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New state law tackles concussion problem
(by Tony Lange - April 27, 2013)
New state law tackles concussion problem
By TONY LANGE
She never collapsed. She never cried. She never lost consciousness.
When Berkshire junior Katie Paul got hit in the head by a soccer ball kicked by a goaltender in fall 2011, her sophomore season, the game did not stop.
Of course, she felt like her bell was rung, but it wasn’t like she was wiped out for an injury. It just kind of hurt.
“It hit me on the side of my head and kind of did a whiplash sort of effect to it,” she said. “I subbed myself out of the game for like 10 minutes to get some Motrin, then I went right back into the game and continued playing.”
In a game two weeks later, it was much the same.
“I was playing on turf, and a girl kind of knocked me over, and my head bounced up against the turf a couple of times,” she said. “I came out, got some Motrin and went right back in and continued playing.”
Katie had no clue she had withstood multiple concussions until the season ended and she started experiencing severe headaches.
“I had never been a headache person before, but they were excruciating,” she said. “It wasn’t just a throbbing of the head. It felt like someone was almost hitting me in the back of the head with a hammer just constantly. But I went to school, because I didn’t know otherwise, and my focus and my attention – everything was just affected.”
After visits to her family doctor and a neurologist, Katie was diagnosed with post-concussion syndrome following an MRI test.
Sometimes referred to as shell shock, PCS is a set of symptoms that can continue for weeks, months or, in Katie’s case, more than a year after a traumatic brain injury.
Serious situations
This year, there will be millions of sports-related concussions, according to the Centers for Disease Control and Prevention, many of which will go undiagnosed.
Children and teens are more likely to experience them and take longer to recover than adults. Symptoms may appear mild, but a head injury can lead to significant, life-long impairments affecting an individual’s memory, behavior, learning and emotions.
Identifying and treating an initial blow to the head are keys to minimizing or preventing those impairments, said Jessica Clark, a certified athletic trainer with the Cleveland Clinic who works for Kenston School District, her alma mater since 2005.
“If an athlete goes back into a game or practice before it’s healed and gets hit again, it’s called second-impact syndrome,” Mrs. Clark said about a condition in which the brain swells rapidly and catastrophically after a person suffers a second concussion before symptoms from an earlier one have subsided.
“What happens is the brain does not have enough time to heal, so it’s a cumulative injury. Whatever injury you had before, it’s going to be 10 times worse than it was,” she said. “Honestly, some athletes who get hit that second time, they’re never the same again. They have cognitive disabilities and may not be able to go back to school. They’re in therapy for a very, very long time learning basic functions like walking and talking again, so it’s actually life-threatening.”
Legislative help
Mrs. Clarks’ comments come on the heels of a new Ohio law addressing how concussions and return-to-play protocol are handled for athletes at youth and recreational levels. The law, passed by Ohio’s 129th General Assembly and signed by Gov. John Kasich in December, will go into effect Friday.
Athletes who exhibit a loss of consciousness, headaches, dizziness, confusion or balance problems shall be immediately removed from a practice or contest by a coach or official and will not be permitted to return to participation on the same day, according to the law.
A student’s condition must be assessed by a physician or other licensed healthcare provider, with written authorization submitted before an athlete can return to practice or play.
Also, all coaches, paid or volunteer, must complete an online concussion education course to complement his or her coaching permit every time it’s renewed or at least every three years.
In speaking to the benefits of the new law, Kenston football Head Coach Jeffrey Grubich said it’s a matter of making sure that youth athletes are kept safe and that their health is a priority.
“The whole atmosphere of concussions has come a long way since I played,” said Mr. Grubich, a 1996 graduate of Chagrin Falls High School. “I remember when I saw stars a couple times, and it was no big deal. You go back in the next play. So it’s come along way, and I think it’s the best thing for our athletes.”
Concussions rates are highest among football players, with girls’ soccer the second-most prevalent sport for traumatic brain injuries. One girls’ soccer program particularly familiar with concussions is Chardon High School.
Girls more susceptible
The Lady Hilltoppers had four players who were removed from practice for at least a week this past season. The year before, they had four players experience concussions, one of whom was taken away in an ambulance, Head Coach Sara Neumore said.
“It’s quite a common injury that we’re seeing,” said Mrs. Neumore, who earned a master’s degree in athletic training in 1990, but no longer practices sports medicine.
One reason female soccer players experience more concussions than their male counterparts is because of weaker necks, she said. “They’re heading a ball that has quite a lot of velocity coming down on it. I don’t really feel that their necks are quite as strong to be able to handle that force that’s impacting them. Sometimes we don’t even see any reaction when they do it, and later they’re having a headache from it.
“At Chardon, we’re actually teaching our girls not to go after those high-punted balls any longer with their heads, because we’ve had so many concussions over the last couple of years.”
Girls also are playing more aggressively, even dirty at times, so officiating needs to be more protective, Mrs. Neumore said.
“The kids get frustrated with me because I don’t hesitate to pull them and sit them the minute they say they have a headache, because I don’t want to take that chance,” she said. “That’s more the mother in me than the coach in me, because I just don’t want to have a kid brain damaged.”
While she coaches at Chardon, daughters Peyton and Kendall played for the Berkshire Lady Badgers and were teammates with Katie, whom Mrs. Neumore spent eight years coaching year-round at the youth level.
Emotional impact
After her concussions in 2011, Katie was incapacitated from cognitive development and missed five weeks of school after winter break. “Then I went back, and nothing really changes physically or symptom-wise for me, but I couldn’t afford missing two months of school, so I went back.”
Last summer, Katie followed up with her neuropsychologist and was retested. Her results still showed she was suffering from post-concussion syndrome.
When fall arrived, Katie still was not cleared by her healthcare provider and missed her junior soccer season.
“I did attend a few games, but it just got to the point where it was too difficult emotionally for me to be there, because I wasn’t playing and I wasn’t able to do the thing that I love,” she said. “So it just got to the point where I couldn’t be around it and nobody could talk about it to me. It was not a good time.”
PCS is known to cause emotional and behavior problems such as extreme irritability, according to the CDC. “A lot of what people don’t get about concussions is they affect so many people outside of just you,” she said. “I know my family and I went through a really difficult time period just because I was on edge and I was emotionally unstable, because I wasn’t playing soccer and I had no release for any of my anger.”
Katie finally was cleared by her neuropsychologist to return to play in February, 15 months after her initial doctor’s visit.
Naturally, her parents do not want her to go back to the game after seeing what she went through, but she hopes to return for her senior season. “I told them the physical side effects of the whole thing is easier for me to deal with than the emotional pain that it actually put me through,” she said. “Either way, I would hate for anyone to go through what I did.”
Baseline testing
To help identify concussions, many schools have implemented what is known as baseline testing for all athletes in contact sports. As an athletic trainer, Mrs. Clark implements ImPACT (immediate post-concussion assessment and cognitive testing), which is a computerized neurocognitive assessment tool, for Kenston athletes.
“Not only is it the signs and symptoms that we’re looking for, but we also test them on their balance, their memory, their reaction time,” she said. “If we suspect something, we can retest them and compare their post-concussion results with their baseline.”
Concussions often are not physically visible, Mrs. Clark said. “It’s not like a broken leg or a broken arm. There are signs and symptoms that nobody can see, so you usually talk to the athlete’s parents just to see if they’re acting normal. If an athlete says, ‘Oh, no, I don’t have a headache. I’m not dizzy yet,’ it’s easy to hide, and that’s what can happen sometimes.”
‘Invisible’ injury
After her first concussion, Katie said nobody at Berkshire said anything to her, and she didn’t say anything to anybody else. “I know my doctors were kind of upset with my coach and the athletic trainer and everything, and I get it. At the same time, how can they know if I feel the way I do if I don’t say anything to anybody because I don’t think it’s a big deal?
“When it comes to soccer, if everybody who got hit in the head had to be checked for a concussion, you know heading is a part of the game. There would be no players.”
While football helmets, headbands and mouth guards can absorb an impact, they are not made to prevent concussions, Mrs. Clark said.
“Football helmets, in particular, are made to prevent skull fractures, not concussions,” she said. “That’s why there’s so much focus on using proper techniques while hitting and tackling now.”
If Katie returns to the soccer field, she is going to stay away from heading the ball, she said. “In May, I go to my sports medicine doctor to discuss whether playing soccer in the fall again is a good option or not. There are ways to be proactive and prevent it from happening, and I know that now. But before, it was just a headache.”
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