. In sports alone, between 200,000 and 300,000 concussions are estimated to occur annually.

But often concussions are not properly diagnosed by doctors, he noted.

"I've heard of young people who have been cleared to return to a sport because they haven't been properly evaluated," Sullivan said.

And that's one of the goals of the council, Wagner noted — to educate, not only parents, teachers and those associated with athletic programs, but physicians.

Sullivan said he has been meeting with area physicians, including pediatricians and emergency room personnel, in an effort to provide information that goes beyond a scan.

According to Sullivan, signs and symptoms can include headaches, dizziness, sleep problems, balance issues, fatigue and nausea.

But the repercussions of a concussion are not all physical, he added. Head trauma also can result in poor concentration, memory problems and sudden change in ability to comprehend, such as a straight-A student suddenly failing tests. And there are emotional symptoms, ranging from nervousness and anxiety to depression or irritability. The right assessment, followed by proper management are the keys to a safe outcome from concussions, Wagner said.

That's why the outreach council has been working over the past few years to implement concussion testing in Washington County schools.

"We've been talking with public school officials for a number of years, trying to move things forward," Wagner said. "We met with Eric Michael, supervisor of athletics, health and physical education, and discussed the opportunity to put together a pilot program within one of the schools that would involve baseline testing that could be used as a tool if an injury occurred. And this fall, it has become a reality."

Wagner said council members have worked for several years with Smithsburg High School's Athletic Director Teresa Bachtell to bring awareness to the issue.

Along with Ryann Frye, Smithsburg's trainer, the pilot testing was put into place in September.

Wagner said the testing program selected for use was ImPACT, a neurocognitive test battery.

Frye said ImPACT is a computer-based program which evaluates and documents multiple aspects of brain function.

Sitting at a computer, athletes are tested on impulse control, sustained attention, visual-motor processing speed, visual and verbal memory, selective attention, reaction time and response variability.

Results can identify whether or not a student athlete has had a brain injury and should be referred to a physician.  The testing program can also aid in decisions about when an injured athlete can return to play following a concussion.

When testing information was distributed to parents, Frye said, many were curious and asked to come in to see the test in action.

"Obviously, a lot of people had never heard of it," she said, "especially the athletes, who had a ton of questions — ‘why are we taking it, what's the point?'"

In the past, Frye said, one of the concerns with athletes who had concussions was that they might not let anyone know they had a head injury.

"They wanted to play, not sit on the bench. Now," she said, "if they've had a blow to the head, they're coming in and asking to take the test.  They're not hiding it."

Wagner said it's the council's goal to eventually have the testing program in all Washington County high schools, as well as community youth sports.

"We've been receiving a lot of positive feedback from other schools who want to be a part of this," she said. "It's very exciting that something the council has worked so hard on is becoming a reality."

Wagner said the concussion testing program is a natural step in efforts to protect young people, following Maryland's new student athlete concussion law that was signed in May of 2011.

The law requires:

 The creation of concussion awareness programs in which student athletes in public schools under the age of 19, as well as their parents/guardians, receive concussion information prior to participating in a sport;

 The removal of a student athlete demonstrating signs of a concussion during practice or play;

 That the injured student athlete can only return to play after being seen and cleared by an appropriate health care professional with training in concussion.

Bachtell said it has been mandated by the Maryland legislature that every volunteer or paid coach must have completed a course on head trauma.

Wagner said the council, which goes by the nickname "The Know Brainers," continues to spread awareness of concussions throughout the community.

The group will have a booth at the annual Smithsburg Steam and Craft Show on Saturday, Sept. 29, and Sunday, Sept. 30, she said, where volunteers will offer bicycle helmet giveaways and fittings and provide educational materials related to head injuries.

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